From Health Care

Doctor’s Social Media Promos For His Company’s Cancer ‘Breakthrough’ May Violate Federal Rules

Following questions from Stat about promotion of a non-Food and Drug Administraiton approved treatment, NantKwest softened the language. Meanwhile, The New York Times writes on how more surgeries are being conducted while patients are awake. And other news outlets report on tuberculosis, the flu vaccine, Zika, another virus that can cause birth defects called Cytomegalovirus and more public health stories.

Stat: CEO’s Promotion Of ‘Breakthrough’ Cancer Therapy Raises Questions
The emotional video tells of a patient with blood cancer who tries an experimental therapy involving “natural killer” cells. “NEW BREAKTHROUGH HELPS PATIENTS KILL CANCER” the banner headline declares as the patient, wiping away tears, covers her face with her hands and murmurs, “It’s really good news.” Billionaire Dr. Patrick Soon-Shiong retweeted the video several times in recent days, amid a flurry of social media posts in which he vowed to “solve” cancer. But where the ordinary viewer might see an inspirational story, drug industry experts saw a likely violation of federal regulations. (Robbins, 3/27)

The New York Times: Going Under The Knife, With Eyes And Ears Wide Open
“Do you want to see your tendons?” Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility. (Hoffman, 3/25)

Stat: How One County Battled A Deadly Strain Of Tuberculosis
The drug-resistant TB had quietly spread for the better part of a decade among [Atlanta’s] homeless population. Then in 2014, the stubborn strain turned fatal, killing at least three men and infecting dozens. The deadly “Atlanta strain” also cropped up in more than a dozen states nationwide. Alarmed, the Centers for Disease Control and Prevention intervened with emergency aid. A multimillion-dollar effort to screen and treat vulnerable residents has worked: Officials announced this week that TB cases in Fulton County, which includes most of Atlanta and and some of its surrounding suburbs, have dropped by nearly a third. They say the approach here can offer valuable lessons to other communities battling public outbreaks. (Blau, 3/24)

NPR: New Parents Get Baby Boxes To Encourage Safe Sleep
For Jernica Quiñones, the reality of sudden infant death syndrome, or SIDS, hit close to home this year when a friend woke up on New Year’s Day and discovered the lifeless body of her baby girl. That’s why Quiñones’ 4-month-old son, Bless’n, has spent a lot of his life so far sleeping in a cardboard box. (Pao, 3/26)

The Baltimore Sun: Study: African-Americans Don’t Trust Flu Vaccine; Whites Don’t Think Flu Is That Bad 
The researchers found African-Americans worried about the safety of the shot more than the health risks of the flu. The findings are important as the medical community tries to improve vaccination rates. Fewer than half of Americans get the flu vaccine, according to the Centers for Disease Control and Prevention. Just 41 percent of African-Americans get vaccinated, compared with 47 percent of whites. The study, published in the journal Risk Analysis, included 800 white and 800 African-American participants. Researchers from the University of Georgia and the University of Pittsburgh also participated in the research. (McDaniels, 3/25)

NPR: Common Virus Can Cause Devastating Birth Defects
When Kathleen Muldoon had her second child everything was going smoothly. The delivery was short, the baby’s APGAR score was good and he was a healthy weight. “Everyone said he was amazing,” says Muldoon. But when a doctor noticed that Gideon was jaundiced, everything changed. (Neighmond, 3/27)

NPR: Breast-Fed Kids May Be Less Hyper, But Not Necessarily Smarter, Study Finds
Breast-feeding has many known health benefits, but there’s still debate about how it may influence kids’ behavior and intelligence. Now, a new study published in Pediatrics finds that children who are breast-fed for at least six months as babies have less hyperactive behavior by age 3 compared with kids who weren’t breast-fed. (Aubrey, 3/27)

Kaiser Health News: Want To Live Past 100? Centenarians Share Secrets Of Knee Bends And Nips Of Scotch
Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said. John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets. “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Jayson, 3/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

New Utah Law Requires Doctors To Tell Women That Abortion Induced By Pill Can Be Stopped, Despite No Evidence Proving Claim

In news from other states’ debates on the abortion issue, an Oklahoma lawmaker defends his antiabortion legislation that does not include an exception for cases of rape or incest, saying such pregnancies are instances when “God can bring beauty from ashes.” And in Montana, state senators advance a measure seeking to protect “pain-capable” fetuses.

The Washington Post: Oklahoma Lawmaker Defends Pregnancy From Rape And Incest As ‘Beauty From Ashes’
In defending his controversial antiabortion legislation, Oklahoma state Rep. George Faught said that even in pregnancies that result from rape or incest, “God can bring beauty from ashes.” Faught made the statement during a debate on the Oklahoma House floor earlier this week. Faught’s bill, which overwhelmingly passed the House on Tuesday, would outlaw abortions sought by women based solely on a diagnosis of Down syndrome or other genetic abnormalities. A fellow lawmaker criticized the Republican from Muskogee for not including an exception for pregnancies that resulted from rape and incest. (Phillips, 3/25)

The Associated Press: Montana Bill Seeks Abortion Ban On ‘Pain-Capable’ Fetuses
The Montana Senate on Friday advanced a proposal seeking to extend protections to so-called “pain-capable” fetuses. If approved, Montana would join more than a dozen states adopting laws protecting pain-capable fetuses. The measure is one of a pair of anti-abortion bills that continued moving through the Montana Legislature. Earlier in the week, a House committee further advanced a bill that would effectively ban all abortions after 24 weeks of pregnancy by requiring doctors to save a fetus. (Calvan, 3/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

First Edition: March 27, 2017

Mar 27 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: House Leaders ‘Came Up Short’ In Effort To Kill Obamacare
Mary Agnes Carey reports: “Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act. House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage. “We came really close today, but we came up short,” he told reporters at a hastily called news conference.” (Carey, 3/27)

California Healthline: Californians Speak After GOP’s Obamacare Repeal Attempt Falls Flat
Relief, disappointment, unassuaged worry, political swagger, straightforward determination. From the state Capitol to the halls of academia, and from the interior to the coast, Californians reacted strongly on Friday to the dramatic news that the Affordable Care Act would be around “for the foreseeable future,” as House Speaker Paul Ryan conceded after being forced to withdraw the Republican repeal bill for lack of support within his own party. Here are some of the comments from policymakers, advocates and consumers around the state. (3/27)

Kaiser Health News: ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life
Anna Gorman reports: “Gerald Chinchar isn’t quite at the end of life, but the end is not far away. The 77-year-old fell twice last year, shattering his hip and femur, and now gets around his San Diego home in a wheelchair. His medications fill a dresser drawer, and congestive heart failure puts him at high risk of emergency room visits and long hospital stays.” (Gorman, 3/27)

Kaiser Health News: Want To Live Past 100? Centenarians Share Secrets Of Knee Bends And Nips Of Scotch
Sharon Jayson reports: “Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said. John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets. “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Jayson, 3/27)

The New York Times: In Major Defeat For Trump, Push To Repeal Health Law Fails
House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday in a major defeat for President Trump on the first legislative showdown of his presidency. “We’re going to be living with Obamacare for the foreseeable future,” the House speaker, Paul D. Ryan, conceded. (Pear, Kaplan and Haberman, 3/24)

Politico: How A Secret Freedom Caucus Pact Brought Down Obamacare Repeal
Speaker Paul Ryan and House leaders had been toiling behind closed doors for weeks assembling their Obamacare repeal bill as suspicion on the far-right simmered to a boil. So on March 7, just hours after Ryan unveiled a plan that confirmed its worst fears, the House Freedom Caucus rushed to devise a counterstrategy. The few dozen true believers knew that pressure from House leaders and President Donald Trump to fall in line would be immense and they were intent on not getting boxed in. (Bade, Dawsey and Haberkorn, 3/26)

The New York Times: Some Lawmakers Now Look To Bipartisanship On Health Care
The sudden death of legislation to repeal the Affordable Care Act has created an opening for voices from both parties to press for fixes to the acknowledged problems in President Barack Obama’s signature health law, as lawmakers and some senior White House officials appealed for bipartisanship. But the White House, still smarting from a disastrous defeat on Friday, appeared uncertain on the path forward. President Trump predicted that “Obamacare will explode” and offered no plan to stop it, but his was not the only voice from the White House. (Pear and Shear, 3/26)

The New York Times: Democrats, Buoyed By G.O.P. Health Defeat, See No Need To Offer Hand
President Trump, looking for a flicker of hope after his Republican majority fell to pieces last week, predicted that the opposition party would eventually give in: “I honestly believe the Democrats will come to us and say let’s get together and get a great health care bill or plan,” he said. But Democrats will not be lending a hand anytime soon. (Martin, 3/26)

Reuters: How Republicans Can Hobble Obamacare Even Without Repeal
Republicans may have failed to overthrow Obamacare this week, but there are plenty of ways they can chip away at it. The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law. (3/26)

The Wall Street Journal: With GOP Plan Dead, Trump Weighs Other Ways To Reshape Health Care
With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to alter the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes. The initiative now rests with Health and Human Services Secretary Tom Price, who has vowed to review every page of regulation and guidance related to the ACA. The steps he and the administration take next could have sweeping repercussions, accomplishing some of the same types of changes Republicans were unable to push through Congress. (Armour, 3/25)

The New York Times: Paul Ryan Emerges From Health Care Defeat Badly Damaged
For two days in January, all seemed right in the Republican Party. Gathered in Philadelphia for their annual congressional retreat, less than a week after President Trump’s inauguration, lawmakers exulted in the possibilities of total government control, grinning through forums about an aggressive 200-day agenda that began with honoring a central campaign promise: repealing the Affordable Care Act. (Flegenheimer and Kaplan, 3/25)

The New York Times: Dealt A Defeat, Republicans Set Their Sights On Major Tax Cuts
Picking themselves up after the bruising collapse of their health care plan, President Trump and Republicans in Congress will start this week on a legislative obstacle course that will be even more arduous: the first overhaul of the tax code in three decades. Mr. Trump’s inability to make good on his promise to repeal the Affordable Care Act has made the already daunting challenge of tax reform even more difficult. (Rappeport, 3/26)

The Associated Press: Failure On Health Bill Also Hurts Prospects For Tax Overhaul
House Republicans’ failure to repeal Barack Obama’s health care law deals a serious blow to another big part of President Donald Trump’s agenda: tax reform. Trump and House Speaker Paul Ryan, R-Wis., say they will soon turn their attention to the first major re-write of the tax code in more than 30 years. But they will have to do it without the momentum of victory on health care. (3/25)

The Associated Press: GOP Controls Federal Government But Struggles To Govern
The Republican Party of “no” for Democrat Barack Obama’s eight years is having a hard time getting to “yes” in the early Donald Trump era. The unmitigated failure of the GOP bill to replace Obamacare underscored that Republicans are a party of upstart firebrands, old-guard conservatives and moderates in Democratic-leaning districts. Despite the GOP monopoly on Washington, they are pitted against one another and struggling for a way to govern. (3/27)

The New York Times: Trump Becomes Ensnared In Fiery G.O.P. Civil War
President Trump ignites a lot of fights, but his failure to repeal the Affordable Care Act, the biggest defeat in his short time in the White House, was the result of something else: a long-running Republican civil war that humbled a generation of party leaders before he ever came to Washington. (Thrush and Haberman, 3/25)

The Associated Press: Blaming Conservatives, Trump Signals New Openness To Dems
President Donald Trump on Sunday attacked conservative lawmakers for the failure of the Republican bill to replace former President Barack Obama’s health care law, as aides signaled a greater willingness to work with moderate Democrats on upcoming legislative battles from the budget and tax cuts to health care. (3/26)

The Washington Post: Trump Shifts Blame For Health-Care Collapse To Far Right
His attack — starting with a tweet that singled out the House Freedom Caucus as well as the influential Club for Growth and Heritage Action for America — marked a new turn in the increasingly troubled relationship between the White House and a divided GOP still adjusting to its unorthodox standard-bearer. (Sullivan, Wagner and Phillips, 3/26)

The Washington Post: Trump Goes After Freedom Caucus, But Its Leader Doesn’t Hit Back
Asked about the tweet on the Sunday news shows, two Freedom Caucus members appeared set on avoiding a confrontation with the president.“If they’re applauding, they shouldn’t,” Rep. Mark Meadows (R-N.C.), the head of the Freedom Caucus, said of the Democrats on ABC’s “This Week.” “Because I can tell you, conversations over the last 48 hours are really about how we come together in the Republican Conference and get this over the finish line.” (Sullivan, 3/26)

The Wall Street Journal: House Conservatives Are Undeterred After Health-Bill Failure
The head of the most conservative Republican House faction sought to deflect blame Sunday for last week’s stunning collapse of a White House-backed health-care measure, saying the lawmakers hadn’t given up on trying to repeal the Affordable Care Act. The chairman of the House group also signaled in an ABC interview that the bloc would make its voice a central part of other legislative debates, including an overhaul of the federal tax code. (Bender and Hughes, 3/26)

Politico: Trump’s Obamacare Stumble Empowers Pelosi
Nancy Pelosi is suddenly relevant again. The implosion of the all-Republican effort to lay waste to Obamacare showed that President Donald Trump might need the San Francisco Democrat to salvage the rest of his agenda. The self-professed master negotiator couldn’t get it done with his own party, despite a 44-seat House majority, and hinted afterward he might start to look across the aisle. (Caygle, 3/27)

The Wall Street Journal: How Democrats Aided In The Demise Of The GOP’s Health Bill
President Donald Trump blamed Democrats for the defeat of his bid to overturn the 2010 Affordable Care Act and enact Republican policy in its place. In some ways he may have been right. Supporters of the health law popularly known as Obamacare launched an all-out campaign for its survival, keeping Democrats unified in opposition to its repeal, and identifying and exploiting Republican divisions that ultimately forced GOP leaders to pull the bill at the eleventh hour Friday. (Radnofsky, 3/26)

The Washington Post: With AHCA Defeat, Some Democrats See Chance To Push For Universal Coverage
At their first town meeting since the Republicans’ surprise surrender on the Affordable Care Act, progressives in blue America celebrated — then asked for more. Rhode Island’s two Democratic senators, joined by Rep. Jim Langevin, told several hundred happy constituents that the next step in health reform had to mean expanded coverage, provided by the government. “We have to look harder at a single-payer system,” said Langevin (D-R.I.), using a term for universal coverage. (Weigel, 3/26)

The New York Times: Health Bill’s Failure Leaves Supporters In A Political Jam Back Home
They went to unusual, even dangerous lengths to support President Trump’s unpopular health care bill, facing down protesters at home and begging for special accommodation from House leaders in Washington. John Faso of New York negotiated a side deal for his state in exchange for backing it. Mike Coffman was the lone Colorado lawmaker to endorse the bill, while his Republican neighbors agonized and stalled. (Burns, 3/25)

The Associated Press: New Anxieties As Trump Says Obamacare Will ‘Explode’
Americans who have benefited from the Affordable Care Act are feeling some relief at the failure of Republican efforts to repeal it, but they face new anxieties with President Donald Trump tweeting that “ObamaCare will explode.” Premiums have risen and major insurers have backed out of the state markets where people can buy insurance online under Obama’s signature health care law. But people who say it saved their lives or helped them start a business want lawmakers to fix these problems, not encourage them. (3/26)

The Associated Press: Now What? Options For Consumers As Health Law Drama Fades
As the political drama over health care legislation in Washington fades, the rest of the country faces a more immediate concern: Getting insurance for next year. The Republican health plan designed to replace the Obama-era health law known as the Affordable Care Act would not have taken full effect for a few years anyway — and now it’s dead. (3/25)

The New York Times: More Than Obamacare Repeal, Small Businesses Want Congress To Rein In Costs
LaRonda Hunter, a business owner in Fort Worth, Tex., views the Affordable Care Act as a literal job killer. Fearful of triggering the law’s employer mandate, which requires businesses with 50 or more workers to offer health insurance or pay penalties, Ms. Hunter has held off on expanding her small chain of hair salons. She voted for President Trump with the hope that he would quickly make good on his promise to strike down the health care law. (Cowley, 3/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

First Edition: March 27, 2017

Mar 27 2017

Politico: Republicans Turn Fire On Each Other
White House officials insisted Sunday that the relationship between President Donald Trump and Speaker Paul Ryan is strong, even as Republican infighting over the failure to repeal Obamacare exploded into the open over the weekend. After Trump urged his Twitter followers Saturday to watch Fox News’ Jeanine Pirro — who opened her show last night with six-minute plea for Speaker Paul Ryan to step down — Washington was abuzz with speculation about a Trump-Ryan rift. (Cheney and Bresnahan, 3/26)

Politico: Republicans Wonder Whether Trump’s Heart Was In Healthcare Fight
While President Donald Trump’s first major legislative push hurtled toward a major defeat, one of his top advisers, his son-in-law Jared Kushner, was photographed with his wife, Ivanka Trump, on a ski gondola in Aspen. Kushner may not have been the lead White House negotiator on the doomed healthcare bill. But the image of Trump’s top consigliere hitting the slopes at perhaps the most critical moment of his young presidency sent a message loud and clear: The White House wanted a win, but health care was not the dominant priority for Trump that it was for the Republican members of Congress who actually had to take a vote. (Karni, 3/25)

Politico: Freedom Caucus Member Resigns From Group Over Obamacare Rift
Rep. Ted Poe (R-Texas) resigned from the House Freedom Caucus over the group’s opposition to the Republican plan to repeal and replace Obamacare. “I have resigned from the House Freedom Caucus. In order to deliver on the conservative agenda we have promised the American people for eight years, we must come together to find solutions to move this country forward,” Poe wrote in a statement. (Bade, 3/26)

The Washington Post: Pence’s Strange Claim That Selling Health Insurance Across State Lines Would Be Like Car And Life Insurance
One of President Trump’s signature promises is to allow the purchase of health insurance across state lines. This was supposed to be tackled in “phase three” of the administration’s plan to repeal and replace the Affordable Care Act, now in doubt because of the failure on Friday to advance the “phase one” bill in the House. Many experts are skeptical about whether buying health insurance across state lines would actually work — more on that below — but we were interested in claims made by administration officials such as Vice President Pence and White House press secretary Sean Spicer that this would be similar to buying life insurance and car insurance. (Kessler, 3/27)

Politico: Sanders To Offer Single-Payer Health Care Plan
Sen. Bernie Sanders said Sunday he planned to introduce a single-payer health care plan to Congress, inviting Republican leaders to negotiate the measure. “I’m going to introduce a Medicare-for-all single-payer program,” Sanders told anchor Dana Bash on CNN’s “State of the Union.” The Vermont senator, who has repeatedly stated his support for such a plan in the past, said he hoped to garner bipartisan support for the plan. (Lima, 3/26)

NPR: Worries About Health, Prejudice And Immigration Swirl At LA Clinic
Lourdes Flores Valdez says she got her diabetes under control after she was able to sign up for Medi-Cal, California’s version of Medicaid, under the Affordable Care Act’s expanded eligibility rules. Sitting in an exam room at the UMMA Community Clinic’s Fremont Wellness Center in South Los Angeles, she suddenly veers away from discussing the health law and starts talking about her husband, who is in the United States illegally. (Plevin, 3/25)

The Washington Post: Montana Bill Seeks Abortion Ban On ‘Pain-Capable’ Fetuses
The Montana Senate on Friday advanced a proposal seeking to extend protections to so-called “pain-capable” fetuses.If approved, Montana would join more than a dozen states adopting laws protecting pain-capable fetuses. The measure is one of a pair of anti-abortion bills that continued moving through the Montana Legislature. Earlier in the week, a House committee further advanced a bill that would effectively ban all abortions after 24 weeks of pregnancy by requiring doctors to save a fetus. (Calvan, 3/24)

The Washington Post: Oklahoma Lawmaker Defends Pregnancy From Rape And Incest As ‘Beauty From Ashes’
In defending his controversial antiabortion legislation, Oklahoma state Rep. George Faught said that even in pregnancies that result from rape or incest, “God can bring beauty from ashes.” Faught made the statement during a debate on the Oklahoma House floor earlier this week. Faught’s bill, which overwhelmingly passed the House on Tuesday, would outlaw abortions sought by women based solely on a diagnosis of Down syndrome or other genetic abnormalities. A fellow lawmaker criticized the Republican from Muskogee for not including an exception for pregnancies that resulted from rape and incest. (Phillips, 3/25)

The Washington Post: Are Right-To-Try Laws A Last Hope For Dying Patients — Or A False Hope?
Thirty-three states have passed [right-to-try] laws, which ostensibly allow patients to take experimental medicines outside of clinical ­trials and without FDA oversight as long as the therapies have undergone preliminary safety testing. Many of the remaining states are considering such bills or are expected to do so.And now, for the first time, federal legislation is gaining traction. (McGinley, 3/26)

The New York Times: Going Under The Knife, With Eyes And Ears Wide Open
“Do you want to see your tendons?” Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility. (Hoffman, 3/25)

NPR: Breast-Fed Kids May Be Less Hyper, But Not Necessarily Smarter, Study Finds
Breast-feeding has many known health benefits, but there’s still debate about how it may influence kids’ behavior and intelligence. Now, a new study published in Pediatrics finds that children who are breast-fed for at least six months as babies have less hyperactive behavior by age 3 compared with kids who weren’t breast-fed. (Aubrey, 3/27)

NPR: New Parents Get Baby Boxes To Encourage Safe Sleep
For Jernica Quiñones, the reality of sudden infant death syndrome, or SIDS, hit close to home this year when a friend woke up on New Year’s Day and discovered the lifeless body of her baby girl. That’s why Quiñones’ 4-month-old son, Bless’n, has spent a lot of his life so far sleeping in a cardboard box. (Pao, 3/26)

NPR: Telehealth Makes Some Health Care More Expensive
Telehealth takes a lot of forms these days. Virtual visits with a health care provider can take place by video, phone or text, or via the Web or a mobile app. The one commonality: You get to consult a doctor from your home, the office, Starbucks or anywhere with a wifi or mobile connection. (Brooks, 3/26)

NPR: Common Virus Can Cause Devastating Birth Defects
When Kathleen Muldoon had her second child everything was going smoothly. The delivery was short, the baby’s APGAR score was good and he was a healthy weight. “Everyone said he was amazing,” says Muldoon. But when a doctor noticed that Gideon was jaundiced, everything changed. (Neighmond, 3/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Want To Live Past 100? Centenarians Share Secrets Of Knee Bends And Nips Of Scotch

Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said.

John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets.

“Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.”

Mac Miller, who is 102, has a standard reply.

“People ask me ‘What is the secret?’ The answer is simple. Choose the right grandparents. They were in their 80s. My mother was 89, and my father was 93,” he said.

John Henderson and his wife of 77 years, Charlotte, live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors. They were the first people to move into the retirement community when it opened. (Sharon Jayson for KHN)

Genetics and behaviors do play roles in determining why some people live to be 100 or older while others don’t, but they aren’t guarantees. And now, as increasing numbers are reaching triple digits, figuring out the mysteries of longevity has taken on new importance among researchers.

Although those 100 and older make up a tiny segment of America’s population, U.S. Census reports show that centenarian ranks are growing. Between 1980 and 2010, the numbers rose from 32,194 to 53,364, an increase of almost 66 percent. The latest population estimate, released in July 2015, reflects 76,974 centenarians.

“The number of centenarians in the U.S. and other countries has been doubling roughly every eight years,” said James Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany.

“When the baby boomers hit, there’s going to be acceleration, and it might be doubling every five or six years,” he said.

John Henderson’s secret to a long life? “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Sharon Jayson for KHN)

Henderson and his wife of 77 years live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors, many of whom have ties to the University of Texas at Austin. Henderson is UT’s oldest-living former football player, arriving in 1932 as a freshman. They’re the only centenarians in the complex and are a rare breed: married centenarians.

Charlotte Henderson said she believes being married may have helped them reach these 100-plus years.

“We had such a good time when John retired. We traveled a lot,” she said. “We just stay busy all the time, and I’m sure that helps.”

Bernard Hirsh, 100, of Dallas agrees. His wife, Bee, is 102. They married in 1978 when both were in their early 60s and each had been widowed, she for the second time.

“I think it’s been such a wonderful marriage, and we’ve contributed to each other’s benefit,” he said.

Little research exists on the effects of marriage on longevity. One 2015 Belgian study of centenarians born between 1893 and 1903 did focus on their living arrangements during ages 60 and 100 and found “in very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse.” The study explained that “living with one’s spouse at the oldest ages does not provide the same level of protection as it does at younger ages. This may be explained by the decline of the caregiver’s own health as the needs of his or her spouse increase. Caregiving could also have negative consequences for the health and economic condition of the spouse who is the primary caregiver, especially for older women.”

However, Vaupel, who directs the Institute’s International Research Network on Aging, said being married is a positive for both.

“Especially if you’re quite old, it’s very helpful have a spouse. If you’re very old and don’t have a spouse, the chance of death is higher,” he said.

Siegel, who lives in a senior living community in Boca Raton, Fla., outlived two husbands. She never smoked and occasionally has a glass of dry, red wine.

“I am not a big eater. I don’t eat much meat,” said Siegel, who said she weighs 90 pounds and used to be 5 feet tall but is shrinking.

She stays active by walking inside the building about a half-hour each day, playing bridge twice a week and exercising.

“I feel that’s what really kept my body pretty good. It wasn’t sports. It was exercises,” she said of the routine she does daily twice a day for about 20 minutes.

Miller, of Pensacola, Fla., also outlived two wives.

He was a fighter pilot in the Marine Corps during World War II and spent eight years in active duty, which Miller said “was not so good for me because I sat in the cockpit of a plane for 5,000 hours.”

But, he was active as a youth — running track, playing football and spending hours surfing while living in Honolulu.

Charlotte and John Henderson, now 102 and 104 years old respectively, have been married for 77 years. Charlotte said she believes being married may have helped them reach these 100-plus years. (Courtesy of the Henderson family)

Miller is gluten-free because of allergies and doesn’t eat many carbohydrates. He also never smoked. And, he still enjoys a scotch in the evening.

The Hendersons usually have wine or a cocktail before dinner. She never smoked. He quit in 1950.

Hirsh, of Dallas, another non-smoker, attributes his long life to “good luck.”

“I was very active in my business and did a lot of walking during the day. I was not sedentary,” he said.

Now, exercise is limited to “some knee bends every morning to keep my legs stronger.”

“My father died of a heart attack in his early 50s, and my mother died in her early 60s of a stroke, so I don’t think my genes were very good,” Hirsh said.

Geriatrician Thomas Perls, director of the New England Centenarian Study at Boston Medical Center, said research shows that behaviors have a greater influence on survival up until the late 80s, since he said most people have the right genes to get there as long as their behaviors aren’t harmful. But once people reach the 90s and beyond, genetics play a more significant role.

“To get to these very oldest ages, you really have to have the right genes in your corner,” he said.

As an international leader in the field, Perls’ focus is on finding the right mix of behavior, environment and genetics to produce long lives. His work includes a National Institute on Aging study called the Long Life Family Study.

“There are always questions about environment versus genes,” said endocrinologist Nir Barzilai, founding director of the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “We are with our genes in this environment. It’s really 50-50, no matter how you look at it.”

Barzilai’s studies include centenarians and their children, as well as efforts to slow the process of aging.

Among those who reach the 100-year-old milestone, Perls’ said his research and that of Barzilai and others has found certain commonalities: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.” Studies show that whatever their stress level, they manage its well. And they’re related to other centenarians or have a parent or grandparent who lived past 80.

These lessons of long life are playing well with the public, who have made changes for the better in the 21st century, Vaupel said.

“We don’t smoke or drink so much, and we’re better at exercise. People are taking better care of themselves. People are better educated, and the more educated know when to go to the doctor and follow the doctor’s advice,” he said, adding that people now tend to have higher income and can spend more on health care and improved diet.

“The most important thing is we’re living longer and living longer healthy,” Vaupel said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging

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‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life

Gerald Chinchar isn’t quite at the end of life, but the end is not far away. The 77-year-old fell twice last year, shattering his hip and femur, and now gets around his San Diego home in a wheelchair. His medications fill a dresser drawer, and congestive heart failure puts him at high risk of emergency room visits and long hospital stays.

Chinchar, a Navy veteran who loves TV Westerns, said that’s the last thing he wants. He still likes to go watch his grandchildren’s sporting events and play blackjack at the casino. “If they told me I had six months to live or go to the hospital and last two years, I’d say leave me home,” Chinchar said. “That ain’t no trade for me.”

Most aging people would choose to stay home in their last years of life. But for many, it doesn’t work out: They go in and out of hospitals, getting treated for flare-ups of various chronic illnesses. It’s a massive problem that costs the health care system billions of dollars and has galvanized health providers, hospital administrators and policymakers to search for solutions.

Sharp HealthCare, the San Diego health system where Chinchar receives care, has devised a way to fulfill his wishes and reduce costs at the same time. It’s a pre-hospice program called Transitions, designed to give elderly patients the care they want at home and keep them out of the hospital.

Social workers and nurses from Sharp regularly visit patients in their homes to explain what they can expect in their final years, help them make end-of-life plans and teach them how to better manage their diseases. Physicians track their health and scrap unnecessary medications. Unlike hospice care, patients don’t need to have a prognosis of six months or less, and they can continue getting curative treatment for their illnesses, not just for symptoms.

Before the Transitions program started, the only option for many patients in a health crisis was to call 911 and be rushed to the emergency room. Now, they have round-the-clock access to nurses, one phone call away.

“Transitions is for just that point where people are starting to realize they can see the end of the road,” said San Diego physician Dan Hoefer, one of the creators of the program. “We are trying to help them through that process so it’s not filled with chaos.”

The importance of programs like Transitions is likely to grow in coming years as 10,000 baby boomers — many with multiple chronic diseases — turn 65 every day. Transitions was among the first of its kind, but several such programs, formally known as home-based palliative care, have since opened around the country. They are part of a broader push to improve people’s health and reduce spending through better coordination of care and more treatment outside hospital walls.

But a huge barrier stands in the way of pre-hospice programs: There is no clear way to pay for them. Health providers typically get paid for office visits and procedures, and hospitals still get reimbursed for patients in their beds. The services provided by home-based palliative care don’t fit that model.

In recent years, however, pressure has mounted to continue moving away from traditional payment systems. The Affordable Care Act has established new rules and pilot programs that reward the quality rather than the quantity of care. The health reform law, for example, set up “accountable care organizations” networks of doctors and hospitals that share responsibility for providing care to patients. They also share the savings when they rein in unnecessary spending by keeping people healthier. Those changes are helping to make home-based palliative care a more viable option.

In San Diego, Sharp’s palliative care program has a strong incentive to reduce the cost of caring for its patients, who are all in Medicare managed care. The nonprofit health organization receives a fixed amount of money per member each month, so it can pocket what it doesn’t spend on hospital stays and other costly medical interventions.

Gerald Chinchar’s medicine is packed in a kitchen drawer for a Sharp HealthCare Transitions program nurse to check. (Heidi de Marco/KHN)

‘Something That Works’

Palliative care focuses on relieving patients’ stress, pain and other symptoms as their health declines, and it helps them maintain their quality of life. It’s for people with serious illnesses, such as cancer, dementia and heart failure. The idea is for patients to get palliative care and then move into hospice care, but they don’t always make that transition.

The 2014 report “Dying in America,” by the Institute of Medicine, recommended that all people with serious advanced illness have access to palliative care. Many hospitals now have palliative care programs, delivered by teams of social workers, chaplains, doctors and nurses, for patients who aren’t yet ready for hospice. But until recently, few such efforts had opened beyond the confines of hospitals.

Kaiser Permanente set out to address this gap. Nearly 20 years ago, it created a home-based palliative care program, testing it in California and later in Hawaii and Colorado. Two studies by Kaiser and others found that participants were far more likely to be satisfied with their care and more likely to die at home than those not in the program. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

One of the studies, published in 2007, found that 36 percent of people receiving palliative care at home were hospitalized in their final months, compared with 59 percent of those getting standard care. The overall cost of care for those who participated in the program was a third less than for those who didn’t.

“We thought, ‘Wow. We have something that works,’” said Susan Enguidanos, an associate professor at the University of Southern California’s Leonard Davis School of Gerontology, who worked on both studies. “Immediately we wanted to go and change the world.”

But Enguidanos knew that Kaiser Permanente was unlike most health organizations. It was responsible for both insuring and treating its patients, so it had a clear financial motivation to improve care and control costs. Enguidanos said she talked to medical providers around the nation about this type of palliative care, but the concept didn’t take off at the time. Providers kept asking the same question: How do you pay for it without charging patients or insurers?

“I liken it to paddling out too soon for the wave,” she said. “We were out there too soon. … But we didn’t have the right environment, the right incentive.”

A Bold Idea

Dan Hoefer’s medical office is in the city of El Cajon, which sits in a valley in eastern San Diego County. Hoefer, a former hospice and home health medical director and nursing home doctor, has spent years treating elderly patients. He learned an important lesson when seeing patients in his office: Despite the medical care they received, “they were far more likely to be admitted to the hospital than make it back to see me.”

When his patients were hospitalized, many would decline quickly. Even if their immediate symptoms were treated successfully, they would sometimes leave the hospital less able to take care of themselves. They would get infections or suffer from delirium. Some would fall.

His patients were like cars with 300,000 miles on them, he said. They had a lot of broken parts. “You can’t just fix one thing and think you have solved the problem,” he said.

And trying to do so can be very costly. About a quarter of all Medicare spending for beneficiaries 65 or older is to treat people in their last year of life, according to a report by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

Hoefer’s colleague, Suzi Johnson, a nurse and administrator in Sharp’s hospice program, saw the opposite side of the equation. Patients admitted into hospice care would make surprising turnarounds once they started getting medical and social support at home and stopped going to the hospital. Some lived longer than doctors had expected.

In 2005, the pair hatched and honed a bold idea: What if they could design a home-based program for patients before they were eligible for hospice?

Thus, Transitions was born. They modeled their new program in part on the Kaiser experiment, then set out to persuade doctors, medical directors and financial officers to try it. But they met resistance from physicians and hospital administrators who were used to getting paid for seeing patients.

“We were doing something that was really revolutionary, that really went against the culture of health care at the time,” Johnson said. “We were inspired by the broken system and the opportunity we saw to fix something.”

Doctors, nurses and social workers gather in a small conference room for their bimonthly meeting to discuss patient cases for the Sharp HealthCare Transitions program in January. (Heidi de Marco/KHN)

Despite the concerns, Sharp’s foundation board gave the pair a $180,000 grant to test out Transitions. And in 2007, they started with heart failure patients and later expanded the program to those with advanced cancer, dementia, chronic obstructive pulmonary disease and other progressive illnesses. They started to win over some doctors who appreciated having additional eyes on their patients, but they still encountered “some skepticism about whether it was really going to do any good for our patients,” said Jeremy Hogan, a neurologist with Sharp. “It wasn’t really clear to the group … what the purpose of providing a service like this was.”

Nevertheless, Hogan referred some of his dementia patients to the program and quickly realized that the extra support for them and their families meant fewer panicked calls and emergency room trips.

Hoefer said doctors started realizing home-based care made sense for these patients — many of whom were too frail to get to a doctor’s office regularly. “At this point in the patient’s life, we should be bringing health care to the patient, not the other way around,” he said.

Across the country, more doctors, hospitals and insurers are starting to see the value of home-based palliative care and are figuring out how to pay for it, said Kathleen Kerr, a health care consultant who researches palliative care.

“It is picking up steam,” she said. “You know you are going to take better care of this population, and you are absolutely going to have lower health care costs.”

Providers are motivated in part by a growing body of research. A study published in January showed that in the last three months of life, medical care for patients in a home-based palliative care program cost $12,000 less than for patients who were getting more typical treatment. Patients in the program also were more likely to go into hospice and to die at home, according to the study.

Two studies of Transitions in 2013 and 2016 reaffirmed that such programs save money. The second study, led by outside evaluators, showed it saved more than $4,200 per month on cancer patients and nearly $3,500 on those with heart failure.

The biggest differences occurred in the final two months of life, said one of the researchers, Brian Cassel, who is palliative care research director at the Virginia Commonwealth University School of Medicine in Richmond.

One reason for the success of these programs is that the teams really get to know patients, their hopes and aspirations, said Christine Ritchie, a professor at UC San Francisco’s medical school. “There is nothing like being in someone’s home, on their turf, to really understand what their life is like,” she said.

A Home Visit

Nurse Sheri Juan and social worker Mike Velasco, who both work for Sharp, walked up a wooden ramp to the Chinchars’ front door one recent January morning. Juan rolled a small suitcase behind her containing a blood pressure cuff, a stethoscope, books, a laptop computer and a printer.

Mary Jo Chinchar was already familiar with Transitions because her mother had been in the program before entering hospice and dying in 2015 at the age of 101. Late last year, Gerald Chinchar’s doctor recommended he enroll in it, explaining that his health was in a “tenuous position.”

Chinchar, who has nine grandchildren and four great-grandchildren, likes to tell stories about his time in the Navy, about traveling the country for jobs and living in San Francisco as a young man.

He has had breathing problems much of his life, suffering from asthma and chronic obstructive pulmonary disease — ailments he partly attributes to the four decades he spent painting and sandblasting fuel tanks for work. Chinchar also has diabetes, a disease that led to his mother’s death. He recently learned he had heart failure.

“I never knew I had any heart trouble,” he said. “That was the only good thing I had going for me.”

Now he’s trying to figure out how to keep it from getting worse: How much should he drink? What is he supposed to eat?

That’s where Juan comes in. Her job is to make sure the Chinchars understand Gerald’s disease so he doesn’t have a flare-up that could send him to the emergency room. She sat beside the couple in their living room, its bookshelves filled with titles on gardening and baseball. A basket of cough drops and a globe sat on a side table.

Any pain today? Juan asked. How is your breathing? Are you more fatigued than before? Is your weight the same? He replied that he had gained a few pounds recently but knew that was because he’d eaten too much bacon.

At this point in the patient’s life, we should be bringing health care to the patient, not the other way around.

Physician Dan Hoefer

Posted on the couple’s refrigerator was a notice advising them to call the nurse if Gerald had problems breathing, increased swelling or new chest pain.

Juan checked his blood pressure and examined his feet and legs for signs of more swelling. She looked through his medications and told him which ones the doctor wanted him to stop taking. “What we like to do as a palliative care program is streamline your medication list,” she said. “They may be doing more harm than good.”

Mary Jo Chinchar said she appreciates the visits, especially the advice about what Gerald should eat and drink. Her husband doesn’t always listen to her, she said. “It’s better to come from somebody else.”

A Nearly Impossible Decision

On a rainy January day, doctors, nurses and social workers gathered in a small conference room for their bimonthly meeting to discuss patient cases. Information about the patients — their hospitalizations, medications, diagnoses — was projected on the wall. Their task: to decide if new patients were appropriate for Transitions and if current patients should remain there.

It’s nearly impossible to predict how long someone will live. It’s an inexact algorithm based on the severity of their disease, depression, appetite, social support and other factors. Nevertheless, the team tries to do just that, and they may recommend hospice for patients expected to live less than six months.

That was the case with an 87-year-old woman suffering from Alzheimer’s disease. She had fallen many times, slept about 16 hours a day and no longer had much of an appetite. Those were all signs that the woman may be close to death, so she was referred to hospice.

Patients typically stay in Transitions about seven or eight months, but some last as long as two years before they stabilize and are discharged from the program. Others go directly to hospice, and still others die while they are still in Transitions.

The group turned its attention to an 89-year-old woman with dementia, who believed she was still a young Navy wife. She suffered from depression and kidney disease, and had been hospitalized twice last year.

“She’s a perfect patient for Transitions,” Hoefer told the team, adding that she could benefit from extra help. Another good candidate, Hoefer said later, was El Cajon resident Evelyn Matzen, who is 94 and has dementia. She had started to lose weight and was having more difficulty caring for herself. They took her in because “we were worried that it was going to start what I call the revolving door of hospitalization,” Hoefer said.

Evelyn Matzen, 94, has been a Sharp HealthCare Transitions patient for eight months. (Heidi de Marco/KHN)

About eight months after she joined the program, Matzen sat in Hoefer’s office as he checked her labs and listened to her chest. Her body was starting to slow down, but she was still doing well, he told her. “Whatever you are doing is working.”

Bill Matzen, who accompanied his mom to the appointment, said she had started to stabilize since going onto Transitions. “She is on less medication, she is in better condition, physically, mentally, the whole nine yards,” he said.

Hoefer explained that frail elderly patients have fewer reserves to tolerate medical treatment and especially hospitalization. Bill Matzen said his mother leaned that the hard way after a recent fall. Though the Transitions nurse had come to see her, the Matzens decided to go to the hospital because they were still concerned about a bruise on her head. While she was in the hospital, Evelyn Matzen started hallucinating and grew agitated.

Being in the hospital “kicks her back a notch or two,” her son said. “It takes her longer to recover than if she had been in a home environment.”

A Changed Climate

Outpatient palliative care programs are cropping up in various forms. Some new ones are run by insurers, others by health systems or hospice organizations. Others are for-profit, including Aspire Health, which was started by former senator Bill Frist in 2013.

Sutter Health operates a project called Advanced Illness Management to help patients manage symptoms and medications and plan for the future. The University of Southern California and Blue Shield of California recently received a $5 million grant to provide and study outpatient care.

“The climate has changed for palliative care,” said Enguidanos, the lead investigator on the USC-Blue Shield project.

Ritchie said she expects even more home-based programs in the years to come, especially if palliative care providers work alongside primary care doctors. “My expectation is that much of what is being done in the hospital won’t need to be done in the hospital anymore and it can be done in people’s homes,” she said.

Challenges remain, however. In addition to questions about reimbursement, not enough trained providers are available. And some doctors are unfamiliar with the approach, and patients may be reluctant, especially those who haven’t clearly been told they have a terminal diagnosis.

Now, some palliative care providers and researchers worry about the impact of President Donald Trump’s plans to repeal the Affordable Care Act and revamp Medicare.

“It would be horrible,” Kerr said. “Before, we had an inkling that this was helping a lot of folks. Now we know it is really helping.”

Gerald Chinchar, who grew up in Connecticut, said he never expected to live into old age. His father, a heavy drinker, died of cirrhosis of the liver at 47. In his family, Chinchar said, “you’re an old-timer if you make 60.”

Chinchar said he gave up drinking and is trying to eat less of his favorite foods — steak sandwiches and fish and chips. He just turned 77, a milestone he credits partly to the pre-hospice program.

“If I make 80, I figured I did pretty good,” he said. “And if I make 80, I’ll shoot for 85.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Categories: Aging, Cost and Quality

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White House Shifts Into Damage Control Mode

Mar 24 2017

Although President Donald Trump publicly blames Democrats for the bill’s defeat, behind the scenes some place the blame elsewhere. “This is 100 percent a Ryan failure,” one senior administration official says. Others though downplay any tension between the two men.

Politico: White House Launches Damage Control After Health Bill Collapses
Damage control was underway at the White House even before the Obamacare repeal bill was pulled from the House floor Friday afternoon, an effective waving of the white flag on one of Republicans’ top priorities. And as the White House sought to prevent any blame from landing on Trump, House Speaker Paul Ryan emerged as a prime target. (Nussbaum and Palmeri, 3/24)

Fox News: Trump Blames Democrats For GOP Health Care Bill Failure, Says ObamaCare Is ‘Imploding’
President Trump said Friday the White House “learned a lot about loyalty and the vote-getting process” following the dramatic failure of a Republican-backed bill that would have made good on a campaign promise to repeal and replace ObamaCare. Trump said House Republicans were 10 to 15 votes shy of getting the bill passed and blamed the defeat on Democrats. House Speaker Paul Ryan pulled the bill minutes before a vote was to take place as it became apparent there was not enough support for passage. Democrats were united against it, and a conservative bloc of Republicans were unmoved by 11th-hour negotiations. (Chakraborty, 3/24)

Bloomberg: Trump Praises Ryan On Health As Aides Privately Blame The Speaker – Bloomberg
Behind the scenes, though, the president’s aides blame Ryan for the bill’s embarrassing defeat, which stymied a Republican goal for more than seven years, a senior administration official said. Asked whether Trump, Ryan, or the Freedom Caucus chairman, North Carolina Republican Mark Meadows, would be most to blame if the bill fails, the administration official said Ryan. The official insisted on anonymity to discuss internal White House deliberations. (Jacobs and Pettypiece, 3/24)

The New York Times: Trump The Dealmaker Projects Bravado, But Behind The Scenes, Faces Rare Self-Doubt
President Trump, the author of “The Art of the Deal,” has been projecting his usual bravado in public this week about the prospects of repealing the Affordable Care Act. Privately he is grappling with rare bouts of self-doubt. Mr. Trump has told four people close to him that he regrets going along with Speaker Paul D. Ryan’s plan to push a health care overhaul before unveiling a tax cut proposal more politically palatable to Republicans. (Thrush and Haberman, 3/23)

Bloomberg: Trump’s Retreat On Health Care Deals A Blow To The Rest Of His Agenda
The gambit was straight out of a corporate deal-maker’s playbook: President Donald Trump told House Republicans that it was now or never to repeal and replace Obamacare and demanded a vote by Friday. No more negotiations. It was a bluff, and a stubborn band of Republican lawmakers called him on it. Now Trump’s been struck with a humiliating defeat on his first major legislative test, and it’s a body blow that calls into question whether he can move his agenda through Congress, including proposals on tax reform and infrastructure spending that helped propel a stock market rally since his election. (Pettypiece and Jacobs, 3/24)

Politico: White House Complains Pro-Trump Group MIA On Health Bill
Amid the biggest policy showdown of Donald Trump’s presidency, top White House aides are perplexed that an outside group created to boost him at such critical junctions was missing in action. The pro-Trump nonprofit, America First Policies, has been gripped by its own internal headaches as two of the six announced members of its leadership team have left in recent days, according to two officials involved with the group. (Goldmacher, 3/24)

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Health Stocks Surge On News That GOP Pulled Health Bill

Mar 24 2017

A look at how the markets reacted to the the defeat of the American Health Care Act.

Bloomberg: Hospitals Gain As Republican Health Repeal Bill Is Pulled
Health stocks surged late in the trading session Friday after Republicans pulled their bill to repeal and replace Obamacare, lacking the votes to pass it in the House. Hospitals led the advance, with the BI North America Hospitals Competitive Peer Group Index up 5.4 percent at the close in New York. Centene Corp., an insurer that focuses on Medicaid plans, rose 5.2 percent to $68.73. Hospitals and insurers like Centene would have been hurt by the GOP bill, which would cut millions of people from health insurance and roll back an expansion of the Medicaid program for the poor. (Tracer and Greifeld, 3/24)

CNBC: Winners And Losers After Friday’s Pulled Health-Care Bill
Health-care stock performance diverged Friday after the controversial GOP health care bill was pulled from the floor of the House of Representatives. UnitedHealth, Anthem and Cigna closed lower. The three stocks would have been among the top winners if the bill had passed, Leerink Partners analyst Ana Gupte said on CNBC’s “Squawk Box.” Cigna fell 2.25 percent in its worst day of the year so far. The stock was also the worst performer in the S&P 500’s health care sector. The second worst performer was Anthem, which fell more than 1.5 percent in its worst day since Feb. 17. (Cheng, 3/24)

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‘Today’s A Great Day For Our Country’: Dems Celebrate Health Plan’s Collapse

Mar 24 2017

House Minority leader Nancy Pelosi credited the win partly to the American people who voiced their concerns about repeal plans. “Our phone lines were all deluged,” she said.

CNN: Dems Gleeful After Obamacare Victory
Democrats erupted in glee Friday afternoon after dozens of Republicans spurned their party leadership and the White House to keep Obamacare alive, at least for now. The repeal of Obamcare was all but assumed after Republicans won the White House and kept control of both houses of Congress in November. But a surprising level of dissent within the GOP ranks has allowed President Barack Obama’s signature health care program to live on in the immediate term. (Schleifer, 3/24)

CNBC: Pelosi Calls GOP’s Health-Bill Defeat A ‘Victory For The American People’
House Democratic leader Nancy Pelosi said Friday was a “victory for the American people,” after Republicans pulled their bill to replace Obamacare before a scheduled vote. “It’s about our country and the vision of our founders. It’s about our faith, and it’s about the unity of the Democrats, united by our values,” she said in a news conference. (3/24)

USA Today: Republicans Give Up On Obamacare Repeal Bill, Move On To Other Issues
Senate Minority Leader Chuck Schumer, D-N.Y., said the bill failed because Trump couldn’t close the deal. “They can’t write policy that actually makes sense, they can’t implement the policies they do manage to write, they can’t get their stories straight, and today we’ve learned that they can’t close a deal, and they can’t count votes,” Schumer said. “So much for the Art of the Deal.” (Kelly, Collins and Shesgreen, 3/24)

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Next Steps Uncertain For GOP, As Defeat Weighs Heavy On Future Goals

Mar 24 2017

“If you look at this health care problem, it’s not going away. At some point, we’re going to have to come back to this,” said Rep. Bradley Byrne of Alabama. But Republicans don’t appear to have a clear path forward of what that looks like.

Kaiser Health News: House Leaders ‘Came Up Short’ In Effort To Kill Obamacare
It’s not clear what will happen next to the Republican effort to overturn or modify Obamacare. But White House officials told members Thursday that if they couldn’t pass the legislation, the president wanted to turn to other priorities, including tax reform. “The president understands this is it,” Spicer said. “We had this opportunity to — to change the trajectory of health care, to help improve — put a health care system in place and to end the nightmare that Republicans have campaigned on called Obamacare.” (Carey, 3/24)

Wall Street Journal: GOP House Leaders Pull Their Health Bill
House Republicans met in a basement in the Capitol to decide their next steps, but it was starting to look like House GOP leaders had simply decided to abandon health legislation that was years in the making. Mr. Trump, through White House budget director Mick Mulvaney, had said Thursday night that he was done negotiating and issued an ultimatum to Republicans, insisting that a vote take place on Friday, with the party moving on if the legislation was defeated. (Hughes and Peterson, 3/24)

Stat: GOP Leaders Punt On Health Care Bill, Postponing Vote
Republican streaming out of a conference meeting gave no clear indication of where the party would head next on health care either. Some lawmakers expect Health and Human Services Secretary Tom Price to take regulatory actions to address problems Republicans see in the law. But there seemed to be a general sense that Congress would have to come back to the issue, at some point. (Scott, 3/24)

The Hill: Trump: White House Moving On From Healthcare Push
President Trump is moving on after the House GOP pulled its healthcare bill from a floor vote, he told The Washington Post’s Robert Costa Friday afternoon. Trump told Costa by phone that a push to repeal and replace ObamaCare — the centerpiece of Republican messaging throughout the last several elections — won’t come up again in the near future. (Kamisar, 3/24)

NPR: Republicans Kill Health Care Vote As GOP Members Defect
The legislative stalemate endangers Trump’s and the GOP’s agenda and casts a cloud over the legislative path forward after an election waged almost entirely as the antithesis to a progressive agenda enacted by former President Barack Obama, Trump’s predecessor. (Taylor, 3/24)

Reuters: Republicans Pull Healthcare Legislation Plan In Blow To Trump
The House failure to pass the measure called into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party. “There’s nobody that objectively can look at this effort and say the president didn’t do every single thing he possibly could with this team to get every vote possible,” Spicer told reporters before the legislation was pulled. (Volz and Lawder, 3/24)

Politico: Did The GOP Just Dodge A Bullet?
One aspect of the GOP health care bill seemed settled even before House Speaker Paul Ryan pulled the plug Friday: public opinion. Polls conducted since House Republicans released the first draft of legislation three weeks ago show little public support for the bill, the surest sign that Americans were not yet on board with the GOP plan. In the most recent survey, a Quinnipiac University poll released Thursday, only 17 percent of registered voters approved of the legislation — far fewer than the 56 percent who disapproved. (Shepard, 3/24)

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Not A Done Deal: Ryan Pulls Back Bill To Replace Obamacare

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to win enough support to pass their plan to partially repeal and replace the Affordable Care Act.

House Speaker Paul Ryan made the announcement at the Capitol after rushing to the White House to meet with President Donald Trump. The decision came after a fluid 24 hours of negotiation among Republican leaders and different factions of the party. The leadership had hoped to have a vote on their bill Thursday but put that off after it was clear they didn’t have enough “yes” votes. Trump issued an ultimatum to House members Thursday night, saying he was done with concessions and they needed to vote Friday to get the legislation moving. But the gambit did not change enough votes to push the bill through the House.

Story is developing. Check back here for more details shortly.

Categories: Repeal And Replace Watch, The Health Law

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Ryan Warns Trump That There Are Not Enough ‘Yes’ Votes To Pass Health Replacement Bill

Mar 24 2017

On the House floor, lawmakers are debating the American Health Care Act. But behind the scenes, Republican leaders scramble to secure the necessary votes to pass.

The New York Times: Paul Ryan Rushes To White House To Tell Trump Votes Are Lacking To Repeal Obamacare
House Speaker Paul D. Ryan, facing a revolt among conservative and moderate Republicans, told President Trump on Friday that he did not have the votes to pass legislation to repeal the Affordable Care Act and to decide whether to pull the bill from consideration. But the president insisted that lawmakers cast their public votes Friday afternoon. The president and the speaker faced the humiliating prospect of a major defeat on legislation promised for seven years, since the landmark health legislation was signed into law. Vice President Mike Pence and Tom Price, the secretary of health and human services, rushed to Capitol Hill to meet with Republican conservatives but made little headway. (Pear, Hirschfeld Davis and Steinhauer, 3/24)

The Washington Post: GOP Health-Care Bill: Ryan Visits White House To Say He Lacks Support For Health-Care Bill
House Speaker Paul D. Ryan (R-Wis.) visited White House at midday Friday to warn President Trump that, despite their pitches, he lacked the votes to pass a conservative rewrite of the nation’s health-care system. Even as Ryan met with Trump, however, Press Secretary Sean Spicer said during his daily briefing that a vote would proceed at 3:30 p.m. A House GOP aide confirmed the expected timing of a vote. (DeBonis, Snell and O’Keefe, 3/24)

Politico: Obamacare Repeal On Track To Fail
The scene at the Capitol laid bare the deep uncertainty over the high-stakes gambit. Lawmakers on Speaker Paul Ryan’s whip team cornered reluctant Republicans in the House chamber, working to extract additional support for the measure. Senior Trump aides Marc Short and Rick Dearborn huddled with members just outside the chamber. (Cheney, Bresnahan and Bade, 3/24)

NPR: GOP Health Care Bill In Jeopardy As More Republicans Defect
The Republican health care plan is on life support. House Speaker Paul Ryan headed to the White House Friday afternoon to brief President Trump on the bill’s status amid key GOP defections Friday afternoon. A defeat of their plan, the American Health Care Act, would be devastating to the GOP. The party has vowed repeatedly over the past eight years that they would repeal and replace the Affordable Care Act, also known as Obamacare. An inability to do that, with control of the House, Senate and White House, would hurt their image as a party that can govern. (Taylor, 3/24)

Bloomberg: GOP Leaders Not Confident They Have Votes To Pass Health Bill
The Trump administration is doubling down on its demand that House Republican leaders hold a vote Friday on their embattled health-care bill without any changes. White House Press Secretary Sean Spicer said the vote will proceed as scheduled Friday afternoon. “It’s not a question of negotiating any more, it’s understanding the greater good,” Spicer said at a news conference. “This is it.” The president, he added, has “made it clear this is our moment.” But an influential GOP member said he’s not sure they have the votes. (House, Kapur and Edgerton, 3/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Insurers May Notch Bigger Profits From Fewer Customers In ‘Trumpcare’

The House GOP’s embattled health care bill has plenty of detractors: Democrats, hospitals, the American Medical Association and the House Freedom Caucus all oppose it. But the insurance industry is not on that list — even though it stands to lose millions of customers.

One reason the industry has been hanging back: Insurers’ profits are expected to fatten under the bill.

The House Republicans’ replacement plan would likely attract more younger, healthier consumers to the individual market than the Affordable Care Act did, according to Standard & Poor’s, the corporate credit rating firm. The ACA tilted the opposite way, offering more options for older, sicker Americans whose health care claims eroded insurers’ profits.

“Profitability will likely improve, as the replacement plan can result in an improved risk pool in the individual market,” S&P said in a report on the House leadership’s initial plan.

A vote on the GOP “Trumpcare” bill is expected Friday, but by late Thursday it remained unclear whether there were enough votes to pass it. The Trump administration has said if the measure doesn’t pass Friday, it will abandon the effort to replace Obamacare.

Under the current health law, an insurer is allowed to charge a 64-year-old consumer a premium that’s three times what it charges a 21-year-old. The House bill allows insurers to charge older consumers premiums that are five times higher.

That change would reduce premiums for younger consumers but boost them significantly for people in their 50s and 60s – even with tax credits that increase for older people under the GOP plan.

Not all insurers are enthusiastic about what’s in the House bill. Those that are also mainly in the business of managing Medicaid services to enrollees under contract with states — such as Molina Healthcare — oppose the bill because of the expected sharp reductions in Medicaid if the House measure is enacted.

In a new analysis of the House bill that was released Thursday, the Congressional Budget Office predicted 9 million people would fall off Medicaid rolls by 2020 and 14 million by 2026. Overall, 52 million Americans under 65 would be uninsured by 2026 compared with 28 million that year under current law, the CBO said.

America’s Health Insurance Plans (AHIP), which has expressed concerns about the bill but hasn’t taken a formal position for or against the bill, has said the legislation’s provisions would give short-term relief to insurers that have been mostly losing money since the exchanges started in 2014.

Those include giving states $100 billion over 10 years to start high-risk pools and stabilization funds to help insurers deal with higher-risk customers.

One of the most significant positives for insurers in the GOP bill is the elimination of a tax that all insurers paid under the ACA. The industry paid $8 billion in 2014 and is expected to pay $14.3 billion in 2018. Congress temporarily suspended the fee for this year.

Insurers’ opposition to the tax was one of the main reasons why the insurance industry chose not to support the ACA when it was approved in 2010. However, the insurance industry built support for the law by throwing its weight behind a requirement preventing insurers from refusing coverage to consumers with preexisting conditions in exchange for a mandate that most Americans have health coverage.

Although many conservative Republicans favor ending the individual mandate, the GOP bill as originally proposed would instead require that Americans keep continuous health coverage or pay a 30 percent penalty when they do buy private coverage.

Many of the nation’s largest insurers, such as UnitedHealthcare, Cigna and Aetna, were never large players in the health law’s exchanges or they have pulled out citing steep financial losses. For them, the elimination of the health insurer tax makes the GOP bill look appealing, said Ana Gupte, a health analyst with Leerink, an investment bank. “The GOP bill is a net positive” for those insurers, she said.

Even insurers with many customers on ACA policies now will be better off financially in the GOP bill, Gupte said. “They will make a bigger [profit] margin on a smaller number of people,” she said.

Anthem, a larger player in the Obamacare marketplaces, has said the GOP bill would benefit insurers and individuals by ensuring that remaining insurers stay in the market to provide choices for consumers.

Health insurers’ cautious optimism about the bill contrasts with the rest of the health industry. Lobbying groups representing doctors, hospitals and nurses have objected vehemently to the legislation. AHIP spokeswoman Kristine Grow said the group remains concerned about the long term stability of the Medicaid health plan market because the GOP bill would kill the Medicaid expansion and reduce federal Medicaid funding to states. She also said it’s too early to know how insurers’ 2018 premiums would be affected under the GOP bill.

A big uncertainty for insurers is whether the Trump administration will continue to allow a key program under Obamacare that helps low-income individuals with out-of-pocket health costs. House Republicans suspended a lawsuit that claimed the $7 billion federal funding of the program was illegal.

The program’s future is of concern to Dr. J. Mario Molina, CEO of Molina Healthcare, which has 3 million Medicaid members and nearly 1 million customers on Obamacare exchange plans. The Long Beach, Calif.-based company operates in about a dozen states.

But Molina said his biggest concern is the GOP bill will return the country to the broken individual market system in place before 2014. “The main thing I am worried about is this bill will cause millions of people to lose insurance coverage,” he said.

Regardless of what Congress and the Trump administration decide to do with Medicaid’s federal funding, Molina predicted more states will shift Medicaid recipients into managed care plans to control costs. “In the short term, we will still grow,” he said.

Categories: Health Industry, Insurance, Repeal And Replace Watch, The Health Law

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Viewpoints: Support For Paid Leave; Immigrants Afraid Of Seeking Care

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

Arizona Republic: The Wrong Bill About Dying Went To Ducey’s Desk
Gov. Doug Ducey can stand up for individual rights and dignity. Or he can sign Senate Bill 1439 and buck a trend toward letting people control their lives and deaths. The bill is ostensibly about religious freedom. It is supported by the powerful Center for Arizona Policy, which supports conservative social policies and is headed by Ducey supporter Cathi Herrod. SB 1439 is supposed to protect health-care professionals and hospitals from discrimination if they refuse to help people die. (Linda Valdez, 3/22)

Louisville (Ky.) Courier-Journal: Savannah’s Funeral – ‘Tired Of Burying My Friends’
We should not feel comfortable raising children in a world where they learn how to order flowers for their friend’s funeral before they learn how to buy a house or start a retirement fund. I am a full-time student with a part-time job. I went to decent schools and stayed away from the neighborhoods my parents warned me about. I am not an anomaly, and neither is gun violence. I apologize if I seem insensitive towards the individual’s right to own a gun, but it is time we take a critical look at our society’s priorities. What good is a world full of guns if we must fill our days with this pain? How many of our children are we willing to lose to maintain our sense of entitlement? (Tara Ann Steiden, 3/23)

The New England Journal of Medicine: Chilling Effect? Post-Election Health Care Use By Undocumented And Mixed-Status Families
Navigating the health care system is particularly difficult for people with limited English proficiency and health literacy or without health insurance or a Social Security number. Many undocumented immigrants and their families therefore go without needed care, to their detriment and sometimes that of others, as in the case of a woman with syphilis who is pregnant with a future U.S. citizen. (Kathleen R. Page and Sarah Polk, 3/23)

The New England Journal of Medicine: Patient Inducements — High Graft Or High Value?
In May 2016, Uber announced a partnership with the Southeastern Pennsylvania Transportation Authority (SEPTA) to provide discounted ride-sharing services to “bridge the first and last mile gap” and encourage people to ride the regional rail system. It was a potential win for all — increased ridership for Uber and SEPTA, decreased traffic and pollution. The partnership was lauded for testing an innovative way to advance social goals. Contrast this partnership with one that might be arranged in health care. For instance, a partnership between a health system and a ride-sharing service to provide free rides for patients with transportation barriers might help elderly patients with disabilities or those with limited transportation options get needed care. However, it might be illegal. (Krisda H. Chaiyachati, David A. Asch and David T. Grande, 3/23)

The New England Journal of Medicine: Adopting Innovations In Care Delivery — The Case Of Shared Medical Appointments
Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for routine care of chronic conditions, patient education, and even physical exams. Providers find that they can improve outcomes and patient satisfaction while dramatically reducing waiting times and costs. (Kamalini Ramdas and Ara Darzi, 3/23)

JAMA: The Rise Of Crowdfunding For Medical Care
The rise of medical crowdfunding carries the promise of more efficiently matching potential donors with unmet needs in ways that may increase overall giving, mirroring emerging technologies in other industries such as ride-hailing and retail services that aim to more efficiently match supply and demand. Despite its protean promises, however, medical crowdfunding raises a constellation of ethical and legal hurdles for patients, clinicians, institutions, and society. Understanding these issues will be of increasing importance as medical crowdfunding continues to grow in popularity. (Michael J. Young and Ethan Scheinberg, 3/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Essential Health Benefits Reviewed: ‘Galling’ Return To Bad Old Days; Lowering Premiums

Some opinion writers urge caution before jettisoning insurance guarantees, but premium costs appear to be at the heart of the argument to get rid of the health law’s essential health benefits.

Los Angeles Times: Remember When You Couldn’t Get Insurance With A Preexisting Condition? Those Days Are Probably Coming Back
Raise your hand if you want to go back to the days when you couldn’t get health insurance because you’d been sick or injured. That’s one of the galling possibilities raised by the evolving version of the American Health Care Act, the House GOP leadership’s plan to repeal and replace Obamacare. The blame lies with the changes that President Trump and House leaders reportedly pledged to make in the bill to win the support of members of a group of far-right House members, the Freedom Caucus. (Jon Healy, 3/23)

Forbes: Bring GOP Right-Wingers And Pragmatists Together On Obamacare — By Making Premiums Affordable
Thursday, March 23 was a wild day in Republicans’ quest to repeal and replace Obamacare, with vote cancellations, last-minute amendments, CBO analyses, and Presidential ultimatums. But the most surprising development of all was this: a way has emerged to get both hard-line and pragmatic conservatives to support the American Health Care Act. … The GOP’s right wing came to a surprisingly pragmatic realization. While refundable tax credits were not their favored approach to health reform, there were too many Republicans who believed otherwise; stubbornness on this point would jeopardize the success of any bill to replace Obamacare. So, congressional hard-liners reoriented their efforts toward repealing most, if not all, of Obamacare’s insurance regulations. (Avik Roy, 3/24)

The New York Times: Late G.O.P. Proposal Could Mean Plans That Cover Aromatherapy But Not Chemotherapy
Why should that 60-year-old man have to pay for maternity benefits he will never use? If 60-year-old men don’t need to pay for benefits they won’t use, the price of insurance will come down, and more people will be able to afford that coverage, the thinking goes. … But there are two main problems with stripping away minimum benefit rules. One is that the meaning of “health insurance” can start to become a little murky. The second is that, in a world in which no one has to offer maternity coverage, no insurance company wants to be the only one that offers it. (Margot Sanger-Katz, 3/23)

Huffington Post: Spicer Denies That Ending Maternity Care Guarantee Would Mean Women Pay More For Health Care He’s Wrong.
White House press secretary Sean Spicer on Thursday defended the idea of taking away guaranteed maternity coverage in health insurance, denying that it would mean women must pay relatively more for their health care. He’s wrong about that. Ending the guarantee could mean slightly lower premiums for individual men and much older women, but it would just as surely drive up premiums for women of child-bearing age and their families ― unless it left them paying the full cost of prenatal care and delivery, typically many thousands of dollars, out of their own pockets. (Jonathan Cohn, 3/23)

The New York Times: Yes, Senator, You Wouldn’t Want To Lose Your Mammograms — Or Women Voters
Republicans seem to have an evil genius for tone-deafness when it comes to women. On Thursday, a photograph that was widely circulated on Twitter showed a room packed with white men cutting a deal to eliminate maternity care and mammograms from the package of essential benefits that insurers are required to provide in the Republican bill to replace the Affordable Care Act. There were some women out of camera range, including Kellyanne Conway, the White House counselor. Earlier in the day, Senator Pat Roberts, Republican of Kansas, made an ill-judged quip that he quickly had to apologize for: “I wouldn’t want to lose my mammograms,” he said to a reporter from Talking Points Memo. (Susan Chira, 3/23)

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Health Debate Opinions: Crisis Is Not Trump’s Or Ryan’s Fault; GOP Failed Its Voters’ Needs

As consideration of the Republican health bill stalls on Capitol Hill, opinion writers find many faults.

The Wall Street Journal: The Freedom-From-Reality Caucus
The delay is said to be a defeat for President Trump and Speaker Paul Ryan, but both men have done about as much as they can. They’ve listened to different points of view across a diverse coalition of Members and 33 Governors, and the House bill is a realistic compromise …. No one has offered a better policy alternative to the American Health Care Act that could pass the House and Senate. The real obstacle to progress has been the 29 or so Members of the House Freedom Caucus, who have the power to deny Mr. Ryan a majority of 216 with a mere 22-vote margin of error. (3/23)

The New York Times: The Trump Elite. Like The Old Elite, But Worse!
Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed? The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp. (David Brooks, 3/24)

Politico: The Health Care Albatross
The lesson of Obamacare is that passage of a major health care law never puts health care behind you, only in front of you. For Republicans, their replacement bill will — one way or the other, pass or fail — loom large in 2018 and presumably 2020, if not beyond. (Rich Lowry, 3/22)

The Washington Post: A Postponed Health-Care Vote, A Big GOP Embarrassment And No Good Options Ahead
Legislative sausage-making is never pretty, but what has been happening all week with the signature legislative priority of the GOP seems beyond the norms. Faced with possible defeat on the floor, House Republican leaders postponed a scheduled vote until Friday, hoping that another day of negotiations could produce what seven years of talking have failed to produce, which is a consensus bill that all factions of the party can support. The difficulties Republicans are confronting are entirely of their own making. (Dan Balz, 3/23)

The Wall Street Journal: The Big Health Fix Bruises Ryan And Trump
Former President Barack Obama tried the big fix in health care and he came away with the scars to show for it. Now, House Speaker Paul Ryan and President Donald Trump are trying for the big health-care fix, and they are coming away with the scars to show for it. Maybe there is a lesson in there. (Gerald F. Seib, 3/23)

Bloomberg: Paul Ryan Is Trying To Save Himself
The basic problem is that Republicans have spent years building up expectations for repealing Obamacare without coming up with two crucial parts of their solution: An alternative that they agree on, and the votes in the Senate to impose whatever they want– if they could agree on what they want. (Jonathan Bernstein, 3/23)

The New England Journal of Medicine: The Mirage Of Reform — Republicans’ Struggle To Dismantle Obamacare
[A]s its potential demise draws nearer, the popularity of the ACA, now part of the status quo, is growing. In the Republican imagination, Obamacare has been a disaster. The GOP’s problem is that in reality Obamacare has substantially expanded health coverage, with 20 million Americans gaining insurance. Rolling back the ACA means making insurance less affordable for low-income Americans, increasing the uninsured population, and taking vast funds away from states and medical providers. The GOP health plan neither fully repeals the ACA nor provides a compelling replacement. Instead, in my opinion, it offers only a mirage of reform. (Jonathan Oberlander, 3/22)

The Wall Street Journal: Here’s How 51 Senators Can Reduce Premiums
As this week’s jousting between Speaker Paul Ryan and the Freedom Caucus makes clear, the Republican Party’s conservative and pragmatic wings don’t always agree. But there’s consensus on this: The American Health Care Act, the GOP’s bill to repeal and replace ObamaCare, doesn’t do enough to make insurance more affordable. … The trouble is the Senate’s rules. Republican leaders are counting on passing the AHCA through the budget reconciliation process, which requires only 51 votes, bypassing a filibuster. But for a bill to go through reconciliation, every provision must be budget-related, with clear relevance to either taxing or spending. GOP leaders expect the Senate parliamentarian to rule that repealing ObamaCare’s regulations through the AHCA would have only incidental fiscal consequences. (Avik Roy, 3/23)

USA Today: Obamacare Is Broken, And Republicans Can Fix It
When President Obama signed the Affordable Care Act seven years ago, he saddled Americans with a healthcare system that put the ultra-liberal agenda ahead of our best interests. We were promised that Obamacare would bring down healthcare costs with increased competition between insurance providers. We were promised we could keep our healthcare plans. We were promised that Obamacare would not raise middle class taxes. Instead, the law brought the American people rising premiums, unaffordable deductibles, fewer insurance choices and higher taxes. We were let down. (Ronna McDaniel, 3/23)

The Washington Post: Republicans Have Met The Enemy On Health Care. It’s Them.
The legislation may pass — either Friday or over the weekend. (It almost certainly won’t pass without changes.) But House Republicans had to be feeling a sense of deja vu as it became clear Thursday that despite the efforts of President Trump and Speaker Paul D. Ryan, the votes simply weren’t there to pass the legislation. Republicans — led by then-Speaker John A. Boehner — failed time and time again to rally votes behind proposals, from the fiscal cliff in 2012 to the farm bill in 2013 to the debt ceiling in 2014. (Chris Cillizza, 3/23)

Politico: Trump’s No-Win Health Care Debacle
Now it is Trump who needs wavering members of his party to come to his rescue. … [B]y 2018, the impact of “Trumpcare” will be start to be felt; and if the analyses of the Congressional Budget Office, the Kaiser Family Foundation and others are correct, the impact will be felt most sharply among older, less affluent, working-class Americans … in other words, Trump’s base. If that prospect ripens into reality, what would be celebrated as a legislative triumph may wind up as an epic disaster. (Jeff Greenfield, 3/22)

Georgia Health News: ACA Repeal Is Too Great A Chance To Take 
People in Georgia are relying on the ACA. If it is repealed, Georgia would lose much of the federal funding that helps sustain its health care system, which has struggled to pay for uncompensated care. Additionally, repeal of the ACA would cost many Georgia jobs. Policymakers are rushing to repeal or restrict the ACA even though that could cause many Georgians to lose their coverage. (Karuna Ramachandran, 3/23)

Arizona Republic: Ducey Not (Yet) Deserting 400,000 Arizonans
The House Republican plan to replace the Affordable Care Act would be huge step back, even for those of us who have insurance (for now). It would be a complete disaster, and in some cases, a death sentence, for Arizona’s most needy citizens. Gov. Doug Ducey knows this. (EJ Montini, 3/23)

Des Moines Register: Branstad Cheerfully Ignores Threat To Medicaid Expansion
Health and Human Service Secretary Thomas Price and Centers for Medicare and Medicaid Service Administrator Seema Verma have sent a letter to Branstad and the governors of 30 other states who expanded Medicaid …. They’re also urging the governors to pursue changes in Medicaid, such as charging beneficiaries higher premiums and requiring beneficiaries to pay for emergency-room visits to discourage such visits. … Apparently, the governor’s enthusiasm for Medicaid expansion has been supplanted by his enthusiasm for a CMS director determined to scuttle that effort. Could it be “the health needs of our state” are less of a priority than the president’s political agenda? (3/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Ads And Testosterone Use; Home Monitoring With Apps; Per Capita Caps

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA: Association Between Direct-To-Consumer Advertising And Testosterone Testing And Initiation In The United States, 2009-2013
Question: Is there an association between televised direct-to-consumer testosterone advertising and testosterone testing and initiation in the United States? Findings: In this ecological study of 75 US designated market areas, each exposure to a testosterone advertisement was associated with monthly relative increases in rates of new testosterone testing of 0.6%, new initiation of 0.7%, and initiation without a recent baseline test of 0.8%. (Layton et al., 3/21)

JAMA Surgery: Effect Of Home Monitoring Via Mobile App On The Number Of In-Person Visits Following Ambulatory Surgery
Question: For patients undergoing ambulatory surgery, can follow-up care via a mobile app avert in-person visits compared with conventional, in-person follow-up care during the first 30 days after the operation? Findings: In this randomized clinical trial of 65 patients, those who used the mobile app attended fewer in-person visits for follow-up care during the first 30 days after the operation than patients in the in-person follow-up care group. This difference was statistically significant. (Armstrong et al., 3/22)

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Question: Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? Findings: In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 3/22)

JAMA Internal Medicine: Patient Mortality During Unannounced Accreditation Surveys At US Hospitals
Question: What is the effect of heightened vigilance during unannounced hospital accreditation surveys on the quality and safety of inpatient care? Findings: In an observational analysis of 1984 unannounced hospital surveys by The Joint Commission, patients admitted during the week of a survey had significantly lower 30-day mortality than did patients admitted in the 3 weeks before or after the survey. This change was particularly pronounced among major teaching hospitals; no change in secondary safety outcomes was observed. (Barnett, Olenski and Jena, 3/20)

The Kaiser Family Foundation: Health Insurance Premiums Under The ACA Vs. AHCA: County-Level Data
These maps compare county-level estimates of premiums and tax credits under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress. The maps were updated on March 21, 2017 to show estimates of how much a person buying their own insurance would have to pay under both the ACA and the House replacement bill. The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000. (3/22)

Urban Institute: The Impact Of Per Capita Caps On Federal And State Medicaid Spending
In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryan’s “Better Way” health care plan, released in June 2016. We estimate the effect of each of these per capita caps on federal and state spending from 2019 to 2028. We estimate that between 2019 and 2028, the Better Way proposal would reduce federal Medicaid spending by $841 billion, or 18.1 percent. The AHCA would reduce federal spending by $457 billion, or 9.8 percent. Assuming the bulk of states that expanded coverage under the ACA dropped eligibility for their expansion populations, we estimate that 8 million enrollees would lose Medicaid coverage, and federal savings would increase to $735 billion between 2019 and 2028. (Holahan, Buettgens and Wang Pan, 3/20)

The Kaiser Family Foundation: What Could A Medicaid Per Capita Cap Mean For Low-Income People On Medicare?
Policymakers are giving serious consideration to proposals, such as the American Health Care Act (AHCA), that would fundamentally change the structure and financing of Medicaid – the federal-state program that provides health coverage for 70 million low-income Americans, including one in five people on Medicare. Federal financing for Medicaid would be converted to a per capita cap model (such as under the AHCA) or block grant, both of which aim to limit and make more predictable federal spending on Medicaid and provide states more flexibility in their management of Medicaid spending. Such a change could affect low-income people on Medicare because Medicaid help cover Medicare’s premiums and cost-sharing, and pays for services not covered by Medicare, such as nursing home care. (Jacobson, Neuman and Musumeci, 3/20)

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State Highlights: Mass. Gov. Proposes Revised Tax On Employee Health Plans; Family Files Wrongful Death Suit Against Opioid Maker

Media outlets report on news from Massachusetts, Illinois, Connecticut, Ohio, Pennsylvania, New Jersey, Mississippi, Tennessee, Iowa, Wisconsin, California, Texas and Minnesota.

Boston Globe: Baker Administration Floats Alternative To Health Plan Levy 
After a backlash from the business community, Governor Charlie Baker is floating a new plan for employers to help cover the state’s soaring health care costs. But the proposal, an alternative to the one the administration included in its January budget proposal, still lacks broad support among businesses. (Dayal McCluskey, 3/24)

Stat: Lawsuit Blames Improper Marketing Of Potent Opioid For Woman’s Death
The family of a New Jersey woman who died after using a prescription version of the potent opioid fentanyl filed a wrongful death lawsuit Thursday against the drug’s maker, her doctor, and a specialty pharmacy that provided the drug. The lawsuit, filed in a New Jersey state court, alleges 32-year-old Sarah Fuller was the victim of a nationwide push by Insys Therapeutics to entice doctors to prescribe its Subsys fentanyl spray for patients for which the drug was not suitable. (Armstrong, 3/24)

St. Louis Post Dispatch: Illinois Supreme Court Delivers Partial Win For Hospitals On Property Taxes 
Illinois’ not-for-profit hospitals can continue to skip paying property taxes, for now, after an Illinois Supreme Court decision Thursday that follows years of battles between hospitals and municipalities over those dollars. The state Supreme Court on Thursday vacated the ruling of a lower court, which had found that an Illinois law exempting not-for-profit hospitals from paying property taxes was unconstitutional. The justices said the lower court didn’t have jurisdiction. (Schencker, 3/24)

The CT Mirror: State Worker Union Launches TV Ad To Fight Layoffs
Two days after Gov. Dannel P. Malloy threatened to lay off 4,200 unionized state workers unless concessions are granted, Connecticut’s largest healthcare workers union launched a television ad urging viewers to keep its members on the job. The 30-second spot, funded by 1199 New England SEIU, also comes five months after the union went to court to block nearly 500 layoffs tied to an administration plan to privatize 40 group homes for the disabled. (Phaneuf, 3/23)

Columbus Dispatch: Ohio Slips In National Mental Health Care Assessment
Ohio continues to slip in terms of mental health prevalence and access to care in a national ranking by Mental Health of America. The Buckeye State’s overall ranking, 26th among the 50 states, was a slot lower than last year and a drop of three positions since 2011, according to the report released today. The national organization looked at 15 indicators, including the number of adults and juveniles with mental illness, the incidence of adults with drug or alcohol problems, prevalence of suicide, and people with unmet needs for treatment. (Johnson, 2/23)

Columbus Dispatch: Elderly Often Victimized By Addicted Relatives, Friends
Addiction to prescription painkillers among seniors also is growing, with older adults increasingly seeking emergency treatment or coming to the attention of authorities. With the rise in heroin use, more grandparents are also raising their grandchildren because their parents are dead, in jail, chasing their next high or in rehab. It can be particularly challenging for those with limited financial resources or health problems. (Pyle, 3/24)

The Philadelphia Inquirer: New Digital Health Fund In Philadelphia Makes Its First Deal
A $6 million digital health investment fund launched in December by Ben Franklin Technology Partners of Southeastern Pennsylvania, Independence Health Group, and Safeguard Scientifics has made its first investment, of $150,000 in seed financing. The recipient was VitalTrax, a Philadelphia company started last year to help facilitate clinical trials for patients and researchers through a smartphone app and cloud-based data services. VitalTrax is expected to use the money to continue developing its system. (Brubaker, 3/23)

Stat: Mississippi’s Middle Class Carries The Burden Of High Medical Debt
Americans are no strangers to medical debt, and the burden is most severe in Mississippi, where nearly 40 percent of adults under age 65 owe hospitals or doctors, according to the Urban Institute. But the men and women carrying that debt are not always poor – they’re increasingly middle class. And their inability, or refusal, to pay their bills is straining hospital budgets and threatening the availability of care. (Blau, 3/24)

WBUR: Can Cardboard Boxes Save Infants’ Lives?
Since January, about 3,800 New Jersey parents have opted to lay their infants to sleep in simple cardboard boxes. It’s a public health initiative to reduce cases of sudden infant death syndrome, which killed 3,700 babies in the United States in 2015. (Young, 3/23)

Nashville Tennessean: Hendersonville Doctor Arrested On Prescription-Related Charges
A Hendersonville doctor has been arrested for issuing prescriptions for narcotics in exchange for money and sexual acts, police said. Special agents with the Tennessee Bureau of Investigation, the 18th Judicial District Drug Task Force and the Gallatin Police Department began investigating Dr. Lawrence Joseph Valdez after complaints he was issuing prescriptions for sexual favors. The investigation found he had made these exchanges to multiple individuals. (Todd, 3/23)

Des Moines Register: These Families With Children Injured By Doctor Mistakes Say They Don’t Want Caps On Malpractice Payouts
Families of Iowans who were severely injured by medical errors traveled to the Statehouse on Thursday to denounce bills that would limit awards in malpractice lawsuits. The families said if the bills were in effect, they probably couldn’t have found lawyers to take their cases, even though medical providers’ mistakes or neglect caused permanent disabilities or death of patients. (Leys, 3/23)

Milwaukee Journal Sentinel: An Epidemic Of Childhood Trauma Haunts Milwaukee 
In Milwaukee, the nation’s third most impoverished big city, trauma researchers contend the seeds of distress were planted years ago when the current generation of adults were children. They say new seeds are being planted right now. That revelation is beginning to shift how Milwaukee and other cities respond to social and economic decline. It also is prompting researchers to explore why some who are exposed to childhood trauma emerge undefeated — and whether their resilience can be coaxed out of others and even scaled to entire neighborhoods. (Schmid, 3/23)

The Philadelphia Inquirer: Why Christie Has More Than Tripled N.J.’s Funding Of Doctor Training
Gov. Christie wants more doctors in New Jersey, and he’s budgeted money to train them. But increasing the number of medical professionals — and getting them to stay in New Jersey — isn’t as easy as graduating more students. The calculation also includes the number of postgraduate residencies offered in New Jersey and the number of doctors who stay afterward. The state already has increased the number of graduates, with Cooper Medical School of Rowan University opening in 2012 and Seton Hall University’s medical school slated to open next year. Older schools also have added seats. (Lai, 3/24)

Sacramento Bee: Sacramento County Sheriff Adds Mental Health Beds To Jail 
As the Sacramento County Main Jail handles more inmates with psychiatric problems, the Sheriff’s Department is developing a new section staffed by UC Davis medical professionals, social workers and deputies that can provide intensive mental services without 24-hour care. The county currently keeps inmates who are suicidal or deemed a threat to others in an 18-bed “acute care” unit, which functions like a residential treatment facility. (Garrison, 3/23)

Houston Chronicle: Confusion Over Medical Facilities Could Cost A Bundle 
Walking into one type of neighborhood medical clinic instead of another can be a $2,000 mistake. Or at the very least, a big surprise. That is the finding of a new Rice University study that examines the proliferation of free-standing emergency rooms in Texas in recent years, which to the uninformed patient can look a lot like their lower-cost storefront cousin, the urgent-care clinic. (Deam, 3/23)

The Star Tribune: State: Waite Park Nurse Did Nothing For Patient’s Seizures Before He Died 
A Minnesota Health Department investigation lasting six months ruled that the nurse’s neglect was to blame for the anguish that 58-year-old Kenneth L. Allers endured last August for at least 11 hours at the Sterling Park Health Center in Waite Park. The licensed practical nurse, who is not identified in the state’s findings released this week, was suspended during the investigation and later fired. (Walsh, 3/23)

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KanCare Expansion Headed To Full State Senate Vote

Even as uncertainty swirls in Washington, D.C., supporters of the Medicaid expansion say, “we have to move forward as a state.” Media outlets also report on news out of Minnesota, New Hampshire and California.

Kansas City Star: Medicaid Expansion Moves Forward
Kansas state lawmakers advanced a Medicaid expansion proposal on Thursday even as Congress contemplated a bill that could halt states from expanding the program. Supporters of expanding KanCare, the state’s privatized Medicaid program, said the debate in Kansas can’t be dictated by Washington. Opponents urged lawmakers to wait until the federal health care debate progresses. (Shorman, 3/23)

KCUR: KanCare Expansion Bill Heads To Senate For Vote Next Week
Kansas lawmakers are now a step away from what could be a showdown with Republican Gov. Sam Brownback on the political football issue of Medicaid expansion. The Senate Public Health and Welfare Committee on Thursday advanced an expansion bill to the full Senate for a vote supporters say will take place Monday…Since 2013, 31 states and the District of Columbia have expanded Medicaid eligibility. Kansas and Missouri are among 19 that have not. (Mclean, 3/23)

Pioneer Press: New Tax Or Dip Into Savings? Dayton And GOP Differ On How To Stabilize Insurance Market 
Minnesota lawmakers are on the verge of approving as much as $300 million per year to try to stabilize the state’s 2018 individual health insurance market and lower premiums. But before the program, known as reinsurance, gets off the ground, lawmakers and the governor first have to settle an important question: where should the money come from? The idea, which DFL Gov. Mark Dayton supports despite some qualms, is a top priority for lawmakers and some business groups. (Montgomery, 3/24)

Kansas City Star: Effort To Keep Guns Out Of Public Hospitals Revived In Kansas Senate Panel 
Officials with the University of Kansas Health System made another effort Thursday to keep guns out of its buildings before a state law that would allow concealed weapons takes effect July 1. Senate Bill 235, which had a hearing Thursday before the Senate budget committee, would allow Kansas’ state hospitals and public hospitals, like the University of Kansas Hospital in Kansas City, Kan., to keep banning handguns. (Woodall, 3/23)

San Francisco Chronicle: California Passes Nation’s Toughest Methane Emission Regulations 
California air quality officials have approved what are widely considered to be the most rigorous and comprehensive regulations in the country for controlling methane emissions, a move that helps cement the state’s status as a standard-bearer for environmental protection. The new rules, green-lighted Thursday by the state’s Air Resources Board, seek to curb methane emissions at oil and gas production plants by up to 45 percent over the next nine years. (Fracassa, 3/23)

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Trump, A Self-Avowed Dealmaker, Faces High Stakes In Outcome Of Friday’s House Vote

As the GOP health plan became mired in intense negotiations this week, the ability to secure the measure is increasingly viewed as a major test for President Donald Trump. Meanwhile, news outlets also report that the process has caused him doubts about choosing to pursue Obamacare replacement as first item on his agenda.

The New York Times: Trump The Dealmaker Projects Bravado, But Behind The Scenes, Faces Rare Self-Doubt
President Trump, the author of “The Art of the Deal,” has been projecting his usual bravado in public this week about the prospects of repealing the Affordable Care Act. Privately he is grappling with rare bouts of self-doubt. Mr. Trump has told four people close to him that he regrets going along with Speaker Paul D. Ryan’s plan to push a health care overhaul before unveiling a tax cut proposal more politically palatable to Republicans. (Thrush and Haberman, 3/23)

Politico: Delayed Vote A Setback For Trump The Dealmaker
Most Republicans appeared comfortable with the delay, taking the lumps of a single negative news cycle, so long as the legislation eventually passes. But some worried that if Trump can’t muscle the first major bill he’s backed through a single chamber in a Republican-controlled Congress, it could devastate his agenda and weaken his authority moving forward. “This is a reputational deal,” said Scott Reed, the chief strategist for the U.S. Chamber of Commerce. “We have a lot riding on this.” (Goldmacher, Dawsey and Palmeri, 3/23)

The Hill: Report: Trump Regrets Backing Health Plan Before Pushing For Tax Reform 
President Donald Trump regrets throwing his support behind Speaker Paul Ryan’s healthcare proposal before his administration could propose a tax reform plan that more Republicans would favor, according to a Thursday New York Times report. Trump reportedly questioned his decision to several allies, saying he should’ve prioritized tax reform after seeing the immediate Republican fallout from the GOP healthcare proposal. (Beavers, 3/23)

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Clearing The House Is Just The First Step; GOP Plan Faces Significant Hurdles In The Senate

In the upper chamber, Republicans only claim a 52-48 majority, and many senators have already expressed their dismay at parts of the House’s American Health Care Act. Democrats also see opportunities to snag parts of the GOP plan. Meanwhile, Sen. Rand Paul (R-Ky.), who argues that the measure does not go far enough to repeal Obamacare, is among those who has raised constitutional issues.

Politico: Trump’s Obamacare Repeal Concessions Likely Can’t Pass Senate
Democrats say they are certain they can kill any language in the repeal bill that erases Obamacare’s mandate for minimum benefits in insurance plans. And top Republicans are making no promise that the last-ditch changes to win over conservatives will fly in the more centrist Senate, which is beginning to write its own health care plan. (Everett and Haberkorn, 3/23)

The Hill: Senate GOP Hedges On ObamaCare Repeal Timeline 
Senate Republicans are starting to publicly hedge on when they’ll be able to repeal and replace ObamaCare as their House counterparts struggle to find a deal. On Thursday afternoon, the House delayed a vote on the bill that was originally scheduled for later that day. Sen. Bill Cassidy (R-La.), who has been skeptical of the House bill, said after a caucus launch that he was told that senators would have “more time” to consider a repeal and replace bill and that the House might not vote until next week.  (Carney, 3/23)

CQ Magazine: Even If The GOP Passes A Health Care Bill, Some Wonder If It’ll Be Constitutional
If Republicans rescind the Affordable Care Act mandate that everyone buy health insurance, will their bill be constitutional? GOP Sen. Rand Paul of Kentucky is raising that question, citing the reasoning of Chief Justice John G. Roberts Jr., who wrote the 2012 opinion that upheld the individual mandate penalties in the 2010 health care overhaul. In his opinion in NFIB v. Sebelius, Roberts said the health care law essentially violated the Constitution’s Commerce Clause that gives Congress the power to regulate interstate commerce because it forced people to buy health insurance. But he wrote the requirement that individuals pay a penalty for not obtaining health insurance “may be reasonably characterized as a tax” and let it slide. (Lesniewski, 3/27)

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High Stakes Of GOP Health Bill Leaves Divisions Among Representatives, Many State Officials

News outlets around the country report on how their local congressional delegations — and state officials — are leaning on the Republican plan to dismantle Obamacare.

Chicago Tribune: Health Care Vote Delay Leaves Illinois GOP Delegation Uncertain 
After House Republicans suffered a setback Thursday in their bid to overhaul health care, some GOP lawmakers from Illinois refused to commit to future revisions of the GOP plan and expressed skepticism about quick action moving forward. …While saying Obamacare is in a “death spiral,” [Rep. Randy] Hultgren said it’s important for House and Senate Republicans “get a replacement that works.” He said he could not predict “whether that can happen today or tomorrow or over the weekend or next week” and added: “I really feel like it’s unknown right now how this ends.” (Skiba, 3/23)

Atlanta Journal-Constitution: In Tom Price’s Backyard, A Republican Split Over Health Plan
Even in Tom Price’s home turf, there’s a sharp divide over the embattled GOP health plan among the Republicans racing to replace him. Several of the top Republicans in the April 18 special election to succeed Price, Donald Trump’s health secretary, say the plan needs broader changes before they can accept it. Others, including those running as Trump loyalists, say they would vote for it in a flash. (Bluestein, 3/23)

The Wall Street Journal: House GOP Super PAC Pulls Support From Iowa Congressman Who Opposes GOP Health Bill
The super PAC overseen by House Speaker Paul Ryan and the House GOP leadership is yanking support from a House Republican who pledged to oppose the health-care legislation pushed by President Donald Trump and House GOP leadership. The Congressional Leadership Fund is pulling staff from and closing an office it opened last month in Iowa Rep. David Young’s Des Moines-based district. (Epstein, 3/23)

Texas Tribune: Gohmert, Weber Among Holdouts As House Postpones Health Bill Vote
The process got somewhat easier on Thursday when two Republicans, U.S. Rep. Joe Barton of Ennis and Michael McCaul of Austin moved into the affirmative column. The Dallas Morning News reported McCaul’s change of heart from undecided to yes. “I don’t have a comment other than I am glad Donald Trump got elected president so that we have a chance to bring an end to Obamacare,” said the fiercest GOP holdout of the delegation, U.S. Rep. Louie Gohmert of Tyler. (Livingston, 3/23)

The Philadelphia Inquirer: Where Philly-Area Representatives Stand On The Health-Care Bill
One local Republican – Rep. Patrick Meehan, whose district mostly covers Delaware County – has yet to decide whether he would support his party’s long-promised plan to repeal and replace Obamacare. The stance of another local GOP representative, Ryan Costello of Chester County, remains unclear. Like Meehan, Costello supported the bill in committee but has not committed to voting for the final measure. (Tornoe and Babay, 3/23)

The Baltimore Sun: Rep. Andy Harris Remains A ‘No’ On GOP Health Care Bill 
Rep. Andy Harris, a Baltimore County Republican and member of the conservative Freedom Caucus, said Thursday that last-minute changes to the Republican plan to replace Obamacare are not yet enough to win his support. Harris, who ran his first campaign for Congress on a vow to repeal the Affordable Care Act, joined about three dozen Republicans who announced opposition to the legislation. Because of that opposition, GOP leaders pulled the measure from a scheduled vote Thursday — dealing a blow to President Donald Trump. (Fritze, 3/23)

St. Louis Post Dispatch: One St. Louis-Area Republican’s Shuttle Diplomacy In The Health-Care Quicksand Of Repeal And Replace 
Rep. Rodney Davis thought he was about to cast a long-anticipated vote to begin repealing and replacing Obamacare on Thursday. Instead, he took another trip to the White House, part of the extraordinary and sometimes confusing shuttle diplomacy that was going on inside the Republican Party on health care reform this week. Davis, R-Taylorville, and Rep. Ann Wagner, R-Ballwin, are among a small group of Republican vote-counters in the U.S. House on the Republicans’ American Health Care Act. They’re “whips” in the parlance of what is often called legislative sausage making. (Raasch, 3/24)

The CT Mirror: As GOP Health Care Plan Falters, CT Dems Watch And Wait 
President Donald Trump and House Republicans are making both threats and promises to try to salvage the GOP health care bill – but the deal-making is all on the Republican side of the aisle, with Connecticut’s all-Democratic congressional delegation sitting on the sidelines… While Democrats are not sitting at the negotiating table, that doesn’t mean Connecticut’s lawmakers were idle. (Radelat, 3/23)

The CT Mirror: CT GOP Legislative Leaders Urge Delay On Obamacare Replacement 
The Republican leaders of the Connecticut House and Senate politely distanced themselves Thursday from the push by President Trump and U.S. House Speaker Paul Ryan for the immediate passage of an alternative to the Affordable Care Act. In a letter to the president and speaker, Sen. Len Fasano of North Haven and Rep. Themis Klarides of Derby said they shared the national Republican leaders’ concerns about Obamacare, but urged Trump and Ryan to avoid passage of a bill still being digested by state officials and members of Congress. (Pazniokas, 3/23)

Kansas City Star: Brownback, Greitens Sign Letter In Support Of GOP Health Care Bill 
Kansas Gov. Sam Brownback and Missouri Gov. Eric Greitens have both signed a letter in support of a controversial bill that would repeal the Affordable Care Act. Brownback’s office released the letter after U.S. House Speaker Paul Ryan delayed a vote on the American Health Care Act because of a lack of support for the bill. The letter from eight GOP governors thanks Ryan, a Wisconsin Republican, and U.S. Senate Majority Leader Mitch McConnell of Kentucky for their efforts to repeal the ACA, also known as “Obamacare.” (Lowry, 3/23)

The Associated Press: Walker: Up To 45K Alaskans Could Lose Coverage With GOP Bill
Gov. Bill Walker says as many as 45,000 Alaskans could lose health care coverage under a Republican bill proposed in the U.S. House. Walker says that includes 30,000 Alaskans covered by the expanded Medicaid program and roughly two-thirds of the Alaskans with individual plans on the federally facilitated insurance marketplace. About 19,000 Alaskans have individual plans. Walker said about 13,000 could lose coverage. (Bohrer, 3/24)

WBUR: Mass. Democrats Denounce GOP Health Care Bill
Gov. Baker has estimated the state would lose about $1 billion in federal reimbursement, starting in 2020, should the American Health Care Act pass. On Tuesday, Baker said, “I think our hope and our expectation is that the issues that are raised not just by people here in Massachusetts but by people in other states who have similar concerns can help affect the nature of the debate and the discussion.” Today also marks the seventh anniversary of the Affordable Care Act. (Bologna, Bruzek and Chakrabarti, 3/23)

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Majority Of Americans Oppose Republicans’ Replacement Bill, New Poll Finds

Only 17 percent surveyed by Quinnipiac University support the American Health Care Act. And as former President Barack Obama makes a rare statement about the debate regarding his signature health care legislation, Democrats mobilize to use the vote against vulnerable Republicans.

The Hill: Poll: Just 17 Percent Of Voters Back ObamaCare Repeal Plan 
A majority of American voters oppose the Republicans’ plan to repeal and replace ObamaCare, while very few voters support it, a new poll finds. A poll published Thursday by Quinnipiac University found that 56 percent of voters disapprove of the GOP healthcare plan, while just 17 percent support it. Even among Republicans, only 41 percent support the American Health Care Act, while 24 percent oppose it. And 58 percent of Democratic voters disapprove of the plan. (Firozi, 3/23)

Politico: As Repeal Vote Nears, Obama Pleads To Preserve Affordable Care Act
Former President Barack Obama, who has remained on the sidelines for much of the contentious debate surrounding the Trump administration’s plan to repeal and replace the Affordable Care Act, urged lawmakers Thursday to preserve and build on his signature legislative achievement. The lengthy statement … celebrated the merits of Obamacare and described the legislation as a watershed moment in determining that health care is “not just a privilege for a few, but a right for everybody.” (Sutton, 3/23)

Bloomberg: Democrats Aim To Weaponize Health Bill Against House Republicans 
Democrats seized on the House health-care vote as an opportunity to inflict political damage on vulnerable Republicans.The Democratic National Committee has begun blanketing the districts of roughly 50 House Republicans with targeted emails and robocalls about the bill, urging recipients to call the lawmakers to express opposition to the bill…It’s the first time the DNC has carried out this kind of campaign since Perez became chair of the party last month and reflects the committee’s efforts to be a hub of anti-Trump activity. (Epstein, 3/23)

Meanwhile, protests against the GOP bill and in support of Planned Parenthood take place in cities like Los Angeles, Chicago, Phoenix and Detroit —

Reuters: Obamacare Supporters Rally Against Congressional Repeal Efforts
Supporters of Obamacare staged rallies across the country on Thursday denouncing efforts by President Donald Trump and Republican congressional leaders to repeal the landmark law that has extended medical insurance coverage to some 20 million Americans. Hundreds of demonstrators turned out in Washington, Chicago and Los Angeles marking the seventh anniversary of enactment of Obamacare, as the Affordable Care Act (ACA) has become widely known. (Simpson, 3/23)

Los Angeles Times: Crowd In Downtown L.A. Protests Obamacare Repeal
Crowds marched through Downtown Los Angeles Thursday afternoon to protest efforts by Republican lawmakers to overhaul the Affordable Care Act. In a rally that occupied a portion of Temple Street outside of the Roybal Federal Building, speakers addressed a crowd of healthcare providers and advocates. (Kohli, 3/23)

Chicago Sun Times: Hundreds Rally, March Downtown To Decry American Health Care Act 
Hundreds of protesters rallied and march through downtown Thursday afternoon, denouncing plans — since delayed — to repeal and replace the Affordable Care Act on the seventh anniversary of the bill becoming law. Rallying in Federal Plaza before heading north on Dearborn, eventually stopping across the Chicago River from Trump Tower, the crowd cheered as they learned that a vote on the American Health Care Act would not be held Thursday, as was originally planned. (Charles, 3/24)

Arizona Republic: Planned Parenthood Advocates Rally In Phoenix Against ‘Obamacare’ Repeal
As wrangling continued in Washington, D.C., on Thursday over a bill to repeal the Affordable Care Act, Planned Parenthood supporters gathered in Phoenix and cities across the nation to oppose what they call the “worst piece of legislation for women in a generation.” In Phoenix, about 50 people gathered outside the Arizona State Capitol to rally against the health bill. (Newman, 3/23)

Detroit Free Press: Detroit Protesters Stage ‘Funeral’ For Obamacare
Ahead of today’s unsure vote on Republican changes to former President Barack Obama’s signature health care reform, protesters in downtown Detroit staged a mock funeral of the Affordable Care Act, saying its replacement would leave millions without coverage. Among the protesters was Ed Weberman, a lawyer from White Lake Township whose 24-year-old son, Alex, is in remission from stage 4 non-Hodgkin’s lymphoma. Weberman said his son’s recovery was possible only because he could keep him on his insurance up to age 26 under Obamacare. (Helms, 3/23)

KQED: As House Vote Approaches, Protesters Of GOP Health Care Bill Get Creative 
Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads. They’re not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. (Klivans, 3/23)

California Healthline: From ‘Stressed Out’ To Hopeful, Five Californians Weigh In On GOP Bill
[T]he GOP proposal could have a big impact on the nearly 14 million Californians — about one-third of the state’s population — who are covered by Medicaid, the health program for low-income people, known as Medi-Cal in California. The GOP plan would also likely scramble the health care calculations of people who buy their own coverage, especially if they do so through Covered California, the state’s insurance exchange, and get federal help with their premiums. (Gorman and Bazar, 3/23)

San Jose Mercury News: Bay Area Voters Not Surprised By GOP Health Care Vote Delay
Yet no matter where they got the news, and regardless of their political leaning, several people on the Bay Area News Group’s 25-member voters’ panel — assembled to evaluate President Donald Trump’s first 100 days in office — said they weren’t surprised that the dismantling of Obamacare had gotten so gummed up in the nation’s capital that the GOP plan appeared to be going nowhere for now. (Seipel, 3/23)

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GOP House Leaders Are On Edge With Gamble On Health Bill Vote

The vote — which was scheduled in response to demands by President Donald Trump — is dicey for the majority and highlights the continuing factions within the Republican caucus as well as their hesitancy to negotiate and compromise.

The Associated Press: House Sets Risky Health Care Vote After Trump Demands It
In a gamble with monumental political stakes, Republicans set course for a climactic House vote on their health care overhaul after President Donald Trump claimed he was finished negotiating with GOP holdouts and determined to pursue the rest of his agenda, win or lose. House Speaker Paul Ryan set the showdown for Friday, following a nighttime Capitol meeting at which top White House officials told GOP lawmakers that Trump had decided the time for talk was over. (Fram and Alonso-Zaldivar, 3/24)

USA Today: Damn The Torpedoes: GOP Sets Friday Vote On Health Care Despite Opposition
Rep. Chris Collins, R-N.Y., told reporters at the Capitol that Mulvaney’s message was: “The president needs this, the president has said he wants a vote tomorrow. If for any reason (it fails) we’re just going to move forward with additional parts of his agenda. This is our moment in time but the president is insisting on a vote one way or the other.” Collins said the message from the administration — Stephen Bannon, Reince Priebus and Kellyanne Conway also attended the meeting — was that negotiations were over and it was time to act. (Kelly, Collins and Shesgreen, 3/23)

Roll Call: House GOP Heads Into Health Care Vote ‘Between A Rock And A Hard Place’
The outcome of Friday’s House vote to partially repeal and replace the 2010 health care law is not certain, but one thing is: All parties to the Republican negotiations will walk away with some losses. … the chips in this case are a group of conservative hardliners and moderate majority-makers (members leadership typically relies on to help pass bills) that have stood in opposition to bill before the latest round of changes. While at least a dozen of those Republicans have said since the final plan was announced Thursday evening that they remain “no” votes, several others appear to be wavering. (McPherson, 3/24)

News outlets note that the difficulties GOP leaders have confronted during this week’s negotiations are similar to the ones that dogged them during the Obama administration –

The Wall Street Journal: In Health-Law Fight, GOP Leaders Struggle To Reconcile Factions’ Needs
After years of making the repeal of the Affordable Care Act a signature issue, Republicans are struggling to deliver on the promise, floundering amid warring factions that neither President Donald Trump nor House Speaker Paul Ryan have been able to whip into line. … They are confronting a thorny challenge that required two things in short supply among today’s Republican rank and file: a willingness to compromise or to defer to leadership. (Hook and Epstein, 3/23)

The Associated Press: New Congress, All-GOP, Same Political Divisions
With control of the White House and Senate and a commanding majority in the House, Republicans were supposed to brush off any challenge from the hardline Freedom Caucus and work their will with impunity. But something happened on the way to governing. Now, House Republican leaders are struggling with the same divisions that plagued them under President Barack Obama. (Ohlemacher, 3/24)

Politico: Trump Vs. The Freedom Caucus
The House Freedom Caucus has threatened to tank the House GOP Obamacare replacement bill unless they get what they want. But Trump is now calling their bluff. White House officials told members of the group on Thursday they have one shot: If they help defeat the American Health Care Act, the Trump administration is going to move on — meaning the Freedom Caucus could be pinned with actually saving Obamacare. The White House is betting that they will cave, given that saving Obamacare is something these conservative Republicans will never be able to stomach. (Bade and Bresnahan, 3/23)

And some tips on how to salvage the repeal-and-replace effort if the bill fails –

Politico: How The GOP Could Still Salvage The Obamacare Repeal
House Republican leaders scrambling to buck up wavering members had portrayed the vote as the only shot to eliminate the GOP’s longtime boogeyman — and as an essential show of support for President Donald Trump. But in fact, they have several options to salvage the repeal effort after they couldn’t muster 215 votes. (Cancryn, 3/23)

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