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Republicans Press Forward With Repeal Efforts Despite Governors' Plea To Reject Measure

A group of bipartisan governors urges Congress to reject the last-ditch repeal-and-replace effort coming from Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), but lawmakers are charging forward. It's still unclear if they have the votes, but Sen. Lisa Murkowski (R-Alaska) says she's considering the bill, touting the flexibility it gives to states.

The New York Times: Republican Leaders Defy Bipartisan Opposition To Health Law Repeal
Eleven governors, including five Republicans and a pivotal Alaskan independent, urged the Senate on Tuesday to reject a last-ditch push to dismantle the Affordable Care Act. But Republican leaders pressed toward a showdown vote. And they choked off separate bipartisan efforts to shore up health insurance markets under the Affordable Care Act, hoping to give Republican senators no alternative but to vote for repeal. (Pear and Kaplan, 9/19)

Politico: Backlash Throws Last-Ditch Obamacare Repeal Effort Into Doubt
Opponents of the proposal co-authored by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina seized on its plan to overhaul Obamacare’s subsidized insurance and Medicaid expansion and replace those with block grants to the states — a mass restructuring they warned would sow chaos in insurance markets. They panned its new regulatory flexibilities as a backdoor route to undermining key patient protections — including safeguards for those with pre-existing conditions. And in the biggest blow, several Republican governors urged the GOP to abandon a plan that would force states to swallow potentially billions in funding cuts — and instead to focus on stabilizing Obamacare. (Cancryn, 9/19)

The Washington Post: New Health-Care Plan Stumbles Under Opposition From Governors
Among the signers were Alaska Gov. Bill Walker (I), who holds some sway over Murkowski, a potentially decisive vote who opposed a previous Republican effort to repeal and replace the Affordable Care Act. Nevertheless, Murkowski said Tuesday afternoon that she was still weighing her options and explained how her position on the bill might ultimately differ from her opposition to the repeal effort that failed dramatically in July. “If it can be shown that Alaska is not going to be disadvantaged, you gain additional flexibility. Then I can go back to Alaskans, and I can say, ‘Okay, let’s walk through this together.’ That’s where it could be different,” she said. (Sullivan, Eilperin and Snell, 9/19)

The Associated Press: A Last, Last Chance: Republicans Strain For Obamacare Repeal
Republicans must act by Sept. 30 in the Senate or face the prospect of a Democratic filibuster. That blocking action is currently staved off by budget rules that will expire at the end of the month. The new legislation, by Graham and Sen. Bill Cassidy of Louisiana, would undo the central pillars of former President Barack Obama’s health care law, and replace them with block grants to the states so they could make their own health care coverage rules. (Werner, 9/20)

Bloomberg: McConnell Won’t Promise Obamacare Repeal Vote As Foes Mobilize 
Senate Majority Leader Mitch McConnell refused to promise a vote on Republicans’ last-ditch proposal to repeal Obamacare as Democrats and other opponents started ramping up a new campaign Tuesday to block it. "If we were going to go forward, we would have to act before Sept. 30," McConnell told reporters when asked if the GOP-only bill will come to the Senate floor before next week’s procedural deadline. "We are in the process of discussing all of this." (Litvan, 9/19)

The Hill: Trump, White House All In On ObamaCare Repeal Push
President Trump and Vice President Pence have been making calls to senators and governors in a furious effort to gain support for a last-ditch ObamaCare repeal bill. The Trump administration is making clear it's all in on the repeal push, with Pence warning that the White House will not support efforts to "fix" or "prop up" ObamaCare. (Hellmann, 9/19)

The Hill: Graham Predicts ObamaCare Repeal Bill Will Get 50 Votes 
Sen. Lindsey Graham (R-S.C.) is predicting he will get enough votes on his bill to repeal ObamaCare and says House leadership has pledged they would also pass it. "I really believe we're going to get 50 Republican votes," Graham told reporters after a closed-door GOP caucus lunch on Tuesday. "I've never felt better about where we're at." (Carney, 9/19)

Politico: Republicans Rip Rand For Rejecting Obamacare Repeal
Rand Paul might soon go down as the Republican who saved Obamacare — and he couldn’t care less. "I'm actually happy to be out there as the leading advocate for repealing Obamacare, not keeping it," the Kentucky Republican said in an interview. Of his GOP colleagues, Paul added: "These people, they so totally do not get it." (Kim and Everett, 9/20)

The Hill: GOP Faces Risks, Rewards In Rushing To Repeal Vote Without CBO Score 
Senate Republicans are rushing toward a vote on an ObamaCare repeal bill without getting a full analysis from the Congressional Budget Office on how their legislation would affect coverage and premiums. It’s a risky move, as Sens. Susan Collins (R-Maine) and John McCain (R-Ariz.) have both said they’d prefer to have a full score before casting their votes. (Sullivan, 9/19)

A look at where governors stand on the issue —

The Hill: Kasich, Sandoval, Alaska Governor Oppose New ObamaCare Repeal Bill
A bipartisan group of governors including Republicans John Kasich (Ohio) and Brian Sandoval (Nevada) is urging the Senate to reject the latest ObamaCare repeal effort. In a letter to Senate leaders, the governors urged lawmakers not to abandon bipartisan market stabilization talks led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). (Weixel, 9/19)

Cleveland Plain Dealer: Ohio Gov. John Kasich Joins Bipartisan Governors In Opposing Graham-Cassidy
Ohio Gov. John Kasich on Tuesday joined a bipartisan group of governors who formally declared opposition to the latest U.S. Senate plan to repeal and replace the Affordable Care Act. Kasich joined nine other governors including Colorado Democrat John Hickenlooper in a letter that asked Senate Majority Leader Mitch McConnell and Democratic Leader Chuck Schumer to not consider the controversial proposal. (Eaton, 9/19)

The Baltimore Sun: Hogan Opposes Latest Version Of Obamacare Repeal Bill 
Gov. Larry Hogan urged Congress Tuesday to reject the latest version of a Senate Republican plan to repeal Obamacare, saying it would cost Maryland $2 billion a year. Hogan, a Republican, has so far opposed all of the measures supported by President Donald J. Trump to scrap the Affordable Care Act. The new version, known as Graham-Cassidy, faces a potentially close vote in the Senate before the end of September. (Dresser, 9/19)

The Philadelphia Inquirer/ With A New Term, Pat Toomey Flexes His Muscles On Health Care, Taxes
Pat Toomey is making the most out of his new term in the Senate. Fresh off a near-political-death experience — winning reelection last year by 1.5 percentage points — the Pennsylvania Republican has dived into the two most contentious legislative battles of 2017, authoring conservative proposals and pushing some colleagues to go farther than first inclined. Toomey began the year by serving as a leading voice for rolling back the Affordable Care Act; he wrote one of the most controversial parts of the Senate GOP’s initial proposal, a plan to drastically scale back Medicaid spending. (Tamari, 9/19)

Des Moines Register: Graham-Cassidy Obamacare Repeal: Iowa Gov. Reynolds Backs Measure
Iowa Gov. Kim Reynolds said Tuesday she supports a Republican initiative in Congress to repeal the Affordable Care Act and replace it with a plan to give block grants to the states to help individuals pay for health coverage. Reynolds, a Republican, pointed to the success of a welfare reform initiative approved by Congress under President Bill Clinton in the 1990s that resulted in reductions in welfare rolls. However, she quickly added she isn't suggesting that she supports major cuts in the rolls of Iowa's Medicaid program, which provides health care for thousands of low-income persons. (Petroski, 9/19)

The Hill: Virginia GOP Gov Candidate Says ObamaCare Repeal Effort 'Falls Short' 
Virginia gubernatorial candidate Ed Gillespie (R) on Tuesday appeared to distance himself from the Graham-Cassidy bill, a last-ditch effort by Senate Republicans to repeal and replace ObamaCare. During a debate with opponent Lt. Gov. Ralph Northam (D), the Republican said that while he supports a bill intended to replace the Affordable Care Act, also known as ObamaCare, the one put forth by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) doesn't protect states that chose not to expand Medicare. (Bowden, 9/19)

What Would New Bill Do? Get Rid Of Subsidies, Drastically Alter Medicaid And More

Media outlets take a look at what's being proposed — including a major rethinking of federal health care funding — in the Graham-Cassidy bill.

Los Angeles Times: Obamacare 101: What Would The Graham-Cassidy Repeal Bill Do?
The Graham-Cassidy proposal shares some features of earlier repeal legislation approved in the House and debated in the Senate, including scrapping the requirement that Americans have health coverage and placing new restrictions on federal funding for Planned Parenthood. ... But the new repeal bill is substantially more sweeping and goes far beyond just repealing the 2010 healthcare law, often called Obamacare. The Graham-Cassidy proposal would completely restructure how the federal government provides healthcare assistance to some 80 million Americans and create a new system for distributing hundreds of billions of dollars of government aid. (Levey, 9/19)

The Wall Street Journal: Q&A: Explaining The Graham-Cassidy Repeal Bill
The Graham-Cassidy bill would lump together the money spent on two ACA programs to expand health coverage: subsidies for private insurance and an expansion of the Medicaid program. That funding would be redistributed as block grants to states, who could use it to fashion their own health systems. All of the bill’s health spending would end in 2027 and need to be reauthorized by Congress. The bill also makes structural changes to Medicaid by capping how much federal money states can get. (Hackman, 9/19)

Kaiser Health News: Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know
The Graham-Cassidy proposal would eliminate the federal insurance exchange,, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it. It would eliminate the tax on medical devices. (Rovner, 9/19)

Reuters: Factbox: Latest Obamacare Repeal Bill Would Block Grant Money To States, Gut Medicaid
Like previous repeal bills, the Graham-Cassidy proposal retroactively repeals the so-called individual mandate, the requirement that everyone purchase health insurance or else pay a fine. It also retroactively repeals the mandate that certain employers provide health insurance for their workers. Health policy experts say the individual mandate is needed to induce young, healthy people who may otherwise forgo coverage to buy insurance and offset the costs of sicker, more expensive patients. (Abutaleb, 9/19)

Bloomberg: Last-Ditch Repeal Plan Would Keep Obamacare’s Biggest Taxes
Senate Republican leaders’ renewed Obamacare repeal-and-replace effort -- in the form of the bill authored by senators Lindsey Graham and Bill Cassidy -- maintains the largest tax hikes imposed by the 2010 law, using them to fund block grants to states. The new repeal bill would keep levies on top earners -- a 3.8 percent tax on net investment income and a 0.9 percent Medicare surtax for individuals earning more than $200,000 or couples above $250,000. It would also preserve a tax on health insurers. Each of those levies would raise more than $100 billion in revenue over a decade, according to the nonpartisan Congressional Budget Office. (Kapur, 9/19)

Stat: Under Graham-Cassidy Bill, Could Some States Keep Obamacare?
Republican senators are promising that a new health care plan circulating on Capitol Hill will give states wide flexibility to set up an insurance system as robust or as limited as they like. States that want to cut ties with Obamacare will have that authority; states that want to preserve Obamacare can do so, supporters say. But experts argue that, given the funding structure proposed in the new plan from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana — what may amount to the GOP’s last chance in the near future to replace the Affordable Care Act — even states willing to commit far more of their own budgets to the cause will struggle to establish anything close to Obamacare. (Mershon, 9/19)

The 'Losers' Under Graham-Cassidy: States That Expanded Medicaid, Patients With Preexisting Conditions

Because of the way Medicaid would be restructured, the states that embraced expansion will face the largest cuts. Most of the states that did not expand Medicaid coverage under the Affordable Care Act would see an increase in federal funding.

The Associated Press: Winners And Losers In GOP's Last-Ditch Health Overhaul
The GOP's last-ditch effort to repeal "Obamacare" would redistribute hundreds of billions of dollars in federal financing for insurance coverage, creating winners and losers among individual Americans and states in ways not yet fully clear. Independent analysts say the latest Senate Republican bill is likely to leave more people uninsured than the Affordable Care Act, and allow states to make changes that raise costs for people with health problems or pre-existing medical conditions. (Alonso-Zaldivar, 9/19)

The New York Times: Blue States Face Biggest Cuts Under New Republican Health Care Plan
A new Republican plan to repeal the Affordable Care Act would give each state a federal block grant for health care using a complex formula that cuts funding for some states — including many that were won by Hillary Clinton in 2016 — according to a New York Times analysis of estimates from the Center on Budget and Policy Priorities, a left-leaning think tank. (Park, 9/19)

Politico: Graham-Cassidy Health Care Bill: What You Need To Know
The liberal-leaning think tank Center on Budget and Policy Priorities released estimates of how federal funding would change if the bill became law. In its analysis, California would be hardest hit, losing $27.8-billion in funding. ... Cassidy's office released its own estimates. Massachusetts takes the hardest hit with a more than $5 billion loss in funding. Overall, Southern states that did not expand Medicaid are poised to receive more in federal funding. (Frostenson, 9/19)

'You Pass It There, We'll Pass It Here': Ryan Promises To Shepherd Graham-Cassidy Bill Through House

Despite having passed their version with just a single vote to spare, Speaker Paul Ryan (R-Wis.) and Republican House leaders are optimistic that if the bill gets to them, they'll get members to fall in line.

Los Angeles Times: White House, Republican Leaders Join New Push For Obamacare Repeal As Bipartisan Effort Falters
House Speaker Paul D. Ryan (R-Wis.) made clear earlier Tuesday that House Republicans would not support the bipartisan Senate effort, further narrowing the options for those hoping for an alternative to the Graham-Cassidy bill. Ryan said the House instead was ready to approve the Cassidy-Graham bill. “He told me, ‘You pass it there, we’ll pass it here,’” said Graham, recounting a phone call with the speaker. (Levey and Mascaro, 9/19)

Politico: House GOP Under Pressure If Senate Passes Repeal
Though House GOP leaders are bullish that they can pull off a repeat performance on Obamacare repeal if given the chance, they’ll have to twist a lot of arms within the ranks to get there. Some conservatives want more flexibility for governors. At the same time, vulnerable centrists from states that would be hit hardest by the Senate bill, including California and New York, could face a severe backlash from constituents. (Bade and Cheney, 9/20)

Democrats Try To Rally As They're Criticized For Having Celebrated Too Soon

Between the debt deal cut with President Donald Trump and the single-payer proposal by Sen. Bernie Sanders (I-Vt.) -- which Sen. Lindsey Graham says is "a gift from the political gods" -- some people are starting to wonder if the Democrats got ahead of themselves. Meanwhile, lawmakers are trying to get their base motivated one more time to stave off the latest round of repeal-and-replace efforts.

The Washington Post: Democrats Ask Base For One More ACA Rescue Mission
Senate Democrats, who spent weeks thinking they would won the fight to keep the Affordable Care Act in place, are mobilizing alongside progressive activists for 11 more days on the defensive. “They’re going to hear from us one more time!” Senate Minority Leader Charles E. Schumer said at a Tuesday afternoon rally outside the Capitol. “Protesting, picketing, emailing — you name it!” The multilevel campaign to block the Republican bill consists of everything progressives did to stop previous iterations — from “melting the phones” of Republican senators to waging sit-ins at their offices. (Weigel, 9/19)

The Hill: Cruel September Shifts To Democrats 
Democrats feeling whiplash over the GOP’s new effort to repeal ObamaCare have sought to step up their opposition to the new bill, which could be headed for a vote next week. After a Monday night floor protest, Democrats pointed to a bipartisan letter from 10 governors on Tuesday as a reason to kill the GOP bill. (Carney, 9/19)

Politico: Did Democrats Jump The Gun With Single-Payer Splash?
Last week, a group of Senate Democrats rallied behind single-payer health care at a splashy news conference. This week, the same group is scrambling to beat back the GOP's latest Obamacare repeal blitz. The contrast shows the chasm between the two parties’ approach to health care: Republicans claim that Bernie Sanders’ “Medicare for All” pitch fueled their revived repeal effort, an argument that even Democratic single-payer foes dismiss as untrue. Yet some Democrats wish more attention had been paid to protecting the Affordable Care Act before some of the party's biggest names turned to single payer. (Schor, 9/19)

Roll Call: Single Payer Democrats: Save Obamacare Now, Single Payer Later
Democratic senators who threw their support behind single-payer health care last week are prioritizing the 2010 health care law as Republicans take one more crack at repealing it. At an event with Democratic senators and liberal activists, independent Sen. Bernie Sanders, who sponsored the single-payer bill, criticized Republicans for trying to ram through a health care proposal from Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin. (Garcia, 9/19)

Health Groups Join Opposition To Repeal-And-Replace Efforts

“This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” said Rick Pollack, the American Hospital Association's president and CEO.

Bloomberg: Doctors, Hospitals Oppose GOP's Latest Obamacare Repeal Effort 
The latest Republican Obamacare repeal effort is getting as much support from doctors and hospitals as the last one did -- which is to say, not much. On Tuesday, the American Hospital Association joined the growing list of groups that oppose the latest effort, which would replace much of Obamacare with a set of grants to states. The AHA says it represents about 5,000 hospitals, making it one of the biggest health-care trade organizations in the U.S. (Tracer and Edney, 9/19)

The Hill: Hospitals Come Out Against New ObamaCare Repeal Bill 
The American Hospital Association is opposing the GOP’s last-ditch ObamaCare repeal bill, saying the legislation puts the health coverage of 10 million people at risk. “This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” Rick Pollack, the group's president and CEO, said in a statement Tuesday. (Roubein, 9/19)

The Hill: AARP Calls On Senators To Reject Latest ObamaCare Repeal Bill
The AARP on Tuesday slammed the latest ObamaCare repeal bill and called on senators to reject it. The bill from Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would increase health-care costs for older Americans with an age tax, decrease coverage and undermine protections for people with pre-existing conditions, the group said. (Weixel, 9/19)

NPR: Republicans Try One Last Effort To Repeal Obamacare
"The Graham-Cassidy plan would take health insurance coverage away from millions of people, eliminate critical public health funding, devastate the Medicaid program, increase out-of-pocket costs and weaken or eliminate protections for people living with pre-existing conditions," says Georges Benjamin, executive director of the American Public Health Association, in a statement. (Kodjak, 9/19)

Cassidy Got Credit For Coining 'The Jimmy Kimmel Test' But TV Host Says Senator Has Failed His Promise

Jimmy Kimmel made headlines during the Republicans' summer push to repeal and replace the Affordable Care Act with his story about what his son has gone through with his medical treatment.

The Washington Post: Jimmy Kimmel Gets Heated About Health-Care Bill, Says Sen. Bill Cassidy ‘Lied Right To My Face’
In May, late-night host Jimmy Kimmel delivered an emotional monologue as he revealed that his newborn son, Billy, was born with a heart defect that required immediate surgery. The operation was successful, but Kimmel was deeply shaken by the experience, which happened amid the debate over replacing the Affordable Care Act. Kimmel delivered a passionate plea about the astronomical costs of health care: “No parent should ever have to decide if they can afford to save their child’s life.” (Yahr, 9/20)

The Hill: Jimmy Kimmel Slams Cassidy Over ObamaCare Repeal Bill 
“Your child with the pre-existing condition will get the care he needs if – and only if – his father is Jimmy Kimmel. Otherwise, you might be screwed,” Kimmel said, drawing laughs from the audience. He went on to say how Cassidy had in the past promised coverage for all, no discrimination based on preexisting conditions, lower premiums for middle-class families and no life-time caps. (Conradis, 9/19)

Bipartisan Efforts To Stabilize Marketplace Halted As Graham-Cassidy Gains Traction

Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) says there's not a path forward for the bipartisan work in a clear sign that Republicans are optimistic about the prospects of the Graham-Cassidy bill. Democrats call the move a political strategy to bolster the replacement bill.

The Hill: GOP Chairman Declares Bipartisan ObamaCare Fix Dead 
The Senate Health Committee chairman on Tuesday released a statement ending a bipartisan effort to find an ObamaCare fix amid a new GOP push to repeal the law. "During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted," Senate Health Committee Chairman Lamar Alexander (R-Tenn.) said in the statement. (Sullivan, 9/19)

Politico: Ryan, White House Reject Bipartisan Health Fix
House Speaker Paul Ryan and the White House have informed Senate Republican leaders that they oppose a bipartisan plan to stabilize Obamacare being written in the Senate, according to Trump administration and congressional sources, in a clear bid to boost the Senate's prospects of repealing the health law. (Everett, Dawsey and Bade, 9/19)

Nashville Tennessean: Obamacare: Sen. Lamar Alexander Ends Push For Bipartisan, Short-Term Fix
Murray, the committee’s top Democrat, said the negotiations with Alexander had taken place in “good faith.” “We identified significant common ground, and I made some tough concessions to move in Chairman Alexander’s direction when it comes to giving states more flexibility,” she said. “I am disappointed that Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill. But I am confident that we can reach a deal if we keep working together — and I am committed to getting that done.” (Collins and Fletcher, 9/19)

CQ: Alexander Says No Path Forward On Bipartisan Health Deal
Senate Minority Leader Charles E. Schumer of New York said the impasse was due to political strategy. "This is not about substance," said Schumer spokesman Matt House. "We gave them many of the things they asked for, including copper plans and wide waiver authority. The Republican leadership is so eager to pass Graham-Cassidy that they’re scuttling a balanced, bipartisan negotiation.” (McIntire, 9/19)).

Other heath care efforts are feeling the strain as well —

CQ: Children's Health Program Progress Threatened By Repeal Plan
Senate Finance members are eager to move a new bill that would renew funding for the Children’s Health Insurance Program, but Democrats worry that the reconciliation time crunch for Graham-Cassidy could cause further delays .“Unfortunately, just when this committee ought to be celebrating a big victory for the millions of kids who count on CHIP, the Cassidy-Graham-Heller proposal threatens the health care of millions of children and families,” said Senate Finance ranking member Ron Wyden of Oregon at a hearing on business tax issues on Tuesday. (Raman, 9/19)


Insurers Breathe Sigh Of Relief For Another Month As Trump Makes Subsidy Payments For September

The companies are looking for a longer-term guarantee, but as of now the Trump administration has decided to make the call on a month-to-month basis.

The Hill: Trump To Make ObamaCare Payments For September
The payments compensate insurers for lowering out-of-pocket costs for certain ObamaCare enrollees. However, the administration has been making the payments on a monthly basis. “We are weighing our options and still evaluating the issues,” a White House spokesman wrote in an email, referring to if the payments would continue beyond September. (Roubein, 9/19)

'Remarkably Stubborn Stability' Coming To Define Employer-Provided Insurance Marketplace, Survey Finds

Despite the uncertainty and wild price spikes that plague the individual market, the employer-based one, from which most people get their health coverage, is relatively stable.

The New York Times: While Premiums Soar Under Obamacare, Costs Of Employer-Based Plans Are Stable
In sharp contrast to the soaring health insurance premiums in many Affordable Care Act marketplaces, the cost of coverage for the vast numbers of people who get insurance through their jobs rose relatively little this year, continuing a period of remarkable stability in the employer market, according to a national survey released Tuesday. The annual premium for family coverage rose an average of 3 percent to $18,764 this year, according the Kaiser Family Foundation, a nonprofit group, which conducted the annual survey of employers. (Abelson, 9/19)

The Associated Press: Health Benefit Offers From Small Businesses Keep Vanishing
Only half of America's smallest businesses now offer health coverage to their workers because many say steady cost hikes have made it too expensive to afford a benefit that nearly all large employers still provide. The Kaiser Family Foundation said Tuesday that 50 percent of companies with three to 49 employees offered coverage this year. That's down from 59 percent in 2012 and 66 percent more than a decade ago. (Murphy, 9/19)

Kaiser Health News: In Stark Contrast To ACA Plans, Premiums For Job-Based Coverage Show Modest Rise
Family health insurance premiums rose an average 3 percent this year for people getting coverage through the workplace, the sixth consecutive year of small increases, according to a study released Tuesday. The average total cost of family premiums was $18,764 for 2017, according to a survey of employers by the Kaiser Family Foundation and the Health Research & Educational Trust. That cost is generally divided between the employer and workers. (Galewitz, 9/19)

Bloomberg: Rising Health-Insurance Costs Are Eating Into Employees' Paycheck Gains 
Rising health-care costs are eating up the wage gains won by American workers, who are being asked by their employers to pick up more of the heftier tab. The average worker is shelling out $5,714 for a family health-insurance plan this year, 30 percent of the total $18,764 cost, according to an annual study from the Kaiser Family Foundation and the Health Research & Education Trust released on Tuesday. Five years ago, workers shouldered $4,316 of the $15,745 cost, or 27 percent. (Tracer, 9/19)

Milwaukee Journal Sentinel: Health Benefits Up Modestly, Now Average $18,764 Per Year For Family
The cost of health insurance provided by employers rose an average of 3% for family coverage this year and now has risen at a relatively modest rate for six years. ... Nationally, health benefits for a family averaged $18,764 this year, according to the annual survey by Kaiser Family Foundation and Health Research & Educational Trust, an affiliate of the American Hospital Association. (Boulton, 9/19)

In a separate study on health insurance and costs —

Houston Chronicle: Health Care Study: Nation More United Than People Think
Despite the seemingly never-ending bickering and bombast over health care in this country, a new Texas Medical Center Health Policy Institute survey shows that people are, in fact, overwhelmingly in agreement on many points. The survey, released Tuesday, also showed that such uniformity of opinion about the importance of health insurance crosses political boundaries. Now in its third year, the survey asked a wide ranging series of health care questions to 9,200 consumers across 15 states and more than 450 physicians earlier this summer. For the first time the survey looked at political leanings of a state to see if that influenced answers. (Deam, 9/19)

Administration News

HHS Secretary Price Eschews Commercial Flights For Private Jet

Health and Human Services Secretary Tom Price is a frequent critic of federal spending who has been developing a plan for department-wide cost savings.

Politico: Price’s Private-Jet Travel Breaks Precedent
In a sharp departure from his predecessors, Health and Human Services Secretary Tom Price last week took private jets on five separate flights for official business, at a cost of tens of thousands of dollars more than commercial travel. The secretary’s five flights, which were scheduled between Sept. 13 and Sept. 15, took him to a resort in Maine where he participated in a Q&A discussion with a health care industry CEO, and to community health centers in New Hampshire and Pennsylvania, according to internal HHS documents. (Diamond and Pradhan, 9/19)

In other news on doctors in Washington, D.C. —

Stat: In Congress, A Doctor Becomes A Cancer Patient — And Preaches Candor
Of all the members of Congress, Phil Roe, a Republican from Tennessee, seemed the best prepared for a cancer diagnosis. When it comes to Roe and medicine, it is hard to separate the personal and the professional: He heads the GOP Doctors Caucus. His colleagues, Republicans and Democrats alike, call him “Doc.‘’ ...But Roe also acknowledges that he is a terrible patient — his neurosurgeon, he admitted, still wants to strangle him after his woeful attempts to rest after back surgery last year. So when the call came from his own doctor on that day last July, informing him he had prostate cancer, he was determined to do the right thing. (Mershon, 9/20)

Capitol Hill Watch

Grassley Presses For Public Disclosure Of Hospital Inspections

The Wall Street Journal reports that Sen. Chuck Grassley (R-Iowa) is calling for more transparency regarding hospital inspection reports.

The Wall Street Journal: Senator Pushes For Hospital Inspections To Be Made Public
The chairman of the Senate Judiciary Committee is pressing for the public disclosure of hospital inspection reports, amid complaints that the nation’s largest hospital accreditation group doesn’t rigorously enforce health and safety standards. Sen. Chuck Grassley (R., Iowa) asked federal regulators in a letter Monday to outline specific statutory changes that would be needed to end the confidentiality of inspection reports done by accreditors, including the Joint Commission, a nonprofit organization based in Oakbrook Terrace, Ill. (Armour, 9/19)

In other hospital news from Capitol Hill —

The Wall Street Journal: The Hidden Obamacare Detail That Could Cost Hospitals Billions
Investors should get ready for more belt-tightening in the hospital industry. Maybe a lot more. Some aspects of  the Affordable Care Act, commonly known as Obamacare, were a blessing for hospitals. Expanded access to insurance has meant more customers who can pay for services they consume. That limits bad debt generated from bills that uninsured patients can’t afford to pay. (Grant, 9/19)


N.M. Officials To Brief Lawmakers Today On Plans To Curb Medicaid Spending

Proposals to cut state spending have included requiring enrollees to pay monthly premiums and copayments. In other Medicaid news, a look at Louisiana's program, a managed care contract controversy in Mississippi and record backlogs in Oregon.

The Associated Press: New Mexico Presses Forward With Medicaid Premiums, Copays
New Mexico is pressing forward with plans to limit increases in state spending on Medicaid health care for low-income and disabled residents by adding monthly premiums and copays from patients, as Senate Republicans in Washington contemplate fundamental changes to Medicaid. State officials will brief lawmakers Wednesday on an array of proposed changes to the state's Medicaid health care program designed to keep costs down while improving the delivery of health care for New Mexico's poorest residents. (9/20)

New Orleans Times-Picayune: Medicaid In Louisiana: Who Gets It? How Does It Work?
Medicaid has been at the center of much of the health care and budget debate this year in Washington and Baton Rouge. Here is a primer on the program. ... About 74 million people -- 1 in 5 five Americans -- are enrolled in Medicaid. Louisiana is more dependent, with 1.6 million -- about 1 in 3 residents -- using the program. (O'Donoghue, 9/19)

Jackson (Miss.) Clarion-Ledger: $2B Medicaid Contract Moving Forward After Contract Review Board Refuses To Vote
Public Service Contract Review Board members took a passive role on the Medicaid managed care debate Tuesday, refusing to take up the matter after their staff recommended they approve the $2 billion contract. The non-vote means the MississippiCAN contract, the subject of much controversy since the Mississippi Division of Medicaid signed it in June, is effective and will move forward, according to the board and Medicaid's attorney. (Wolfe, 9/19)

East Oregonian: Eliminating Medicaid Backlog Will Cost Oregon At Least $4.3 Million
An intensive effort to shore up Oregon’s Medicaid enrollment records is expected to cost the state at least $4.3 million. Participants in the Oregon Health Plan, Oregon’s Medicaid program, must have their eligibility for the plan verified annually in a process called redetermination. Oregon had fallen behind on those annual redeterminations, and by late May had an estimated backlog of about 115,000 people whose eligibility for the Oregon Health Plan was in question. (Withycombe, 9/19)


Following 9 Deaths At Florida Nursing Home, Task Force Formed To Push For Reforms

"We now have a chance to fix what went wrong and ensure something like this never happens again,” said one state lawmaker.

Miami Herald: Haunted By Nursing Home Deaths, Task Force Joins Rush To Make Reforms
In a crowded North Miami Beach City Hall chamber, elected officials, first responders and healthcare workers gathered to establish a task force to better regulate senior facilities, in the wake of eight deaths in Hollywood. The task force, started Tuesday, aims to combine efforts to enact national, state and local policies to ensure the safety of those in assisted living facilities in the wake of a disaster. (Ostroff, 9/19)

The Washington Post: Hurricane Aftermath: Death Toll Rises To 9 In South Florida Nursing Home That Overheated
A ninth patient from a South Florida nursing home that overheated during power outages following Hurricane Irma died on Tuesday, according to police. The death of Carlos Canal, the ninth patient, occurred nearly a week after the nursing home in Hollywood, Fla., became the focus of a criminal investigation when the air conditioning failed and eight other patients ultimately died. (Berman, 9/19)

Kaiser Health News: Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’
It does not take a hurricane to put nursing home residents at risk when disaster strikes. Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses. (Rau, 9/19)

Miami Herald: Gov. Scott Places Blame For 9 Deaths Directly On Hollywood Nursing Home
Four days after the owners of a Hollywood nursing home released a detailed time line casting blame for the deaths of eight elders on Florida health administrators and a local utility, Gov. Rick Scott’s administration issued a time line of its own — declaring that the Rehabilitation Center at Hollywood Hills “failed to do their basic duty to protect life.” (Marbin Miller and Klas, 9/19)

Public Health And Education

Critics Worried $200M Donation To Calif. University Lends Credence To Trend Of Unproven Therapies

Philanthropists Susan and Henry Samueli just donated a huge sum to UC Irvine, and some are concerned it will lead the institution to focus on alternative therapies that have no basis in science at a time when they're gaining in popularity. In other public health news: domestic violence, lupus, smoking, and strange health events in Cuba.

Stat: A Huge Gift Boosts Alternative Therapies At A Med School, Sparking Outrage
When billionaires Susan and Henry Samueli this week announced a $200 million donation to the University of California, Irvine to launch a new health program dedicated to integrative medicine, they drew a standing ovation and glowing coverage. But for those who have been watching the steady creep of unproven therapies into mainstream medicine, the announcement didn’t go over quite as well. (McFarling, 9/20)

Los Angeles Times: Domestic Violence Homicide Rate Drops With Stricter Gun Law, Study Finds
When domestic violence offenders are required to relinquish their guns, instead of simply being barred from owning firearms, the risk that those offenders may kill their partners goes down, a new study finds. The paper, described in the Annals of Internal Medicine, highlights a simple method for lowering the risk women face of being killed by an intimate partner: Enforce the laws already in place. (Khan, 9/19)

The New York Times: A Stress Link To Lupus
Psychological trauma is associated with an increased risk for lupus, a new study reports. Lupus is a potentially fatal autoimmune disease that causes inflammation of the skin, joints and internal organs. Its cause is unknown. (Bakalar, 9/20)

The New York Times: The Fatal Toll Of Cheap Cigarettes
A new study suggests that the availability of cheaper, off-brand cigarettes is associated with an increase in infant mortality. Researchers writing in JAMA Pediatrics studied the link between cigarette prices and infant mortality in 23 European countries from 2004 through 2014. During this time, there were more than 53 million live births. (9/19)

The Associated Press: Cuba Again Denies Role In 'Health Attacks' On US Diplomats
The Cuban government on Tuesday again denied any involvement in or any knowledge of a mysterious series of health incidents that have affected American diplomats in Havana. ... At least 21 members of the American diplomatic community in Havana have suffered from symptoms, including brain damage, believed to have come from some sort of sonic attack since late last year. The most recent incident was in August. (9/19)

Health Warnings On Soda Ads Suppresses Free Speech, Judges Rules

A San Francisco ordinance would have required a warning on sodas and sugary beverages, but Ninth U.S. Circuit Court of Appeals Judge Sandra Ikuta writes in the ruling that the label is "not purely factual" and "unduly burdens and chills protected commercial speech."

The Associated Press: Appeals Court Blocks San Francisco Warning Law For Soda Ads
A federal appeals court on Tuesday blocked a San Francisco law requiring a health warning on soda ads, saying the measure was misleading and would suppress free speech. A unanimous, three-judge panel of the 9th U.S. Circuit Court of Appeals stopped the 2015 ordinance from going into effect until a lawsuit filed by the American Beverage Association and other groups is resolved. (Thanawala, 9/19)

The Wall Street Journal: Appeals Court Blocks San Francisco Law Requiring Soda Health Warnings
The three-judge panel of the Ninth U.S. Circuit Court of Appeals found the ordinance stifles commercial speech and unfairly targets soda over other potentially unhealthy food and drinks. The panel blocked the rule from going into effect. The San Francisco ordinance, passed in 2015, requires advertisements for certain sugar-sweetened drinks to include a disclaimer that says “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Randazzo, 9/19)

State Watch

State Highlights: States, Localities Face High Costs For Retiree Health Benefits; Hepatitis A Outbreak Declared In Los Angeles

Media outlets report on news from Illinois, California, the District of Columbia, Delaware, Maryland, Connecticut, Arizona, Ohio, Kansas, Florida, Minnesota, Colorado and Texas.

The Wall Street Journal: States Need $645 Billion To Pay For These Promises, And That’s Not Counting What They Owe In Pensions
When Aurora, Ill., closed its books in December, about $150 million disappeared from the city’s bottom line. The Chicago suburb of 200,000 people hadn’t become poorer. Instead, for the first time it recorded on its balance sheet the full cost of health care promised to public employees once they retire. States and cities around the country will soon book similar losses because of new, widely followed accounting guidelines that apply to most governments starting in fiscal 2018. (Gillers, 9/20)

Los Angeles Times: Health Officials Declare Hepatitis A Outbreak In L.A. County
Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego. (Karlamangla, 9/19)

The Washington Post: Poor, Sick And Still Traveling Long Distances For Health Care In D.C.
The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser. Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered. (Itkowitz, 9/19)

The Associated Press: New Delaware Law Will Expand Cancer Treatment Options
Cancer patients in Delaware will soon have more treatment option under legislation being signed by Gov. John Carney. A bill to be signed Wednesday requires health insurers to cover any medically appropriate drug that has been approved by the Food and Drug Administration for the treatment of stage 4 metastatic cancer and other cancers without requiring proof that the patient failed to respond to a different drug or drugs. (9/20)

The Baltimore Sun: Baltimore Health Department Seeks To Double Buprenorphine Treatment 
Baltimore health officials want to double the number of people in the city who can get access to the addiction treatment drug buprenorphine, help they say heroin addicts desperately need. Officials estimate that 25,000 people in the city are addicted to heroin or other opioids. Numbers on how many people are currently getting buprenorphine in Baltimore were not available, but officials said that even doubling the number of patients with access would not close the gap entirely. (Duncan, 9/19)

The Wall Street Journal: Doctor’s Defamation Suit Highlights Online Patient Reviews
A defamation lawsuit filed by an Ohio plastic surgeon that is slated to go to trial early next year could have far-reaching consequences for disputes between doctors and their patients over online reviews about the quality of medical care, according to legal experts. Dr. Bahman Guyuron, former chairman of the department of plastic surgery at Case Western Reserve University School of Medicine, sued Marisa User in 2015 over anonymous reviews she had posted on the cosmetic-surgery website RealSelf and other sites where patients swap information about doctors. (Palazzolo, 9/19)

KCUR: Southeast Kansas County Among Eight U.S. Communities Awarded Culture Of Health Prize 
Residents of Allen County in Kansas are getting some national recognition for their health-improvement efforts. The county is one of eight 2017 winners of the Culture of Health Prize awarded by the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy.  Richard Besser, the foundation’s president and CEO, traveled to Iola, the county seat, to make the announcement in person Tuesday. (Mclean, 9/19)

Health News Florida: Preventing Mosquito Infestations After Irma
With restoration continuing this week after Hurricane Irma, Florida Department of Health officials are warning residents about standing water left by the storm as a thriving environment for mosquitoes. Containers like garden pots, birdbaths, tires and cans, when filled with standing water, can host mosquitoes laying up to 200 eggs. (Riggins, 9/19)

The Star Tribune: St. Paul Considers Restricting Sale Of Menthol Tobacco
The City Council is considering adding menthol, mint and wintergreen-flavored tobacco to the list of products that can only be sold at tobacco shops. The council will hold a public hearing Wednesday night on the proposed change, which is similar to one the Minneapolis City Council approved last month. (Van Berkel, 9/19)

Columbus Dispatch: Legionnaires' Cases Involving Ohio State Under Investigation
Columbus Public Health is investigating two separate Legionnaires’ disease cases with ties to Ohio State: one a student at the Drackett Tower dormitory and a Columbus resident who is employed at the university’s Newark campus. A statement released by Ohio State University said Columbus Public Health informed them late Tuesday afternoon that they believe there is no connection between the two cases. (Woods, 9/20)

Denver Post: These Services For Developmentally Disabled Residents Have Grown Because Douglas And Araphoe Voters Approved A Tax In 2001 
In the last 15 years, nonprofits and programs serving people with developmental disabilities have multiplied across Douglas and Arapahoe counties. Much of that growth can be traced to 2001, when voters in both counties approved a tax to fund those operations. ...Wellspring Community opened in 2009 with a mission to provide work, education and enrichment opportunities to adults with special needs. Today, the growing organization has an art studio in downtown Castle Rock, a fully operational bakery in the Emporium and cooperative work/education programs at four locations around town. (Mitchell, 9/19)

Texas Tribune: For Some Transgender Texans, Bathroom Bill Fight Spurs Bids For Office
Four people in two years are hardly a speck in a state of nearly 28 million, but that number means Texas currently has more transgender candidates than any other state, according to Logan Casey, a Harvard researcher who studies LGBTQ representation in politics. And it’s a disproportionately large group — Texas carries just under 9 percent of the country’s population, but about 14 percent of its current transgender candidates. (Platoff, 9/20)

Chicago Tribune: Centegra Health To Eliminate, Outsource Hundreds Of Jobs
Financially troubled Centegra Health System plans to eliminate 131 jobs and outsource another 230 positions, the northwest suburban hospital system announced Tuesday. The layoffs and outsourcing come amid a time of financial stress for many hospitals nationwide and follow a year of steep losses for Centegra, which has hospitals in McHenry, Woodstock and Huntley. (Schencker, 9/19)

Prescription Drug Watch

This Caustic Crusader With A Knack For Making Enemies Has Especially Harsh Words For Pharma

News outlets report on stories related to pharmaceutical pricing.

Stat: Armed With Data, And Twitter, This Doc Takes On The Medical Establishment
Dr. Vinay Prasad is a professional scold: He takes to Twitter each day to critique this cancer drug as ineffective, or blast that one as overpriced, or dismiss the clinical trial of another as completely irrelevant. So it’s a bit of a surprise to catch him at the bedside of an elderly man with lymphoma, laughing gently with his patient as he inquires about his day — and painstakingly explains a potent drug’s unpleasant side effects. (Keshavan, 9/15)

Chicago Tribune: Insurers Cutting Back On Drug Coupons Amid Concerns Over Consumer Costs 
With many drug prices rising, consumers often pull out coupons or discount cards from drugmakers to save money when they buy medications at pharmacies. But some insurers, including in Illinois, are limiting how those discounts may be applied amid concerns they’re driving up health care costs for everyone. Curbing the coupons could mean more money out of consumers’ pockets in the short term, but in the long run could also help hold down drug prices and health care costs, say critics of the cards and coupons. (Schencker, 9/14)

Stat: Brand-Name Drug Prices Are Still Rising, Just Not As Fast As Before
Prescription drug prices may be rising, but a new analysis suggests just not as fast as before. Price hikes for brand-name drugs in this year’s second quarter were 7.1 percent. This obviously exceeds inflation and may have crimped some wallets, but this is below the 9.7 percent hikes that occurred in the same period a year earlier, according to SSR Research, which tracks the pharmaceutical industry. (Silverman, 9/19)

Stat: Streamlined FDA Reviews Fail To Catch Harmful Glitches In Health Software
The Food and Drug Administration carefully polices many categories of drugs and devices. But when it comes to software, the agency’s oversight is scanty at best — something that a new study finds is resulting in failure to detect dangerous glitches in software-enabled medical equipment. The study comes amid ongoing debate over the FDA’s role in reviewing the booming number of software-enabled products in health care. (Ross, 9/12)

Reuters: Drug Industry On Tenterhooks As Maryland Price-Gouging Law Nears
As U.S. consumer outrage grows over prescription drug prices, state authorities and patient advocates in Maryland are preparing to enforce the nation's first law designed to punish drugmaker price-gouging. The state Attorney General's office said it will field complaints and investigate "unconscionable increases" in essential generic medicines when the closely watched law takes effect Oct. 1. (Beasley, 9/15)

Stat: What It's Like To Be A Hollywood Director Making An Ad For Pfizer
If Pfizer’s latest ad looks to you like a visual effects-heavy Hollywood film, it’s by design. The beaming couples and natural landscapes typical of pharma ads have been replaced by dreamlike scenes of a giant sailing ship, a launching rocket, and twin-sized beds flapping their wings through the clouds. And no, Pfizer (PFE) wouldn’t disclose the ad’s budget. It’s the handiwork of Hollywood veteran Robert Stromberg, who won Academy Awards for art direction in “Avatar” and “Alice in Wonderland,” and more recently directed the fantasy film “Maleficent.” (Robbins, 9/15)

Bloomberg: FDA Clears Biotech Drug Copycats, But Buying Them Isn’t So Easy 
In 2016, Roche Holding AG sold $3 billion worth of its blockbuster biotechnology drug Avastin. Last week, the U.S. Food and Drug Administration approved what’s expected to be a less-expensive version. Patients and insurers won’t be able to start counting the savings any time soon. Of seven so-called biosimilar drugs the FDA has cleared since the first approval of one of the drugs in 2015, only three are available for sale. The rest are tied up in legal disputes that can block the cheaper versions for years. (Koons, Edney and Decker, 9/18)

Stat: Pricing Wars Flare In Ireland As Government Battles With Two Drug Makers
The latest flare-up over prescription drug pricing is taking place in Ireland, where two drug makers are at war with the government for refusing to provide coverage for a pair of medicines. In one instance, CSL Behring (CSL) announced plans to end a compassionate use program later this month for its Respeeza treatment for people with an inherited form of emphysema. The move had previously been signaled if government coverage was not provided, but was formalized after Ireland’s Health Service Executive last month decided the drug is not cost effective. (Silverman, 9/18)

Cleveland Plain Dealer: Issue 2 Fact Check: Are All Of The VA's Prices Public Record?
Despite claims from supporters of Issue 2, drug prices from the Department of Veterans Administration are not entirely a matter of public record, according to the department. One of the main arguments over Issue 2, an Ohio initiative on the November ballot seeking to lower the price the state pays for pharmaceuticals to no more than the VA pays, is whether the VA's pricing is publicly available. (Richardson, 9/18)

Reuters: Doctors Who Take Pharmaceutical Money Use Twitter To Hype Drugs
Some cancer doctors use Twitter to promote drugs manufactured by companies that pay them, but they almost never disclose their conflicts of interest on the social media platform, a new study shows. “This is a big problem,” said senior author Dr. Vinay Prasad, a professor at Oregon Health and Science University in Portland. “Doctors are directly telling patients about their views on drugs, and financial conflict plays a role. But they’re not telling patients they have a conflict.” (Cohen, 9/11)

The New York Times: Why Are Drug Prices So High? We’re Curious, Too
This much is clear: The public is angry about the skyrocketing cost of prescription drugs. Surveys have shown that high drug prices rank near the top of consumers’ health care concerns, and politicians in both parties — including President Trump — have vowed to do something about it. What’s not as clear is exactly why prices have been rising, and who is to blame. (Thomas and Ornstein, 9/17)

Perspectives: Drugmakers Love To Hide Behind R&D Costs. Are They Justified?

Read recent commentaries about drug-cost issues.

Bloomberg: Pharma Keeps Ignoring Its Price Problem
Want to get pharma companies up in arms? Tell them it doesn't cost that much to get a cancer drug to market.A widely reported paper published Monday in the Journal of the American Medical Association did exactly that, claiming that the median cost of developing a cancer drug was $648 million for a set of 10 companies. A recent industry-sponsored study puts the number closer to $3 billion. (Max Nisen, 9/14)

Stat: This Pharma CEO Promised Fair Pricing, But His Latest Move Is Raising Ire
One year ago, Brent Saunders tried to single-handedly reset the national debate over drug pricing. The Allergan chief executive issued a “social contract” and vowed to keep price hikes below 10 percent a year. He argued that drug makers could — and should — act responsibly amid smoldering criticism over prices. Few companies followed suit, but Saunders won a high profile for his efforts. Now, though, an ingenious deal he struck to protect Allergan’s patents on a lucrative drug calls into question his campaign to do right by the American public. In short, the social contract may be headed for the trash bin. (Ed Silverman, 9/19)

Bloomberg: So Much PARP Inhibitor Deal Hype, So Little Payoff
We're more than a year into a frenzy of M&A speculation about a new group of cancer drugs called PARP inhibitors, and there's been no big buyout payoff. But investors aren't jaded yet. An unverified rumor that Eli Lilly & Co. is considering buying PARP competitor Clovis Oncology Inc. was enough to send the purported target's shares up 10 percent on Monday. (Max Nisen, 9/18)

The Columbus Dispatch: Drug-Price Issue Risky, Speculative
Many elections, voters are left with the choice of having to cross their fingers or hold their nose. If Issue 2 passes in November, Ohioans would be doing both. The highly confusing Ohio Drug Price Relief Act boils down to this: Ohioans would be stuck with an unworkable ballot-initiated law that, given its faulty premise, won’t produce the fantastical savings promised. Likely, the legislature would struggle with repairing the law to stanch damage to critical social programs; politicians generally are reluctant to tamper with a vote of the people. (9/18)

Bloomberg: Biotech Gets More Forgiving, But Riskier
More than just about any other sector, biotech demands faith from its investors. Right now, belief appears to be strong. Faced with a string of worrying news from prominent biotechs in the past two weeks, investors have largely been willing to give the benefit of the doubt. That's a big shift from 2016, when any weakness was immediate cause for a huge selloff. (Max Nisen, 9/13)

Bloomberg: Allergan Patent Deal Isn't Just Unusual. It's Ugly.
Late last year, at a Forbes magazine health-care conference, I heard Brent Saunders, the chief executive of Allergan PLC, talk about drug prices. He said the drug industry’s reliance on big price increases to generate profits had gotten out of hand. He vowed that Allergan wouldn’t raise prices more than 10 percent a year, and described a patient assistance program that would ensure no one would lack an Allergan medicine because of cost. ... you know the old saying: Watch what they do, not what they say. Late Friday afternoon, Saunders and Allergan showed their true colors: The company announced that it would transfer the patent rights to one of its most important drugs, the eye medication Restasis, to the Saint Regis Mohawk Tribe. (Joe Nocera, 9/11)

Editorials And Opinions

Thoughts On Graham-Cassidy: 'Bad Idea'; 'Shoddiest' Repeal Idea Yet; 'Ideological Crusade'

Opinion writers offer dim views of the current measure being advanced by Senate Republicans to undo the Affordable Care Act.

The Washington Post: Another Execrable Health-Care Bill Proves Bad Ideas Never Die
Over the next week and a half, Republican senators may try one last time to repeal and replace Obamacare. The latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive. The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. (9/19)

Bloomberg: The Latest Obamacare Repeal Is The Shoddiest Yet
The new version, sponsored by Senators Lindsey Graham of South Carolina and Bill Cassidy from Louisiana, would do a number of things to a health care system that millions rely upon. A main selling point is giving states additional ability to act on their own -- which means that virtually all of the popular protections of the Affordable Care Act, including on pre-existing protections, would be at risk -- and also slashing health care funding. What exactly would it do? It's not much clearer than that now and won't get much clearer until next month. The Congressional Budget Office has announced they "will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks." (Jonathan Bernstein, 9/19)

USA Today: Obamacare Repeal Is An Ideological Crusade Past Its Sell-By Date. Give It Up, GOP
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back. When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. We get that. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government? (Jill Lawrence, 9/19)

Bloomberg: Graham-Cassidy Is Already Hurting Health Care 
This last-gasp bill -- called Graham-Cassidy after the senators leading it -- would be extremely disruptive to hospitals and government-focused insurers. The proposal ends individual and employer insurance mandates, gives states a big chunk of money and then largely leaves them to run their own health-care markets. It would likely lead to large cuts to Medicaid, destabilize the individual insurance market, and significantly reduce insurance coverage. (Max Nisen, 9/19)

The Washington Post: The Graham-Cassidy Health-Care Bill Puts Millions Of Americans At Risk
The Senate is on the verge of launching a dangerous experiment. Having failed for months to repeal and replace the Affordable Care Act, Republicans hope to dump onto the states the problem of providing low- and moderate-income Americans with access to health care. So long as they are determined to push forward without meaningful Democratic input, they have until Sept. 30 to act under Senate rules. The Graham-Cassidy bill — their last chance to meet this deadline — would simply hand the states block grants and abandon to them millions of Americans whom the ACA now helps. (Timothy Jost, 9/19)

Los Angeles Times: Repeal And Replace Is Back, And Scarier Than Ever
Like the villain in a slasher movie, Senate Republicans keep coming for the health insurance of tens of millions of Americans. After Sen. John McCain’s dramatic “no” vote seemed to finish off this year’s attempts to repeal the Affordable Care Act, a proposal by two senators with mostly unearned reputations for moderation — Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — represents the latest threat to the many people who gained access to healthcare under President Obama. The scariest part is that it might just pass. (Scott Lemieux, 9/19)

St. Louis Post-Dispatch: Last-Ditch Graham-Cassidy Health Care Bill Is The Worst One Yet
Under cover of a fog of news, Senate Republicans have been trying to round up enough votes for yet another bid to repeal and replace the Affordable Care Act. The bill they have in mind is in many ways worse than any of the three bills that failed this summer. After a dramatic thumbs-down “no” vote by Sen. John McCain, R-Ariz., killed the GOP’s third ACA replacement bill, Senate Majority Leader Mitch McConnell, R-Ky., said it was time to move on. Congress went into recess until after Labor Day, and the nation’s attention turned to hurricanes, immigration, budget matters and rapprochement between President Donald Trump and Democrats. (9/19)

The New York Times: John McCain Faces A New Test Of His Principles
It looks as if John McCain’s Senate colleagues are going to test him once again. And the health insurance of millions of Americans depends on the outcome. This summer, when his party was trying to force a health bill with unprecedented haste — no hearings, no support from medical experts — McCain stood up for the idea of the Senate. By now, you’ve probably heard a line or two from his July 25 speech, shortly after learning he had aggressive brain cancer. But the full speech is worth reading. It’s McCain at his best, a defense of the imperfect but noble pursuit of democratic politics. (David Leonhardt, 9/19)

Roll Call: The Fatal Flaw For Republicans In Graham-Cassidy
The Republicans’ latest drive to repeal Obamacare is reminiscent of a poetry fragment from Tennyson’s “The Charge of the Light Brigade”: “Theirs not to make reply, theirs not to reason why.” Whatever happens with the bill likely slated to reach the Senate floor next week, it is hard to escape the feeling that this wild charge will end badly for the Republicans. (Walter Shapiro, 9/20)

Policy Points: Looking For Innovation In Medicare And Medicaid; Health Care In Japan

Editorial pages feature an announcement by the head of the Centers for Medicare & Medicaid Services on Trump administration plans, one suggestion for covering more Americans and a look at how Japan handles health care.

The Wall Street Journal: Medicare And Medicaid Need Innovation
More than 130 million Americans are enrolled in Medicare and Medicaid. America’s elderly and most vulnerable citizens depend on these programs. But both face fiscal crises. ... The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. ... This administration plans to lead the Innovation Center in a new direction. On Wednesday we are issuing a “request for information” to collect ideas on the path forward. (Seema Verma, 9/19)

New Haven (Conn.) Register: 'Medicare For All' Could Be Cheaper Than You Think
Sanders’s plan would come at a steep price: likely more than US$14 trillion over the first decade, based on an estimate I did of a previous version. There is, however, a simpler and less costly path toward single-payer, and it may have a better chance of success: Simply strike the words “who are age 65 or over” from the 1965 amendments to the Social Security Act that created Medicare and, voila, everyone (who wants) would be covered by the existing Medicare program. While this wouldn’t be single-payer – in which the government covers all health care costs – and private insurers would continue to operate alongside Medicare, it would be a substantial improvement over the current system. (Gerald Friedman, 9/20)

Bloomberg: Want A Better Health Care System? Check Out Japan
Senator Bernie Sanders’s new health care plan, called “Medicare for All,” would eliminate private health insurance and have the government pay for 100 percent of all health services. It's not going to happen, but it does point the way toward a system that could work better: A public-private hybrid akin to what Japan has. (Noah Smith, 9/19)

Viewpoints: Returning To Work After A Psychotic Break; The Fiscal Responsibility Of Legalizing Weed

A selection of opinions on health care from around the country.

The New York Times: The ‘Madman’ Is Back In The Building
For my first day back to work I dressed in a sober navy sweater and a pair of dark slacks. Normal haircut, neatly trimmed beard. I got there early to avoid the morning rush and the inevitable stares and whispers. I had been “away with some issues” — that was the official company line, but offices are gossip hotbeds, and I wondered how much of the real story had filtered through. Did they know that I’d marched through the city for 12 hours — manic, psychotic and convinced I was being videotaped by secret TV producers, the star of my own reality show? That the police had found me later that evening shirtless, barefoot and crying on a subway platform? That I’d been involuntarily committed to Bellevue, the notorious psych ward to which we at Legal Aid routinely sent our most mentally ill clients? (Zack McDermott, 9/20)

Bloomberg: Marijuana Sales Can Make U.S. Tribes Richer And Poorer
"This is going to be bigger than bingo," James Billie told CNN over the summer. A former chief of the Seminole, whose company MCW gives financing and legal counsel to American Indian tribes to help them grow and sell marijuana on their land, Billie could barely contain his excitement about this new venture. (Naomi Schaefer Riley, 9/19)

Louisville Courier-Journal: Repeat After Me: Yes. We. Cannabis.
Let me be blunt: I used to smoke weed. I have notebooks filled with very profound and original observations about the interconnectedness of all beings to prove it. But, I haven’t burned one down for more than a decade. So, when I suggest that Kentucky legalize recreational marijuana, it’s not because I have a toke in this fight. Instead, Kentucky lawmakers should stop puffing and start passing legislation to legalize weed for two reasons: It’s the right thing to do, and it’s the fiscally responsible thing to do. (Ben Carter, 9/19)