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Perspectives On What Happens Now: Can Obamacare Be Fixed Or Will It Be Left To ‘Explode’?

Opinion writers offer their thoughts on this question, outline ways the health law can be spared and examine the direction in which the political winds could send the ongoing debate.

The Washington Post: Obamacare Is The Law Of The Land. But It’s Still Vulnerable.
House Speaker Paul D. Ryan’s (R-Wis.) decision to pull legislation to reconfigure the nation’s health-care system is a major setback to President Trump and the GOP. For seven years, Republicans promised to repeal and replace Obamacare. Their failure to deliver on this promise exposes intraparty divisions that will not be easily healed. (Eric Patashnik and Jonathan Oberlander, 3/27)

Los Angeles Times: Can Trump Be Stopped From Making Obamacare ‘Explode’?
Supporters of the Affordable Care Act may have celebrated prematurely at the demise last week of the House Republicans’ proposal for its repeal. Yes, the most immediate threat to the future of Obamacare is dead, for now. And in the wake of the House fiasco, President Trump as well as some Senate Republicans have made noises about reaching out to Democrats to shore up the health insurance program. But the Trump White House and congressional Republicans still have it within their power to damage the prospects of health coverage for millions of Americans, whether by actively undermining the Affordable Care Act by administrative fiat or by letting it wither by neglect. (Michael Hiltzik, 3/27)

The Atlantic: Obamacare Won’t Explode Unless Trump Wants It To
The scope of Obamacare’s problems is small, but significant. While health-care costs have been going up less than normal in recent years and premiums for people insured by their employers have also been fairly stable, people who buy their own insurance through the Obamacare marketplaces saw premiums spike by an average of about 25 percent this year. Also, several insurers pulled out of the Obamacare exchanges in the past year, leaving 21 percent of exchange enrollees with just one insurance option and people in Knoxville, Tennessee with potentially no insurers at all. (Olga Khazan, 3/28)

The New York Times: Pushing Obamacare Over The Cliff 
After Republicans pulled their legislation to repeal and replace the Affordable Care Act last Friday, President Trump told The Washington Post, “The best thing politically is to let Obamacare explode.” Or he could light a match. Republicans may have conceded defeat in their legislative effort to get rid of Obamacare, but their guerrilla war to achieve its demise remains underway. (Steven Rattner, 3/28)

The Washington Post: Why Trump Won’t ‘Let Obamacare Explode’
As President Trump licked his wounded ego Friday, he told The Post in an interview, “The best thing politically is to let Obamacare explode.” His Office of Management and Budget director, Mick Mulvaney, echoed that sentiment on “Meet the Press.” (Jennifer Rubin, 3/27)

The Des Moines Register: It’s Time To Embrace And Fix Affordable Care Act
“I have to tell you, it’s an unbelievably complex subject,” President Donald Trump told governors during a meeting last month. “Nobody knew that health care could be so complicated.” Nobody except everyone else. That is why the 2009 Democratic-controlled Congress spent a year debating and ironing out the details of what eventually became the Affordable Care Act. The two-part law and regulations total thousands of pages. Before passage, lawmakers met with insurers, hospitals, physicians and patient advocacy groups to build a consensus for what they all understood was a labyrinthine endeavor. (3/27)

The New York Times: Republicans For Single-Payer Health Care
Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer. That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept. (David Leonhardt, 3/28)

Atlanta Journal-Constitution: Post-AHCA, How Health Reform Can Move Forward In Georgia
When Roswell’s Tom Price moved from Congress to the executive branch as secretary of health and human services, he instantly gained the power to reshape much of the way health care works in this country, regardless of what becomes of Obamacare. Ironically, it’s Obamacare that gives him that ability… It also gives Price’s department the authority to grant the states waivers to the law’s requirements for health plans offered on their insurance exchanges, and that’s where this gets interesting. (Kyle Wingfield, 3/27)

WBUR: Can Gov. Charlie Baker Fix Health Care In America?
Republicans have long hyped the need for a replacement bill by sowing the fear that Obamacare is imploding. Yet they hypocritically ignore their own complicity in creating the conditions for failure. Now that their bill has collapsed, the new mantra is to practice saying “I told you so,” in the event their self-fulfilling prophecy comes to fruition. (Lauren Stiller Rikleen, 3/28)

The Washington Post: Why Trump And The GOP Could Fail On Tax Reform, Too
There are many lessons to be learned from the failure of the GOP health-care effort. An important one is that being a businessman, even a successful one, does not prepare you for the complexities of governing, any more than being a successful software engineer means you could easily become a great carpenter. (Paul Waldman, 3/27)

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

Different Takes On Who’s To Blame For The Demise Of The House GOP Health Plan

Editorial pages across the country offer their thoughts on the blame game as well as the policies and politics that led to last week’s dramatic outcome.

Los Angeles Times: Healthcare Debacle Results From Republicans Believing Their Own Myths
Donald Trump and congressional Republicans created a political debacle for themselves by believing a set of scare stories about Obamacare that came back to haunt them. It is an object lesson in how false realities ultimately pop like soap bubbles when pricked by plain old truth. There are five fatal fibs the GOP sold to supporters and to themselves. (David Horsey, 3/27)

Boston Globe: In Donald Trump’s Oval Office, The Buck Stops Elsewhere
Since US House Speaker Paul Ryan scrapped last week’s vote on the Republican proposal to replace Obamacare, Trump has blamed different people for its demise, depending on the day. From the Oval Office on Friday, Trump blamed Democrats. On Saturday, Trump asked people to watch a Fox News Channel show on which the host proclaimed, “Paul Ryan needs to step down as speaker of the House.” (Pindell, 3/27)

The Wichita Eagle: Trump’s Ego Costs Him Opportunity On Health Care
When President Trump’s first major governing challenge unexpectedly crystallized last week, his failure to meet it was preordained by his personality. Because he considers himself the center of every universe, an opportunity to step toward greatness was invisible to him. His primary failure wasn’t his inability to persuade the hard-liners in his party to go along with a cobbled-together, cynical and desperate attempt to repeal and replace the Affordable Care Act. Solomon could not have salvaged that wreck. (Davis Merritt, 3/28)

Los Angeles Times: Who’s To Blame For Trump’s Failures? Must Be Paul Ryan
Paul Ryan did it. That’s the argument many of the louder voices on the right are shouting. In the story they tell, the speaker of the House is fully responsible for the GOP’s failure to pass an Obamacare repeal-and-replace bill last week. President Trump should walk across a Havana ballroom like Michael Corleone in “The Godfather Part II,” kiss Ryan on the mouth and say, “I know it was you, Paul. You broke my heart.” (Jonah Goldberg, 3/27)

The Washington Post: This Is Why The Freedom Caucus Called The Shots On Trump’s Health-Care Bill
The Republicans’ failed strategy to repeal and replace the Affordable Care Act is puzzling. Knowing that a more conservative health-care bill would be dead on arrival in the Senate, why did President Trump and House Speaker Paul D. Ryan (R-Wis.) seek the votes of the House Freedom Caucus (HFC), a group of about 30 of the chamber’s most conservative members? Desperate to secure a majority, the White House offered significant last-minute policy concessions to the group — turning off the more centrist members of the Tuesday Group, failing to secure Freedom Caucus votes and dooming the bill. (Ruth Bloch Rubin, 3/27)

The Wall Street Journal: The GOP Entitlement Caucus
The full dimensions of the GOP’s self-defeat on health care will emerge over time, but one immediate consequence is giving up block grants for Medicaid. This transformation would have put the program on a budget for the first time since it was created in 1965, and the bill’s opponents ought to be held accountable for the rising spending that they could have prevented. (3/27)

The Washington Post: The Freedom Caucus Blows Its Chance To Govern
A few days before the House Freedom Caucus brought down the American Health Care Act, Rep. Mark Meadows laid out the stakes for his group: “This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus.” The North Carolina Republican was right. The vote was indeed a defining moment — a test in which the Freedom Caucus had to decide: Would it remain a minoritarian opposition bloc whose only role was to defend truth without compromise? Or could it become something bigger, transforming itself into a majoritarian governing force that could lead Congress toward achievable conservative victories and have a lasting impact on the direction of our country? (Marc A. Thiessen, 3/27)

Huffington Post: The Death Of Trumpcare Is The Ultimate Proof Of Obamacare’s Historic Accomplishment
Somehow, despite the intense political forces arrayed against it, and the mind-boggling policy problems it tries to solve, the 2010 health care law keeps defying efforts to wipe it out. That says something about the people who wrote it ― and what they have achieved. Obamacare has never been hugely popular, and it has never worked as well as its architects hoped. Millions of Americans don’t like it and, even now, there are parts of the country where the markets are struggling to survive. But the program has provided security and access to care for millions of others. More importantly, it has shifted the expectations of what government should do ― and of what a decent society looks like. (Jonathan Cohn, 3/26)

Los Angeles Times: The Original Mistake That Distorted The Health Insurance System In America
A World War II-era mistake distorted the U.S. health insurance system. Reformers tried to fix the problem with patchwork solutions until Obamacare dumped yet another layer of misguided policy onto what was already a mess. Now the tangle is so perplexing that a Republican Congress, under a Republican president, could not even bring a health-insurance reform bill to a vote last week. But legislators will no doubt try to tackle the issue again, and when they do, they should consider erasing the original error instead of merely papering it over. (Myron Magnet, 3/28)

RealClear Health: Five Lessons From The AHCA’s Demise
While the keyhole of history has had insufficient time to bring the failed launch of the American Health Care Act (AHCA) into focus, it’s not too soon to begin learning some of the lessons it can teach us. Legislative efforts have a lifespan but our health care system does not. So whether we are still rejoicing or recriminating, let’s take a look at some timeless principles we can apply to the ongoing effort to improve health care in the United States. (Billy Wynne, 3/27)

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

Clinic Seeks To Turn Marijuana From ‘Gateway Drug’ To Gateway To Treatment

A small but growing number of pain doctors and addiction specialists are overseeing the use of marijuana as a substitute for more potent and dangerous drugs. In other public health news: the opioid epidemic, lead standards, childhood trauma, multiple sclerosis, Zika, HPV vaccines and concussions.

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

Stat: EPA Sidestepped Decision To Tighten Standards For Lead Levels
The 750,000-ton stack is a mix of lead, arsenic, and other toxic metals, blended with sand and abandoned by the businesses that once employed most of the town, about 100 miles southwest of Chicago, in the Illinois River Valley. When the wind blows, specks of toxic metals sail off the slag heap and land on the town’s modest houses and gardens, in school playgrounds, on church steps and, sometimes, in the water…It is the lead — a toxin that can damage children’s brains at even low levels of exposure — that worries most people here. (Kaplan, 3/28)

Milwaukee Journal Sentinel: An Intractable Problem
Public health experts in Milwaukee and around the nation now see a direct link between childhood trauma and an incapacitated workforce. Improving the latter is impossible without addressing the former. Children exposed to abuse, violence and neglect may not be able to concentrate in school, much less job training programs. (Schmid and Crowe, 3/27)

Columbus Dispatch: Multiple Sclerosis Drug Offers Hope Of Halting Disease
In multiple sclerosis, an abnormal immune-system response leads to an attack of nerve fibers and the fatty myelin that surrounds them in the central nervous system… Ocrelizumab works by depleting B cells, which are immune cells that participate in the attack on myelin, Racke said. The drug represents a transformation in MS care, said Dr. Aaron Boster, director of the MS center at OhioHealth, where he also serves as systems medical chief of neuroimmunology. (Viviano, 3/28)

Miami Herald: Zika Virus: Rick Scott Visits Miami Prepare Mosquito Season 
South Florida’s battle plan for Zika, expected to rebound with the rainy season, includes more boots on the ground to inspect and fumigate for mosquitoes, more lab resources to speed up test turnaround times and the promise of a more collegial collaboration between the federal and state governments. (Chang, 3/27)

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

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

McAuliffe Says Health Bill’s Collapse In Congress Signals Need For Virginia To Expand Medicaid

But the state’s Republican lawmakers, who have consistently opposed such a move, appear unlikely to accept the governor’s suggestion. News outlets also examine a proposal in Georgia to revamp Medicaid, a look at how the program for low-income Americans has evolved since the 1960s and a request from Wisconsin to add drug tests for eligibility.

The Washington Post: McAuliffe: If Obamacare Is Here To Stay, Then It’s Time To Expand Medicaid
The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medi­caid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans. But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid. (Schneider, 3/27)

CNN: McAuliffe Pushes Virginia Medicaid Expansion After GOP’s Failure To Repeal Obamacare
Virginia’s Democratic governor is using President Donald Trump’s failure to repeal Obamacare to heap pressure on Republican state lawmakers to expand Medicaid. Gov. Terry McAuliffe — who has long supported the Affordable Care Act’s Medicaid expansion, but has been stymied by GOP legislators in extending the coverage to more than 400,000 Virginians — announced the push Monday. (Bradner, 3/27)

Atlanta Journal-Constitution: Georgia Eyes New Medicaid Options After Trump Health Bill Fails 
Gov. Nathan Deal said Monday his administration is exploring changes to Georgia’s Medicaid program after a sweeping Republican overhaul of the Affordable Care Act was scuttled in a stunning rebuke to Donald Trump and Congressional leaders. The Republican governor said there are limits to what the state can request “as long as mandates under the basic Obamacare legislation stand in place.” But he said the state would review healthcare options that could include changes to “mandated minimum coverage” provisions that require the state Medicaid program to cover a range of health services to recipients. (Bluestein, 3/27)

The Associated Press: Georgia Governor Says State Will Explore Health Care Changes
Trump’s administration has signaled a willingness to let states experiment with Medicaid funds using waivers. Former Georgia congressman Tom Price now leads the Department of Health and Human Services under Trump. Deal said Monday that he wants the state to look into the options but didn’t discuss details. He also added that his administration hasn’t developed a proposal so far. (Foody, 3/27)

The New York Times: In Health Bill’s Defeat, Medicaid Comes Of Age
When it was created more than a half century ago, Medicaid almost escaped notice. Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills. (Zernike, Goodnough and Belluck, 3/27)

Milwaukee Journal Sentinel: With Congress Gridlocked, Scott Walker Wants Trump To OK Drug Tests For State Health Coverage
With the GOP’s repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage. Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he’s not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers. (Stein, 3/27)

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

Kansas Senate Gives Preliminary Approval To Medicaid Expansion Bill

Moderate Republicans join with Democrats to easily push through the legislation. But Gov. Sam Brownback has criticized the measure and may veto it.

KCUR: KanCare Expansion Bill Now Just One Step Away 
Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Monday gave tentative approval to a Medicaid expansion bill after debating it for nearly three hours. A bipartisan group of 25 senators voted for the bill. All 13 “no” votes were cast by Republicans concerned about the cost of expansion and opposed to covering low-income, non-disabled adults. If it survives a final-action vote Tuesday, the bill would go to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during the debate but did not say whether he would veto it. (McLean, 3/27)

Wichita (Kan.) Eagle: Kansas Senate Votes To Expand Medicaid
The legislation in the Senate would expand eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four. The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent. (Shorman, 3/27)

Kansas City Star: Kansas Senate Votes To Expand Medicaid As Gov. Sam Brownback Doubles Down On Opposition
Opponents of the bill have spent much of the 2017 session downplaying the legislation’s chances because of uncertainty over how health care would change under President Donald Trump’s administration. … But the opponents’ argument faded slightly after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a bill that would have repealed the Affordable Care Act and effectively barred states from expanding Medicaid beyond March 1, due to a lack of GOP support. (Woodall and Lowry, 3/27)

The Associated Press: GOP Failure In Congress Boosts Medicaid Effort In Kansas
Legislators and advocates in Kansas pushing to expand the state’s health coverage for the poor to thousands of adults are buoyed by the failure of Republicans in Washington to repeal former President Barack Obama’s signature health care law. … The effort in Kansas could prove largely symbolic because Republican legislators remain deeply divided and Brownback is a longstanding critic of health care policies championed by Obama, a Democrat. Yet supporters have scored a significant gain by getting a bill so close to passage. (Hanna, 3/27)

Topeka Capital Journal: Senators Back Medicaid Expansion To Aid Vulnerable Hospitals
Financially fragile hospitals in Kansas — especially facilities in rural areas of the state — have a lot to lose in the Kansas Legislature’s debate about expanding Medicaid services. The Alliance for a Healthy Kansas reported 31 of the state’s 107 hospitals are financially vulnerable because each must grapple with costs of providing care to people who are uninsured. The Senate voted 25-13 on Monday to send the Medicaid expansion bill, House Bill 2044, to final action on Tuesday. Expansion would deliver Medicaid services to about 150,000 more Kansans. (Harford, 3/27)

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

Viewpoints: When Insurers Reject ‘Unproven Therapies’; Can Trump Help Americans Who Are Dying ‘Deaths Of Despair’

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

Arizona Republic: Sarah Wants Her Life Back (UnitedHealthcare Refuses To Give It To Her)
Isn’t it nice that the insurance company is looking out for Sarah, preventing her from having to endure “unproven therapies,” regardless of what her doctor has witnessed with other patients over and over and, well, over again? I’m quite sure UnitedHealthcare’s denial is for Sarah’s own good. Quite sure it has nothing to do with the cost of IVIG: about $32,000 a month. Or the fact that she’d need it for up to a year. (Laurie Roberts, 3/26)

The Washington Post: Americans Are Dying ‘Deaths Of Despair.’ Will Trump Help? 
It is a political cliche that President Trump owes his electoral victory to the extraordinary support he received from white voters without a college degree, two-thirds of whom voted for the Republican. Much less settled is the question of why these largely low-income voters, once reliable Democrats, cast their lot with a brash billionaire from New York. (3/25)

The Washington Post: More Lies On Planned Parenthood
Not “even a scintilla of evidence.” That was the judgment of a federal judge last month in Texas about allegations of wrongdoing by Planned Parenthood. He was not alone in finding that the health-care organization did not illegally profit from fetal-tissue donation: Three Republican-led congressional investigations, 13 states and a Texas grand jury all could find no substance to claims about the alleged sale of “baby body parts,” which gained currency through videos released by anti-abortion activists. (3/26)

The Wall Street Journal: High-Tech Help For The Freelance Physician
From Amazon to eBay and Uber to Airbnb, digital technology has revolutionized everyday life. But when you get sick, you might as well take a time machine back a few decades. You phone your doctor’s office to make an appointment. You sit in a waiting room stocked with old magazines. The physician writes down notes about your symptoms and stores them in paper files. When you’re done, a receptionist hands you a little card with the date and time of your next visit. (Allysia Finley, 3/24)

Louisville Courier-Journal: ‘Tired Of Burying My Friends’
I am a full-time student with a part-time job. I went to decent schools and stayed away from the neighborhoods my parents warned me about. I am not an anomaly, and neither is gun violence. I apologize if I seem insensitive towards the individual’s right to own a gun, but it is time we take a critical look at our society’s priorities. What good is a world full of guns if we must fill our days with this pain? How many of our children are we willing to lose to maintain our sense of entitlement? (Tara Ann Steiden, 3/23)

The New York Times: To Win Again, Democrats Must Stop Being The Abortion Party
But once-solid Catholic support for Democrats has steadily eroded. This was due at least in part to the shift by many American Catholic bishops from emphasizing social issues (peace, the economy) to engaging in the culture wars (abortion, gay marriage). Along the way, many Catholics came to view the Democrats as unconditionally supporting abortion. Last year’s election was a watershed in this evolution. Hillary Clinton lost the overall Catholic vote by seven points — after President Obama had won it in the previous two elections. She lost the white Catholic vote by 23 points. In heavily Catholic states like Pennsylvania, Wisconsin and Michigan, she lost by a hair — the last by less than 1 percent. A handful more of Catholic votes per parish in those states would have won her the election. (Thomas Groome, 3/27)

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

Taking Stock: After The Smoke Clears, The Health Insurance Issues Remain

Premium costs, essential benefits, Medicaid expansion and the fact that the health industry has a huge impact on the financial markets are among the thoughts on which opinion writers continue to focus.

Bloomberg: Market Impact Of Republicans’ Insurance Debacle Far From Clear
Having stiff-armed political risk for quite a while, market participants now have to think a lot more about the issue in general — and specifically, about how much the Trump administration’s legislative agenda will suffer on account of Republicans’ last-minute decision on Friday to pull their health-care bill from an imminent vote on the floor of the House of Representatives. Some may be inclined to predict other failures that would impact forthcoming economic bills, given the erosion of Republicans’ political capital and the Washington blame game that’s sure to play out. But the situation on the ground is a lot more complicated than that. (Mohamed A. El-Erian, 3/24)

RealClear Health: The Root Cause Of Health Care Dysfunction
Before the Affordable Care Act (ACA) passed in March 2010, President Obama repeatedly promised that the typical family’s health premiums would go down by (sometimes “up to” but frequently “on average”) $2,500. That decline did not occur because the ACA strengthened the control that insurance companies—as opposed to patients—have over health care spending. In fact, Americans’ increasing dependence on health insurance over the last seven decades has been a major contributor to exploding health costs. (John R. Graham, 3/27)

Modern Healthcare: Some Insurance Benefits Are Essential
The House of Representatives last week postponed voting to gut Obamacare after new provisions weakening the essential benefits guarantee failed to win the support from right-wing Republicans, who are opposed to any form of subsidized health insurance. Suffice it to say that the last-minute maneuvering clarified how far the modern Republican Party is willing to go in undermining health insurance, and the healthcare system along with it. (Merrill Goozner, 3/25)

Forbes: More States To Expand Medicaid Now That Obamacare Remains Law
More states will pursue expansion of Medicaid health benefits for poor Americans under the Affordable Care Act after Republicans failed to repeal and replace the law. … At least two states – Kansas and North Carolina – are already working toward becoming the 32nd and 33rd states to expand Medicaid under the ACA. (Bruce Japsen, 3/26)

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

State Reviews Of The GOP’s Health Plan Implosion

Editorial pages examine who dodged the bullets in their states and detail what went wrong with the American Health Care Act.

Kansas City Star: Americans Want Health Care That Works For All 
I continue to believe that most Americans think everyone should have health care. And while the current law is far from perfect and would benefit from some bipartisan improvements, it is by any measure — coverage, cost, continuity of care — vastly superior to the law Republicans proposed and then couldn’t pass last week. (Kathleen Sebelius, 3/25)

Cleveland Plain Dealer: Collapse Of Trumpcare A Victory For Republicans Who Pushed Back To Protect States Like Ohio
The dramatic collapse today of efforts by House Speaker Paul Ryan and President Donald Trump to force House Republicans to pass Ryan’s jury-rigged repeal of Obamacare was a victory not just for common sense but also for those Republicans who stood up to Trump. Among them: Sen. Rob Portman of Ohio, who, along with several other Republican senators, sent a letter to Majority Leader Mitch McConnell earlier this month outlining the plan’s likely harm to the millions of Americans covered by Medicaid expansion, in Ohio and other states — and to the states themselves. (3/24)

Miami Herald: Healthcare Bill, And GOP, Fail Miserably
But, and pardon the tortured mix of metaphor, Republicans had the ball in their court, for seven years now, and fumbled it — most spectacularly on Friday. That’s when their controversial bill to replace the Affordable Care Act, failed to win the necessary 216 votes to pass. House Speaker Paul Ryan recommended pulling it. President Trump, the biggest loser, agreed. The bill, a cornerstone of Trump’s campaign and that of scores of new Republican lawmakers, went down. Obamacare rules — until Republicans get serious. That’s great news for millions of Americans, and Floridians especially. The bill would have left almost 2 million state residents without health insurance and forced many others to pay thousands more for coverage. Republican Rep. Ileana Ros-Lehtinen told her local constituents she would vote No, while her more cowed Miami colleagues kept mumbling about having to study the situation. (3/25)

The Kansas City Star: Congratulations, Republicans. This Health Care Defeat Is Really A Win.
Cheer up, Republicans. Sometimes, what looks and feels like a loss is really a win. Usually it takes a while for the all-for-the-best benefits of a short-term defeat to sink in. But the health care bill that the Republicans pulled at the last minute on Friday would have quickly made the GOP nostalgic for the days when they could take bows for show votes repealing the Affordable Care Act for the umpteenth time. Had the bill passed, Republicans would have lost both politically and in human terms as the bill devastated many of the very voters who believed President Donald Trump’s campaign promise that “everybody’s going to be taken care of much better than they’re taken care of now.” (3/24)

Chicago Tribune: Why Health Care Can’t Be Fixed
Bill Clinton tried to fix America’s health care problems and was shot down by Congress. Barack Obama got his solution enacted only to find most people didn’t like it. Republicans who voted repeatedly to repeal Obamacare and replace it with something far better have found it fiendishly hard to agree on how. (Steve Chapman, 3/24)

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

Perspectives From Monday Morning Quarterbacks: How The Health Bill Unraveled

Opinion writers analyze what happened last week in Congress when the House GOP’s health law replacement plan came undone.

The Wall Street Journal: The ObamaCare Republicans
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government. (3/24)

The Wall Street Journal: High Anxiety Over Health-Care Reform
What politicians, those hardy folk, don’t understand about health care is how anxious it makes their constituents. Not suspicious, not obstinate, but anxious. Because unlike such policy questions as tax reform, health care can be an immediate life-or-death issue for you. It has to do with whether, when, and where you can get the chemo if you’re sick, and how long they’ll let you stay in the hospital when you have nobody, or nobody reliable and nearby, to care for you. To make it worse, the issue is all hopelessly complicated and complex and pits you as an individual against huge institutions—the insurance company that doesn’t answer the phone, the hospital that says “I’m afraid that’s not covered”—and you have to make the right decisions. (Peggy Noonan, 3/24)

The Washington Post: The Lessons Trump And Ryan Failed To Learn From History
If President Trump and House Speaker Paul D. Ryan (R-Wis.) had paid attention to Mitt Romney, they could have avoided the fiasco of their now dead and unmourned health-care bill. They would not now face a situation in which both of them are being blamed because they both deserve to be. And the Republican Party would not be engulfed in a festival of recriminations. (E.J. Dionne Jr., 3/26)

The New York Times: The G.O.P.’s Existential Crisis
Give Donald Trump this: His travel ban enraged only half the country. The House Republicans’ attempt to replace the Affordable Care Act, meanwhile, has alienated everyone, including members of the Republican Party itself. The bill was supposed to go to a vote on Friday, but the leadership, facing a likely defeat, was forced to pull it when it became clear it didn’t have the necessary support. It was perhaps better off dead: Already a rushed, Rube Goldberg solution in search of a problem, by the time it neared the House floor it had so many compromises woven into it to win votes that, even if it passed, it would have probably gone down in defeat in the Senate. (Corey Robin, 3/24)

The Washington Post: Republicans’ Dangerous Health-Care Delusions
The jaw-dropping spectacle in which their party holds the White House and majorities in both houses of Congress and yet failed on its first, and arguably most significant, agenda item should disabuse Republicans of a number their deeply held, inaccurate beliefs. (Jennifer Rubin, 3/26)

USA Today: Colossal GOP Failure And Not Just On Health
The plan to replace Obamacare with a new bill crafted by House Speaker Paul Ryan has failed, and embarrassingly so. And that failure is part and parcel of a larger failure of the Republican-led Congress to push an agenda in the new administration. (Glenn Harlan Reynolds, 3/26)

Bloomberg: A Republican Fiasco Years In The Making
We should pause and realize what a big deal this is. The number one agenda item for years, the one that most House Republicans campaigned on when first elected, and they couldn’t manage to even get an initial bill out of the House. Not only that, but it was clear this week that even though most of them were willing to vote for it, practically no one was enthusiastic about what they had produced. It also polled terribly, and conservative health care wonks hated the bill. (Jonathan Bernstein, 3/24)

Los Angeles Times: Trump Discovers That Legislating Is Complicated As The GOP Healthcare Bill Goes Down In Flames
Having recently learned that healthcare is complicated, President Trump has now discovered that legislating is complicated too. Trump’s attempt to force a half-baked bill to “repeal and replace” Obamacare down the throats of reluctant House Republicans failed, as House leaders were simply unable to satisfy the conflicting demands from the two wings of their party. In the end, it wasn’t a case of savvy dealmakers coming up with an offer that buyers couldn’t refuse; it was a case of buyers looking at the offer and saying, “No thanks.” (3/24)

Los Angeles Times: Boy, These Washington Big Shots Ate Well While Their Healthcare Bill Was Blowing Up
One can always count on this feature in the aftermath of any great event that has taken place behind closed doors: the journalistic “inside story.” It’s known in the trade as a “tick-tock.” And the implosion of the House Republicans’ Obamacare repeal bill has thrown off its fair share of examples, notably in the New York Times, Politico, the Washington Post and at CNN. They’re full of scenes of heightened drama from the last week, all described in cinematic detail, replete with the interior monologues of participants at the White House, the Capitol and other locations around town. (Michael Hiltzik, 3/26)

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State Highlights: Incidents Call Into Question Mass. Mental Health Care System; Texas ‘Granny Tax’ Sparks Nursing Homes Debate

Media outlets report on news from Massachusetts, Texas, Kansas, Connecticut, Washington, Tennessee, California and Wisconsin.

Boston Globe: In Massachusetts’ Failing Mental Health Care System, Even The Lucky Ones Aren’t So Lucky
James Boyd Jr.’s death is one of seven recent incidents involving Department of Mental Health clients that illuminate a growing concern inside the state agency: that the department is releasing a steady stream of people with serious mental illness to live in the community without proper supervision. While thousands with serious mental illness struggle to get any help, the roughly 21,000 Department of Mental Health clients are promised treatment at state-run facilities and state-funded programs in the community that are operated by private vendors… But the string of incidents raises questions about whether the department is doing enough to ensure the safety of its clients and the public. (Helman and Russell, 3/25)

San Antonio Press-Express: Nursing Homes Joust Over Fee Proposal: ‘Granny Tax’ Or Funding Lifeline? 
Nursing homes that are stretched thin as they care for Medicaid residents are asking lawmakers to approve a fee on their facilities that would allow Texas to get hundreds of millions of matching federal dollars to boost their low reimbursements. But the idea has generated a backlash from nursing homes that serve private-pay patients and object to paying the proposed assessment, which they call a “granny tax.” Their private-pay patients are outside of Medicaid, and the homes aren’t confident of promises that they’ll be otherwise repaid for their share of the fees that would trigger more Medicaid dollars. (Fikac, 3/25)

KCUR: Kansas Mental Health Centers Seek Exemption From Gun Law 
Unless the Legislature makes a change, community mental health centers across Kansas will have to allow patients and staff to bring their guns starting in July. A 2013 state law requires most publicly owned buildings to allow concealed weapons or to install metal detectors and post armed guards. The law included a four-year exemption for community mental health centers, universities, publicly owned medical facilities, nursing homes and low-income health clinics that ends July 1. (Wingerter, 3/24)

The CT Mirror: Anthem’s Cost Savings At Center Of Merger Suit Appeal Argument
Anthem and the Justice Department faced off in court Friday over the insurer’s proposed merger with Cigna, with the legal wrangling centered on whether any savings from the deal would justify shrinking the market for large employer insurance policies from four to three carriers. A federal district court in February sided with the Justice Department – and 11 states including Connecticut – in blocking the $54 billion merger. (Radelat, 3/24)

Seattle Times: Nurses Gain Traction In Legislature On Bills To Address ‘Dangerous’ Staffing 
For years, nurses have gone to Olympia, imploring lawmakers to understand that staffing problems were placing patient care at risk. There are constant staff shortages that force nurses to forgo meals and bathroom breaks in order to properly care for patients. There are the 12-hour nursing shifts that grow longer due to scheduling issues. There are nurse-to-patient ratios that seem to grow more dangerous. Nurses returned to Olympia this week to reiterate those messages to the Legislature yet again. But this time they have more optimism that lawmakers are listening. (Baker, 3/26)

Boston Globe: New State Rules For Long-Term Care Insurance Forgo Limits On Rate Hikes 
After five years of fits and starts, Massachusetts regulators are close to adopting rules that would increase oversight of long-term care insurance, a market that has been roiled by skyrocketing premiums for consumers and declining profits for insurance companies. But some consumers and advocates argue that the proposals would not do enough to protect policyholders from the escalating costs of long-term care insurance, which helps pay for nursing homes, home health services, and assisted living. (Fernandes, 3/26)

Nashville Tennessean: Can Nashville Find Cure For Price Blindness In Health Care?
“Price blindness,” or a lack of price transparency, affects healthcare consumers across the U.S. Pricing is so opaque that even many doctors and hospitals can’t estimate what a service might cost, leaving patients no options to compare or price-shop. This problem is unique to healthcare — can you imagine driving a car off the dealer’s lot and getting a bill in the mail later? Would you buy a television at Best Buy without a quick Amazon search? Most of us would not, but until recently, there just wasn’t a way for consumers to easily compare costs in healthcare. But Nashville companies like Healthcare Bluebook and MD Save are trying to change that, especially as consumers pick up more of the costs of their care. (Tolbert, 3/26)

Los Angeles Times: L.A. Officials Push For New Steps To Address Health Risks From Homebuilding Near Freeways
In a new push to address health risks from a surge in residential construction near freeways, Los Angeles officials have requested a study of development restrictions, design standards and other steps to protect residents from traffic pollution. Planning, transportation and other officials should prepare “strategies to address the hazard of freeway pollution affecting residents of new and existing structures,” according to a motion filed this week by councilmen Jose Huizar and Paul Koretz. These could include buffer zones and barriers, air filtration requirements and regulations on building design. (Barboza and Zahniser, 3/24)

Milwaukee Journal Sentinel: State Nearly Returned Suspended Psychologist To Wisconsin’s Youth Prison
State officials last year were on the verge of returning a suspended psychologist to his job at Wisconsin’s troubled juvenile prison, but backed off after a prosecutor said he could be charged with falsifying records, state records show. After learning of possible charges, the Department of Corrections kept psychologist Wilson Fowle on paid leave and began its own investigation. Six weeks later, Fowle retired and by the end of 2016 agreed to surrender his psychology license. (Marley, 3/24)

Boston Globe: Dozens Of Industries Could See A Boost From Legalized Marijuana 
A Swiss company that for years has provided Massachusetts with cigarette tax stamp services — helping the state thwart the black market — has its eyes set on what could be a much bigger public contract: tracking legal marijuana from seed to sale to keep it from being diverted to criminal enterprises… Such product tracing is one of dozens of industries that could see a big boom in business when recreational marijuana shops, growhouses, testing facilities, and infused-product manufacturers (think candy and brownies) open in Massachusetts, probably next year. (Miller, 3/27)

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New ‘War On Drugs’ Needed To Battle Opioid Crisis, Sen. Manchin Argues

Stat interviews the West Virginia senator about his focus on a national epidemic that has hit his state particularly hard. In related news about the crisis: a New Jersey family files suit against a fentanyl manufacturer, doctor and pharmacy; Maryland lawmakers rush to pass an opioid bill; a New Hampshire physician assistant faces criminal charges over his Subsys prescriptions; and more.

Stat: Sen. Manchin: Time For A New ‘War On Drugs’ To Tackle Opioids
Senator Joe Manchin stepped onto the Senate floor last week to read a letter sent to him by Leigh Ann Wilson, a home caregiver whose 21-year-old daughter, Taylor, died from an opioid overdose last fall. “Please work quickly to prevent thousands of other Taylors from the same fate,” Manchin read. That was just the latest of many such letters that Manchin, a Democrat, has read on the Senate floor over the past year. He represents West Virginia, which has the highest rate of drug overdose deaths in the nation. And he seeks to amplify the voices of those most affected. (Blau, 3/27)

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

Columbus Dispatch: More Ohio Newborns Suffer From Mother’s Addiction
The number of Ohio babies who come into the world sick and craving drugs continues to soar. New state reports show that the rate of neonatal abstinence syndrome — the medical term for withdrawal symptoms suffered by newborns — jumped to 159 per 10,000 live births in 2015. That’s more than eight times the rate a decade earlier, in 2005, when there were just 19 such hospitalizations for every 10,000 live births. (Price, 3/27)

The Hill: ‘Deaths Of Despair’ On The Rise Among Blue-Collar Whites 
A decades-long trend of economic stagnation and social immobility may be to blame for a shocking increase in death rates among middle-aged white Americans, a new study finds, as the number of deaths caused by drugs, alcohol abuse and suicide reaches levels not seen in generations. For nearly a century, advances in medical technology and healthy living have sent mortality rates of all Americans plummeting. But in recent years, a stark divide has emerged along educational and racial lines: as death rates plunge for minorities and well-educated whites, the number of whites without a college education dying in middle age is skyrocketing. (Wilson, 3/25)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: Ryan Says Vote Will Fulfill GOP Promise; Small Business Sees Relief; Vote No On ‘Skinflint’ Bill

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

The Wall Street Journal: Keeping Our Promise To Repeal ObamaCare
The election of Donald Trump and a Republican Congress provides an opportunity: We can immediately halt the leftward drift of American social policy, while renewing prosperity through market-based, state-driven solutions that empower people instead of bureaucrats. This is the stuff of conservative dreams. But it will become reality only if Republicans keep the promises we have made. (House Speaker Paul Ryan, 3/22)

Los Angeles Times: A Healthcare Test We’re Hoping Republicans Will Flunk
On Thursday, House Republicans and President Trump face their first big test since the election that put the GOP in complete control of the federal government. The House will be voting on a bill to repeal much of the healthcare reform law Democrats pushed through Congress in 2010, replacing it with a skinflint alternative that’s projected to leave 24 million more people uninsured in a decade. It’s a horrible proposal, and the main hope for the country is that dissident Republicans will kill it because it’s not awful enough for them. (3/22)

Huffington Post: Mental Health, Maternity Care Guarantees In Jeopardy As GOP Wrangles For Votes
Someone with bipolar disease might have no way to pay for a psychiatrist to monitor his condition. A couple might have to fork over $15,000 to have a baby. These are just two of the possible consequences of a deal now under discussion in the U.S. House as Republican leaders working with the Trump administration try furiously to round up the votes they need to win approval for their bill to repeal the Affordable Care Act. (Jonathan Cohn, 3/23)

Los Angeles Times: Eliminating Essential Health Insurance Benefits Is A Stupid Idea That Won’t Save Money. Here’s Why.
David Anderson of Duke points us to a recent paper by Milliman, the preeminent cost-analysis firm in healthcare, about how much these essential benefits actually add to the cost of health insurance and the consequences of removing the mandates. The paper finds that eliminating the most vulnerable mandates, such as maternity care, will reduce average premiums somewhat but drive costs for people who need those services sky-high and transfer much of the cost to other public programs. The net gain for society is almost invisible. To put it another way, the savings are an illusion. In fact, eliminating the mandates might even cost the federal government more money. (Michael Hiltzik, 3/22)

USA Today: Vote ‘No’ On Ryancare: Our View
During the presidential campaign, Donald Trump repeatedly promised to repeal Obamacare and replace it with “something terrific.” There are many words for the House Republicans’ latest health care plan, embraced by Trump and scheduled for a vote on Thursday. “Terrific” is not among them. (3/22)

USA Today: Repair Damage From Obamacare: Opposing View
For decades, the National Federation of Independent Business (NFIB) has asked small business owners to rank the top challenges. For more than 30 years, their No. 1 problem has been the high cost of health care. Obamacare turned this concern into a crisis for small businesses. It fails to deliver on its main promise to make health care more affordable. For small business owners, the law has made insurance more complicated, more restrictive and more expensive. (Juanita Duggan, 3/22)

Los Angeles Times: The GOP Healthcare Bill Would Be Good For Small Business
The Affordable Care Act, or Obamacare, was perfectly misnamed. It failed entirely to make insurance affordable for small business owners and millions of other Americans. On the contrary, Obamacare has driven up costs for small business owners, who are hit with higher payroll taxes, taxes on health insurance products, the employer and individual mandate penalties, and the so-called Cadillac tax on expensive health insurance plans. (Tom Scott, 3/23)

Richmond Times-Dispatch: Obamacare Stinks. Small Businesses Need Something Better. 
Eight years ago, small-business owners were given many promises about the Affordable Care Act: that it would drive down costs; that small-business owners could take advantage of new tax credits; and that new exchanges would give owners and employees new options to purchase coverage. By the time President Obama signed the bill, it was abundantly clear that the law would do more to harm small businesses than help them. (Nicole Riley, 3/22)

The Washington Post: The GOP’s Health-Care Plan Goes In The Exact Wrong Direction
There’s a lot not to like about America’s fragmented, inefficient health-insurance system. If you had to identify its fundamental flaw, however, it would probably be this: People need medical care whether they have a job or not, yet the U.S. system is built on a linkage between health insurance and employment. (Charles Lane, 3/22)

Los Angeles Times: The GOP’s Tax Cut For Healthcare CEO Pay Is A Bigger Ripoff Of Taxpayers Than It First Seemed
As the House of Representatives prepares to vote Thursday to repeal the Affordable Care Act, there’s a new estimate of the cost of one of its hidden provisions, a rollback of rules designed to restrain executive pay at health insurance companies. Here’s the bottom line: Rolling back the provision will result in an even bigger ripoff of the American taxpayer than previously calculated. (Michael Hiltzik, 3/22)

Boston Globe: Health Bill Isn’t Reform; It’s A Tax Cut For The Wealthy 
Under Barack Obama, the Affordable Care Act adapted the Massachusetts model, and it now covers 22 million formerly uninsured Americans. But congressional Republicans are attacking national health reform and are seeking to destroy the ACA, not reform it. If they succeed, a moderate Republican governor and a liberal state legislature will soon face the choice of undoing coverage or once again leading the country on health reform. (Jon Kingsdale, 3/22)

Boston Globe: Romney’s Health Care Legacy Under Attack, Just Like Obama’s
Romneycare, as it came to be known, provided the conceptual foundation for Obamacare. And President Trump’s commitment to repealing President Obama’s signature accomplishment — the Affordable Care Act — also puts Romney’s signature accomplishment at great risk. Governor Charlie Baker is warning that the Republican plan to repeal the ACA would reduce federal funding to Massachusetts by as much as $1.1 billion to $1.9 billion. (Joan Vennochi, 3/22)

Forbes: In Amended Health Care Bill, GOP Doubles Down On Tax Breaks For The Rich, Reduced Medicaid Funding
Yesterday, the GOP released amendments to its health care bill, and in response to the shortcomings highlighted by the CBO report, the changes to the bill would add more tax breaks for the rich and further slash Medicaid funding. Yup, you read that right. But as counterintuitive as it may seem, there is a method to the GOP’s madness, as yesterday’s changes 1) make it more likely the bill will pass the House and potentially, the Senate, and 2) it brings within reach the bigger prize being sought by Republican leaders: tax reform. (Tony Nitti, 3/22)

The Washington Post: Health-Care Reform Is A Lot Harder Than Tax Cuts. So Why Are The Republicans Trying To Do It First?
Today, the House Republicans are voting on what I consider their awful health-care replacement plan for the Affordable Care Act. I’ve already explained my negativity about the highly regressive American Health Care Act. If you think the problem is that the wealthy don’t have enough after-tax income and the poor have too much health care, this is the plan for you. … Why are Republicans making their lives harder by starting with a complicated health-care replacement plan, one that itself conflates health policy with tax cuts? The answer, as tax analyst Chye Ching Huang points out in a new piece, is that “passing the health package first facilitates deeper tax cuts for the wealthy and corporations in subsequent tax legislation.” (Jared Bernstein, 3/22)

Bloomberg: Republicans Want To Repeal Medicaid, Too 
Under the AHCA, each state would instead be given a capped allowance, and that amount would rise each year with medical inflation. It would not account for any unforeseen expenses. Over time, as the rise in per-patient costs outstripped the rise in general medical inflation — as the Congressional Budget Office assumes they will — the federal share of funding would decline. Hundreds of billions in costs would be shifted from the federal government to the states. In response, states would need to either raise their own spending on Medicaid — or more likely, offer fewer services to fewer people. (3/22)

Seattle Times: Medicaid Is A Lifeline For Our Children
As discussions continue to swirl around the future of our nation’s health-care system and the American Health Care Act (AHCA), it’s vital we do not forget about the well-being of those who represent the future of our nation — our children. Medicaid is the most critical health care program for our country’s youth, and we at Seattle Children’s are deeply alarmed about the proposed changes to Medicaid that would disproportionately impact our children. (Jeff Sperring, 3/22)

The New York Times: Why Medicaid Work Requirements Won’t Work
Paul Ryan’s plan to replace Obamacare is headed to the House floor on Thursday for a vote that, even now, could go either way. That may sound surprising since Republicans have a sizable majority in the House. But if you’ve been following the debate over their replacement plan, the American Health Care Act, you know that, as harsh as it is, it’s not draconian enough for some members of Speaker Ryan’s party. In an attempt to win over those lawmakers, the Republican leadership has offered ideas to restrict coverage even further. One of the worst is a Medicaid work requirement. (Jared Bernstein and Ben Spielberg, 3/22)

Cincinnati Enquirer: America Needs A Clean Repeal Of Obamacare
There is no question that former President Barack Obama’s signature legislation – Obamacare – has been a massive failure with deadly consequences. The law, which requires Americans to buy insurance from private companies, also manages to increase premiums drastically. … Democrats have been stunningly comfortable playing politics with the life and death consequences of health insurance coverage. … Now is the chance to repeal Obamacare, and it is not a minute too soon. (Ken Blackwell, 3/22)

Cincinnati Enquirer: Insurance Has No Place In Medicine
No fiscal conservatives make health care policy or legislation. Nothing about today’s health care system is fiscally conservative. Insurance is a “needless markup” in the healthcare industry. The management and control of the medical/industrial/Congressional complex must be returned to physicians. Doctors receive only 10 percent of the monies that flow through this system, so they are not the cost problem. (James Baker, 3/22)

The Washington Post: Would The GOP Benefit If Its Obamacare Replacement Failed?
House Republicans plan to vote Thursday on an Obamacare replacement plan, called the American Health Care Act. On Tuesday, Post Opinions writer Jennifer Rubin and Alice Stewart, former spokeswoman for Sen. Ted Cruz’s 2016 presidential campaign, discussed how passage of the bill would affect the GOP’s political fortunes. The email discussion was moderated by Post Opinions digital editor James Downie and has been edited for style and clarity. (3/22)

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

Rural Georgia Hospitals To See Financial Benefit From New Tax Increase

In other state hospital news, executives for Beth Israel Deaconess Medical Center and Lahey Health tout the economic benefits of merging the two facilities. And a Philadelphia hospital brings in puppies and kittens to relieve the stress of its medical staff.

Georgia Health News: Recent Events Hearten Advocates Of Georgia’s Rural Hospitals 
Voters in Monroe and Jefferson counties Tuesday approved tax increases to help preserve their rural hospitals, which are in financial danger. And a proposed tax credit upgrade for donors to rural hospitals, an idea that had appeared dead in this year’s Georgia General Assembly session, is alive again less than two weeks before the legislators are expected to adjourn. (Miller, 3/22)

Boston Globe: Beth Israel, Lahey CEOs Say Merger Will Help Contain Health Care Costs
The chief executives of Beth Israel Deaconess Medical Center and Lahey Health on Wednesday pitched their proposed merger as an antidote to the state’s high health care costs, arguing that coming together would allow them to grab market share from pricier hospitals. In their first sit-down interviews with The Boston Globe since going public with their merger negotiations nearly two months ago, Dr. Howard R. Grant of Lahey and Dr. Kevin Tabb of Beth Israel Deaconess said the deal would also help them weather coming changes in the health care market, including shrinking reimbursements from insurers and the government, and changes to federal health care policy. (Dayal McCluskey, 3/23)

The Philadelphia Inquirer: RX For Hospital Stress: Hug A Puppy, Cuddle A Kitten
Wednesday’s event was Paws for Pennsy (P4P), a popular program that was started last year at the Philadelphia hospital. It was the creation of Care for the Care Provider, a hospital committee whose mission is to look at ways to address the stress and even sorrow that can come with being in the medical profession. Losing a longtime patient, experiencing the unexpected death of a patient or colleague, or other on-the-job losses can be so traumatic, the consequences have come to be known as “second-victim phenomenon.” (Giordano, 3/22)

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

Opponents Of KanCare Expansion Challenge Supporters’ Claim It Will Pay For Itself

Outlets report on news out of state legislatures in Kansas, Minnesota, Texas, Arkansas and Florida.

KCUR: Cost Of KanCare Expansion Debated Ahead Of Key Vote
A dispute about the cost and potential benefits of expanding Medicaid eligibility is heating up ahead of a Kansas Senate committee vote on a bill. In testimony Monday to the Senate Public Health and Welfare Committee, supporters of expanding eligibility for KanCare, the state’s privatized Medicaid program, said expansion would more than pay for itself. Former Kansas Senate President Dave Kerr, a Hutchinson Republican, said in its first full year, expansion would add about $81 million to the cost of KanCare. But he said it would generate more than $154 million in revenue and savings, enough to cover the costs of expansion with about $73 million to spare. (Mclean, 3/22)

The Star Tribune: Dayton Issues Warning On ‘Reinsurance’ Plans 
Gov. Mark Dayton on Wednesday warned Republican lawmakers he won’t agree to give insurance companies hundreds of millions of dollars to stabilize Minnesota’s individual health insurance market without more information about how the companies would use the money. The House and Senate passed bills last week to spend, respectively, $384 million or $600 million over the next two years on a new “reinsurance” program to protect insurers against unusually high claims. (Golden, 3/22)

Austin American-Statesman: Texas Senate Gives Initial OK To Ban On Abortion Insurance
The Texas Senate, voting 19-10, gave initial approval Wednesday to a bill that would ban insurance coverage for abortions in the state. Senate Bill 20 by Sen. Larry Taylor, R-Friendswood, would prohibit abortion coverage in private plans, under the Affordable Care Act and in state-issued insurance plans, except for medical emergencies. Those interested in abortion coverage would have to purchase supplemental coverage if offered by their insurer. (Lindell, 3/22)

Texas Tribune: Texas Senate Passes Restrictions On Abortion Insurance 
The Texas Senate on Wednesday gave initial approval to a measure that would require women to pay a separate premium if they want their health plan to cover an elective abortion. Under Senate Bill 20, health plans would still be allowed to cover abortions that are deemed medically necessary. The measure does not make exceptions for cases of rape or incest. (Evans, 3/22)

The Associated Press: ‘Sex-Selection’ Abortion Ban Gets Final OK In Arkansas House
A proposal to impose fines and prison time on doctors who perform abortions that are based solely on whether the mother wants to have a boy or girl received final passage from the Arkansas House. The measure was passed Wednesday on a 57-9 vote. The bill’s sponsor, Republican Rep. Charlie Collins previously told lawmakers that having this ban as law is the right thing to do. (Mukunyadzi, 3/22)

Tampa Bay Times: Future Of Medical Pot In Florida Still Cloudy After Senate Discussion 
Lawmakers have put forward competing proposals to implement Amendment 2, which passed with 71 percent of the vote in November and lets patients with debilitating medical conditions such as cancer, HIV/AIDS, epilepsy and post-traumatic stress disorder use cannabis. On Wednesday, the Senate’s Health Policy panel discussed five approaches to implement the voters’ will. Their deliberations, led by Sen. Dana Young, R-Tampa, revealed the first look at what kind of cannabis bill might pass the Senate — as well as early fault lines. (Auslen, 3/22)

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Texas Braces For Medicaid Cuts Under GOP Health Plan

Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors and people with disabilities who all get help from Medicaid. And Texans on both sides of the political spectrum say the Lone Star State is not going to fare well.

As the GOP bill, the American Health Care Act, works its way through Congress, Anne Dunkelberg, with the left-leaning Center for Public Policy Priorities in Austin, said she’s a little stumped.

“I have worked on Medicaid and uninsured and health care access issues in Texas for well over 20 years,” she chuckled. She said this bill leaves the fate of some current funding streams unclear, and there’s one pot of money she’s particularly concerned about. Texas has struck deals with the federal government under something known as a 1115 waiver to help reimburse hospitals for the cost of caring for people who don’t have insurance. And Texas has more uninsured residents than any other state.

“About half of what Texas hospitals get from Medicaid today comes through payments that are outside from the regular Medicaid program,” she said, which adds up to $4 billion in federal funds every year.

But even if Texas gets to keep all that money, there’s another issue — the GOP plan will reduce how much the federal government pays for Medicaid. It will either cap how much money states get for Medicaid from the federal government for every person they cover. That’s called a per-capita cap, and the payments under that formula would start in 2020, but would be based on how much the state spends this year. Or, in line with this week’s modification of the GOP bill, it would let states choose a lump sum, or block grant, also likely to cut the federal support Medicaid gets.

Adriana Kohler with Texans Care for Children, an advocacy group based in Austin, said Texas already leaves too many people without care.

“Last legislative session there were cuts to pediatric therapies for kids with disabilities enrolled in Medicaid,” she said. The cuts caused some providers to shut their doors, which left some children without services, she said. “That’s why these cuts coming down from the ACA repeal bill are very concerning to us.”

In Texas, she said, children, pregnant women, seniors and people with disabilities will bear the brunt of any belt-tightening. These populations make up 96 percent of people on Medicaid in Texas. That’s why, Dunkelberg said, the program as is should not be the baseline for years to come.

“They could lock Texas into a lot of historical decisions that were strictly driven by a desire to write the smallest budget possible,” she said.

Some on the right agree Texas is getting a raw deal. Dr. Deane Waldman, with the right-leaning Texas Public Policy Foundation, said there are things he likes in the bill. But in general, he said, “it’s bad deal for Texas. It’s a bad deal for the American people.”

He said it was the right thing for Texas not to expand Medicaid, but this bill punishes Texas for it. Under the GOP bill, states that expanded Medicaid would get more money. And because the initial Republican bill left the door open for states to expand Medicaid before 2020, he worried more states would do that to get in on the deal.

“It’s going to be a huge rush — an inducement to drag in as many people as they can drag in, because the more they can drag in, the more federal dollars they can get,” he said. The GOP’s latest plan, however, makes it impossible for any new states to expand Medicaid and cuts off funding for Medicaid expansion states earlier.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

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


Repeal Of Health Law Could Force Tough Decisions For Arizona Republicans

Connie Dotts is a big fan of her insurance.

“I like that we can choose our own doctors,” said the 60-year-old resident of Mesa, Ariz. “They also have extensive mental health coverage.”

Dotts isn’t on some pricey plan, either. She’s among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2014.

Her eight prescription drugs are cheap, Dotts said, and she has no copays or premiums. The Medicaid benefits have helped her manage her emphysema, depression and osteoarthritis.

But taking care of other problems has to be delayed: “I have torn ligaments in my ankles, and I can’t take the time off work to go to physical therapy or surgery.”

Dotts works in retail and lives paycheck to paycheck. Without Medicaid, she said, she wouldn’t be able to afford to see a doctor. “It’s just barely above what they consider livable income. Any extensive medical issues would put an excessive burden on me,” she said.

The replacement health plan the GOP leaders are pushing in Congress would gradually cut off the federal funding for Medicaid that expanded eligibility. The bill also bars any additional states from expanding Medicaid immediately.

Swapna Reddy, a professor at Arizona State University’s School for the Science of Health Care Delivery, said that as Congress overhauls the health care law, a state like Arizona might particularly suffer.

Unlike some states that expanded Medicaid, Arizona saw a rush of people joining the rolls, Reddy says, because it had a “high-need, uninsured” population.

The Republican bill would continue to pay the higher federal rates that the ACA’s Medicaid expansion offered people like Dotts, Reddy said — but only if they’re already enrolled in Medicaid, and their personal income stays about the same.

“What we know about the Medicaid population is that they kind of fall in and out of eligibility on a regular basis,” she said, because the amount of money they earn tends to fluctuate.

“So it has the real potential of eradicating Medicaid expansion over a period of time,” Reddy says.

The states and the federal government share the cost of Medicaid. Instead of an open-ended entitlement, the bill making its way through Congress right now would cap the federal government’s contribution or turn it into a block grant.

Putting a fixed limit on the federal government’s contribution is unlikely to allow Arizona Medicaid to keep up with the growing cost of covering people, Reddy said.

“The states will have to come up with the remaining money to cover these folks,” she said.

The Republican health plan would eventually cost Arizona nearly half a billion dollars a year, according to calculations by the state, to keep the adults with the lowest income in the expansion population insured. It’s a group that Arizona voters actually required the state to cover in 2000 through a ballot initiative. But during the recession in later years, financial pressure led state lawmakers to freeze enrollment for those adults.

Scaling back Medicaid could be a particularly risky proposition for Arizona, according to the state program’s administrators, because Arizona is already one of the most efficient, lean programs in the country.

Getting locked in at the current funding rates would give other states a leg up, said Tom Betlach, who runs Medicaid in Arizona.

“If they are able to achieve improved outcomes and reduced costs, they are able to capture those savings,” Betlach said. “Versus we actually get penalized for being a good steward of taxpayer funds.”

Betlach said Arizona needs more control than it currently has over who and what types of treatments and procedures are covered if the federal government intends to give Arizona only a fixed amount of cash.

The federal fight over health care puts the state’s Republican governor, Doug Ducey, in a tricky situation. Ducey has said he would like the ACA repealed, but he has also said he doesn’t want hundreds of thousands of people to lose coverage. He has expressed concern that the GOP bill doesn’t give the state enough flexibility.

And it wasn’t even on Ducey’s watch that Arizona expanded Medicaid. The expansion happened under Jan Brewer, Arizona’s former governor and an ally of President Donald Trump. To pull that off, Brewer had to band together with Democrats and buck some of her fellow Republicans in the state Legislature, who then sued her over the expansion. In their lawsuit, the legislators claimed that the way the state pays its share — a fee on hospitals — is unconstitutional.

At a recent court hearing for that long-running lawsuit, Brewer defended her controversial decision to accept the ACA’s expansion funding.

“I think it was the right thing to do,” she said in an interview outside the courtroom. “It saved lives. It insured more people. It brought money into the state. It kept rural hospitals from being closed down. And today there are tens of thousands of people that are very, very grateful.”

But some Republicans, like state Sen. Debbie Lesko, who was among the Arizona legislators who sued Brewer, figured the day would come when the feds would try to roll back the funding.

“I voted against Medicaid expansion, not because I don’t want people to get health coverage,” Lesko said, “but because I’m a realist and I know how much we can afford in our budget.”

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

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


Viewpoints: Concern Over NIH Budget Cuts; Abortion And The Supreme Court Again Are Front And Center

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

The New York Times: Why Trump’s N.I.H. Cuts Should Worry Us
Last week I was in London to participate in a scientific symposium. During coffee breaks, many British colleagues asked me and other American visitors to explain the bewildering news that President Trump had announced his intention to cut the budget for the National Institutes of Health by 18.3 percent, about $5.8 billion. (Harold Varmus, 3/22)

The New York Times: Gorsuch, Abortion And The Concept Of Personhood
Judge Neil M. Gorsuch has written little about abortion, and we do not know whether he would vote to overturn Roe v. Wade, the 1973 Supreme Court decision that established abortion as a fundamental right. But he has expressed a position on two related subjects, assisted suicide and euthanasia. In his Oxford dissertation and a later book, he defended the inviolability of human life. He rejected the role of states in granting the terminally ill a right to die and offered a legal framework that could be applied to abortion. (Corey Brettschneider, 3/21)

The Kansas City Star: Hobby Lobby Case Affirms That The Law Protects Religious Beliefs, Even Unpopular Ones
Democratic senators questioning Supreme Court nominee Neil Gorsuch appear quite preoccupied with how often he has ruled for “the little guy.” That seems an odd way to measure the independence and acuity of a judge; presumably, little guys can be wrong now and again. But in his opinion in the controversial Hobby Lobby case, Gorsuch did rule for the little guy. And in doing so, he has given us some clues about the kind of justice he would be. (Melinda Henneberger, 3/21)

Chicago Tribune: Why Tomi Lahren Will Get ‘Right’ On Abortion
Lahren, the 24-year-old conservative internet provocateur, angered many of her followers Friday when she said this during an interview on ABC’s “The View”: “I’m pro-choice and here’s why. I’m a constitutional — you know, someone that loves the Constitution. I am someone that’s for limited government. And so I can’t sit here and be a hypocrite and say I’m for limited government but I think that the government should decide what women do with their bodies. I can sit here and say that, as a Republican, and I can say, you know what, I’m for limited government, so stay out of my guns, and you can stay out of my body as well.” This did not go over well with her bosses at The Blaze, a conservative media site founded by Glenn Beck. (Eric Zorn, 3/21)

Morning Consult: Fentanyl: The Next Wave of the Opioid Crisis
We’re in the midst of a rampant opioid epidemic that has surged in three successive waves. The first involved prescription opioids. The second saw increased usage of heroin as many of those addicted to prescription opioids sought a different source of pain relief, for various reasons. The third wave has been fentanyl. The drug that killed Prince has been linked to a soaring amount of overdoses and deaths across the country. (Rep. Tim Murphy (R-Pa.), 3/21)

WBUR: In Pausing Human Research On Zika, Medical Ethicists Acknowledge A Dark Past 
This was the proposal: Deliberately infect a small group of consenting adults with the Zika virus to learn about the disease and speed up the search for a vaccine… What might go wrong and what might go right with such an experiment? Perhaps no institution can handle those questions better than the National Institutes of Health. (Paul McLean, 3/21)

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

Policy Thoughts: Much Is At Stake As The House Approaches A Vote On The GOP Health Bill

Editorial pages across the country are full of tough talk for the American Health Care Act and challenges for the Republican Party.

USA Today: The Republican Reckoning On Health Care
Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care. The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it’s because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose. (Jill Lawrence, 3/21)

The Wall Street Journal: A Defining Health Vote
The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters. (3/21)

The Wall Street Journal: The GOP Is Out Of Excuses On Health Care
Although this week got off to a crackling start with high-profile hearings on Judge Neil Gorsuch’s Supreme Court nomination and potential Russian interference in the 2016 presidential election, the event with the largest consequences for the Trump administration and the Republican congressional majority occurs on Thursday. That’s when the full House takes up legislation to repeal and replace the Affordable Care Act. (William A. Galston, 3/21)

San Francisco Chronicle: Trump’s Orgy Of Unnecessary Cruelty 
Next comes the House Republican plan, which Trump enthusiastically supports, to repeal the Affordable Care Act and replace it with a system that will cause 14 million Americans to lose their health insurance next year, and 24 million by 2026, according to the Congressional Budget Office. How does Trump justify this human hardship? The plan barely makes a dent in the national debt. It cuts the federal budget deficit by only $337 billion over the next 10 years — a small fraction of the national debt. (Robert Reich, 3/21)

Atlanta Journal-Constitution: Trumpcare, A Bullhorn Touting Its Scorn For The Poor
The poor can be safely ignored largely because they allow themselves to be split along tribal lines of creed and color and kept at one another’s throats. Then they are nickled and dimed and robbed damn near blind by monied interests and their political henchmen. The new health care bill is a prime example. (Leonard Pitts, 3/22)

USA Today: GOP Should Slow Down And Rethink Health Bill
Exactly seven years ago Thursday, after decades of effort to make health care available to all Americans, the Affordable Care Act was signed into law. Now, in what House Speaker Paul Ryan calls “an act of mercy,” the House is planning an anniversary vote to repeal it and, in addition, to radically alter the Medicaid program that has been a staple of the national safety net since the 1960s. For members of Congress, this is one of the most consequential votes they might ever face. (Andy Slavitt, 3/22)

Los Angeles Times: House Republicans Are Hoping The Senate Can Save Them From Their Own Ruinous Healthcare Bill
The House GOP leadership has aligned itself so closely with President Trump on healthcare, it’s borrowing his signature sales tactic as it tries to ram through a bill this week to “repeal and replace” Obamacare: the bold but empty promise. Specifically, it’s promising House Republicans a solution to their concerns about drastically increasing insurance premiums for millions of older Americans, but leaving the Senate to figure out how to deliver it. (Jon Healey, 3/21)

The Washington Post: Who Gets Blamed If The House Doesn’t Pass The AHCA
No great political acumen or psychology degree is necessary to conclude that President Trump is highly susceptible to flattery. It’s little wonder then that House Speaker Paul D. Ryan (R-Wis.), desperate to pass GOP health-care reform or at least not be blamed if it fails, keeps talking about what a terrific “closer” Trump is. (Jennifer Rubin, 3/21)

The New York Times: What’s At Stake In A Health Bill That Slashes The Safety Net
What do we lose when social insurance unravels? It is startling to realize just how much the social safety net expanded during Barack Obama’s presidency. In 2016, means-tested entitlements like Medicaid and food stamps absorbed 3.8 percent of the nation’s gross domestic product, almost a full percentage point more than in 2008. (Eduardo Porter, 3/21)

The New York Times: Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple Repeal
The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place. That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance. (Margot Sanger-Katz, 3/21)

Axios: Why Deductibles Would Rise Under The GOP Health Care Plan
Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans. (Drew Altman, 3/22)

The New York Times: A Republican Health Care Bill In Search Of A Problem
Republican leaders in the House have been huddling over the last few days in a frantic search for enough votes to win passage of their proposed revision of Obamacare, in the process making an already flawed bill even worse. One measure of their desperation was a cynical last-minute provision that would shift Medicaid costs from New York’s rural and suburban counties to the state government, pleasing upstate Republicans who represent those counties but reducing coverage provided by the state. (3/21)

The Charlotte Observer: What You Need To Know About Medicaid This Week
Per capita caps on Medicaid beneficiaries? Block-granting Medicaid? Do these wonky and innocuous-sounding proposals really make any difference? They do. The American Health Care Act – the Republicans replacement for Obamacare – is scheduled for a vote this week in the U.S. House. You will hear much discussion about the individual insurance marketplace, tax credits, and promotion of health savings accounts. However, the changes in Medicaid are the most profound in the AHCA. (Jessica Schorr Saxe, 3/21)

Bloomberg: Better Health Care for Less Money? It’s Not Easy
“America spends more on health care than other rich nations, but has lower life expectancy.” If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system. (Megan McArdle, 3/21)

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

State Highlights: Fla. House Committee OKs Hospice Measure; In Ariz., Bill Allowing Providers To Not Give End-Of-Life Instructions Gains Approval

Outlets report on news from Florida, Arizona, Georgia, Illinois, Missouri and California.

Health News Florida: House Panel Approves Hospice Care Expansion 
The House is advancing a measure making it easier for patients to access hospice care. Florida confines hospice services to the final six months of a person’s life.  But Rep. Gayle Harrell (R-Stuart) wants to ensure terminal patients can receive access to pain relief more quickly. (Evans, 3/21)

Georgia Health News: State Shows Improvement In Health System Scorecard
Georgia’s ranking on a health system scorecard has improved from 46th in the nation to 41st. The Commonwealth Fund’s 2017 scorecard ranked the 50 states and the District of Columbia on the most recent data available in five areas: health care access, quality, avoidable hospital use and costs, health outcomes, and health care equity. (Miller, 3/21)

Chicago Tribune: Advocate Children’s Hospital Takes On Rare Surgery To Help Baby Born With Four Legs 
Advocate Children’s Hospital surgeons have successfully operated on a baby from Africa born with two spines and an extra set of legs protruding from her neck. The Park Ridge hospital announced Tuesday that 10-month-old Dominique from Ivory Coast, or Cote d’Ivoire, in West Africa, is recovering well from the March 8 surgery. The baby already has started sitting up again, and doctors expect she’ll be able to live a normal, fully functional life. (Schencker, 3/21)

St. Louis Public Radio: More Farmers Claim That Monsanto’s Leading Weed Killer Product Caused Them Cancer 
Monsanto is facing more pressure to compensate farmers and farm workers who allege that its leading pesticide product caused them to develop cancer. A Los Angeles-based law firm on Friday filed 136 new cases against the company in St. Louis County Circuit Court. The lawsuits allege that exposure to glyphosate, the active ingredient in Roundup, caused the plaintiffs to develop non-Hodgkin’s lymphoma. (Chen, 3/21)

San Jose Mercury News: Walgreens’ “Disney” Animal Crackers Contain Cancerous Chemical, Group Says
“The Jungle Book” may be one of Disney’s most beloved animated movies, but a consumer health watchdog group is warning parents to lay-off feeding their kids Walgreens’ Disney Jungle Book whole grain animal crackers, featuring the storybook characters Mowgli and Baloo on the package. Turns out the bare necessities involved in making that version of the crackers requires higher baking temperatures, which produces excessive levels of a cancer-causing chemical called acrylamide, said Charles Margulis of the Oakland-based Center for Environmental Health. (Seipel, 3/21)

Tampa Bay Times: Senators Poised For First Major Medical Marijuana Hearing
Florida’s new medical marijuana market will start to take shape today as a panel of senators workshops five proposals to put the voter-approved constitutional amendment legalizing the drug into place. The Senate Health Policy committee, chaired by Tampa Republican Sen. Dana Young, will consider issues related to the five proposed bills and hear public comment, the first step toward passing legislation and the first time members of the public will hear what key senators think about how medical marijuana should be implemented. (Auslen, 3/22)

Health News Florida: Florida Legislature Starts To Tackle Medical Marijuana Bills 
Florida senators will begin hashing out possible medical marijuana laws this week. There are five competing bills just in the Florida Senate on how the state should implement a medical marijuana amendment. The Florida Senate’s Health Policy Committee under Senator Dana Young will start the medical marijuana debate. (Aboraya, 3/21)

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

Va. Board Of Health ‘Watered Down’ Abortion Regulations, Foundation Claims In Suit

The Family Foundation of Virginia is issuing a legal challenge to the board’s decision to do away with hospital-style regulations for abortion clinics imposed by the General Assembly in 2011. Media outlets report on news out of Missouri and Texas, as well.

The Associated Press: Conservative Group To Challenge Abortion Regulation Changes 
The conservative Family Foundation of Virginia says it plans to file a legal challenge over the way the state did away with restrictive regulations for abortion centers. The group says it notified Gov. Terry McAuliffe’s administration Tuesday of its intention to file an administrative appeal over the health and safety regulations, which were updated in October.Foundation President Victoria Cobb says the administration violated state law in its “quest to water down” the standards. (3/21)

Richmond Times-Dispatch: Family Foundation Of Virginia Attempts Appeal Of Abortion Clinic Regulation Changes 
A group that includes some members of the Virginia Board of Health intends to file an appeal alleging that the board violated state law last year during the regulatory process it used to change abortion clinic standards. Victoria Cobb, president of the anti-abortion Family Foundation of Virginia, said Tuesday the lawsuit will be filed within 30 days in Henrico County Circuit Court. The appeal takes issue with the way the Board of Health last year enacted changes to the state’s code overseeing clinics that provide abortions. (Demeria, 3/21)

The Associated Press: Federal Judge Defers Ruling On Missouri Abortion Rules
Planned Parenthood pressed a federal judge Tuesday to block abortion-restricting Missouri rules similar to Texas ones struck down last year by the U.S. Supreme Court, while an attorney for Missouri countered that undoing the Missouri regulations could endanger women. U.S. District Judge Howard F. Sachs deferred a ruling until at least next month after hearing arguments over the preliminary injunction request by Planned Parenthood affiliates with Missouri health centers. (Suhr, 3/21)

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