Tagged States

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.

State Highlights: Audit Of Colo. Insurance Exchange Still Finds Deficiencies; Indian Reservation Declares Public Emergency Over Opioid Crisis

Media outlets report on news from Colorado, Missouri, Minnesota, California, Florida, Massachusetts, Texas, Kansas and Wisconsin.

Denver Post: Connect For Health Colorado Is Making Progress To Fix Accounting Troubles
Colorado’s health insurance exchange has made progress in addressing repeated accounting troubles but still fails to always follow its own policies when it comes to contracts and purchases, according to a state audit released Tuesday. The audit of the exchange, known as Connect for Health Colorado, found that 11 percent of payments analyzed — which came out to about $50,000 — did not have the proper documentation. The same was true for nearly $4 million in contract costs. In one instance, the audit found that Connect for Health’s general counsel signed off on a nearly $3 million database contract despite not having the authority to do so for contracts that big. (Ingold, 7/25)

The Star Tribune: Red Lake Indian Reservation Declares Public Health Emergency Over Drug Epidemic
A rampant heroin and opiate epidemic on the Red Lake Indian Reservation has prompted tribal leaders to declare a public health emergency, seek outside help in addressing the crisis and consider the extraordinary step of banishing tribal members involved in drug dealing. … Overdoses on the northern Minnesota reservation have increased significantly in the past few months, tribal leaders said, adding that the problem has worsened with the arrival of more heroin and more of it laced with deadly fentanyl. (Smith, 7/26)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean’s Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

Miami Herald: Jackson Health Proposes $1.9 Billion Spending Plan For 2018
Jackson Health System is counting on growth in its core operations — plus an estimated $442 million from Miami-Dade taxpayers — to break even on a proposed $1.9 billion spending plan for 2018 approved by hospital trustees on Tuesday. Salaries and benefits for Jackson’s 12,000 full-time employees, who will receive an average 2 percent pay raise next year, tops the hospital system’s list of expenses for next year at about $1.1 billion or 59 percent of the total. (Chang, 7/25)

The Star Tribune: Minneapolis Menthol Tobacco Sales Restriction Vote Delayed Until Aug. 2
Opponents of restricting menthol tobacco sales in Minneapolis claimed victory Tuesday after a City Council committee failed to vote on the ordinance and send it to the full council, though members will vote on the proposal Aug. 2. An already-depleted Health, Environment and Community Engagement Committee fell to three members and lost its quorum when Council Member Alondra Cano stepped out near the end of a lengthy public hearing, delaying the vote. (Belz, 7/25)

St. Louis Public Radio: Missouri Doctor Grapples With State’s High Rate Of Deaths In Childbirth
Twice as many United States women are dying in childbirth today as in 1990, even though all other wealthy nations have seen declines in maternal mortality rates. …Dr. Shilpa Babbar, who specializes in high-risk pregnancies at SSM Health St. Mary’s Hospital in St. Louis County, said that rising rates of obesity and women having children later in life may help explain these figures. (Bouscaren, 7/26)

Health News Florida: Nonprofit Group: HIV Infections Up In Florida
A nonprofit that serves Central Florida residents with HIV and AIDS says the rates are going up. …[Joshua] Meyers said the Ryan White figures show 600 new HIV infections in Orlando last year, which made Orlando the city with the sixth highest infection rate in the country – up from No. 8. (Aboraya, 7/25)

KQED: California Decides All Drinking Water Must Be Tested For A Toxin. But Who Pays?
The State Water Resources Control Board on July 18 adopted the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. …Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to data from the state water board. (O’Neill, 7/25)

Minnesota Public Radio: Threats To Drinking Water Supplies Intensifying, Health Dept. Says
Minnesota’s public drinking water supplies are in good shape, according the state’s Department of Health, but a new report also warns agencies should remain prepared for that to change. …Minnesota also needs to be prepared to address other pollution in the water supply, including nitrate contamination, which the report states is an ongoing concern for a several areas of the state. (Richert, 7/25)

The Star Tribune: Baby Deliveries To End At St. Joseph’s Hospital In St. Paul
Facing changing demographics and a steep dropoff in demand, the state’s oldest hospital will discontinue maternity care this year. HealthEast Care System’s St. Joseph’s Hospital made the move because fewer women are choosing the St. Paul facility for their baby deliveries. Health system leaders announced the decision Tuesday, noting that women will still be admitted for maternity care through Sept. 7 and that babies will still be delivered until Sept. 10 at HealthEast’s flagship hospital — Minnesota’s first hospital when it was founded in 1853. (Olson, 7/25)

Texas Tribune: Texas Senate Approves Teacher Bonuses, Benefits — But Not Pay Raises
The Texas Senate on Tuesday approved legislation to give teachers bonuses and to improve retired teachers’ health benefits — but only after the bill’s author removed a controversial provision requiring school districts to cover the cost of teacher pay raises. The upper chamber voted 28-3 to give initial approval to Senate Bill 19, authored by Sen. Jane Nelson, R-Flower Mound, which would borrow money from the Texas Health and Human Services Commission to pay for $193 million in statewide teacher bonuses and inject $212 million into a faltering state-run health insurance program for retired teachers. (Swaby, 7/25)

Pioneer Press: St. Joseph’s Hospital Plans To Close Maternity Ward
Minnesota’s oldest hospital will no longer be a destination to deliver babies. St. Joseph’s Hospital in downtown St. Paul will close its maternity ward Sept. 10, according to Fairview HealthEast, which operates the 164-year-old downtown hospital. The decision comes after HealthEast merged with Fairview Health Services earlier this year and is the result of mothers choosing to give birth in the suburbs, according to a Fairview HealthEast statement Tuesday. (Orrick, 7/25)

Kansas City Star: Kansas City Chatbot To Help Prescription Filling
A Kansas City team this week won an award from the Robert Wood Johnson Foundation for developing a robotic chat app that could steer you to a place where that prescription won’t break your budget. Project Helix — a collaboration of KC Digital Drive and two consulting outfits — aimed to help patients navigate the dizzying worlds where prescriptions, pharmacy prices and often inscrutable insurance plans overlap. (Canon, 7/25)

Milwaukee Journal Sentinel: Wisconsin DNR Says Milwaukee Industrial Barrel Plants Broke Environmental Laws
Three Milwaukee-area industrial barrel refurbishing plants have been cited by state regulators for violating 19 environmental laws, including misrepresenting information and sending hazardous ash to a landfill not permitted to handle such waste. Inspectors found that the plants handled, stored and shipped hazardous waste without permits, failed to keep numerous required records, and continued to spew putrid odors over neighborhoods three years after similar smells were noted by inspectors. (Diedrich and Barrett, 7/25)

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Missouri Poised To Enact Stricter Abortion Regulations

Lawmakers approved a bill that provides the state’s attorney general with more power to prosecute abortion law violations and requires doctors to meet with patients three days before the procedure, among other rules. The bill has been sent to Republican Gov. Eric Greitens, who is expected to sign it.

The Associated Press: Missouri Sends Governor Law Tightening Abortion Regulations
Missouri lawmakers on Tuesday delivered Republican Gov. Eric Greitens a political win by sending him a wide-ranging bill tightening abortion regulations that would give the attorney general power to prosecute violations, prompting critics to say the changes are aimed at limiting access to abortion in a state that already has tough restrictions. (Ballentine, 7/25)

St. Louis Public Radio: New Abortion Regulations Headed To Missouri Governor, Ending 2nd Special Session
Physicians will have to meet with women seeking abortions three days before the procedure and Missouri’s attorney general will have the ability to enforce abortion laws under the bill headed to Gov. Eric Greitens on Tuesday. … Supporters say the legislation, sponsored by Sen. Andrew Koenig, R-Manchester, will make clinics safer, while critics contend it will make it harder for women to obtain abortions. (Rosenbaum, 7/25)

And in Texas —

Texas Tribune: Senate Approves Abortion-Related Bill In Overnight Vote
The Texas Senate gaveled in around 10 a.m. Tuesday, but it wasn’t until past midnight that lawmakers turned their attention to Senate Bill 4, an anti-abortion measure that was initially approved over objections from Democrats. Passed in a 21-10 vote, the measure prohibits local and state government agencies from contracting with abortion providers and their affiliates. (Smith and Najmabadi, 7/26)

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

Viewpoints: Talking About Suicide; Military Life’s Toll On Women; Listening To Patients

Here’s a review of editorials and opinions on a range of public health issues.

The New York Times: Let’s Talk About Suicide
Chester Bennington, the lead singer of the band Linkin Park, was found dead on Thursday in his home near Los Angeles. The coroner’s office has confirmed that the 41-year-old died of suicide. That’s something I — and so many millions of other Americans suffering from mental illness — have considered. … more often than not, we don’t talk about mental health. And shows like Netflix’s “13 Reasons Why” or artists like indie pop singer Lana Del Rey have sensationalized or glamorized mental illness and suicide rather than taking it seriously. Worldwide, 350 million people (that’s 5 percent of the population) suffer from depression every day. And they are suffering – and sometimes dying – in silence because we can’t seem to talk openly about mental health. (Robert Rigo, 7/24)

Stat: Protecting Interns And Other Physicians From Depression And Suicide
This month, more than 25,000 medical school graduates will begin working at hospitals and medical centers across the United States. By the end of September, nearly one-third of these new doctors could become depressed and 24 percent could have thoughts of suicide. First-year interns often move away from family and friends to start the next chapter of intensive training. It is an exciting time, but also a difficult time. A recent study in Academic Medicine confirms that their suicide risk is highest in the early months of training. (George Keepers and Mary Moffit, 7/24)

Los Angeles Times: What Military Recruiters Aren’t Telling Women: You’ll Face Disproportionate Health Risks
Recently, 18 brave women graduated from the U.S. Army Infantry School, pioneers headed for fully gender-integrated “ground close-combat” units. Women have long served valiantly and effectively in almost every military role, but now they are tackling extremely physical combat jobs that, until recently, were designated men-only. … In this push for more female recruits, it’s not at all clear that young women — or the civilian population in general — understand the unique, disproportionate health risks women face in combat roles. The dangers, which have been known for decades, will undoubtedly be exacerbated as women serve in the most physically demanding units. (Julie Pulley and Hugh P. Scott, 7/25)

Bloomberg: Trump’s Quiet Progress On Veterans Affairs
[I]n one area, Veterans Affairs, there actually has been progress. Since the Senate approved his appointment unanimously in February, Secretary David Shulkin has sought to improve accountability at hospitals by publicly posting wait times and care-quality data, and has extended much-needed mental health services to veterans with less-than-honorable discharges. Even Congress has made a contribution, passing a bill to streamline the agency’s hiring and firing processes — legislation that Trump signed and tweeted about three times. (Mark Whitehouse, 7/24)

WBUR: Against Medical Advice: Sometimes, When Patients Defy Accepted Wisdom, So Must Doctors
Keeping the whole patient in view, including the social challenges they will return to after their short stint in a hospital, is as much a part of medical decision-making as the understanding of disease, or selection of the right medication. While this lesson is far from new — you’ll hear it taught to every medical student across the country — it is much harder to apply it in practice than to learn in principle. (Abraar Karan, 7/24)

Cincinnati Enquirer: Heroin Epidemic Must Be A Priority
Currently, human services funding is allocated towards increasing gainful employment, reducing homelessness, and preventing violence, all in need of our attention. Heroin is often a component of these other issues but the acute nature of this crisis demands prioritized attention not secondary. (Amy Murray, 7/24)

RealClear Health: Ending The Opioid Epidemic: Only The US Can Stop China’s Counterfeit Pharmaceutical Trade
The United States is facing an explosion of counterfeit opioids from China. Illegal synthetic opioids like carfentanil and fentanyl are being packaged as legal prescription opioids (like oxycodone) and sold on the black market. The US has dealt with counterfeit drug scandals before, notably in 2008 when 149 Americans died from a counterfeit blood thinner found to have originated in China. Today, counterfeit opioid compounds with carfentanil and fentanyl are blamed for the sudden increase in overdose deaths in the United States, making drug overdoses the current leading cause of death for Americans under age 50. (Emily Foecke Munden, 7/25)

Sacramento Bee: Reparations For Drug War? Consider It California
The same people who went to prison in disproportionate numbers for selling marijuana are on the verge of being cut out of California’s multibillion-dollar legal marijuana industry – and, without help, could even become victims of it. …Together, they are demanding that local governments adopt a reparations strategy that would begin to repair the damage done to communities of color. (Erika Smith, 7/24)

The Kansas City Star: Scrutiny Of Overland Park Pain Doctor Highlights Challenge Of Fighting Opioid Addiction
An Overland Park doctor is in the crosshairs of an expanding investigation into the business practices that are fueling American’s addiction to opioids. The records of Steven Simon of The Pain Management Institute have been seized by the FBI. He earns more than only a handful of other doctors in the U.S. from payments by drug manufacturers to promote both opioids and the medications that treat side effects of the drugs. It’s a revenue stream that can influence doctors to write more prescriptions. (7/23)

USA Today: Trump Budget Would Set Back Global AIDS Fight Just When We’re On Track To Win It
When we started our HIV/AIDS Initiative at Saddleback Church 13 years ago, we reminded our congregation, “If you’re going to be like Jesus, you have to learn to be compassionate toward people when they’re sick.” Even in this time of tight budgets, America’s leaders should show precisely this kind of compassion for our brothers and sisters living with HIV and AIDS in Africa and around the world. (Rick and Kay Warren, 7/25)

The New York Times: Fixes: The Tasmanian Hep C Buyers’ Club
In 2014, when Greg Jefferys’s urine started smelling like dead meat, he knew there was something seriously wrong. For weeks, Jefferys, an Australian then 60 years old, had felt fatigued and noticed that just a slight bump would leave a dark purple bruise on his skin. Blood tests revealed to Jefferys that he had chronic hepatitis C – a disease he’d never heard of. (Sophie Cousins, 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.

Ideas About Issues: The Right Answers On Health Policy Are Beyond Politics; Could The Free Market Deliver A Solution?

Columnists offer thoughts on these issues as well as who has gained ground with Obamacare, how self-employed people are bracing for change and the future of single-payer concepts.

The Columbus Dispatch: Cast Aside Politics, Get Health Care Right
If you want to know what’s wrong with the never-ending political battle being fought in Washington to get rid of the Affordable Care Act, look no further than the lives, families, and communities that have been destroyed by opioid addiction all across America. Opioid addiction is a crisis ripping the heart out of our country. And every plan that’s been put forward by the Republican leadership in Congress takes a blow torch to the most important preventive care and treatment that’s currently covered by health insurance for those caught in the grip of addiction. If the Republicans get their way, that coverage goes away, and with it goes the best hope — and maybe the only real hope — that families and communities have to overcome the ravages of this terrible disease. (Joe Biden, 7/25)

Bloomberg: Obamacare’s Big Win: It Helps Some People Be A Little Less Poor
There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier? I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong. (Megan McArdle, 7/24)

Modern Healthcare: Self-Employed People Weigh Returning To Corporate Jobs If Senate Passes ACA Repeal Bill
Steven DeMaio of New York City has been happily self-employed as a writer and editor since 2008. At that time, he felt comfortable leaving a corporate job with health benefits and going out on his own because the state where he then lived, Massachusetts, had established a system guaranteeing affordable individual-market coverage without regard to health status. But DeMaio, 46, recently decided to look for a corporate job with health benefits because of uncertainty over the future of his health insurance posed by Republican efforts to repeal and replace the Affordable Care Act. As of Aug. 1, he will begin working for a company that offers a group health plan. (Harris Meyer, 7/24)

RealClear Health: Single-Payer Health Care Looms As 2020 Campaign Issue
With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020. (Ford Carson, 7/25)

Los Angeles Times: Single Payer Can’t Happen In California. At Least, Not Right Away
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time. Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office. (Steve Tarzynski, 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.

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)

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

State Highlights: In Special Session, Texas Senate Takes Up Abortion Bills; Ohio’s Cost Transparency Law Stalls Amidst Strong Opposition

Media outlets report on news from Texas, Ohio, Pennsylvania, Minnesota, California, Tennessee, Florida, Maryland and Kansas.

Texas Tribune: Texas Senate Tackles Special Session Abortion Bills
Under state Sen. Donna Campbell’s Senate Bill 10, in procedures where complications occur, physicians would be required, within 72 hours, to submit reports to the state health commission that include detailed information like the patient’s year of birth, race, marital status, state and county of residence, the date of her last menstrual cycle, the number of previous abortions, and the number of previous live births. Physicians who failed to comply with the reporting requirements would face a $500 fine for each day of each violation. (Smith, 7/24)

Texas Tribune: Texas Senate OKs Maternal Mortality Task Force
State senators on Monday tentatively approved a bill that would give a state task force more time to study why an alarming number of Texas mothers are dying less than a year after childbirth. Under Senate Bill 17, the state’s Task Force on Maternal Mortality and Morbidity would be able to continue its work until 2023. (Evans, 7/24)

Kaiser Health News: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors
Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation. One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment. (Bluth, 7/25)

The Philadelphia Inquirer/Philly.com: New Five-Year Contract Between Independence And Jefferson
Independence Blue Cross is pushing for new contracts with area health systems that accelerate the hoped-for transition from paying for volume of services to paying for positive results. But it is not taking a one-size-fits-all approach. “We need to adapt to different providers” because they have “different states of readiness,” Anthony V. Coletta, president of Facilitated Health Networks at Independence, said Monday after the announcement of a contract with Jefferson Health that starts Sept. 1 and will last five years. (Brubaker, 7/24)

The Star Tribune: Minneapolis Proposal To Restrict Menthol Tobacco Sales Sparks Debate
While public health advocates pushed for the restrictions at a packed public hearing — arguing that tobacco companies target black smokers and young people with menthol products — Minneapolis store owners said it’s the latest example of City Hall overreach and would devastate their livelihoods. …The City Council heard from dozens of speakers Monday in crowded council chambers and is expected to vote on the policy in August. (Belz, 7/24)

San Francisco Chronicle: Jahi McMath’s Family Wins Backing For Argument That She’s Alive
It’s been more than three years since 13-year-old Jahi McMath was declared dead after something went terribly wrong following throat surgery at Children’s Hospital Oakland. Her family has never accepted the declaration and has kept her on life support ever since — and in a new twist, a prominent neurologist says recent videos of the girl show she is alive, with a partially functioning brain. (Johnson, 7/24)

The Philadelphia Inquirer/Philly.com: Horizon Blue Cross Ordered To Turn Over Omnia Documents
The New Jersey Supreme Court on Monday ordered Horizon Blue Cross Blue Shield, the state’s largest health insurer, to turn over a McKinsey & Co. report and other documents it used to establish two tiers of health systems for an insurance plan introduced in 2015. Providers in the second tier, including Capital Health System Inc. and St. Peter’s University Hospital Inc., sued, alleging that Horizon treated them unfairly and breached their contracts when it set up the tiers for its Omnia insurance plan. At the seven Tier One health systems in the Omnia Health Alliance consumers have lower out-of-pocket costs. (Brubaker, 7/24)

Texas Tribune: Texas To Lose Galveston And Hill Country Children’s Therapy Providers
Children in the Galveston and Hill Country areas are going to be without state-funded speech, occupational and physical therapy services as two more providers prepare to leave the Early Childhood Intervention program. The Texas Health and Human Services Commission confirmed Monday that the University of Texas Medical Branch and Hill Country MHDD Centers are ending services through the program. (Evans, 7/24)

Nashville Tennessean: Children’s ER At TriStar Centennial Opens
A new children’s emergency room in Nashville — the city’s second — is now seeing patients. The first patient at The Children’s Hospital at TriStar Centennial arrived at 9:21 a.m. on July 24 to the new seven-bed, 6,000-square foot facility on the hospital’s campus in Midtown Nashville. (Fletcher, 7/24)

Columbus Dispatch: Mount Carmel Adding 80 Beds For Mental-Health Treatment
Mount Carmel Health System and Acadia Healthcare announced on Monday that they are teaming up to open an 80-bed inpatient behavioral health hospital in Columbus to replace a 20-bed hospital at Mount Carmel West hospital in Franklinton. Officials say they are still finalizing a site for the $26 million, 64,300-square-foot freestanding facility that will have units for adult and geriatric patients as well as for dual-diagnosis patients — those who are suffering from both mental-health and drug-addiction illnesses. (Viviano, 7/25)

The Baltimore Sun: CVS Opens First Maryland Hearing Center
CVS Pharmacy opened its first Maryland hearing center in an Ellicott City store, as part of the drug store chain’s move to capture more health related business in its retail outlets. The store, which sells and services hearing aids, is staffed by audiologists and can provide hearing screenings and fittings. Insurance is accepted for some services. (Cohn, 7/24)

Cleveland Plain Dealer: Johnson Amends Cleveland ‘Lead Safe’ Law Proposal To Exclude Owner-Occupied Homes
Cleveland City Councilman Jeff Johnson, after hearing from a slew of residents said today he’s changing the ‘Lead Safe’ ordinance he plans to propose next month so that it excludes mandatory compliance and fines for homeowners who live in their properties. The ordinance — which proposes that all city homes built before 1978 be certified safe from lead hazards by 2021 — would still apply to rentals and apartments, which comprise the majority of the city’s homes, as well as child care centers and schools constructed prior to 1978, Johnson said. (Dissell and Zeltner, 7/24)

KCUR: Safety Net Clinic To Reopen Facility In Quindaro Neighborhood 
Southwest Boulevard Family Health Care, a safety net clinic in Kansas City, Kansas, will reopen its Quindaro facility after several years’ hiatus. The satellite clinic will be located in a church building owned by Family Health Care. Initially, it will be open a couple of half-days per week and, depending on demand, may increase its hours of operation. (Margolies, 7/24)

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Viewpoints: Is Silicon Valley Losing The Lead In Medical Technology?; Doctors And Hand Writing

Here’s a review of editorials and opinions on a range of public health issues.

The Wall Street Journal: Silicon Valley Trails In Medical Tech
People who develop medical technology have long assumed that Silicon Valley would pioneer smartphone-based devices to make Americans fitter and healthier than ever. To some degree, that forecast is coming true: Tech giants are working with doctors and hospitals on highly sophisticated devices — automated radiology, supercomputer-based oncology, fitness-tracker-based analytics — to monitor the sick, provide better automated care, and keep people out of hospitals in the first place. But it turns out the biggest gains from mobile medicine will come from deploying it in poor countries across Africa and Asia. (Michael S. Malone, 7/23)

KevinMD: Doctor, We Can’t Read Your Writing
So to future pharmacists who will read my prescriptions, and other health care professionals who will read my notes: I pledge from here on in to write as neatly as possible within the time constraints allowed, for the safety of my patients, the posterity of cursive writing, and for the sake of my grandfather (who likes reading my blog on his iPad). (Sarah Fraser, 7/23)

USA Today: Veterans Affairs Secretary: VA Health Care Will Not Be Privatized On Our Watch
As a physician, my professional assessment is that the Department of Veterans Affairs has made significant progress over the past six months — but it still requires intensive care. In order to restore the VA’s health, we must strengthen its ability to provide timely and high quality medical care while improving experiences and outcomes for veterans. (David Shulkin, 7/24)

Lexington Herald Leader: A Woman’s Death, Kentucky’s Opioid Crisis
Jenny Fulton’s brief life and brutal death hold important lessons, especially for Kentuckians in positions of public trust. The 27-year-old woman died in 2014 in the Mason County jail where she was sent because she had relapsed into heroin use, violating her parole. Despite widespread recognition that incarceration is not the solution, Kentucky still spends millions of dollars jailing people who have drug use disorders when that money could be better spent on evidence-based treatment. (7/23)

St. Louis Post-Dispatch: Trump Takes A ‘Just Say No’ Approach To Sex Education
In today’s version of “Just Say No,” first lady Nancy Reagan’s approach to drug use in the 1980s, President Donald Trump’s administration is cutting more than $213 million in funding to help prevent teen pregnancy. The move eliminates evidence-based pregnancy prevention and research programs, and family planning services, but leaves money for abstinence-only education. In addition, Trump appointed a prominent abstinence-only advocate as assistant secretary of Health and Human Services. (7/22)

San Jose Mercury News: Reject Climate Change Skeptic For Top Science Post
President Trump’s disdain for science apparently knows no bounds. He has now nominated climate change skeptic Sam Clovis, a talk radio host, to serve as the Department of Agriculture’s chief scientist — a slap in the face of the scientific community and a disservice to those responsible for the integrity of the USDA’s research. (7/23)

Sacramento Bee: California Workers’ Comp System Remains Nation’s Most Expensive
Obviously, working in California is not inherently more dangerous than in other states, and cash benefits to disabled California workers are not out of line, so the enormous cost differential must be rooted in the system itself, which explains why its rules are the subject of constant political infighting. One factor in those costs is what officials say is an enormous amount of fraud, concentrated in Southern California. (Dan Walters,  7/23)

Los Angeles Times: Don’t Believe The American Heart Assn. — Butter, Steak And Coconut Oil Aren’t Likely To Kill You
Last month, the American Heart Assn. once again went after butter, steak and especially coconut oil with this familiar warning: The saturated fats in these foods cause heart disease. The organization’s “presidential advisory” was a fresh look at the science and came in response to a growing number of researchers, including myself, who have pored over this same data in recent years and beg to differ. A rigorous review of the evidence shows that when it comes to heart attacks or mortality, saturated fats are not guilty. (Nina Teicholz, 7/23)

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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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Perspectives: Despite Senate Difficulties, ACA Is Still At Risk; The Paths Forward For The GOP’s BCRA

Editorial pages analyze the current state of play in Republicans’ push to replace Obamacare.

The New York Times: Health Care Is Still in Danger
Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year. As you may remember, back in March attempts to repeal and replace the Affordable Care Act seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the House Republican bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, House leaders pulled their bill, and the debate seemed over. (Paul Krugman, 7/24)

RealClear Health: A Narrow Path Forward For The BCRA
Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage. (Shea McCarthy, 7/24)

Boston Globe: Republicans Must Challenge Trump On Health Care
But though he [Donald Trump] has browbeaten Republican senators for failing to follow through on repealing the Affordable Care Act, abandoning his own campaign commitments doesn’t seem to bother him at all. Months into the GOP’s repeal-and-replace effort, not one piece of legislation Trump has backed, in either the House or the Senate, would keep all of those promises. (7/23)

The Wall Street Journal: Force Congress’s Hand On Health Care
If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters. (Heather R. Higgins, 7/23)

The Wall Street Journal: Congress Won’t End ObamaCare, So Here’s How To Mend It
Having so far failed to repeal and replace the Affordable Care Act, the best way forward for Republicans would be to work with Democrats to improve the marketplaces set up by the 2010 law. While legislation could help, all that really is needed for the marketplaces to succeed is for the Trump administration to do no harm. This means continuing to implement the law without actively undermining it. (Jason Furman, 7/23)

Los Angeles Times: Under Senate’s Obamacare Repeal, Some Americans Would Have To Pay More Than Their Total Income For Health Coverage
One of the ostensibly brilliant ideas in Senate Republicans’ plan to repeal the Affordable Care Act is to move low-income families from Medicaid to the private insurance marketplace, allowing them to use the premium subsidies provided by the ACA. But there’s a catch, according to a new analysis of the proposal. For many low-income families, the marketplace premiums and deductibles combined would amount to more than their total income, even after subsidies. Moreover, despite shifting more of these costs to enrollees, the change would cost the federal government more than Medicaid.  (Michael Hiltzik, 7/21)

The Kansas City Star: Sens. Moran And Roberts: Don’t Endanger My Daughter’s Health
My beautiful daughter Hannah turns 26 this Saturday. Her birthdays are particularly special because she was diagnosed with stage 4 cancer at age 13. After successful treatment, her cancer returned when she was 14 and she had a less than 10 percent chance of survival. She wasn’t expected to be alive for her 15th birthday. Burkitt’s Lymphoma is a very aggressive cancer that doubles in size every two hours. We were fortunate to receive amazing care at Children’s Mercy Hosptital. Hannah endured dozens of surgeries, 69 days of intense chemotherapy and spent over 300 days in the hospital. She received hundreds of units of blood and platelets, had 38 spinal taps, 18 bone marrow biopsies, a stem cell transplant and countless other treatments and procedures. (Deedra Miller, 7/22)

Lincoln Journal-Star: Nebraska Needs Health Care Reform
Obamacare is failing in Nebraska. Proponents of the law argued that it would increase choice and lower costs, but the exact opposite has taken place. For instance, earlier this year, Blue Cross Blue Shield announced it would be leaving the state’s Obamacare exchange market. The last remaining Obamacare insurer — Medica Health — also announced it might pull out of the market by the end of the year, which would leave thousands of Nebraskans without health coverage. (Jarrett Stepman, 7/24)

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State Highlights: N.J. Raises Smoking Age To 21; Fall Out From Scandal Involving USC’s Former Med School Dean Continues

Media outlets report on news from California, Iowa, New Jersey, Tennessee, Florida, Ohio, Wisconsin, Minnesota and Georgia.

Los Angeles Times: USC Received More Than A Year Of Questions About Former Medical School Dean’s Conduct Before Scandal Broke
Four days after The Times published a story about drug use by the then-dean of USC’s medical school, the university announced it was moving to fire Dr. Carmen A. Puliafito and said it was “outraged and disgusted” by his conduct. USC Provost Michael Quick said the university decided to act because it had been shown “extremely troubling” information that same day about Puliafito’s behavior. Quick provided no details. But he said it was “the first time we saw such information firsthand.” (Pringle, Elmahrek, Hamilton and Parvini, 7/23)

Reveal: Lawmakers Call On Acosta To Address Latino Workplace Deaths
From meatpacking to agricultural fields, Latino immigrants often work the most menial jobs in America and their on-the-job death rate is 18 percent higher than the average worker, recent statistics show. The troubling trend has prompted a group of Democratic senators to call on the Labor Department to protect these workers. (Gollan, 7/23)

Nashville Tennessean: As Medical Bills Rise, D.C. Battle Hinges On Federal Dollars — Not Health
Frustration about health care reform rhetoric is palpable as Tennessee leaders grapple with high rates of chronic disease taking a toll on both the state’s people and economy. But competing health care proposals at the center of the war raging in Washington don’t directly address the stated goals of improving the quality of care and making it more affordable.  (Fletcher, 7/23)

Kaiser Health News: In Appalachia, Two Hospital Giants Seek State-Sanctioned Monopoly
Looking out a fourth-floor window of his hospital system’s headquarters, Alan Levine can see the Appalachian Mountains that have defined this hardscrabble region for generations. What gets the CEO’s attention, though, is neither the steep hills in the distance nor one of his Mountain States Health Alliance hospitals across the parking lot. Rather, it’s a nearby shopping center where his main rival ­— Wellmont Health System, which owns seven area hospitals — runs an urgent care and outpatient cancer center. Mountain States offers the same services just up the road. (Galewitz, 7/24)

California Healthline: California Valley Fever Cases Highest On Record
The number of Valley Fever cases in California rose to a record level in 2016, with 5,372 reported — a jump of 71 percent from the previous year. Historically, about three-quarters of cases have been in the state’s heavily agricultural San Joaquin Valley. The fungal infection, known as coccidioidomycosis, or “cocci,” is most common in the southern portion of the Valley and along the Central Coast of California. (Bartolone, 7/24)

San Francisco Chronicle: Under-Radar Bill Focuses On Polluters In Poverty Areas
AB617 by Assemblywoman Cristina Garcia, D-Bell Gardens (Los Angeles County), was touted as the less-grandiose partner to cap and trade, whose expansive reach allows California polluters to offset their emissions by reducing them in another state. Garcia’s measure is aimed closer to home, attempting to “address air pollution in the most burdened communities,” she said. (Cart, 7/23)

Cleveland Plain Dealer: Law Would Require Nearly All Older Cleveland Homes To Be ‘Lead Safe’
Cleveland homes, childcare centers and schools built before 1978 would have to be certified as safe from lead hazards by 2021 under legislation City Councilman Jeff Johnson will introduce next month. Johnson, along with Cleveland Lead Safe Network (CLSN), created the proposed ordinance as part of a sweeping Lead Safe Cleveland Initiative that would first tackle lead paint hazards in homes and then go after reducing the risk from the toxin in soil and water. (Dissell and Zeltner, 7/23)

San Jose Mercury News: Former Oakland Army Base: Feds Probe Civil Rights Complaint
For years, advocates at the West Oakland Environmental Indicators Project (WOEIP) have lamented the soot on their blinds and the hacking coughs that result from breathing in toxic diesel fumes spewing out of trucks as they enter and exit the Port of Oakland. Now, two federal agencies — the Department of Transportation and Environmental Protection Agency — are launching a formal investigation into whether the city and the Port of Oakland are doing enough to mitigate air pollution in the neighborhood, which has historically been burdened by elevated levels of black carbon, nitric oxide and other toxic particles. (Baldassari, 7/22)

Atlanta Journal-Constitution: Drug Screening Lab Under Federal Investigation Heads For Auction
A drug testing lab in Gwinnett County that had been in the center of a campaign donation bundling scandal is up for auction amid a federal investigation. …In 2014, employees and executives with the company came under federal scrutiny when they combined to give more than $80,000 to U.S. Rep. Jack Kingston, who was seeking the Republican nomination to the U.S. Senate. (Joyner, 7/21)

San Francisco Chronicle: State Bill Aimed At “Big Weed” Marketing Hits Small Businesses Too
State Sen. Ben Allen, D-Santa Monica, is the sponsor of SB162, which would prohibit licensed cannabis businesses from selling or giving away promotional hats, T-shirts or any branded merchandise that bears the name or logo of a cannabis company or product. Allen and his allies say the bill, which in May passed the Senate in a 40-0 vote, is meant to protect children from potentially harmful marketing practices. But for some whose businesses would be affected, the bill is seen as quashing free speech. (Mitchell, 7/23)

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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)

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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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Viewpoints: The Opioid Epidemic Through The Lens Of Neuroscience; Prognostic Uncertainty, Outcomes And Medical Decisions.

Here’s a review of editorials and opinions on a range of public health issues.

Bloomberg: Neuroscience Offers Insights Into The Opioid Epidemic
Most Americans say they’re interested in scientific discoveries, but they may be thinking of the kinds of findings that lead to new gadgets and wonder drugs. When it comes to discoveries about hazards and risks — especially the risks of those wonder drugs — Americans seem more likely to tune out. (Faye Flam, 7/21)

The New England Journal Of Medicine: Managing Uncertainty — Harnessing The Power Of Scenario Planning
Although prognostic certainty remains elusive, many clinicians use statistics to quantify outcomes. We strive to achieve increasing precision with risk calculators and use the best available evidence to report probabilities of discrete complications. Decision aids allow us to share these predictions with patients and facilitate comparison between treatments. Although numbers quantify uncertainty, they offer little guidance to patients for managing this uncertainty. Moreover, these strategies fail to illuminate logical connections between the patient’s current condition, downstream outcomes, and events experienced along the way. (Margaret L. Schwarze and Lauren J. Taylor, 7/20)

The New England Journal Of Medicine: Certain About Dying With Uncertainty
Mrs. C., a woman with whom we’d had a long-standing patient–physician relationship, one of us for over 25 years, died recently in the 87th year of her life. A woman who had always maintained her cheerful spirit even in the midst of quite trying medical setbacks, she was one of our favorite patients. But what made her most special was her perspective on life and death: we learned a lot from her. … when her husband died of a brain tumor about 5 years ago, she witnessed the good and the not-so-good that medicine had to offer. She saw interventions that improved things slightly for a short while but did not provide meaningful and sustained benefit. After he died, we had “the conversation”; we had broached the subject before but had never discussed it in great depth. She knew what she wanted. … We vowed to keep our part of the bargain. If we had only known how hard that would be. (Jeffrey M. Drazen and Maria A. Yialamas, 7/20)

Los Angeles Times: Dear Media: When You Cover Death By Suicide, Do It Thoughtfully
When a family member died by suicide, my parents chose not to tell me his method. They wanted me to remember him as he lived, for both of our sakes. While I didn’t understand their decision at the time, I now see it as one borne out of deep care. I was especially thankful for my parents’ thoughtfulness after reading the media coverage of Linkin Park singer Chester Bennington’s death by suicide this week. (Melissa Batchelor Warnke, 7/21)

The Wall Street Journal: In The Netherlands, The Doctor Will Kill You Now
In 2002 the Netherlands became the first country to legalize euthanasia and physician-assisted suicide for those suffering deadly diseases or in the last stages of life. Not long after the legislation was enacted, eligibility was expanded to include those experiencing psychological suffering or dementia. Today pressure is mounting for the Dutch government to legalize a “euthanasia pill” for those who are not ill, but simply consider their lives to be “full.” (Kees van der Staaij, 7/20)

RealClear Health: Digital Health Hope: Personalized Care Is The Final Frontier
For many health care providers, personalized or precision medicine is the holy grail of their practice. While we have made great gains as new technologies develop, progress in medicine in the past decade has been lacking despite all-time spending highs in research. In order to improve outcomes and make significant progress, physicians must accept change and move toward the more precise approach that personalized medicine affords. Today, medicine revolves around standards of care: the best courses of prevention or treatment for the general population, or the average person on the street—not necessarily what is best for the individual. In personalized medicine, physicians cater medical treatment to a patient based on their particular genetic, environmental and clinical information. This personalized approach results in a more precise treatments that are much more likely to be effective. (Kevin Campbell, 7/21)

St. Louis Post-Dispatch: The U.S. Attorney General Is Stuck In A ‘Reefer Madness’ Time Warp
For reasons that defy understanding, science, public opinion and most state governments, Attorney General Jeff Sessions has decided that cracking down on the use of medical marijuana is a priority. Assuming he survives President Donald Trump’s pique, he wants Congress to roll back rules that prohibit the Justice Department from going around state laws to enforce a federal ban against medical cannabis. As recently as May, Congress reaffirmed that the Justice Department can’t spend money to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” (7/20)

Los Angeles Times: USC Bosses Flunk The Leadership Test Amid Shocking Allegations About Former Medical School Dean
By now you probably know the details. Dr. Carmen Puliafito, a $1.1-million-a-year professor, doctor, dean and big-bucks rainmaker for the University of Southern California, left plenty of time in his busy schedule for extracurricular activities. They included drug-fueled parties with a prostitute, convicted criminals and drug addicts. Los Angeles Times sleuths dug up photos of Puliafito’s exploits in hotel rooms, apartments and even the dean’s office at USC, including a shot of him using a butane torch to light a glass pipe while a female companion smoked heroin. (Steve Lopez, 7/20)

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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)

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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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State Highlights: Advocates Dissatisfied With N.H.’s Rules On Mentally Ill Inmates; Mass. Sends Pregnant Workers’ Bill To Governor

Media outlets report on news from New Hampshire, California, Massachusetts, Kansas, Maryland, Minnesota, Arizona, Texas, Ohio and Florida.

The San Diego Union-Tribune: County To Start Pilot Program For People In Jail With Mental Illness 
Some incarcerated men who have mental illnesses may be put into a new program to help them get care and avoid returning to jail. County supervisors approved a pilot project this past week that puts men who are in jail with mild to moderate mental illness in an intensive treatment regimen of 12-step meetings, outpatient therapy sessions and neighborhood support programs. The hope is that the system will make it easier for participants to better transition back into communities and reduce recidivism. (Stewart, 7/20)

Boston Globe: Pregnant Workers’ Bill Heads To Governor’s Desk
A bill guaranteeing protections for pregnant workers was sent to the governor Thursday, part of a groundswell of support for pregnant workers’ rights that would make Massachusetts the latest in a long line of states to pass similar legislation in recent years. …The Pregnant Workers Fairness Act would require employers to provide “reasonable accommodation” for pregnant women, giving them the right to less strenuous duties, more frequent breaks, and temporary transfers, among other provisions, provided they don’t cause a business “significant difficulty or expense.” (Johnston, 7/20)

KCUR: KU Med Opens $82 Million, State-Of-The-Art Health Education Building 
KU Medical Center on Thursday officially opened its new health education building, an $82 million, 170,000-square-foot facility that will serve as the primary teaching venue for its medical, nursing and allied health profession schools. The state-of-the-art building, at the northeast corner of Rainbow Boulevard and 39th Street, was funded with $26 million in state money, $21 million from the University of Kansas Medical Center, $25 million from the Hall Family Foundation and the rest in additional private money. (Margolies, 7/20)

The Baltimore Sun: CareFirst Puts Price Tag On Dispute With Anne Arundel Medical Center 
CareFirst’s CEO put a price tag Thursday on a dispute between the health insurer and Anne Arundel Medical Center that could affect thousands of county residents. In a conference call with reporters, CareFirst President and CEO Chet Burrell said a recent reduction in fee payments to the hospital “is something in the order of $1 million” out of the $200 million the insurance company pays to AAMC each year. Meanwhile, he said, the hospital has countered with its own list of requests that adds up to a $13 million increase in professional fees. (Yeager, 7/20)

The Star Tribune: Lobbyists Descend On Minneapolis To Fight Menthol Restriction
Tobacco companies and retailers are pushing back against Minneapolis leaders’ move to restrict the sales of menthol cigarettes in the city, bringing in lobbyists and appealing to the public. …Anti-smoking advocates say the fight against this restriction is bigger than they’ve previously seen at the local level. (Nelson, 7/20)

Arizona Republic: Controversial Over-The-Counter Hearing Aids Could Be Coming Soon
Certain hearing aids could soon be as easy to buy as reading glasses, a shift consumer and interest groups say would dramatically boost access to hearing help for the estimated 1 million Arizonans who need it. …The Arizona Commission for the Deaf and Hard of Hearing for months has fought the federal Over-the-Counter Hearing Aid Act of 2017, which would create a new class of over-the-counter hearing devices for adults. (Polletta, 7/20)

San Jose Mercury News: Valley Fever Cases Increase In California
California public health officials on Thursday announced a large hike in the number of reported Valley Fever cases in the state, with illness onset in 2016 — but they don’t know what’s behind the increase. From January through December 2016, 5,372 new cases of Valley Fever were reported to California Department of Public Health corresponding to an incidence rate of 13.7 cases per 100,000 people. (Seipel, 7/20)

Texas Tribune: Environmental Groups Sue EPA Over Lax Texas Air Pollution Permits
A Washington, D.C.-based environmental advocacy group sued the U.S. Environmental Protection Agency on Thursday, arguing the federal government isn’t properly policing air pollution permits the state of Texas issued to some of the largest industrial facilities in the U.S. The Environmental Integrity Project — founded by former EPA officials — alleges that permits the Texas Commission on Environmental Quality (TCEQ) issued to mega-plants across the Houston, Dallas and East Texas regions are illegal because the limits set on their emissions are too high, allowing them to spew too much pollution into the air. (Collier, 7/20)

Dayton Daily News: Ohio Senator Wants Feds To Lift Prohibition On Marijuana
State Sen. Kenny Yuko, D-Richmond Heights, introduced a resolution in the Ohio Senate on Wednesday that would make a formal request to the feds to drop marijuana from the list of controlled substances. The resolution, which would have to pass both the Ohio House and Senate, doesn’t carry much clout. (Bischoff, 7/20)

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How D.C. Pulled Itself Back From The Brink Of An AIDS Epidemic

A decade ago, city officials realized they had to take action, and they turned the numbers around. Stateline looks at how they did it. In other public health news: a breakthrough on cancer, mental illness, female homicide victims, antibiotics and birth defects, heart health and more.

Stateline: Fighting AIDS In The Nation’s Capital
Ten years ago, Washington, D.C., was on the verge of a public health disaster: It had the highest reported rates of HIV in the country. And in a city of 588,000, 1,333 people tested positive for HIV in 2007 alone. By the time they were tested, most had full-blown AIDS.Back then, city officials acknowledged that they didn’t have a complete picture of the problem. But they estimated that as many as one in 20 residents were infected with the disease, rivaling rates in sub-Saharan Africa. (Wiltz, 7/21)

Stat: One Cancer Breakthrough Is On Its Way. Here’s What’s Coming Next
CAR-T is having a moment. The Food and Drug Administration looks poised to approve the first hot-wired white blood cell treatment from Novartis, promising to change the lives of patients with a particularly deadly form of cancer and usher in an entirely new definition of the word “drug.” But scientists around the world are hardly standing pat in the glow of this success. Instead, they’re toiling to discover, refine, and re-invent cellular therapies for cancer in hopes of treating more tumor types, improving safety, and pushing the still-nascent field forward. Some of the most promising applications of the technology remain on the horizon — though plenty of challenges stand in the way. (Garde, 7/21)

Stat: This Biotech Aims To Simplify Diagnosis Of Mental Illness. Can It Work?
Asmall Australian biotech has drawn big-name backers — including swimming superstar Michael Phelps — to its audacious goal: to develop a quick, cheap, and objective way to diagnose an array of mental illnesses. The tool would be a stunning breakthrough in the field of mental health —  if it works. And there’s the rub. Researchers have been trying for decades to find reliable biomarkers for mental illness — that is, tangible biological clues that conclusively indicate whether a person has a particular psychiatric disease. Effort after effort has failed, leaving doctors to diagnose such conditions mostly on the basis of screening checklists and conversations with their patients. (Keshavan, 7/21)

The Washington Post: Most Female Homicide Victims Are Killed By Husbands Or Other Intimate Partners, New Report Shows
A report out Thursday by the Centers for Disease Control and Prevention about homicides and women provides some disturbing numbers about just how common this is. Homicide is the fifth leading cause of death for women ages 18 to 44. In 2015 alone, 3,519 women and girls were killed. More than half of these killings were perpetrated by current or former boyfriends, husbands or other intimate partners. (Cha, 7/20)

The New York Times: Certain Antibiotics May Increase Risk Of Birth Defects
A large study published in the British Journal of Clinical Pharmacology found that certain antibiotics taken during pregnancy may increase the risk for birth defects. Canadian researchers followed 139,938 mothers of babies born in Quebec from 1998 to 2008, tracking their antibiotic use in the first trimester, and their babies’ birth defects through the first year of life. (Bakalar, 7/20)

NPR: Just Thinking That You’re Slacking On Exercise Could Boost Risk Of Death
In a fitness-crazed land of spin classes and CrossFit gyms, Octavia Zahrt found it can be tough to feel as though you’re doing enough. “When I was in school in London, I felt really good about my activity. Then I moved to Stanford, and everyone around me seems to be so active and going to the gym every day,” she says. “In the San Francisco Bay Area, it’s like 75 percent of people walk around here wearing exercise clothes all day, every day, all the time, and just looking really fit.” (Chen, 7/20)

The Washington Post: Coffee With Viagra-Like Ingredient Recalled After FDA Discovery
Albert Yee said the coffee is everywhere you look in the densely packed vendor stalls along avenues in Malaysian cities: an instant mix with a natural ingredient similar to what’s found in Viagra that helps men with erectile dysfunction. And he wanted a piece of the action. “There are whole streets of it, like tequila in Mexico,” Yee told The Washington Post by phone Thursday, describing how his one-man import business outside of Dallas is now at the center of a nationwide voluntary recall coordinated by the U.S. Food and Drug Administration. (Horton, 7/20)

The New York Times: Long Workdays May Be Bad For Your Heart
Working long hours may increase the risk for atrial fibrillation, or irregular heartbeats that can lead to serious cardiovascular complications, a new study in the European Heart Journal found. Lengthy work hours have been shown in several previous studies to increase the risk for cardiovascular disease. (Bakalar, 7/20)

The Philadelphia Inquirer/Philly.com: New Transplant Rules Help More African Americans Get Kidneys
UNOS data he presented this month show that in 2016, a third of those on the waiting list (31,830 people) were African American, and just over a third of transplant recipients (4,284) were African American.  The rates at which other racial groups were wait-listed and transplanted were also even. There still aren’t enough kidneys for those in need. But the system no longer unintentionally works against blacks as it did in the 1990s, when UNOS data show they made up more than a third of the wait inglist, but got only about a quarter of kidney transplants. (McCullough, 7/20)

The Philadelphia Inquirer/Philly.com: A Philly Pediatrician Looks At Why Too Many Babies Die Suddenly
Philadelphia, like most major cities, has a team that regularly reviews the most tragic events many of us can imagine: the deaths of children. The goal is to look for any patterns that might help prevent these deaths, and the circumstances that allowed them to occur. A recent report from the city’s Department of Public Health shows that we still have a long way to go, specifically when it comes to the number of infants who die at what should be a safe time, when they are put to sleep. (Taylor, 7/20)

The Baltimore Sun: Civil Unrest Related To Freddie Gray Death Caused Depressive Symptoms Among Mothers In Affected Neighborhoods, Study Finds 
Half of the mothers who lived in the neighborhoods wracked by the civil unrest that followed the death of Freddie Gray in 2015 became so stressed by the circumstances that they suffered from insomnia, loss of appetite and other depressive symptoms, according to new research by the University of Maryland School of Medicine. While the mothers weren’t tested to see if they fit the clinical definition of depression, the researchers said the results found that the sight of burning buildings, looting, and the constant blue lights from police cars was enough to have a major emotional impact in neighborhoods located in the six ZIP codes where the brunt of the unrest took place. (McDaniels, 7/20)

Stat: Forget ‘Shark Week’: 7 Things In The Water Swimmers Should Actually Fear
It’s shark season — primarily on cable TV. As the decades-long tradition of “Shark Week” approaches, you can expect once again to hear of “serial killer” sharks, attacks near major coastal cities, and menacing, massive shark swarms. But, as you probably also know, shark attacks are incredibly unlikely. You’re 75 times more likely to be killed by lightening than by a shark. On average, one person dies of a shark attack every other year in the United States. (Wosen, 7/21)

Orlando Sentinel/Tampa Bay Tribune: Preeclampsia’s Impact On Families, Health Care Costs: Despair In A Time Of Delight
Physicians, researchers, activists and legislators across the U.S. are working to understand why preeclampsia is rising faster than other chronic conditions and prevent it. …And according to Dr. Anupam B. Jena, internal medicine physician and professor at Harvard Medical School, and his colleagues, preeclampisia increased “from 2.4% of pregnancies in 1980 to 3.8% of pregnancies in 2010.” (Cheatham, 7/20)

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Reddit Offers Dark Marketplace For Opioids, But Also Support Groups For Those Struggling To Get Clean

The online forum does not allow users to solicit illegal substances, but those seeking opioids find ways to get around those rules. On the other hand, the forums help some form a community to help get them through the difficult process of getting and staying sober.

The New York Times: On Reddit, Intimate Glimpses Of Addicts In Thrall To Opioids
Every day, thousands of people who are consumed by the nation’s opioid epidemic connect on the popular discussion website Reddit. They swap advice on getting high and offer encouragement to those who have managed to stay clean or are teetering between recovery and relapse. Addicts lament the deaths of fellow users who have suddenly stopped posting. And until last week, buyers and sellers could easily find each other, relying on coded messages that communicated their intent. (Zapler and Harris, 7/20)

In other news on the crisis —

The Washington Post: A 10-Year-Old’s Overdose Death Reveals Miami Neighborhood’s Intense Struggle With Opioids
When 10-year-old Alton Banks left the community swimming pool on the last day of his life, he walked past the elementary school where he had just finished fifth grade. He passed a cheery banner that defined a beaten-down inner-city neighborhood trying to will itself into up-and-comingness: “Experience Overtown. Eat, Live, Work, Play.” He walked past a fancy new apartment building under construction, then a long row of ragged homes and chickens clucking freely on sidewalks littered with crushed tall-boy beer cans in brown paper bags. (Sullivan, 7/20)

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Texas Sued Again Over Anti-Abortion Laws

Planned Parenthood and other groups are suing the state over its ban on a second-trimester procedure. Also in Texas, state lawmakers consider further abortion regulations. Elsewhere, women’s reproductive health issues draw headlines in Ohio and Washington state.

Texas Tribune: Abortion Rights Groups Sue Texas Over Procedure Ban
The Center for Reproductive Rights and Planned Parenthood announced on Thursday they’re suing over a provision in Texas’ Senate Bill 8 bill that outlaws dilation and evacuation abortions. In that procedure, a doctor uses surgical instruments to grasp and remove pieces of fetal tissue. (Evans, 7/20)

Austin American-Statesman: Senate Panel To Mull Abortion, Resuscitation Order Bills Friday
The Senate Health and Human Services Committee on Friday is slated to hear a suite of bills to regulate abortions as well as to improve patient protections when it comes to do-not-resuscitate orders. The 8 a.m. hearing will kick off a busy day for lawmakers who will hear some of the most controversial issues for the 30-day special legislative session, including a bill to ban transgender-friendly bathroom bills and diverting public school money to help students pay for private school tuition. (Chang and Silver, 7/20)

Columbus Dispatch: Ohio Right To Life Takes Stricter Stance On Abortions
Republicans in Ohio will have to get a little more conservative to land a coveted Ohio Right to Life endorsement in 2018. The organization drew a hard line Thursday by announcing that candidates must hold a “pro-life” position containing no exceptions to abortion stemming from rape or incest to receive their political backing. (Keiper, 7/20)

Seattle Times: Crisis Pregnancy Centers Must Post Disclaimers Stating ‘Not A Health Care Facility’ Under King County Rule 
Facilities commonly referred to as “crisis pregnancy centers,” many of which are faith-based, will be required to post a sign telling patients they are not health-care facilities, under a new rule approved Thursday by the King County Board of Health. After emotional public testimony, mostly against the signs, nine of 10 board members voted for the rule saying their action was meant to bring transparency and accurate information to pregnant women. (Young, 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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State Highlights: Union In New York May Have Discovered Solution To High Health Costs; ‘Buffer Zone’ Requested Around Kentucky Abortion Clinic

Media outlets offer coverage out of New York, Kentucky, California, Texas, Ohio, Wisconsin and Florida.

The New York Times: A New Brooklyn Clinic For Hotel Workers Who Enjoy No-Cost Care
Tania Corchado was already quite happy with the health care promised her family for the next nine years, a plan that would be the envy of many Americans. But once she got a peek at where it would be delivered — with no paperwork or, even better, a promise of never having to wait for a doctor — she was itching to make some appointments. (McGeehan, 7/19)

Los Angeles Times: Alleged Conduct By Former USC Dean ‘Horrible And Despicable,’ Med School Head Tells Angry Students
Addressing scores of bewildered and at times angry students, the dean of USC’s medical school said Wednesday that the university had launched multiple internal investigations into the conduct of his predecessor after The Times reported that he associated with criminals and drug abusers who told of using methamphetamine and other drugs with him. (Parvini, Pringle, Hamilton and Elmahrek, 7/19)

Houston Chronicle: Memorial Hermann Executive Leaving To Head Ascension Texas 
Craig Cordola, a longtime Memorial Hermann Health System executive, is leaving to head operations at Ascension Texas, a network of hospitals in Austin and Waco, officials with both institutions said Wednesday. Cordola has been with Memorial Hermann for 14 years, most recently as senior vice president of the health system and president of its West Region, which includes its hospitals in Memorial City, Katy and Cypress. (Deam, 7/19)

Houston Chronicle: Hospitals Shift Networks As Health Care Growth Expands 
Three northwest Houston hospitals will soon be under new management, as population growth continues to expand health care in the region. Tomball Regional Medical Center has been purchased by HCA Holdings Inc., said Sylvia Saumell-Baston, marketing manager at Tomball Regional Medical Center. HCA is a Nashville-based provider of health care services, which operates 171 hospitals and 119 surgery centers in the United States and the United Kingdom. (Santana, 7/19)

Columbus Dispatch: Does Booming Columbus Have Enough OB-GYN Doctors?
With some cities across the country bracing for potential OB-GYN shortages, a new study assessing OB-GYN staffing in major metro areas shows that Columbus is well-equipped. The study was released Thursday by Doximity, a professional social network for physicians and advanced-practice clinicians designed to enhance collaboration among health-care professionals. (Smola, 7/20)

Milwaukee Journal Sentinel: State Extends Waukesha Deadline To Fully Comply With Radium Standards For Drinking Water
The Wisconsin Justice Department has agreed to extend a court-ordered deadline for Waukesha to fully comply with federal and state safe drinking water standards for radium until the city switches to a Lake Michigan water supply in 2023… The Waukesha Water Utility is allowed under a Waukesha County Circuit Court order to blend water from deep and shallow wells to meet the standards. (Behm, 7/19)

Tampa Bay Times: Medical Marijuana Chain Opens First Dispensary In St. Petersburg
A medical marijuana chain opened the doors to its first dispensary in the city on Wednesday morning… St. Petersburg will mark Trulieve’s third location in the Tampa Bay area — following openings in Clearwater and Tampa — and its ninth in the state, with dispensaries in Edgewater, Jacksonville, Miami, Pensacola, Tallahassee and Lady Lake. (Putterman, 7/19)

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Debate Flares Over Governor’s Drug Monitoring Program In Missouri

Gov. Eric Greitens’ order to create a registry in Missouri — the last state to have one — does not allow doctors to see if a patient has already been prescribed an opioid. Some lawmakers say more legislative action is needed. In other news on the national drug epidemic, Ohio’s board on workers’ compensation wants fewer opioids prescribed for back pain. And a Kansas City doctor is under investigation for prescriber kickbacks and insurer fraud.

Kansas City Star: FBI Seizes Patient Records Of KC-Area Doctor With Ties To Insys Therapeutics
The FBI last week seized patient records of Dr. Steven Simon, an Overland Park pain physician with ties to Insys Therapeutics, an opiate manufacturer at the center of a federal case that alleges prescriber kickbacks and insurance fraud… The owner of the pain clinic, Dr. Srinivas Nalamachu, said FBI agents showed up there with a search warrant for the medical records of every patient whom Simon had prescribed oral forms of fentanyl, a powerful synthetic opioid. (Marso, 7/19)

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Postcard From Capitol Hill: Lawmakers Put Women’s Health Care In Its Place

The atmosphere at a House Appropriations Committee lunch meeting on women’s health midday Wednesday was predictably charged.

The Trump administration has proposed to defund Planned Parenthood and make severe cuts in other women’s health programs, such as Title X, a 40-year-old program that provides grants for family planning, and grants for teen pregnancy prevention.

Much of the male-dominated debate — over chili dogs and orange juice — was nominally about where women prefer to seek health care. But the central character was abortion.

Democratic representatives introduced several amendments related to women’s health, including one restoring teen pregnancy prevention grants and another striking language that would allow employers to exclude certain procedures from their health plans if they found them morally objectionable. All of the amendments failed in the Republican-controlled body.

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“No taxpayer dollars should be used to fund abortion, and I’ll fight any effort to dilute or get around that,” declared Rep. Martha Roby (R-Ala.), who prefaced her comments by calling herself “proudly pro-life.”

Federal funds are already prohibited for abortions under the Hyde Amendment, passed in 1976.

So the question of where women should be able to obtain health care has become an odd proxy for the abortion issue. According to Planned Parenthood, 60 percent of women who use their clinics consider it their main source for medical attention.

“We see community health centers as a more appropriate provider, and those are funded in the bill,” said Rep. Tom Cole (R-Okla.).

Rep. Evan Jenkins (R-W.Va.) agreed, saying women in his state — home to only one Planned Parenthood clinic — prefer to get their care at community health centers. “When we have an opportunity to defund Planned Parenthood and invest in community health centers, that’s good for West Virginia,” Jenkins said.

But money saved by defunding Planned Parenthood isn’t slated for community health centers, whose funding isn’t changing under the Trump administration’s proposed budget.

Rep. Barbara Lee (D-Calif.) pointed out: “We may disagree in terms of a woman’s right to choose abortions, but I hope we can agree that women should be able to make their own health care decisions.”

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Cinco poderosas razones por las que fracasó el proyecto de salud republicano

Siete años de votos republicanos para “derogar y reemplazar” la Ley de Cuidado de Salud Asequible (ACA) se desmoronaron el martes 18 de junio, cuando quedó claro que el Senado no podría reunir los votos necesarios para ninguna de las tres propuestas separadas que se estaban considerando.

El fracaso, al menos por ahora, rompe una de las promesas clave que los republicanos vienen haciendo a sus votantes desde 2010, cuando ACA se convirtió en ley.

“Esta ha sido una experiencia muy desafiante para todos nosotros”, dijo el líder de la mayoría del Senado Mitch McConnell (republicano de Kentucky) a periodistas el martes a la tarde. “Está bastante claro que no hay 50 republicanos en este momento para votar por un reemplazo del Obamacare”.

La declaración de oposición que hicieron el lunes los senadores republicanos conservadores Mike Lee (Utah) y Jerry Moran (Kansas) desterró incluso la oportunidad de iniciar el debate sobre la versión de un proyecto de ley presentado la semana anterior.

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McConnell agregó que el Senado votaría a principios de la próxima semana sobre un plan, originalmente aprobado en 2015 y vetado por el presidente Barack Obama, que derogaría partes de la ley de salud. Ese enfoque retrasaría la fecha efectiva de votación por dos años para dar a los legisladores el tiempo para proponer un reemplazo.

Sin embargo, la oposición de los republicanos moderados Susan Collins (Maine), Shelley Moore Capito (West Virginia) y Lisa Murkowski (Alaska), garantiza que esta votación también fracasará.

“Sólo para decir “derogamos la ley y confíe en nosotros, que vamos a arreglar esto en un par de años’, eso no va a proporcionar consuelo a la ansiedad que muchas familias de Alaska están sintiendo en este momento”, dijo Murkowski a periodistas.

En retrospectiva, la incapacidad de los republicanos para reemplazar la ley de salud no debería ser una sorpresa. Estas son algunas de las razones:

1. Es difícil quitarle las cosas a la gente

Una vez lanzados, los programas federales que proporcionan a las personas beneficios que consideran importantes y valiosos son muy difíciles de quitar. En el caso de la atención de salud, la vida de las personas puede estar en juego. En el debate actual, los pacientes que temían lo que sucedería con su cobertura de salud si se derogaba el Obamacare le hicieron saber sus preocupaciones a los legisladores, en voz bien alta.

2. Los republicanos están divididos desde hace tiempo en el tema de la atención médica

El recóndito secreto que los republicanos guardaron estos últimos siete años es que, fundamentalmente, en lo único que acordaron sobre la atención de salud fue en el eslogan “derogar y reemplazar”. Hay una razón por la cual no tuvieron un plan cuando Donald Trump fue elegido presidente. Hasta ahora, todos los esfuerzos por lograr un consenso fracasaron.

“No vine a Washington para herir a la gente”, dijo Capito en un comunicado. “Tengo serias preocupaciones acerca de cómo seguimos proporcionando atención asequible a aquellos que se han beneficiado de la decisión de West Virginia de ampliar el Medicaid”.

Pero los miembros más conservadores, en particular el senador Rand Paul (republicano de Kentucky), tienen otras prioridades. “Todos nosotros prometimos que derogaríamos al Obamacare”, dijo Paul a periodistas el martes. “Si no está dispuesto a votar de la manera en que votó en 2015, entonces necesita regresar a casa y necesita explicarles a los republicanos por qué ya no apoya la revocación del Obamacare”.

3. El liderazgo presidencial en asuntos difíciles es importante

El presidente Trump dejó claro en todas partes lo que quería de un proyecto de ley de salud. Fue su insistencia original sobre que el “revocar y reemplazar” sucediera simultáneamente lo que alejó al Congreso de su estrategia de 2015 de derogar primero y reemplazar más tarde. Durante una celebración en el Jardín de las Rosas de la Casa Blanca, Trump aplaudió cuando la Cámara aprobó su proyecto de ley, pero luego lo llamó “maldito” durante una reunión de estrategia con senadores.

Cuando se hizo claro el lunes por la noche que el esfuerzo del Senado se estaba hundiendo, Trump twitteó: “Los republicanos deberían simplemente rechazar el Obamacare que está fracasando ahora y trabajar en un nuevo plan de salud desde cero”. “Como siempre han dicho, dejar que Obamacare fracase y luego diseñar un gran plan de salud”, agregó.

El presidente “les dio una tarea imposible con sus promesas (más, mejor, más barato para todos). Pero ni las políticas ni el púlpito bully ayudan en el momento crucial”, dijo Len Nichols, profesor de política de salud en la Universidad George Mason. “Y ahora los culpará por fracasar”.

Thomas Miller, del conservador American Enterprise Institute, agregó: “Ahora tenemos un ensayo clínico aleatorio que demuestra que uno no puede dirigir y gobernar a través de Twitter”.

4. El cuidado de la salud es complicado. De verdad

La atención de salud no ha sido tradicionalmente un tema de votación importante para los republicanos, y por lo tanto ha sido una prioridad menor -en comparación con cuestiones como los impuestos y el comercio- a la hora de elegir a sus representantes.

Agrega complejidad el hecho de que el conocimiento de los republicanos no es tan profundo como el de los demócratas cuando se trata de experiencia en políticas de salud. Los demócratas han trabajado en estos temas durante años. Incluso antes de la Ley de Cuidado de Salud Asequible, muchos ya habían servido en el Congreso durante décadas y habían aprendido de los errores que se cometieron en esfuerzos como el fracasado proyecto de ley de salud del presidente Bill Clinton.

5. Algunas partes del Obamacare son realmente populares, incluso entre los republicanos

El requisito de que la mayoría de las personas tengan un seguro a riesgo de pagar una multa -conocido como mandato individual- ha sido muy poco popular entre los votantes de todos los signos políticos. Pero muchas otras disposiciones importantes de la ley de salud, como garantizar la cobertura para las personas con condiciones preexistentes, siguen siendo ampliamente populares.

De hecho, en los últimos meses, el Obamacare ha ido creciendo en popularidad. La mayoría de las encuestas muestran que es más de dos veces más popular que el esfuerzo republicano por cambiarlo.

“Los republicanos tienen que admitir que realmente nos gustan algunas de las cosas de ACA”, dijo Murkowski.

Eso abrió una gran brecha entre los republicanos que querían mantener los beneficios populares y los que querían derogar la ley por completo. Una brecha que, hasta ahora, los republicanos han sido incapaces de zanjar.

Rachel Bluth contribuyó a esta historia.

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