Tagged Medicaid

How It’s Playing On the Ground: A ‘Farce’ Not A Plan? Scolding A Senator

News outlets beyond the beltway offer their perspectives on the Senate’s replacement for Obamacare and what lawmakers should be doing.

San Jose Mercury News: Republican Health Care Is No Plan, It’s A Farce
Americans are divided on what to do about health care, but they should be united in this conclusion: Senate Republicans’ manic approach to reforming a sector that represents one-sixth of the U.S. economy and determines life or death for millions of people is utterly craven and irresponsible. …This is how Republicans are going to determine how Americans get their health care? (7/25)

Arizona Republic: ‘Obamacare Lies’ Or Trump Lies: Which Would You Rather Have?
President Donald Trump raged against what he called “Obamacare lies” Monday, urging Senators to move forward on a repeal and replace plan for the Affordable Care Act. …But the proposals put forth so far by Republicans, and backed by Trump, are estimated to leave tens of millions of Americans without health care and put tens of millions more with very limited coverage and at risk for bankruptcy should anyone in the family contract a major illness. (EJ Montini, 7/25)

Cleveland Plain Dealer: Sen. Rob Portman Must Stand Against Rush To Flawed Senate Health Care Vote
As Sen. Susan Collins, a Maine Republican, said Sunday, if the Senate does open floor debate, it’s unclear whether senators would be dealing with Paul Ryan’s House-passed bill, Mitch McConnell’s first, second or (unseen) third plan – or an ACA repeal, with a Senate promise to replace the law, eventually. …That’s also why Sen. Rob Portman, a suburban Cincinnati Republican who has spelled out his own careful stance on protecting Ohioans that he says will guide his vote, must vote “no” on moves by McConnell to force Senate action on an ill-considered, narrowly partisan package that would devastate health care in Ohio. (7/25)

Cleveland Plain Dealer: Sen. Rob Portman, You Just Let Ohio Down
Sen. Rob Portman cast the wrong vote Tuesday in supporting a hasty, politically motivated effort to allow Senate debate and, presumably, a vote on one or a series of ill-considered, narrowly partisan measures likely to devastate health care in Ohio. …As Sen. Susan Collins, a Maine Republican who cast one of only two Republican “nos” on the Senate floor, said before the vote, no one even knew exactly what senators were being asked to debate and maybe vote on. (7/25)

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

Senate Votes To Move Ahead With Debate On Obamacare Replacement Bill

Jul 25 2017

Republican leadership secure the needed 50 votes — with Vice President Mike Pence casting the tie-breaking vote to reach 51 — to bring health care legislation to the floor.

Politico: Republicans Vote To Move Ahead On Obamacare Repeal
Senate Republicans voted Tuesday voted to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago. The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who’ve promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House. (Haberkorn, Kim and Everett, 7/25)

Before the vote —

AP News: Mic Captures GOP Senator Ripping Trump, Mocking Lawmaker
Oh, that dreaded open microphone! Republican Sen. Susan Collins got caught Tuesday at the end of a hearing with a microphone that was still hot — and captured her ripping President Donald Trump and making fun of a fellow lawmaker who had been critical of her on health care. (Kerr, 7/25)

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Who Knew Senate Health Bill Debate Could Be So Complicated?

So the Senate has voted to start debate on a bill to replace the Affordable Care Act. Now what?

Well, it gets wonky.

The rules for budget reconciliation, the process the Senate is using that limits debate and allows a bill to pass with only a simple majority, comes with a set of very specific rules. Here are some of the big ones that could shape whatever final bill emerges:

Matters Of Timing

Unlike most other Senate bills, where deliberation can last for days or weeks, budget reconciliation rules limit debate to 20 hours. While that 20-hour clock starts running as soon as the Senate votes to proceed to the bill, the debate can be paused. In other words, the Senate can recess for the night, then come back the next day and the clock would resume where it left off the day before. The 20 hours does not include time spent voting on amendments.

Near the end of the debate, Senate leaders could offer a substitute bill. It may incorporate some of the earlier amendments or not, and it is likely geared to attracting as many votes as possible.

Use Our Content

At the end of the 20 hours, there is potentially unlimited time for senators to vote on (but not debate) amendments. By tradition, the minority and majority party each gets one or two minutes to announce what the amendment is, and why it is good or bad. Unlike the initial debate, the clock does not pause for what is referred to as the “vote-a-rama.” That means voting goes only until members get too tired to continue. Vote-a-ramas in the past have often stretched for more than 12 hours, but rarely longer than 24.


Senate leaders have for the past several weeks talked about starting debate and having an “open amendment process.” But under reconciliation, amendments are more constrained than under almost any other Senate rules.

According a report by the Congressional Research Service (a nonpartisan research group that provides background briefs to Congress), the Budget Act, which sets the reconciliation rules, “requires that all amendments be germane to the provisions in the bill.” What does that mean? Says CRS, “amendments cannot be used to introduce new subjects or expand the scope of the bill.”

Amendments also cannot add to the budget deficit or cause the bill to miss its overall budget targets.

Budget Targets

Reconciliation is designed to be a process to address the federal budget and is governed by the details set in a budget resolution passed by Congress. Even though congressional leaders have often used it to move legislation that has broader intent, the process has strict rules about spending or saving federal dollars. This year’s targets are modest by most budget resolution standards — each of the two health committees in the Senate were instructed to save $1 billion over 10 years.

But the Senate committees did not take up the bill to make changes or meet those targets on their own. As a result, the Senate is working from the bill passed by the House in May. It saved $119 billion, according to the Congressional Budget Office. Although the Senate is certain to make major revisions to the House legislation, any bill it passes must produce at least that much in savings.

And, of course, if the Senate passes a bill, it would have to be approved by the House or the House and Senate would have to work out differences and then pass that bill.

Byrd Rule

Both the underlying ACA replacement bill and its amendments must comply with the “Byrd Rule,” named for former Sen. Robert Byrd (D-W.Va.), which prohibits language that is “extraneous” to the federal budget from being included in the bill. In practice that means language must add to or subtract from federal spending and that the spending must not be “merely incidental” to a broader policy purpose.

Those determinations are made by the Senate parliamentarian. Last Friday, Senate Democrats released a list of initial decisions made by the parliamentarian’s office that found about 10 parts of the Senate- and House-passed health bills run afoul of the Byrd Rule. That list included a temporary defunding of Planned Parenthood and requirements that people with breaks in coverage wait six months before buying individual health insurance.

Republican leaders say they are working to rewrite the problematic provisions. Whether that will pass the Byrd Rule is one of many things no one knows yet in this very tumultuous debate.

Categories: Medicaid, Repeal And Replace Watch, The Health Law

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Tough Takes On The GOP’s Health Legislation Strategy: A New Level Of Cynicism; ‘A Tattered Band-Aid’

Opinion writers offer critiques of the GOP health plans, their strategies and how it could all play out for them in the next election.

The Washington Post: Senate Republicans Take Cynicism To A Horrifying New Level
We are hurtling toward a health-care disaster in the next 36 hours or so, for the worst possible reason. Cynicism is seldom completely absent from the operation of politics, but this is truly a unique situation. Republicans are set to remake one-sixth of the American economy, threaten the economic and health security of every one of us and deprive tens of millions of people of health-care coverage, all with a bill they haven’t seen, couldn’t explain and don’t even bother to defend on its merits. (Paul Waldman, 7/24)

The Wall Street Journal: Can Republicans Govern?
Mitch McConnell is scheduling another showdown vote in the Senate—the third attempt—as early as Tuesday on a motion to proceed to debate on health reform. Succeed or fail, the Republican Majority Leader is right to demand this moment of political accountability. (7/24)

The Wall Street Journal: If Mitch McConnell Fails To Repeal Obamacare, He Should Blame Himself First
Few people in America rode into 2017 higher than Senate Majority Leader Mitch McConnell (R-Ky.). After leading Republicans to the Senate majority in 2014 and blocking President Barack Obama from filling the late Justice Antonin Scalia’s Supreme Court seat, McConnell helped the GOP hold the Senate last fall to deliver the first unified Republican control of government in a decade. Just six months later, though, McConnell is staring at a dramatic reversal of fortunes, facing a full-blown rebellion among the Republican senators he leads and serious doubts about his leadership ability. (Adam Jentleson, 7/25)

The New York Times: How The Health Bill Could Cost Senators In The Next Election
One of the health care bills under consideration by Republican leaders would take health insurance away from 32 million people over the next decade, creating a cohort of Americans who could be motivated to vote against senators who approved the measure. The Senate could vote as early as Tuesday, but it is not yet clear which of the two bills in contention that the majority leader, Mitch McConnell, intends to bring up. The plan that would leave 32 million without coverage would repeal some of the most important parts of the Affordable Care Act without any replacement. (Vickas Bajaj and Stuart A Thompson, 7/24)

Los Angeles Times: A Tattered Band-Aid: Senate GOP’s $200-Billion Obamacare Cushion Would Run Out In Two Years
As Senate Republicans rush pell-mell toward a Tuesday vote on an Obamacare repeal bill that most, if not all, still haven’t seen, a new study examines one of the givebacks the GOP leadership has offered anti-repeal senators to bring them on board. The sweetener is a $200-billion fund for the 31 states that expanded Medicaid under the Affordable Care Act, to be paid out starting in 2022. Since the GOP bill would eliminate the Medicaid expansion, the ostensible idea is to help them cushion health insurance costs for those states and their Medicaid enrollees forced to transition to the ACA’s individual insurance exchanges. (Michael Hiltzik, 7/24)

The Washington Post: Every Republican Health-Care Plan So Far Would Cause Great Harm To The Nation
The Senate has been deadlocked on repealing and replacing Obamacare all month, but Majority Leader Mitch McConnell (R-Ky.) announced Monday afternoon that the chamber would vote Tuesday on . . . well, on something. The scrambling reflected a basic fact: Every major Republican proposal put forward so far would mean millions of Americans would lose access to health care. Each plan would theoretically fulfill a GOP campaign promise while inflicting serious harm on the nation. (7/24)

Los Angeles Times: Lessons From The GOP’s Mostly Dead Healthcare Plan
Hill-watchers say the Republicans so badly need to pass something that they might just surprise everyone and pass … something today. Maybe. But whatever the Senate passes will not be an actual repeal of Obamacare, never mind an actual replacement. (It can’t be. Since Senate Majority Leader Mitch McConnell [R-Ky.] and company can’t or won’t work with Democrats — and vice versa — they are trying to pass their bill using the budget reconciliation process, which is rather limited in scope, but only requires a simple majority.) And even if the miracle happens, the immensely unpopular legislation must then go to conference, and after that go back to both chambers for more voting. It will look less like sausage getting made and more like an elaborate, rolling, mortuary makeover. (Jonah Goldberg, 7/25)

USA Today: GOP Health Bill Pits Freedom Of Choice Against Freedom From Fear
What is the health care debate all about? Freedom. Specifically two different conceptions of freedom. One is freedom to buy what you want. In this view, the country is a collection of 325 million individuals, and freedom is everyone pursuing their lives without interference. The other is freedom from worry. It views America as a community, and freedom is knowing you can get help when you are sick and in need. (EzekielJ. Emanuel, 7/24)

The Kansas City Star: Pat Roberts, Nancy Pelosi And Passing A Health Care Bill To Find Out What’s In It
Kansas Sen. Jerry Moran has been lavished with attention lately. Which is what happens when you buck your party to save Obamacare one day and the very next time the sun comes up, announce that you support a doomed GOP plan to kill the Affordable Care Act and replace it with nothing but hearty best wishes for all Americans. If Moran now sticks with his party after all and green-lights legislation he has said would hurt his constituents, he’s going to wish he hadn’t distinguished himself in the first place. (Melinda Henneberger, 7/24)

Arizona Republic: John McCain Hands Gov. Doug Ducey His Health Care Vote
Until McCain’s tweet, [Doug] Ducey was nothing more than an observer in the health care debate going on in Washington. He could – if he chose to do so – complain about what senators might do in restructuring or abolishing the Affordable Care Act, but he would bear no measure of blame for their work. Now, he has a say. (EJ Montini, 7/24)

New Orleans Times-Picayune: Health Care Speech Might Be Donald Trump’s Most Cynical One Yet
Trump, certainly the most prolific prevaricator who has ever rested his head at the White House, says that the Democrats’ promises regarding the Affordable Care Act all amount to a “big, fat lie.”If the Republicans had presented anything to make it easier for those families Trump trotted out, then maybe it would be fair to accuse the Democrats of overselling the Affordable Care Act.  But the Republicans aren’t really offering much – if anything — to help those who are struggling to pay their medical bills. (Jarvis DeBerry, 7/24)

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Physicians, Often In Fear Of Losing License, Know How To Hide Signs Of Addiction To Escape Notice

“Somehow they believe their knowledge is going to be more powerful than addiction,” said Dr. Marvin Seppala, an addiction expert. Meanwhile, FDA Commissioner Scott Gottlieb is looking to tap unlikely sources as allies in the battle against opioids: benefit payers and insurance administrators.

Los Angeles Times: Doctors And Drug Abuse: Why Addictions Can Be So Difficult
Allegations that Dr. Carmen A. Puliafito used methamphetamine and ecstasy while he was dean of USC’s medical school have opened a window into the pervasiveness of drug use and addiction among physicians and the challenges they face when confronting it. Experts say physicians become substance abusers at about the same rate as the general population. But they are often reluctant to seek treatment out of fear of losing their medical licenses and livelihoods. (Karlamangla, 7/24)

Bloomberg: Trump’s FDA Chief Takes Wide Aim At Opioid Addiction Crisis 
The Food and Drug Administration, as part of a sweeping overhaul in how it regulates opioid painkillers, plans to look to some unusual allies to limit the flood of the addictive pills — health insurers and companies that manage prescription drug benefits. Food and Drug Administration Commissioner Scott Gottlieb plans to meet in September with the benefit payers and insurance administrators, groups the FDA hasn’t typically worked with in its role as a drug regulator. The plan, Gottlieb said, is to stem the tide of addiction to the pills by limiting the number of people exposed to them in the first place. (Edney, 7/24)

And in other news on the epidemic —

The New York Times: Economy Needs Workers, But Drug Tests Take A Toll
Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging. It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test. (Schwartz, 7/24)

Arizona Republic: Hepatitis C: The Public-Health Worry Lurking Behind The Opioid Crisis
Hepatitis C, a blood-borne virus that attacks the liver and causes inflammation, is so infectious it can spread through a few microscopic dots of blood. Intravenous drug users are among the most high-risk populations for infection because they share syringes, cookers, cotton, water, ties and alcohol swabs, according to the Centers for Disease Control and Prevention. (Stanford, 7/24)

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Molina Healthcare To Lay Off About 1,400 Employees, Memo Says

The insurer says the upcoming cuts to 10 percent of its workforce is driven by losses to its Obamacare exchange business.

Reuters: Molina Healthcare To Cut About 1,400 Jobs: Memo
Molina Healthcare, a health insurer that specializes in the Obamacare and Medicaid healthcare programs for low-income and poor people, plans to cut about 1,400 jobs in the next few months, according to an internal company memo reviewed by Reuters. (Humer, 7/24)

Modern Healthcare: Molina To Lay Off 10% Of Its Workforce
Medicaid health plan Molina Healthcare intends to lay off 1,400 employees, or 10% of its workforce, over the coming months to try to offset losses from its Obamacare exchange business, the company said in an internal memo to employees Monday. The cuts will be across-the-board, including senior leadership, interim CEO and Chief Financial Officer Joe White said in the memo. (Barkholz, 7/24)

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Parsing The Policies: What’s To Become Of Medicaid And Medicare?

Opinion writers offer their thoughts on how the current Affordable Care Act replacement debate impacts Medicaid and how governors should proceed in pursuing Medicaid waivers as well as current Medicare funding issues.

Daily Beast: Medicaid Delivers As Obamacare Survives
Medicaid got a reprieve from the budget axe with the GOP’s failure so far to repeal, let alone replace, Obamacare. Suddenly, the program for the poor that began in 1965 seems less like a scapegoat for politicians looking to score rhetorical points and to shore up state budgets, and like it may join Medicare and Social Security on the third rail in American politics—touch it and you die. (Eleanor Clift, 7/24)

RealClear Health: Republicans Are Tackling Medicaid Wrongly
The high decibel fight in the Senate over Medicaid is one more example–did we need more?–of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus. There should be hearings to gather input from all sides and serious debate in committees as well as on the floor. If one party rams through big changes in any program as important as Medicaid, the other party will demonize the result. In the case of Medicaid cuts, arousing public outrage won’t be hard. Individuals and families, state governments, rural hospitals and other health providers will all be vocal about their plight. One wonders why either party would seek such opprobrium when they could be working together on sensible Medicaid reform. (Alice M. Rivlin, 7/24)

Morning Consult: Governors: Avoid Harmful Insurance Practices In Medicaid Waivers
While our nation’s governors recently gathered in Rhode Island for the summer meeting of the National Governors Association, most of the country’s political attention remained focused on the debate in Washington, D.C. over the fate of the Affordable Care Act. Less noticed, but also critically important, is that fact that each governor holds in their hands today the ability to radically reshape Medicaid for their state’s most vulnerable citizens regardless of the outcome of that debate. (Donna Christensen, Scott Mulhauser and Jason Resendez, 7/24)

CBS News: Medicare Funding: Problems And Solutions
Medicare’s funding problems often get overlooked when the Social Security trustees issue their annual report on the funded status of the Social Security and Medicare programs. Yet together they form the twin pillars of financial security for retirees. That’s why it’s important to understand Medicare’s financial situation, so you can be an informed health care planner — and voter. (Steve Vernon, 7/24)

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Both Sides Rack Up Wins On Battlefield Over Women’s Health In The States

While some states are stripping Planned Parenthood of funds, others are passing laws to protect contraception for women. Outlets report on other women’s health news out of Kentucky, Texas, Tennessee, Georgia and Texas.

Stateline: Flurry Of Laws Enacted On Women’s Access To Health Care
As Washington moved to reduce federal funding for women’s health this year, adversaries in the war over affordable birth control and other women’s health services shifted the battleground to state capitals — resulting in a spate of new laws that both expand and contract women’s access to care. … Medicaid pays for three-quarters of all publicly supported women’s health programs. So when Iowa abruptly cut off Medicaid dollars to Planned Parenthood, it was game over, said Jodi Tomlonovik, executive director of the Family Planning Counsel of Iowa, which oversees distribution of federal and state money to women’s health clinics. (Vestal, 7/24)

Reuters: U.S. Abortion Support Groups Put On More Public Face
Patricia Canon drives poor rural Kentucky women to distant abortion clinics each week, part of a national army of volunteers who are growing bolder even as abortion foes ratchet up opposition to the activists they have branded as “accomplices to murder.” The Kentucky Health Justice Network, where she volunteers, is one of dozens of non-profit U.S. abortion funds providing money for procedures or covering travel costs to help women obtain abortions, particularly in states where Republican-backed laws have narrowed options. (Kenning, 7/22)

The Washington Post: Dying After Childbirth: Women In Texas Are At High Risk, Especially If They’re Black
Black women in Texas are dying with frightening frequency after childbirth — at a rate up to nearly three times higher than that of white women. And no one has figured out why. In a state with the worst overall maternal mortality in the nation, the Texas legislature opened a special session this week that will address the issue as one of 20 items that Gov. Gregg Abbott (R) listed in calling lawmakers back to work. The most they may do, however, is extend and expand the scope of a task force that started studying the problem a few years ago. (Murgia, 7/21)

The Associated Press: Tennessee Inmates Get Reduced Sentences For Birth Control
A program in a Tennessee county reduces inmates’ jail time if they voluntarily undergo birth control procedures, in a move that has drawn criticism from the local district attorney and the American Civil Liberties Union. WTVF-TV reports General Sessions Judge Sam Benninfield signed a standing order in May that provides 30 days’ credit toward jail time for men who agree to free vasectomies in White County and women who agree to receive free Nexplanon implants, which prevent pregnancies for up to four years. (7/21)

Atlanta Journal-Constitution: Fed Cuts In Teen Pregnancy Grants Hamstrings Georgia Recipients
Quest for Change, a youth and family development-focused nonprofit run out of tiny Dawson, Ga., trained Jackson and other teenagers in how to discuss pregnancy, sexually transmitted diseases and healthy relationships with their peers. … [Shaunae] Motley’s organization and 80 others across the country were recently notified by the federal Department of Health and Human Services that the five-year grants they applied for and won in 2015 would be cut off two years ahead of schedule.

Austin American-Statesman: Abortion-Related Bills Sent To Full Senate For A Vote
The state Senate Health and Human Services Committee approved five bills Friday, the first of the legislative session to be sent to a full chamber for a vote since Gov. Greg Abbott expanded the scope of the agenda early Thursday. Three of the bills dealt with abortion and passed on a party-line 6-3 vote. (Chang and Silver, 7/21)

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

Opioid Treatment Funds In Senate Bill Would Fall Far Short Of Needs

At a lunch last week, President Trump tried to persuade some reluctant senators to endorse repealing the Affordable Care Act. During the meeting, he mentioned a provision in the Senate Republican proposal that allocates funding for opioid treatment, saying, “We’re committing $45 billion to help combat the opioid epidemic, and some states in particular like that.”

But addiction treatment specialists warn that sum of money is far from enough to address a crisis that has escalated across the United States in recent years, killing tens of thousands of people.

The federal money would be spent over about a decade, and is part of a bill that also dramatically cuts Medicaid, which is helping many people get treatment now. Those cuts will hit people in some states especially hard — those living in states that expanded the Medicaid program under the Affordable Act.

“You’re going to take a lot of people, take away their health care benefit, and basically do just a small grant to each state. It’s going to be real big problem,” said Richard Edley, executive director of the Rehabilitation and Community Providers Association, which includes hundreds of mental health and substance use disorder providers in Pennsylvania. “You hate to say you’re opposing [$45 billion], but it’s packaged with a rollback of benefits to these same individuals.”

In Pennsylvania in 2016, Medicaid expansion helped 124,000 people get treatment for their substance use disorder. Democratic Gov. Tom Wolf has said his state won’t be able to maintain Medicaid expansion if the federal government cuts back its share of spending. Without the program, many of those people would have limited access to help for their addiction.

Edley did some back-of-the-envelope math, and is really concerned at what he found.

If $45 billion is distributed to all 50 states by population, Pennsylvania would get about $1.8 billion, spread out over nine years. Depending on other variables, that could range from somewhere between $1,000 to $2,000 per person per year who might need treatment, based on how many people got treatment under expanded Medicaid in Pennsylvania last year.

By contrast, one year of maintenance treatment with methadone costs about $4,700 per year, according to the National Institute on Drug Abuse. Methadone is an evidence-based treatment that makes it possible for a person with opioid addiction to work and lead a normal life.

But the cuts to Medicaid would amount to billions of lost dollars in Pennsylvania.

The state says it can’t make up the difference. So, many of the people who get opioid treatment through Medicaid could lose coverage and then turn to the grant that’s specifically meant for opioid treatment.

And, like any chronic disease, opioid treatment takes many steps — medication and, perhaps, a lifetime of management.

“Your typical individual doesn’t get treatment right in 10 days on their first try,” said Jennifer Smith, Pennsylvania’s acting secretary for the Department of Drug and Alcohol Programs.

“[The funding] doesn’t even come close. Doesn’t even come close,” Smith added. “We can piece together some solutions that might help get us a little closer to where we had been, but the end result is more people are going to die.”

Every day in Pennsylvania an average of 13 people die from a drug overdose.

And there also would be ripple effects from that drop in funding, Smith said — grandparents taking care of grandkids, bankruptcies because of treatment costs, and more work for each county’s department of children and youth services. Smith also worries that less treatment would mean more people would be desperate to support their habit.

“And they end up with a criminal record,” she said. “Nobody wants to hire them.”

So they drop out of the workforce.

Experts like Smith and Edley are concerned that if the federal government pulls back spending on Medicaid, the costs simply will be shifted somewhere else.

“You stop funding for [treatment and] they don’t go away” said Edley. “People end up in emergency rooms. They end up in uncompensated care, homelessness. You talk to people in the criminal justice system — you see increased incarcerations.”

He expects that if the Senate GOP health bill is approved, lawmakers will have to come back to this issue in six months or a year.

“They’re going to be back at the drawing board,” Edley said, “realizing, ‘All right, that didn’t work, and there are too many people being hurt.’”

Edley and Deb Shoemaker, executive director of the Pennsylvania Psychiatric Society, also see a double standard with how the Senate GOP bill treats people who have a substance use disorder.

Shoemaker is very active on substance use issues in Pennsylvania, and said she often tries to personalize her pitch to lawmakers.

“Would you want to say, ‘Hey, I’m sorry that you have cancer but you can only get treatment once a week,’ or ‘you can only get dialysis once a week,’” she said, pointing to the disparity in the way the proposal treats substance abuse versus other physical conditions.

“So think about it that way,” she said. “Yes, [treatment for substance use disorder] is a cost, but in the long run, they’re healthier. They’re alive.”

Sen. Pat Toomey (R-Pa.) has defended the proposed cuts.

“If it’s not worth it to the state to buy this coverage at 43 cents on the dollar [about what the state contributes to non-expansion Medicaid recipients], then how is it worth it to those very same taxpayers — who, at the end of the day, have to provide the funding for the federal program — why is it worth it to them to pay 90 cents on the dollar? It just doesn’t make sense,” he told NPR in June.

In a written statement, Toomey has said “fighting the scourge of opioid and heroin abuse remains a top priority of mine.” His office also says current Medicaid funding is unsustainable.

An earlier version of the bill included just $2 billion in grants for substance use disorder treatment. Senate GOP leaders included the $45 billion as a concession to moderate Republicans like Sen. Rob Portman of Ohio and Sen. Shelley Moore Capito of West Virginia, who represent states that have been hit particularly hard by the crisis.

This story is part of a reporting partnership with WITF’s Transforming Health, NPR and Kaiser Health News.

Categories: Medicaid, Mental Health, Public Health, Repeal And Replace Watch, States

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Perspectives: End The ‘War On Medicaid’; Keep Eyes On Medicaid In Congressional Health Debate

Opinion writers examine Medicaid’s role in the current effort to replace the health law as well as ideas about controlling the program’s costs, ethical issues related to spending down assets to qualify for it and other provocative topics.

Morning Consult: Time To End The War On Medicaid
Any cuts to Medicaid would be devastating. Changing Medicaid from an entitlement into a state-based per capita grant program will cause permanent and growing damage to people’s health and the ability of our nation to respond to natural or economic disaster. Medicaid is the backbone of health coverage in America. One in two Americans will need Medicaid at some point during their lifetimes. Medicaid provides for healthy births and assistance for older people to be able to remain in their homes. Today, Medicaid is also there to help many thousands of people who lose their jobs in the aftermath of unforeseen disasters like recessions or hurricanes. Similarly, when an outbreak of illness occurs, Medicaid is there to provide coverage for needed care. (Doug Wirth, 7/20)

The Washington Post: Don’t Get Distracted: The GOP’s Cruel Health-Care Plan Isn’t Dead Yet
Focus, America, focus. The most urgent task right now is to make sure a stake is driven through the heart of the Republican effort to gut Medicaid and balloon the ranks of the uninsured. I know that the Russia investigations are charging ahead, with Capitol Hill appearances by members of President Trump’s inner circle scheduled for next week. I know that Trump gave an unhinged interview to the New York Times on Wednesday, bizarrely undermining his own attorney general. I know that one of the few remaining giants in Washington, Sen. John McCain (R-Ariz.), has received a tough medical diagnosis. (Eugene Robinson, 7/20)

The New England Journal Of Medicine: Controlling The Cost Of Medicaid
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching program for Medicaid with a per capita cap on federal funds. This cap would limit the growth of these funds to the growth rate of the medical care component of the Consumer Price Index, with an additional 1% growth allowed for older adult and disabled Medicaid enrollees. The Congressional Budget Office has projected that this policy would result in federal funding reductions of more than $800 billion over the next 10 years, equivalent to a 26% reduction in federal support by 2026. These large reductions represent an unprecedented shift of financial risk to the states. Missing from the debate has been consideration of policies that could improve the value of the Medicaid program, controlling Medicaid spending without diminishing coverage or quality. (K. John McConnell and Michael E. Chernew, 7/20)

The New York Times: The Ethics Of Adjusting Your Assets To Qualify For Medicaid
Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care. (Ron Lieber, 7/21)

Morning Consult: The Value Of A Human Life
As you can see, not only does McConnell’s BCRA dramatically roll back funding for hospitals and insurance companies to cover more people, and slash funding for Medicaid — a program which disproportionately helps poor and low-income Americans — but it also devalues human life as a whole. And with the value of a life now redefined, will Senate Republicans next move to make massive cuts to the Transportation Department highway safety programs, or the Food and Drug Administration’s food safety programs? (Dr. J. Mario Molina, 7/21)

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

Different Takes: How The Trump Administration Is Sabotaging Obamacare; Fear And Loathing In The Health Policy Debate

Editorial pages offer tough takes on the Trump administration’s executive maneuvers to render the Affordable Care Act powerless, the Republican’s plans to replace it and how this particular legislative fight shows Washington ‘at its worst.’

The New York Times: Health Care In A Time Of Sabotage
Is Trumpcare finally dead? Even now, it’s hard to be sure, especially given Republican moderates’ long track record of caving in to extremists at crucial moments. But it does look as if the frontal assault on the Affordable Care Act has failed. And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains. (Paul Krugman, 7/21)

Los Angeles Times: The Trump Administration Is Using Obamacare Marketing Dollars To Attack Obamacare
President Trump keeps saying Obamacare will fail on its own. So why is his administration trying so hard to kill it? The latest effort was uncovered by the Daily Beast website, which reported Thursday that Trump’s Department of Health and Human Services was dipping into its “consumer information and outreach” budget — money Congress provided to encourage people to obtain insurance through Obamacare — to produce nearly two dozen YouTube videos blasting the law as burdensome and harmful. (7/21)

The Washington Post: The GOP’s Repeal-And-Replace Plan Should Stay Dead
Republican senators have been huddling in hopes of reviving their Obamacare repeal-and-replace bill. The Congressional Budget Office (CBO) reminded them Thursday of why the bill should, on the contrary, stay dead. Congress’s scorekeepers found that the latest version of the Senate bill would result in 22 million more people without health coverage by 2026. That is true even after the CBO accounted for $70 billion in new funds meant to stabilize health-insurance markets by driving down premiums and other costs. (7/20)

The New York Times: A Republican Health Care Fix
Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine. While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor. (J.D. Vance, 7/21)

Fortune: Where The Republican Health Care Bill Stands After A Chaotic 72 Hours
It’s been a topsy turvy three days for health care reform (please consider hugging a health care reporter). The Senate’s original Better Care Reconciliation Act (BCRA), which was largely considered to be dead just two days ago, has been revived and somewhat tweaked as of this morning. And the Congressional Budget Office (CBO) is already out with an analysis of that new legislation: 15 million more uninsured Americans next year relative to Obamacare and 22 million more uninsured by 2026. It would also reduce federal deficits by $420 billion over the next decade, according to CBO. (Sy Mukherjee, 7/20)

The Wall Street Journal: Trump, ObamaCare And The Art Of The Fail
It was a political drubbing of the first order. A new Republican president and a Republican Senate and House put everything they had into a bill to repeal and replace ObamaCare, and couldn’t do it. The leadership is rocked. The president looks confused and hapless, while publicly enacting determination and a scolding tone toward those who’d let him down. He rarely showed signs of fully understanding the details or even the essentials of the plan he backed. His public remarks were all over the place: He’ll let ObamaCare collapse of its own weight; he’ll replace it with something big and beautiful; just repeal it; no, let it collapse. He criticized Hill Republicans: They “never discuss how good their healthcare bill is.” But neither did he, not in a persuasive way. (Peggy Noonan, 7/20)

San Francisco Chronicle: Health Care Fight Shows Washington At Its Worst
I like partisan fights when those fights are about something real. The Medicaid fight was at least about something real. But most of this nonsense is a battle of liars trying to protect past lies in the hope of being able to make new lies seem just plausible enough for the liars to keep repeating them. (Jonah Goldberg, 7/21)

Cleveland Plain Dealer: Republicans Trip Over Health Care: Editorial Board Roundtable
It was supposed to be a sprint to the finish line — Republican leadership of the GOP-dominated U.S. Senate planned to repeal speedily the long-hated Obamacare, replace it with the Better Care Reconciliation Act and ride off into the sunset. Instead, it’s been an Army crawl under withering fire for Senate Majority Leader Mitch McConnell, whose initial health care bill was too harsh for moderate Republicans who found it would leave 22 million more people without health insurance, and too generous for conservative Republicans who wanted to strip it bare. (7/20)

Lexington Herald Leader: Ky. Lawmakers Offer Us Hypocrisy, Selfishness In Health-Care Bills
The implosion of the Republican effort to repeal and replace the Affordable Care Act brought to mind the iconic scene in Tennessee Williams “A Cat on a Hot Tin Roof.” There, egged on by his son (Paul Newman) Big Daddy (played by Burl Ives) goes on a verbal rampage about the state of his world, which he characterizes as one of mendacity, lies and hypocrisy. (Ernie Yanarella, 7/20)

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Perspectives From Across The Country: Placing Blame For Senate GOP Health Bill’s Implosion; The Local Damage Repeal Could Do

Opinion writers examine how repealing Obamacare would play out in their states and towns.

The Kansas City Star: Blame Donald Trump For The Collapse Of Health Care Reform
Let’s be clear and up front: President Donald Trump is primarily responsible for this week’s collapse of Obamacare reform. There are other suspects: Sen. Rand Paul, who demanded full repeal and would not compromise. And Senate Majority Leader Mitch McConnell, who cloaked reform efforts in single-party secrecy. Moderates such as Sen. Susan Collins played a role, as did Sens. Mike Lee of Utah and Jerry Moran of Kansas, who drove stakes into the heart of the preferred reform bill Monday night. And, of course, the liberal mainstream media. Might as well throw us in. But the failure is Trump’s. (Dave Helling, 7/19)

Lexington Herald Leader: My Mistake: I Thought GOP Really Wanted To Pass Obamacare Repeal
I owe my liberal Democratic friends an apology. For years they have been saying the congressional GOP was just passing Obamacare repeals for show, and that they didn’t have a valid replacement bill. I defended them, thinking, naively perhaps, that they really did want to repeal the Affordable Care Act, popularly known as Obamacare, and that one of the many bills they had proposed would unify the party and it would pass with a Republican majority in Congress and become law with a Republican president’s signature. (J. Brandon Thompson, 7/19)

WBUR: Who Killed The GOP Health Care Bill? The American People
After eight years of promising voters fix for the ACA’s high deductibles and paltry provider networks, the Republican House and Senate delivered a bill that would have worsened nearly everything that most people hate about health insurance. Their failure is our calling to envision something better and unite behind it. (Miles Howard, 7/20)

Kansas City Star: Repealing Obamacare Outright Would Hurt Kansans
Without enough votes to pass the U.S. Senate’s proposed health reform bill, we’re still hearing calls to simply repeal the Affordable Care Act — including from President Donald Trump. If successful, an outright repeal would greatly harm Kansans and create instability in our insurance markets. (Michael Munger, 7/19)

Lexington Herald Leader: Kentuckians Must Advocate For Their Health Care
Physicians, like our nation, have strong, diverse opinions about the Affordable Care Act and efforts underway to repeal it. As a physician, dean and president of the American Osteopathic Association, which represents more than 129,000 osteopathic physicians (DOs) and medical students, my mandate is to support policies that will ensure patients are better off in the future than they are today. (Boyd R. Buser, 7/19)

Lincoln Journal-Star: Time Ripe For Bipartisan Health Care Revisions
The American Health Care Act is dead. So are the Better Care Reconciliation Act and a repeal of Obamacare without a replacement, as both have sufficient opposition to be dead on arrival. With the Republicans’ efforts for health care reform reduced to smoldering ruins, now what? (7/20)

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Different Takes: A Win For Obamacare?; Women Senators Flex Muscles In Health Care Debate

Editorial writers offer a range of views on how the push to replace the Affordable Care Act reached its current state of collapse and what it means going forward.

The Washington Post: Why Obamacare Won And Trump Lost
The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took health-care policy or the need to bring coverage to millions of Americans seriously. But their bungling also demonstrates that the intense attention to Obamacare over the past six months has fundamentally altered our nation’s health-care debate. (E.J. Dionne, 7/19)

The Wall Street Journal: Obama’s Last Laugh
Like pop-up dolls, across the length of Barack Obama’s presidency, Republicans voted to “repeal” the law that bears his name—ObamaCare. He laughed at them then, and he’s laughing now. No repeal and no replace. They can’t even do repeal and punt. For Democrats, this doesn’t quite make up for losing the election to Donald Trump, but it has to help. Schadenfreude can’t get much better than watching the Republican Party self-humiliate with an abject inability to win while controlling the House, Senate and White House. (Daniel Henninger, 7/19)

Bloomberg: Health-Care Debacle Exposes The Monster In Trump
Let’s put aside for now the extent to which the Affordable Care Act would “fail” without active measures by the White House and the Republican Congress to undermine the state marketplaces; for that matter, ignore the extent to which active Republican resistance, such as the various lawsuits against the law and the decision by many Republican governors to not expand Medicaid, is responsible for a fair number of problems in the first place. Let’s just stipulate for the sake of argument that Trump is correct and the law is doomed if his administration and Republicans in Congress adopt a passive stance of watching and waiting. (Jonathan Bernstein, 7/19)

Bloomberg: Letting Obamacare Fail Would Break Trump’s Oath
Having failed to repeal the Affordable Care Act, President Donald Trump is now stating openly that his plan is to let Obamacare fail instead. 1 Although the end result may be the same, there’s a vast difference between these two options, constitutionally speaking. Repeal is a normal legislative initiative, completely within the power of Congress and the president. But intentionally killing a validly enacted law violates the Constitution’s order that the president “shall take care that the laws be faithfully executed.” (Noah Feldman, 7/19)

Boston Globe: Protecting The Affordable Care Act Was In Trump’s Oath Of Office
At a minimum, if Trump lives up to his threat not to enforce the Affordable Care Act, it will lead to yet more lawsuits against him and his administration like those that have led federal courts to find his Muslim ban unconstitutional. Shirking his constitutional obligation to faithfully execute the laws, and thereby imperiling the health care market and the well-being of millions of Americans, will only bring the nation closer to a constitutional crisis. (Edward Markey, 7/19)

Los Angeles Times: As The Healthcare Bill Goes Down, It’s Another Bad Week For Male Separatists
It’s been a bad week for male separatists. In Washington, D.C., the all-male Republican Senate leadership, which chose not to invite any female senators to their working-group meetings on repealing the Affordable Care Act, watched in frustration as their bill fizzled after those women declined to support it. Sen. Majority Leader Mitch McConnell, demonstrating that overconfidence and sexism often go hand-in-hand, had insisted the bill could succeed without women senators’ input. “Nobody’s being excluded based upon gender,” he said. “Everybody’s at the table.” Sure, if your definition of everybody is “13 middle-aged guys in ill-fitting suits.” (Ann Friedman, 7/20)

The Washington Post: No Women, No Health Care Bill
After Senate Republicans’ second version of a health-care bill collapsed Monday under the weight of more than a dozen senators (male and female) who had concerns, Senate Majority Leader Mitch McConnell decided to just vote on repealing Obamacare without a replacement… And it was Senate Republican women who killed it. (Amber Phillips, 7/19)

The New York Times: If Dr. Trump Were Your Surgeon …
It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet. “We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly. “Er, doctor?” Janet says. “I think my heart is on my left side, not the right.” (Nicholas Kristof, 7/20)

The Hill: How Medicaid Brought Down TrumpCare
Republican efforts to repeal and replace the Affordable Care Act have failed, largely because their legislation did so much more. In their hubris they sought to also dismantle the traditional Medicaid that predated the law by 45 years, something Speaker Paul Ryan had admitted was a dream since his fraternity kegger days. And it was the Medicaid cuts that forced Republicans into their worst public contortions. (Brendan Williams, 7/19)

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Budget Plan That Lays Groundwork For Tax Reform Includes Deep Safety-Net Cuts

The House Budget Committee voted for a plan that would slash $5.4 trillion over the coming decade, including almost $500 billion from Medicare and $1.5 trillion from Medicaid.

The Associated Press: Budget Plan Faces Uncertain Fate After Clearing House Panel
The Budget Committee plan faces opposition from both hard-core conservatives and more moderate Republicans even as it advanced through the GOP-controlled panel on a party-line 22-14 vote. It remains short of the votes required to pass through the House and advance to the Senate, where further complications await. The plan proposes deep cuts to safety net programs like Medicaid and food stamps and reprises a controversial Medicare plan strongly opposed by President Donald Trump — though Republicans are expected to only try to deliver on a small fraction of the cuts. (Taylor, 7/20)

Modern Healthcare: AHCA Savings, $487 Billion In Medicare Cuts Remain In House Budget Proposal
The House Budget Committee on Wednesday agreed to bake in hundreds of billions in Medicaid cuts from its ACA repeal bill to the budget resolution, plus an additional $114 billion in cuts over 10 years. The committee’s Republicans’ unanimously approved the decision with no Democrats on board. The budget resolution, which is the foundation for passing tax reform in the Senate without Democratic votes, also assumes Medicare will reduce spending by $487 million from 2018 to 2027. (Lee, 7/19)

In other spending news —

CQ Roll Call: Contentious Labor-HHS-Education Bill Advances In House
The House Appropriations Committee approved on Wednesday a $156 billion Labor-HHS-Education spending bill for fiscal 2018 that would boost spending for the National Institutes of Health while eliminating funding for Planned Parenthood and other family planning services. Committee members voted 28-22 to send the bill to the House floor after an 11-hour markup that saw 40 amendments proposed but few agreed upon. Two Republican members were not in the room to vote. The bill is $5 billion below current enacted levels (PL 115-31) and about $21.6 billion more than the White House proposed. (Wilkins and Siddons, 7/19)

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Sizing Up Other Key Players: ‘Obamacare Republicans,’ An ‘Unhappy White House’ And, Of Course, Voters

Editorial pages feature different takes on how a range of people — from moderate GOP lawmakers and arch conservatives like Sen. Rand Paul (R-Ky.) — have been center stage in this ongoing health policy debate.

The Wall Street Journal: The ObamaCare Republicans
Senate Republicans killed their own health-care bill on Monday evening, and some are quietly expressing relief: The nightmare of a hard decision is finally over, and now on to supposedly more crowd-pleasing items like tax reform. But this self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. (7/18)

The Washington Post: Don’t Blame The Moderates For The Health-Care Debacle
With the announcement from Sen. Shelley Moore Capito (R-W.Va.) that she would not vote for repeal (at least as defined by the 2015 reconciliation bill that would leave 32 million more Americans uninsured) with no replacement, the whole dreary episode of Republican hypocrisy on Obamacare can come to an end. (Jennifer Rubin, 7/18)

The Washington Post: Raging Over The Health Bill’s Failure, Trump Will Soon Make An Even Crueler Move
Now that the GOP health bill has imploded in the Senate, it’s fitting, in a way, that President Trump is now demanding in a rage that Senate Republicans vote on straight repeal only. If that play fails, as many analysts seem to expect, it will neatly capture just how saturated in cruelty, dishonesty and bad faith the Republican approach — and, more recently, that of Trump — has been all along. (Greg Sargent, 7/18)

Boston Globe: The Human Cost Of Trump’s Health Care Tantrum
Donald Trump’s tantrum on Tuesday, when he said his administration would let the law fail after a Senate replacement plan collapsed, marks an astonishing abdication of responsibility. If the president follows through on his implicit threat to intentionally sabotage the health care market, Trump will inflict a needless burden on millions of consumers. (7/18)

The New York Times: Obamacare’s Future Now Depends On An Unhappy White House
The congressional effort to overhaul the health care system appears to be in shambles. But the current health care system lives on. And decisions the Trump administration makes about how to manage it could have big effects on who has coverage next year, and what it costs them. The Department of Health and Human Services is in charge of administering Obamacare, and so far the department’s staff has given many public indications that it does not enjoy such duties. (Margot Sanger-Katz, 7/18)

Chicago Tribune: The Future Of Obamacare? Voters, Over To You.
The Senate Republican bill to repeal and replace the health law lies in a smoldering heap. Some GOP lawmakers back a loopy repeal-now, replace-later-maybe effort that as of Tuesday already looked to be political toast. You can’t replace something with nothing, or the promise of something later that you’ve failed to deliver today. (7/18)

USA Today: Rand Paul: Time To Repeal Obamacare
There are those who insist Republicans must act as a team to repeal Obamacare. I agree — if the topic is repeal. Every Republican has run on repealing Obamacare for seven years, and all but one voted for clean repeal in 2015. Now we have a president who will sign it and is asking for us to send the same repeal bill to his desk, one that repeals with a two-year window to work with. We also have a majority leader who has said he will bring this vote to the Senate floor. (Sen. Rand Paul, 7/18)

The Wichita Eagle: Sen. Jerry Moran’s Interesting 24 Hours
Jerry Moran began Tuesday as a hero to Kansas moderates, the Sunflower State Republican who took a stand against a second Senate health care bill by criticizing “the closed-door process.” He listened to his constituents, they figured, being one of the few senators to have a town-hall meeting during the July 4 recess. Which makes the rest of the Tuesday so oddly interesting. (7/18)

The New York Times: John Kasich: The Way Forward On Health Care
Columbus — Washington’s approach to health care over the past decade is yet another example of our lawmakers’ increasing distance from the rest of America. First one party rams through a rigid, convoluted plan that drives up costs though unsustainable mechanisms that are now unraveling. Then the other party pursues fixes that go too far the other way — and again ignores ideas from the other side. (Gov. John Kasich, 7/18)

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Analyzing McConnell’s Health Plan Strategery: A Hail Mary Pass? Is The Game Over?

Opinion writers across the country take a hard look at the legislative tactics employed this week by Senate Majority Leader Mitch McConnell (R-Ky.) as his party’s health plan unraveled.

Bloomberg: A Chance For A New Beginning On Health Care
They may have avoided the ditch, but Republicans have driven themselves into a cul-de-sac. After the failure in the Senate of their disastrous plan to replace Obamacare, Majority Leader Mitch McConnell now promises to make his colleagues vote instead on just a repeal of the Affordable Care Act. (7/18)

The Washington Post: McConnell’s Health-Care Hail Mary
To paraphrase Mark Twain, reports of the death of Republican health-care reform are greatly exaggerated. Far from throwing in the towel, as some have reported, Senate Majority Leader Mitch McConnell is actually throwing a final Hail Mary pass in an effort to pass the Senate Republicans’ Better Care Reconciliation Act (BCRA). And he’s found an extremely clever way to do it. (Marc A. Thiessen, 7/18)

San Jose Mercury News: The Game Is Not Over For Mitch McConnell
McConnell’s biggest challenge was getting 50 Republican senators to agree to vote for a “motion to proceed” on a bill that they disagreed with — knowing that it was unlikely to be amended in ways that would make a difference to their final votes given the split between Republican conservatives and moderates and given the Democrats’ refusal to cooperate. Instead of cooperation, Republicans would have to endure an onslaught of politically toxic Democratic amendments, as Senate Democrats forced them to cast one vote after another designed to make them look like monsters come Election Day. (Marc Thiessen, 7/18)

Los Angeles Times: Uh-Oh, The GOP Has No Choice But To Work With Democrats On Healthcare Reform
The sudden collapse of Kentucky Sen. Mitch McConnell’s healthcare bill on Monday was much more than a tactical setback for the Senate Republican leader once considered an unbeatable legislative wizard. It was a catastrophic failure for the GOP’s attempt to make one-party government work. It’s one thing to produce gridlock when control of Congress is divided. When one party manages to produce gridlock all by itself, something is seriously wrong. The setback means that Obamacare will almost certainly survive for the foreseeable future, despite seven years of GOP promises to repeal it. (Doyle McManus, 7/19)

Miami Herald: Suddenly, A Defeated McConnell Sees The Value Of A Bipartisan Healthcare Plan
This is what happens when you try to muscle through in six months — and in secret — what you could have done over seven years. You bear the brunt of the responsibility for the GOP’s disaster of a healthcare plan getting flushed down the tubes. This is what happens when you do anything, short of crawling under a rock, to avoid having to look your scared and angry constituents in the eye at town hall meetings. When you emerge from wherever you’ve been hiding, those constituents are still scared, still angry, having flooded your offices on the Hill with phone calls and emails to make sure you get the message. (7/18)

The Charlotte Observer: The Last Big Republican Lie On Health Care
Moments after the latest Republican health care bill died Monday night, Senate Majority Leader Mitch McConnell proposed that Republicans instead repeal the Affordable Care Act immediately, but let it live for two years while they come up with a replacement. President Trump, at least initially, agreed in a tweet. (7/18)

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Next Directions On Health Policy: Fixes Should Be Bipartisan; Improve The Health Law Or Move On

Opinion writers offer advice to lawmakers about what to do now that efforts to repeal and replace Obamacare seem to have stalled.

The Washington Post: The Bipartisan Way To Strengthen Health Care
You’d think that Republican leaders would have learned their lesson after a second failed attempt to pass the Better Care Reconciliation Act (BCRA) — the Senate GOP’s replacement for the Affordable Care Act. It should come as no surprise that a bill drafted in secret — without holding a single public hearing or garnering the support of a single health-care stakeholder — would face widespread condemnation. (Neera Tanden and Topher Spiro, 7/18)

Los Angeles Times: With Obamacare Repeal Off The Table, Will Republicans Start Trying To Actually Improve Healthcare?
Miillions of Americans whose healthcare coverage was imperiled can breathe a sigh of relief now that congressional Republicans’ reckless efforts to dismantle the Affordable Care Act have foundered. They can thank a handful of courageous moderates in the Senate Republican Caucus for being unwilling to repeal the ACA without having a replacement ready that wouldn’t make matters worse for their constituents. (7/19)

Lexington Herald Leader: Health-Care Fix Must Be Bipartisan
If the Affordable Care Act is the failure that Republicans Mitch McConnell and Donald Trump insist, then getting Congress to repeal and replace it wouldn’t be so difficult. In reality, the law, signed by Barack Obama in 2010, is not a failure, quite the opposite. It has brought security to millions of Americans for whom sickness previously meant bankruptcy or premature death. It has brought greater financial certainty to the hospitals and clinics that care for them. (7/18)

Los Angeles Times: Democrats And Republicans Should Now Agree On These Real Fixes For Obamacare
With Monday’s collapse of the Senate Republicans’ latest effort to repeal the Affordable Care Act, the GOP and the Trump White House are confronted with the question of what to do next, if anything, on healthcare. But that’s a question for Democrats, too. Although there’s a general perception that Democrats consider Obamacare to be the last word on healthcare policy, that’s never been true. The ACA was the product of compromise from its inception, and also something of an experiment. No one was sure how all its moving parts would work. (Michael Hiltzik, 7/18)

Milwaukee Journal Sentinel: On Health Care, Republicans Should Work With Democrats
Now that the plan to “repeal and replace” Obamacare is dead and the plan to “repeal now, replace later” has expired ignominiously, what’s the next treatment noted health care specialists Donald Trump, Paul Ryan and Mitch McConnell will try?… But instead of sabotaging the Affordable Care Act, Republicans should work with Democrats to shore up the insurance exchanges that are at the heart of the ACA. (David Haynes, 7/18)

The Des Moines Register: To Congress: Improve Obamacare Or Move On
Republican leaders in U.S Congress are the epitome of lost and dysfunctional. When it comes to health insurance, it is painfully clear they have no idea what they’re doing or seeking. The Affordable Care Act needs to be improved, and that should be lawmakers’ goal. But that seems impossible for this group of elected officials. Americans are tired of the shenanigans. (7/18)

The Kansas City Star: Republicans Should Move On From Obamacare Repeal
The Republican Party’s effort to repeal the Affordable Care Act and replace it with something — maybe now, maybe a few years from now — stumbled to a predictable stalemate Tuesday. The GOP hates Obamacare. But after seven years of debate, Republicans still can’t agree on how to make it better. (7/18)

The Wall Street Journal: Medicaid’s Potemkin Health Coverage
If ObamaCare’s expansion of Medicaid were measured merely by growth in enrollment and spending, California’s Medi-Cal program would rank as a huge success. Since 2012, Medi-Cal has added six million beneficiaries, primarily able-bodied adults of working age. Covering them last year brought California nearly $20 billion in additional federal funds. If Medi-Cal were a state, its population of 14 million would make it the fifth-largest in the U.S. The program’s $103 billion budget is about three times the size of Illinois’s general fund. (Allysia Finley, 7/18)

Arizona Republic: Will Trumpcare 2.0 Pay For An Operation Like McCain’s?
Now that the Senate replacement for the Affordable Care Act has gone down the toilet, where it belongs, perhaps President Donald Trump will fashion something that lives up to his campaign promises – a plan where every American will get the kind of care received recently by Sen. John McCain.T he Republican plan wasn’t close. (EJ Montini, 7/18)

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Parsing The Post Mortems: Is The GOP’s Health Bill Collapse A ‘Victory For The Truth’ Or A ‘Bipartisan Failure’?

There are no shortages of thoughts and opinions regarding what went wrong with the Republicans Obamacare repeal-and-replace effort.

The New York Times: The Health Care Collapse Is A Victory For The Truth
After Donald Trump won the presidency, many Americans despondently wondered whether facts mattered anymore. Trump, after all, won the presidency despite a constant stream of falsehoods. He launched his political career with a lie about Barack Obama’s birthplace and just kept on lying, about almost every imaginable subject. He also admitted to being a sexual molester. He refused to release his tax returns, unlike every other modern nominee. And yet he was elected president of the United States. There was, and still is, ample reason for despondence. (David Leonhardt, 7/18)

Bloomberg: Congress Achieves Bipartisan Failure On Obamacare
For months, I’ve been watching in a sort of wonder as Republicans crafted the most unpopular major bill in living memory. Could they really mean to make a suicide charge at this –not some longstanding Republican goal, like dismantling the welfare state or slashing through the regulatory thicket, but pushing a sly parody of Obamacare even less likable than its awkward source material? When Republicans explained how this would actually be a strong campaign strategy for 2018, I had astonished flashbacks to Democrats saying the same thing in 2010 … and wondered when it was that people in Washington started believing their own press releases. Were we really due for the Republican version of the 2010 Democratic lemming run? (Megan McArdle, 7/18)

Bloomberg: Repeal And Replace Dies Again. So?
Repeal and replace is dead. Again. Perhaps for good this time. But perhaps not. Here’s what matters now: Will Republicans in Congress hear a sustained, effective push from the White House to revive a viable bill? Will Republicans in Congress hear a sustained, effective push from Republican-aligned interest groups? Will Republicans in Congress hear from rank-and-file Republican constituents who are outraged that the promise they ran on for the last seven years may disappear without a vote? (Jonathan Bernstein, 7/18)

The Wall Street Journal: The Result Of GOP Failure
It’s no excuse for Republican ineptitude, but there is little market in America, and none in the GOP apparently, for coherent health-care policy, to the modest degree that such a description can even apply in Washington. Republicans, and arguably American voters, don’t want an individual mandate. They do want coverage of pre-existing conditions. (Holman W. Jenkins Jr., 7/18)

USA Today: The Obamacare Repeal Fiasco
Tellingly, the latest and perhaps last Republican strategy on health care is a measure that would repeal the Affordable Care Act in two years with no replacement in sight. So much for repeal-and-replace. Republicans did not have a viable alternative to the ACA when they staged their first repeal vote seven years ago. They don’t now, and in all probability would not in two years even if the repeal measure were to pass. (7/18)

The New York Times: The Trumpcare Bonfire
It will come as a huge relief to millions of Americans that Republican lawmakers have struck out in their attempts to destroy the Affordable Care Act — at least for now. But this ideological exercise in futility has already done great damage to the health care system. (7/18)

USA Today: What Killed Senate Health Care Bill? Liberal Medicaid Alarmism
The Senate health care bill is dead, and that’s at least in part due to overheated rhetoric from the left about Medicaid. Many of the over-the-top claims lacked important facts or context, and seemed primarily designed to scare people rather than prompt civil debate. (Chris Jacobs, 7/18)

The Wall Street Journal: Turns Out Governing Is Hard
At a meeting with GOP senators on Monday night, President Trump reportedly said that Republicans would look like “dopes” if they couldn’t pass a health-care bill. “If the Republicans have the House, the Senate and the presidency and they can’t pass this health-care bill, they are going to look weak,” Politico reports Mr. Trump said. “How can we not do this after promising it for years?” (William A. Galston, 7/18)

RealClear Health: The GOP’s Collision With Health Care Reality
The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election. (James C. Capretts, 7/19)

USA Today: Obamacare Repeal Fever: Obvious Fixes, Or A Disastrous Mess?
With the Republican alternative to Obamacare dead, Republican Senate Majority Leader Mitch McConnell, as much a representative of the Republican establishment class as you will find in Washington, and President Donald Trump, leader of the populist rebellion, agreed that what Republicans needed to do is repeal the Affordable Care Act now and come up with some kind of alternative later. (David Mastio and Jill Lawrence, 7/19)

WBUR: Obamacare: What Doesn’t Kill It Makes It Stronger
As the nation considers the utter collapse of the Better Care Reconciliation Act (BCRA), advanced by Senate majority leader Mitch McConnell, to repeal and replace the Affordable Care Act (ACA), some perspective is in order. Since President Donald Trump’s November 8th election, I have heard many people’s distress about the dire threats to the ACA that initially seemed so certain last November. (John McDonough, 7/18)

St. Louis Post-Dispatch: Yet Another GOP Health Care Bill Bites The Dust. Good
This week’s failure of the Better Care Reconciliation Act, version 5.0 of the Republican health care plan, can best be understood by reviewing two famous statements Donald Trump made about health care policy. Very early in his campaign for president, Trump promised that the Affordable Care Act would be repealed and replaced with “something terrific.” (7/18)

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State Highlights: USC To ‘Examine And Address’ Accusations Against Former Med School Dean; Disabled Residents Protest Conn. Budget

Media outlets report on news from California, Connecticut, Massachusetts, Missouri, New Hampshire, New York, Minnesota and Wisconsin.

Los Angeles Times: USC President Tries To Quell Outrage Over Drug Allegations Against Former Medical School Dean
Acknowledging widespread concern on campus, USC President C.L. Max Nikias said Tuesday the university would “examine and address” a report in The Times that its former medical school dean abused drugs and associated with criminals and drug users. Nikias, speaking about the controversy for the first time in a letter to the campus community, said that “we understand the frustrations expressed about this situation” involving Dr. Carmen A. Puliafito and “we are working to determine how we can best prevent these kinds of circumstances moving forward.” (Parvini and Hamilton, 7/18)

The CT Mirror: Malloy Enlists Disabled In Budget Fight — Gets Protest At His Office
A day after Gov. Dannel P. Malloy all but invited disabled recipients of state services to lobby for a new budget, some did: They targeted him in a demonstration that ended with the arrest of five protesters in his outer office at the Capitol. State Capitol police issued summonses for third-degree trespassing to five protesters, three of whom arrived in either wheelchairs or a motorized scooter, after they refused to leave. (Werth and Pazniokas, 7/18)

WBUR: Gov. Baker Pushes Lawmakers For MassHealth Reform
In June, Baker announced a suite of proposals to rein in MassHealth spending — including shifting 140,000 low-income people from MassHealth onto commercial insurance plans. … Now, the governor has given them a two month deadline to take another look at his reforms, or face additional budget cuts elsewhere. (Bruzek and Chakrabarti, 7/18)

The New York Times: Uber Discriminates Against Riders With Disabilities, Suit Says
All around Valerie Joseph, there is a fleet of Uber cars rolling by on New York City streets. But though she could really use the ride-hailing app, Ms. Joseph said she does not bother because Uber has so few wheelchair-accessible cars to dispatch. “It’s plain unfair,” said Ms. Joseph, 41, who relies on a wheelchair. (Hu, 7/18)

Sacramento Bee: Sacramento’s Western Health Advantage Expands Health Coverage In Bay Area
Western Health Advantage, the managed-health plan founded by Sacramento and Solano County doctors in 1996, is further expanding its coverage in the Bay Area and will partner with providers in the UCSF medical system and John Muir Health to cover more populous counties, CEO Garry Maisel said Tuesday. … Those North Bay counties are home to roughly 911,132 residents, according to January 2017 population estimates by the California Department of Finance, compared with 4,429,303 in the counties now being added: San Francisco, San Mateo, Alameda and Contra Costa counties. (Anderson, 7/18)

Milwaukee Journal Sentinel: Democrats Say Gov. Scott Walker Accepted Donation From Marijuana Trade Group
Two Democratic lawmakers and a liberal advocacy group criticized Gov. Scott Walker on Tuesday for accepting a donation from a marijuana trade group on behalf of the Republican Governors Association at the same time he’s championing drug testing for Medicaid and food stamp recipients. The state’s budget-writing committee approved Walker’s proposal to drug test able-bodied adults who want public assistance in May. (Price, 7/18)

WBUR: Here Are The Details Of The Compromise Marijuana Bill
More than eight months after adult recreational use marijuana was approved by Massachusetts voters, a group of state lawmakers has reached a compromise bill making changes to the law, setting the stage for the opening of retail cannabis shops on July 1 of next year… <span>Both the House and Senate are expected to approve the compromise later this week, with the bill likely landing on Gov. Charlie Baker’s desk before the weekend.</span> (Brown, 7/18)

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GOP Senators Balk At Repeal-Only Proposal: ‘There Is Enough Chaos And Uncertainty Already’

Jul 19 2017

Three Republican senators have already said they won’t vote for a plan that only repeals the Affordable Care Act without coming up with a replacement. But Senate Majority Leader Mitch McConnell, wanting the lawmakers on record, says he’ll still hold a vote to proceed next week.

The New York Times: The 3 Republican Women Who Doomed A Senate Repeal Of The Health Law
It was men who started it. It may be women who finished it. The Senate effort to repeal the Affordable Care Act, a process that began with 13 Republican men drafting a plan behind closed doors, collapsed Tuesday, as three Republicans said they would not support an ultimately futile attempt to simply roll back the current health care law without a replacement. (Huetteman, 7/18)

The Washington Post: Senate Republicans’ Effort To ‘Repeal And Replace’ Obamacare All But Collapses
Hours after GOP leaders abandoned a bill to overhaul the law known as Obamacare, their fallback plan — a proposal to repeal major parts of the law without replacing them — quickly collapsed. A trio of moderate Republicans quashed the idea, saying it would irresponsibly snatch insurance coverage from millions of Americans. “I did not come to Washington to hurt people,” tweeted Sen. Shelley Moore Capito (R-W.Va.), who joined Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) in opposing immediate repeal. (Eilperin, Sullivan and O’Keefe, 7/18)

The Wall Street Journal: GOP Stares Down Loss On Health-Care Bill
“To just say, ‘Repeal and trust us—we’re going to fix it in a couple years,’ that’s not going to provide comfort to the anxiety that a lot of Alaskan families are feeling right now,” GOP Sen. Lisa Murkowski of Alaska told reporters. “There is enough chaos and uncertainty already.” (Peterson, 7/18)

Bloomberg: McConnell’s New Obamacare Repeal Lacks GOP Votes To Pass 
Collins of Maine told reporters that repealing the law now and then hoping for a replacement “would create great anxiety for individuals who rely on the ACA.” She said she would oppose bringing a repeal bill up for debate. “I believe it would cause the insurance markets to go into turmoil.” (Litvan and Dennis, 7/18)

Politico: New GOP Plan To Repeal Obamacare Meets Fatal Opposition
But McConnell said Tuesday evening that he would hold a vote to proceed to the bill “early next week,” which would put senators on the record even if the vote’s outcome was preordained. McConnell said the vote was “at the request of the president and vice president and after consulting with our members.” (Kim, Haberkorn and Everett, 7/18)

The Hill: McConnell: Senate To Try To Repeal ObamaCare Next Week 
“For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the ObamaCare repeal bill early next week,” McConnell said from the Senate floor on Tuesday night. (Carney, 7/18)

NPR: Repealing Obamacare Is A Risky Gambit Without A Replacement At Hand
The replacement bill’s language is based on the repeal bill that that passed by the House and Senate in 2015 but was vetoed by President Barack Obama. Here’s how the repeal would have changed the Affordable Care Act, compared with the House and Senate bills. (Kodjak, Hurt and Grayson, 7/18)

Boston Globe: What Happens If Obamacare Is Repealed Without A Replacement?
Republicans on Monday abandoned their latest effort to replace the Affordable Care Act, and some — including President Trump — are now considering an attempt to repeal President Obama’s signature health care law without a replacement bill. Any effort to simply repeal Obamacare is likely to be blocked, but what would happen if the landmark 2010 heath care bill was repealed? (Rocheleau, 7/18)

A look at where other politicians stand on the issue —

New Orleans Times-Picayune: Bill Cassidy Won’t Say Whether He Supports GOP Leadership On Health Care Vote 
Louisiana Sen. Bill Cassidy stopped short of saying he would vote against U.S. Senate Majority Leader Mitch McConnell’s latest proposal to repeal the Affordable Care Act with no immediate replacement. But Cassidy also wouldn’t say he would support McConnell’s effort either in an interview Tuesday (July 18). Instead, the Republican senator said he would continue to pursue the health care replacement plan he put together with South Carolina Sen. Lindsay Graham, also a Republican. A few weeks ago, he had been working with Maine Sen. Susan Collins, another Republican, on a health care replacement strategy as well. Neither plan assembled by Cassidy has gained traction with the rest of the Senate.  (O’Donoghue, 7/19)

The Baltimore Sun: Hogan Balks At Repeal-Only Plan, Saying It Would Leave Millions Without Coverage 
For months, Maryland Gov. Larry Hogan has mostly avoided the political storm raging in the nation’s capital, skirting questions about President Donald Trump and the policy changes his new administration has embraced. But on health care, Hogan appears to be finding his voice. For the second time in as many months, the centrist Republican governor who has eschewed national politics weighed in directly about his party’s faltering efforts to repeal Obamacare — arguing Tuesday that the latest push by Senate leaders could leave millions without insurance. (Fritze, 7/18)

Denver Post: John Hickenlooper Joins Other Governors In Urging Senate Not To Just Repeal Obamacare
Colorado Gov. John Hickenlooper joined his Republican counterparts Tuesday — including Ohio Gov. John Kasich and Nevada Gov. Brian Sandoval — in urging the U.S. Senate not to repeal Obamacare without a replacement. “Congress should work to make health insurance more affordable by controlling costs and stabilizing the market, and we are pleased to see a growing number of senators stand up for this approach,” Hickenlooper and 10 other governors said in a written statement. “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later.” (Paul, 7/18)

Orlando Sentinel: Gov. Scott Still Seeking Obamacare Repeal Despite Senate Health Bill Failure
Gov. Rick Scott, whose political career is largely defined by opposition to the Affordable Care Act, still wants Republicans to repeal the federal health care law despite their apparent failure to do so… The statement appears at odds with President Donald Trump’s solution, to “let Obamacare fail,” in light of the Senate GOP’s inability to pass its own health care bill, dubbed the Better Care Reconciliation Act. (Rohrer, 7/18)

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Viewpoints: History Offers Lessons In Addressing Opioid Addiction Crisis; Minority Communities And Access To Mental Health Care

Opinion writers offer their thoughts on a range of health issues.

Bloomberg: This Isn’t The First U.S. Opiate-Addiction Crisis
It’s true that there’s an opioid epidemic, a public health disaster. It’s not true that it’s unprecedented. A remarkably similar epidemic beset the U.S. some 150 years ago. The story of that earlier catastrophe offers some sobering lessons as to how to address the problem. (Stephen Mihm, 7/17)

Lexington Herald Leader: Ky.’s New Opioid Law Will Only Result In More Death, Pain
As the death toll from opioid overdoses in Kentucky and the rest of the Midwest continues to soar, it’s truly disconcerting to see that policymakers are taking steps that are not only devoid of medical and common sense, but virtually guaranteed to make matters worse. The recent passage of the ill-conceived House Bill 333, which imposes a three-day limit (with certain exceptions) on opioid prescribing, reflects a fundamental misunderstanding of the reasons behind the addiction epidemic. (Josh Bloom, 7/14)

Miami Herald: Minority Communities Lack Access To Mental Healthcare
Despite the need for mental health services, minorities are not seeking medical care. Even when they do seek treatment, they are less likely to receive adequate mental health care and tend to drop out of treatment two to three times more frequently. (Daniel Jimenez, 7/17)

Lincoln Journal-Star: Nebraska Needs Family Planning Clinics
In our neighboring state of Iowa, 15,000 people lost access to preventive care and contraception as Planned Parenthood clinics shut down earlier this month after Iowa politicians passed a law to stop reimbursing the trusted provider for health services. (Mia Fernandez, 7/18)

Stat: It’s Time To Break Down The Wall Between Dentistry And Medicine
In 1840, dentistry focused on extracting decayed teeth and plugging cavities. Today, dentists use sophisticated methods for prevention, diagnosis, and treatment. We implant teeth, pinpoint oral cancers, use 3-D imaging to reshape a jaw, and can treat some dental decay medically, without a drill. We’ve also discovered much more about the intimate connection between oral health and overall health. Periodontal disease, also known as gum disease, has been linked to the development of diabetes, high blood pressure, and cardiovascular disease. Pregnant women with periodontitis are more likely to develop pre-eclampsia, a potentially serious complication of pregnancy, and deliver low-birth-weight babies. (Bruce Donoff, 7/17)

Austin American-Statesman: Vaccines Protect Texas Children
When kids are vaccinated, there is less concern that they will contract diseases when they go with their friends to the local swimming pool or the playground… Pockets of parents in Texas and other states have become complacent because they don’t regard these diseases as threats to their children, while others don’t believe these diseases exist any longer. (Terry Cook, 7/18)

The Des Moines Register: Postpartum Psychosis Claimed Molly Roth. Her Husband Hopes To Save Others
But two weeks after Gracelyn arrived Jan. 5, Molly encountered her biggest hurdle. A nurse practitioner called it the “baby blues,” a benign term for a sometimes monumental change that affects about one in five new mothers. Normally a whirlwind of energy, the 32-year-old Molly, who used to make sure everyone else was OK, now had to drag herself through the motions of daily life. She would cry uncontrollably and say she had made a mistake. About a month in, she was diagnosed with postpartum depression and put on a handful of medicines, Jamison says. By then she was struggling just to bathe: “I had to show her the simple steps of turning on the water and getting a towel.” She talked of suicide. What she was suffering from, according to Jamison, was actually a rarer, more dangerous perinatal mood disorder called postpartum psychosis, compounding her existing anxieties. (Rekha Basu, 7/17)

Los Angeles Times: Domestic Violence Victims Shouldn’t Have To Choose Between Deportation And Medical Care
When Elena attempted to break up with her abusive boyfriend, he beat her horribly, saying he would leave her with scars by which to remember him. Although badly injured, she did not contact the police to report the domestic violence. Nor did she seek medical care for her open wounds or the ringing in her ear. She had heard news of President Trump’s expanded immigration enforcement policies and stories of immigration agents arresting domestic violence and human trafficking victims inside courthouses. She had also learned that her state, California, requires medical professionals to report domestic violence and sexual assault to the police, and she feared deportation more than she desired medical care. (Jane K. Stoever, 7/17)

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Perspectives: The Senate GOP Health Bill Appears To Have Collapsed… But What Could Happen Next?

Editorial pages parse the breaking news late Monday night when two more Republican senators announced their opposition to the measure. What has gone wrong? What paths could go forward? And what issues remain in play?

The New York Times: In Congress, Obstructionists Are Obstructing Themselves
Republican legislative leaders are in a bind. While they appear to have failed for now in their goal of destroying the Affordable Care Act, their eagerness to shower tax breaks on the wealthy at the expense of health coverage for millions of Americans has crimped their ability to pass other fiscal legislation. (7/18)

The Washington Post: Is Trumpcare Finally Dead?
Perhaps the two “no” votes from Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) would have been enough to sink the GOP health-care effort. Senate Republicans and virtually all political watchers have been cultivating a sense of suspense — who would be the third “no” vote? — when in fact there are likely, according to Collins, many more “no” votes (eight to 10, she said in TV interviews Sunday). Then a very public and simple barrier to passage emerged — Sen. John McCain’s (R-Ariz.) undetermined recuperation time. With two “no” votes already clinched, Senate GOP leaders could not even pretend to have sufficient support without McCain (who actually might be a “no” vote in the end). Now comes perhaps the death knell for Trumpcare: Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) both announced their opposition Monday night. (Jennifer Rubin, 7/17)

RealClear Health: The Disturbing Process Behind Trumpcare
Since I came to Washington in 1969, I have been immersed in Congress and its policy process. I have seen many instances of unpopular bills considered and at times enacted. I have seen many instances of bills put together behind closed doors. I have seen bills enacted and repealed after a public backlash. I have seen embarrassing mistakes in bills, and lots of intended consequences. (Norm Ornstein, 7/17)

Los Angeles Times: Is Rand Paul’s Opposition To The GOP Health Bill Principled, Or Cynical?
Thhe greatest trick any politician can pull off is to get his self-interest and his principles in perfect alignment. As Thomas More observed in Robert Bolt’s “A Man for All Seasons,” “If we lived in a State where virtue was profitable, common sense would make us good, and greed would make us saintly.” Which brings me to Sen. Rand Paul, the GOP’s would-be Man for All Seasons. Paul has managed to make his opposition to the GOP’s healthcare bill a matter of high libertarian principle. The fact that the bill is terribly unpopular in his home state of Kentucky — where more than 1 out of 5 Kentuckians are on Medicaid — is apparently just a coincidence. (Jonah Goldberg, 7/18)

McClatchy: The GOP Is Bungling Obamacare Repeal, And Democrats Could Be The Winners
The Republican Party in Congress could be on the verge of losing the 2018 midterm elections 16 months before they happen. Since 2010, the GOP has been vowing and planning and stunting to repeal the Affordable Care Act, that transformative legislative Frankenstein that Democrats crammed through Congress in 2010 without a single Republican vote. (Andrew Malcolm, 7/18)

The Wichita Eagle: Enough Flim-Flam: Move On Now To Solve Health Care Puzzle
When the Senate majority leader wields the possibility of bipartisanship as a threat and dismisses massive cuts to Medicaid as a shell game, you know it’s time to move on. Sen. Mitch McConnell’s desperate scramble for one or two more votes to repeal and replace the Affordable Care Act has actually reached those moral depths. And it isn’t working for congressional Republicans, let alone the American people. (Dave Merritt, 7/18)

Los Angeles Times: How I Got Caught In The Crossfire Between V.P. Pence And Ohio Gov. Kasich Over Medicaid
At the National Governors Conference on Friday, Vice President Mike Pence took Ohio Gov. John Kasich to task in a speech attacking the Affordable Care Act’s Medicaid expansion. Pence presumably had two goals. The first was to silence Kasich, the loudest voice among GOP governors opposed to congressional Republicans’ efforts to drastically roll back Medicaid as part of their ACA repeal plans. The second was to justify that rollback by claiming that the Medicaid expansion eroded services for the program’s traditional beneficiaries, including the disabled. (Michael Hiltzik, 7/17)

The Wall Street Journal: Return Medicaid To Its Rightful Role
Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans. Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation. (Frank Keating and Doug Beall, 7/17)

Bloomberg: HSAs Can Show The Way To Bipartisan Health Reform
The Senate Republicans’ latest plan to overhaul Obamacare includes a significant expansion of Health Savings Accounts (HSAs), but exacerbates a key longstanding problem: HSAs provide significant tax benefits to those Americans who need the least help. That provides an opening for bipartisan compromise. Democrats and Republicans could find agreement on creating “equitable HSAs” — that is, HSAs that are subsidized more equally for everyone — to reform the healthcare system. (Samuel Estreicher and Clinto Wallace, 7/17)

Bloomberg: Taxing Hospitals Is A Lousy Way To Fix Health Care
Before Obamacare passed, we were bombarded with statistics about the uncompensated care that hospitals provide. The numbers were large — in the tens of billions — and the implication was that this was something of a national emergency. Certainly it was one very good reason to pass the Affordable Care Act, so that hospital budgets wouldn’t groan under unpaid bills, and the people getting care could be sure that they wouldn’t get turned away at the hospital door. (Megan McArdle, 7/17)

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State Highlights: D.C.’s Aid-In-Dying Law Takes Effect, Setting Up Showdown With Congress; N.H.’s Mental Health Services Still Found Lacking

Media outlets report on news from D.C., Massachusetts, Kansas, Iowa, New Hampshire, California, Ohio, Colorado and Michigan.

The Washington Post: Assisted Suicide Is Legal And Available In D.C. — For Now
District officials say doctors in the city may now begin the process of prescribing life-ending drugs to terminally ill patients, setting up a showdown with Republicans in Congress who are trying to void the city’s assisted-suicide law. City officials say the rules and regulations to implement the law took effect Monday, adding the District to six states that authorize the practice. (Nirappil, 7/17)

San Jose Mercury News: End Of Life: Family Sues UCSF For Refusing To Help Woman Die
In what may be the first-of-its-kind lawsuit related to California’s End of Life Option Act, the family of a San Francisco terminally ill cancer patient is suing the UC San Francisco Medical Center alleging that her physician and the system misrepresented that they would help the dying woman use California’s right-to-die law when her time came. Instead, according to the July 7 civil lawsuit filed in San Francisco Superior Court, Judy Dale’s wish for a peaceful death was denied to her by the defendants’ “conscious choice to suppress and conceal’’ their decision that they would not participate in the law, despite Dale’s repeated indications to doctors and social workers that she intended to use its provisions. (Seipel, 7/17)

New Hampshire Public Radio: Outside Review Says State Lagging In Some Key Areas Of Mental Health Reform
Three years after the state reached a major legal settlement meant to reform its mental health system, both the outside reviewer hired to monitor the state’s progress and the advocacy organization that sued on patients’ behalf say there’s still significant work to be done. The state is required to submit to regular outside reviews of its mental health offerings as part of a multi-million dollar settlement reached three years ago, as a result of a class action lawsuit brought by the Disability Rights Center of New Hampshire. (McDermott, 7/17)

The Associated Press: Kansas Board Revokes Doctor’s License Again In Abortion Case
Kansas’ medical board for the third time has revoked the license of a doctor whose second opinions allowed the late Dr. George Tiller to perform late-term abortions more than a decade ago. The State Board of Healing Arts acted against Dr. Ann Kristin Neuhaus over what it previously concluded were her inadequate records for 11 patients aged 10 to 18 who sought abortions in 2003. Kansas law at the time required a second doctor to conclude that continuing a pregnancy would permanently harm a patient’s physical or mental health. (7/17)

Iowa Public Radio: First Day Of Testimony In Abortion Restrictions Trial
The medical director of Iowa’s largest abortion provider took the witness stand today in Polk County District Court. Dr. Jill Meadows of Planned Parenthood of the Heartland and the ACLU of Iowa are suing the state, saying that new restrictions on abortion create an undue burden for women. There’s currently an injunction on the new law which requires a woman to have an ultrasound three days before terminating her pregnancy. (Boden, 7/17)

State House News Service: Baker Vetoes $320 Million, Returns Assessments With MassHealth Reforms
Baker signed a budget for fiscal 2018 on Monday afternoon that includes $39.4 billion in spending after he vetoed $320 million from the plan, and went even further than House and Senate budget negotiators to revise tax revenue projections downward for this year by $749 million. The governor also returned to the Legislature a new assessment on employers that he initially proposed to help pay for growing MassHealth expenses, calling on lawmakers to act quickly to package the $200 million in new employer fees with MassHealth reforms that lawmakers laid aside during budget deliberations. (Murphy, 7/17)

Denver Post: Boulder-Based Techstars And Foundry Invest In “Airbnb Of Health Care”
Armed with Boulder money, a California health insurance startup is trying to make it big. But not by selling plans — just by telling people about them. Impact Health is sort of like a dating service, or maybe an Airbnb. First, put in your preferences and history, then the algorithms find you a match: a health insurance plan. The company serves about 59,000 people, according to chief executive and co-founder Christine Carrillo, but they have lofty goals — and that’s where Techstars Venture Capital Fund and Foundry Group can help. (Douglas, 7/17)

Detroit Free Press: Doctor Claims Mike Morse Demanded Kickbacks
Southfield attorney Mike Morse demanded kickbacks and fudged test results in return for patient referrals, according to claims made by a Clarkston doctor who plead guilty to conspiracy to commit wire fraud. Dr. Ram Gunabalan swore to the accusations in a 49-page affidavit filed in federal court last week. The document lays out a series of allegations of questionable dealings Gunabalan said he had with Morse and others related to the treatment of auto accident patients in lawsuits. (Wisely and Reindl, 7/17)

San Francisco Chronicle: Sonoma County Challenges For Pot Supremacy As Others Turn Away
Craft cannabis is becoming a cousin to craft beer in Sonoma County, and the venture by the founder of the San Francisco Patient and Resource Center, or SPARC, is among several operations awaiting permits to grow and manufacture medical marijuana — and, presumably, recreational pot in the future. Around the state, the mainstreaming and legalization of marijuana is prompting many cities, even liberal ones, to fear trouble and shun the exploding industry. (Fimrite, 7/17)

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When It Comes To Path Forward, Intra-Party Discord Isn’t Limited To GOP

There’s a strong push from the left-wing of the Democratic Party for a single-payer system, but others aren’t convinced that’s the way to go.

McClatchy: Obamacare Repeal: Democrats Divided On Single Payer Health Care
Democrats showed uncommon unity in fighting Republican efforts to repeal and replace the Affordable Care Act, and it appeared to be working Monday as two more GOP senators said they can’t support the latest version. But Democrats’ discipline masks a deep and fundamental divide within the party that could complicate efforts to gain ground in the 2018 election and beyond. (Clark, 7/17)

The Hill: Sanders ‘Delighted’ By Failure Of GOP Health Plan 
Sen. Bernie Sanders (I-Vt.) said he’s “delighted” to see GOP senators fleeing from the chamber’s latest version of an ObamaCare repeal-and-replace bill. “I am delighted to see that the disastrous Republican health care plan will not succeed,” he wrote in a statement. (Master, 7/17)

Meanwhile, in New York —

The Wall Street Journal: Cuomo And De Blasio Team Up To Oppose GOP’s Health-Care Efforts
The Republican push to repeal the Affordable Care Act on Monday momentarily united two New York Democrats who are often at odds. Gov. Andrew Cuomo and New York City Mayor Bill de Blasio have long sparred with one another, most recently blaming the other for troubles at the Metropolitan Transportation Authority, and they rarely appear together. (Vilensky and Alfaro, 7/17)

Reuters: New York Attorney General Says Will Sue Over Obamacare Repeal
New York state Attorney General Eric Schneiderman intends to sue the federal government if Republican lawmakers pass proposed legislation to overhaul the U.S. healthcare system, his office said on Monday. Schneiderman’s office said it has identified “multiple constitutional defects” with the Republican healthcare bills. (Levine, 7/17)

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