The Trump administration “blinks”; provides Obamacare funding

.“The Trump administration will make this month’s Obamacare payments to insurers, a White House spokesman confirmed today, despite the president’s repeated threats to cut off the subsidies and potentially tip the insurance markets into turmoil.
It’s widely anticipated that insurers would jack up premiums or exit the Obamacare markets altogether if the subsidies, worth about $7 billion this year, are eliminated. Insurance premiums for the most popular Obamacare plans would likely rise by 20 percent next year if the payments are stopped, according to a Tuesday CBO analysis…
At issue are subsidies that insurers rely on to reduce out-of-pocket costs for low-income Obamacare customers. Insurers would still be on the hook to provide the discounted rates even if the federal payments stop.” (A)

If payments were not made…
“CBO -If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act…. it’s going to cost taxpayers — about $194 billion over 10 years.
An analysis by the Congressional Budget Office released Tuesday found that ending cost-sharing reduction payments to insurers, a move that President Trump is contemplating, would raise the deficit by $194 billion over 10 years.
If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it’s going to cost him.
Or, more accurately, it’s going to cost taxpayers — about $194 billion over 10 years….
The deficit figure comes from the Congressional Budget Office, which on Tuesday released an estimate of the budget impact of ending what is known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they’re required by law to give to low-income customers. (B)

“The public had also changed its tune. Although Medicaid had started as a program of welfare medicine, over time it had expanded well into the middle class. A 2011 poll found that 85 percent of respondents opposed cuts to Medicaid. Medicaid had become as popular as social security and Medicare.”
That shift in public opinion left Republicans without a coherent message for rallying support to repeal. Robbed of their big government bluff, Republicans could only lambast Obamacare for reasons the public no longer believed. Meanwhile, Democrats drew upon an alternative message, defining Republicans’ health care plans as divisive and un-American. When House Speaker Paul Ryan praised the House bill as “an act of mercy,” Rep. Joe Kennedy (D-Mass.) fired back: “With all due respect to our speaker, he and I must have read different Scripture. The one that I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless and to comfort the sick. It reminds us that we are judged not by how we treat the powerful, but by how we care for the least among us.” “ (C)

Here are five decisions looming for the GOP. Should there be one more effort at ObamaCare repeal? Should we work with Democrats? Should we back legislation to make key payments to insurers? What’s to be done with CHIP? What’s to be done with ‘bare’ counties? (D)

“Around 4 in 5 want the Trump administration to take actions that help Obama’s law function properly, rather than trying to undermine it. Trump has suggested steps like halting subsidies to insurers who reduce out-of-pockets health costs for millions of consumers. His administration has discussed other moves like curbing outreach programs that persuade people to buy coverage and not enforcing the tax penalty the statute imposes on those who remain uninsured.
Just 3 in 10 want Trump and Republicans to continue their drive to repeal and replace the statute. Most prefer that they instead move to shore up the law’s marketplaces, which are seeing rising premiums and in some areas few insurers willing to sell policies. “(E)

“This much becomes clear looking at the latest polling data from the Kaiser Family Foundation, which finds that 60 percent of Americans think it’s a “good thing” that the Senate health care bill failed — and 78 percent expect the Trump administration to “do what they can” to make the law work better.
Right now, President Trump is not doing what he can to make Obamacare work. His administration remains cagey about whether it will continue to pay key subsidies. It has not let the thousands of insurance enrollment workers across the country know what type of outreach campaigns it will run, if any. Many insurance plans are nervous that the Trump administration won’t enforce the mandate to purchase coverage, and they are jacking up their premiums as a result.
Trump seems to have had, for months now, a theory about how Obamacare’s failure could play to his advantage. If the marketplaces blew up, he seemed to expect that voters would blame former President Barack Obama for a poorly drafted law — and that Congress would rush to fix these problems with a repeal-and-replace package.” (F)

Interestingly, a bipartisan group of governors has already issued their recommendations.
“Congress should be working to make health care more affordable while stabilizing the health insurance market, but this bill and similar proposals won’t accomplish these goals,” said one statement issued by 13 governors – seven Democrats and six Republicans. “The bill still threatens coverage for millions of hardworking, middle-class Americans.”
The governors then go on to get into the policy weeds on reinsurance, waivers and drug formularies, among others. Their overriding concerns, however, are to retain control over the health insurance markets within each of their states while shoring up and expanding the private insurance market through federal dollars.
So how can America achieve universal coverage regardless of pre-existing conditions — which is what most polls show most Americans want – but at an affordable price? The group of bipartisan governors is not quite ready for a single, national insurance system. But they are willing to consider benchmark standards similar to Obamacare, then have the federal government step in with bigger subsidies for the sickest patients with the highest claims. Under the ACA, those patients cannot be charged higher premiums because of their pre-existing health conditions. Insurers say they cannot sustain those losses without charging higher premiums to those patients or getting financial help.” (G)

(A) Trump administration will make this month’s Obamacare payments but leaves program’s future in limbo, by PAUL DEMKO,
(B) CBO Predicts Rise In Deficit If Trump Cuts Payments To Insurance Companies, by Alison Kodjak,
(D) Five tough decisions for the GOP on healthcare, by RACHEL ROUBEIN AND NATHANIEL WEIXEL,
(E) Around 4 in 5 Americans Want the Effort to Repeal Obamacare to End, Poll Finds, Alan Fram,
(F) Most Trump voters don’t want Trump to sabotage Obamacare, Updated by Sarah Kliff,
(G) Our View: Let governors have a crack at Obamacare,

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American College of Physicians Says Hate Crimes are Public Health Issue

At a recent meeting of their Board of Regents, the American College of Physicians (ACP) adopted a new policy statement recognizing hate crimes as a public health issue.

“It is imperative that physicians, and all people, speak out against hate and hate crimes and against those who foster or perpetrate it, as was seen in the tragic events that occurred in Charlottesville, Virginia,” said Jack Ende, MD, MACP, president, ACP. “In particular for physicians, they must educate the public that hate crimes are a public health issue, exacting a toll on the health of those directly victimized and on the health of the entire community. We must seek policies of inclusion and non-discrimination, as called for in our recent policy statement.”

The new policy reads in full:

ACP opposes prejudice, discrimination, harassment and violence against individuals based on their race, ethnic origin, ancestry, gender, gender identity, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion.
Hate crimes directed against individuals based on their race, ethnic origin, ancestry, gender, gender identity, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion are a public health issue.
ACP opposes all legislation with discriminatory intent upon individuals based on their race, ethnic origin, ancestry, gender, gender identity, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion.
ACP supports the development and implementation of anti- discrimination and hate crime laws.
ACP supports the collection and publication of statistics on hate crimes. More research is needed on the impact of hate crimes on public health, understanding and preventing hate crimes, and interventions that address the needs of hate crime survivors and their communities.
“We offer our deepest condolences to the family and friends of Heather Heyer, Lieutenant H. Jay Cullen and Trooper-Pilot Berke M.M. Bates,” continued Dr. Ende. “We hope for the recovery of those injured and are grateful to the first-responders, physicians, nurses and hospital staff who are treating them.”

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“We would never tolerate a situation where only one in 10 people with cancer or diabetes gets treatment, and yet we do that with substance-abuse disorders,” (A)

“Having recognized the widespread and devastating nature of the opioid crisis, governors are taking action to stem the tide of opioid use disorder and overdose.
States are uniquely positioned to do this work, because they play a central role in protecting public health and safety; regulating health care providers; establishing prescription drug monitoring programs (PDMPs); and paying for care through Medicaid, state employee benefits, corrections and other health programs. Current evidence suggests that the most effective way to end the opioid crisis is to take a public health approach focused on preventing and treating opioid use disorder as a chronic disease while strengthening law enforcement efforts to address illegal supply chain activity. This road map uses a public health intervention model to guide state activities in targeting the problem with health care and law enforcement strategies. A monitoring and evaluation component is included to help states assess the effectiveness of those efforts and inform future activities.” (B)

“President Donald Trump declared the opioid crisis a national emergency Thursday, a designation that would offer states and federal agencies more resources and power to combat the epidemic.
In a statement released late in the day, the White House said, “building upon the recommendations in the interim report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, President Donald J. Trump has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic.”
“The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It’s a national emergency,” Trump said earlier at his golf club in Bedminster, New Jersey. “We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis. It is a serious problem the likes of which we have never had.”
Trump’s actions come just two days after Health and Human Services Secretary Tom Price suggested declaring a national emergency was unnecessary. (C)

“The chairman of the president’s opioid commission, New Jersey Gov. Chris Christie, thanked the president “for accepting the first recommendation” of the commission’s report.
“It is a national emergency and the president has confirmed that through his words and actions today, and he deserves great credit for doing so,” Christie said.
It’s not exactly clear what making the declaration will mean for federal efforts to combat the opioid crisis. But a number of states say similar declarations have helped.
The commission’s report to the president said a declaration “would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life.”” (D)

“For the past 50 years, we have been waging a war on drugs that has relied nearly exclusively on supply control and tough punishment. It hasn’t worked….
Why has it failed? The medical community declared nearly 70 years ago that drug and alcohol addiction and dependence are medical disorders. We can’t punish diabetes or cancer away. So why do we think getting tough on addiction would work?
To complicate the landscape, approximately 40% of opioid-dependent individuals have depression, anxiety, or bipolar disorder, and some have other co-occurring psychiatric disorders. Post-traumatic stress disorder and personality disorders are also present, though less frequently. Punishment is not only ineffective; it often exacerbates these mental health problems…
Drug abuse is a public health problem. It is time we treat it that way. (E)


Some updates:
“Companies that make or distribute opioid painkillers are facing a “tidal wave” of litigation as US officials seek to raise funds to fight the country’s addiction epidemic and punish those they accuse of fueling the crisis.
The number of government officials launching legal action against drugmakers and wholesalers has soared in the past year in what some lawyers see as a harbinger of a settlement that could echo the more than $200bn extracted from the tobacco industry in 1998.
At least 30 states, cities and counties have either filed lawsuits or are formally recruiting lawyers using a process that tends to prelude full-blown legal action, according to a Financial Times analysis.” (F)

“……. Republicans are still considering making dramatic cuts to Medicaid that would severely handicap efforts to overcome the opioid epidemic. Now more than ever, we need to ensure that resources are available to help those struggling with opioid addiction, and Medicaid is the backbone to support these efforts.” (G)



(A) Landmark report by Surgeon General calls drug crisis ‘a moral test for America’, by Lenny Bernstein,
(B) Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association,
(C) Trump: ‘The opioid crisis is an emergency’, by Wayne Drash and Dan Merica,
(D) Trump Says He Intends To Declare Opioid Crisis National Emergency, by Brian Naylor and Tamara Keith,
(E) Trump Clearly Has No Clue How to Stop the Opioid Epidemic, by William R. Kelly,
(F) Drug industry faces ‘tidal wave’ of litigation over opioid crisis, David Crow,


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“In politics you can tell your friends from your enemies, your friends are the ones who stab you in the front”.* Look at what the Republicans are saying about each other now about health care

First prize goes to..
“Sen. Ron Johnson suggested that fellow Republican Sen. John McCain’s brain tumor and the after-midnight timing of the vote were factors in the Arizona lawmaker’s decisive vote against the GOP health care bill.
In a radio interview Tuesday with AM560 ‘‘Chicago’s Morning Answer,’’ Johnson answered questions about the collapse of the years-long Republican effort to repeal and replace Barack Obama’s Affordable Care Act, his criticism of the process and McCain’s dramatic vote…
‘‘He has a brain tumor right now. That vote occurred at 1:30 in the morning. Some of that might have factored in,’’ Wisconsin’s Johnson said.
That surprised the interviewer, who asked, ‘‘Really?’’ and wondered whether the senator’s illness and the late night affected his judgment.
Johnson said he didn’t want to speak for any other senator, ‘‘I don’t know exactly what. … I really thought John was going to vote yes.’’ (A)

And tied for second place…
President Trump and Senate Majority Leader Mitch McConnell (R-Ky.) are publicly criticizing one another as Republicans point fingers over why they have struggled to score political wins.
The public shots between the GOP president and Senate leader follow growing conservative criticism of McConnell, who has become a target for two right-wing candidates in an Alabama Senate race.
Conservatives suspicious of McConnell have used his failure to win a victory on ObamaCare repeal against him.
And they’ve found an ally, at least temporarily, in Trump.
“Senator Mitch McConnell said I had ‘excessive expectations,’ but I don’t think so,” the president said on Twitter Wednesday. “After 7 years of hearing Repeal & Replace, why is it not done?”…
Trump was responding to McConnell’s remarks in Kentucky that the president’s “excessive expectations” were partly to blame for the perception that Republicans hadn’t accomplished anything.
“Our new president has of course not been in this line of work before and I think had excessive expectations about how quickly things happen in the democratic process,” McConnell said during a Rotary Club event. (B)

“President Donald Trump resumed his public feud with Senate Majority Leader Mitch McConnell Thursday over his party’s failure to repeal and replace the Affordable Care Act, a sign of the fraught relationship between two branches of government that are both controlled by Republicans.
“Mitch, get back to work and put Repeal & Replace, Tax Reform & Cuts and a great Infrastructure Bill on my desk for signing. You can do it!” Trump tweeted, his third tweet in two days calling out the Senate majority leader.
“Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn’t get it done…”
The tweets continues a public exchange of criticism between the two GOP leaders this week, exhibiting further tension between the White House and Congress, both of whom have an ambitious policy agendas that have struggled to make progress. On Tuesday, McConnell said Trump had “excessive expectations” for the legislative process and suggested there was a false perception that Congress is underperforming in part “because of too many artificial deadlines unrelated to the reality of the legislature, which may have not been understood.”… (C)

“The phone call, first reported by The New York Times, and comments at Bedminster mirror what Trump has said in private, according to four White House officials and Trump friends: that he is preparing to distance himself from Republicans in Congress if they aren’t successful in passing legislation and that he will not take the blame for them if they can’t.
Increasingly, these people say, the president is prepared to cast himself as an outsider — and Congress as an “insider” Washington institution. He has reminded advisers his poll numbers are higher than Congress’ and that he ran against Washington — and wants bills to sign — and will blast his own party if he doesn’t get them. Trump believes that his supporters will largely blame Congress instead of him, two people who have spoken to him said.” (D)

*attributed to many

(A) GOP senator suggests brain tumor affected McCain health care vote. By By Donna Cassata,
(B) McConnell, Trump point fingers, by Jordain Carney,
(C) Trump to McConnell in third tweet: ‘Get back to work,’ ‘You can do it!’, by Ashley Killough,
(D) Behind the Trump-McConnell feud, by JOSH DAWSEY,


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“For most of my surgical career, I gave out opioids like candy….” “With approximately 142 Americans dying every day”….” We need to take away the matches, not put out the fires.”

“President Donald Trump on Tuesday vowed his administration would beat the opioid epidemic by beefing up law enforcement, strengthening security on the southern border to stop illegal drugs from entering the country.
Trump, joined in Bedminster, New Jersey, by Health and Human Services Secretary Tom Price and other administration officials, emphasized a tough law-and-order approach, rather than new treatment or social programs, as the White House’s primary strategy for halting an epidemic that kills 142 Americans every day, according to federal statistics. (A)

“President Trump declined yesterday to declare the opioid epidemic sweeping the United States a national emergency, despite a recommendation last week by his own commission. Trump’s top health administrator, Health and Human Services Secretary Tom Price, argued that extra step wouldn’t have helped much anyway — and experts tend to agree. (B)

“How did this happen?
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive). Here is what we know about the opioid crisis:
Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them; Between 8 and 12 percent develop an opioid use disorder; An estimated 4 to 6 percent who misuse prescription opioids transition to heroin; About 80 percent of people who use heroin first misused prescription opioids.
This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.” (C)

President Trump’s commission on the opioid crisis asked him Monday to declare a national emergency to deal with the epidemic.
The members of the bipartisan panel called the request their “first and most urgent recommendation.”
Mr. Trump created the commission in March, appointing Gov. Chris Christie of New Jersey to lead it. The panel held its first public meeting last month and was supposed to issue an interim report shortly afterward but delayed doing so until now. A final report is due in October.
“With approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks,” the commission members wrote, referring to the 9/11 terrorist attacks. “Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life.”
In addition to seeking an emergency declaration, the commission proposed waiving a federal rule that sharply limits the number of Medicaid recipients who can receive residential addiction treatment.
It also called for expanding access to medications that help treat opioid addiction, requiring “prescriber education initiatives” and providing model legislation for states to allow a standing order for anyone to receive naloxone, a drug used to reverse opioid overdoses. (D)

“Drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia in just six years, a period when 1,728 people fatally overdosed on these two painkillers, according to an investigation by the Charleston Gazette-Mail.
That amounts to 433 of the frequently abused opioid pills for every man, woman and child in the state of 1.84 million people….
The drug distributors say they’re just middlemen in a highly regulated industry and that pills would never get in the hands of addicts and dealers if not for unscrupulous doctors who write illegal prescriptions, and pharmacists who turn a blind eye. (E)

“My own “Aha!” moment came recently after my father had gallbladder surgery and recovered comfortably at home with a single ibuprofen tablet. Wow. It directly contradicted my residency training 15 years ago, when I was taught to give every surgical patient a prescription for 30 to 90 opioid tablets upon discharge. Some of my mentors told me that overprescribing prevents late night phone calls asking for more. The medical community at that time ingrained in all of us that opioids were not addictive and urged liberal prescribing. So that’s exactly what we did.
The hundreds of excessive opioid prescriptions I wrote in 2015 alone (the last year for which national data are available) were a tiny part of the country’s 249 million opioid prescriptions filled that year, almost one for every American adult. Last year, America produced 14 billion opioid pills (40 for every U.S. citizen), mostly paid for by the American public in the form of tax dollars or increasing health insurance premiums.
Take C-section for example, one of the most common operations paid for by Medicaid tax dollars. Some doctors appropriately prescribe five to 10 opioid tablets after the procedure (in combination with non-opioid meds as recommended by the American Pain Society), while other doctors are still doing what I did for years — give every patient a bottle of 30-60 highly addictive opioid tablets. (F)

(A) Trump says he’ll beat opioid epidemic with law-and-order approach, by BRIANNA EHLEY,
(B) The Health 202: Trump doesn’t need to declare the opioid crisis a national emergency, by Paige Winfield Cunningham,
(C) Opioid Crisis,
(D) White House Panel Recommends Declaring National Emergency on Opioids, by ABBY GOODNOUGH, (A
(E) Probe reveals flood of 780M painkillers in 6 deadly years in West Virginia,
(F) Doctors like me must stop overprescribing opioids, by Marty Makary,

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“.. here’s the first thing I thought about: feel better, Hillary Clinton could be president..” (Senator McConnell) (A) “McCain Voted Against Health Care Bill…Because it Would ‘Screw’ Arizona.” (B)

Despite President Trump’s call to let Obamacare implode its unlikely come September that the Republicans in Congress, many facing reelection, will let Obamacare fail.
Here’s a wrap up as Congress goes on vacation.

“After the failure early Friday of the latest Republican plan to repeal the Affordable Care Act, President Trump said that he wants to “let ObamaCare implode, then deal.” Mr. Trump has already been doing three things to undermine important provisions of the health law, and there is more he could do.
What Trump can do: Weaken enforcement of the individual mandate; Impose work requirements for Medicaid recipients; Fail to do advertising or outreach; Make tax credits for premiums less generous; Defund subsidies that help people pay out-of-pocket costs; Redefine essential health benefits.” (C)

The politics are exceedingly tricky in a divided and dysfunctional Washington, but economists, insurers, doctors and health policy experts across the political spectrum agree that immediately addressing three or four basic shortcomings in the existing system would go a long way toward making the law more effective and financially stable. Stabilize the Markets. Reduce Drug Prices. Expand Access for Poor. (D)

“In an attempt to hit Republicans where it counts, Trump on Monday morning tweeted, “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” It was at once an effort to threaten insurers about withholding Obamacare cost-sharing reduction payments and to threaten Congress about the special treatment it receives under Obamacare.”(E)

‘The first part of Trump’s tweet appeared to be referring to the approximately $8 billion in cost-sharing reduction subsidies the federal government pays to insurers to lower the price of health coverage for low-income Americans.
The second part appeared to be a threat to end the employer contribution for Congress members and their staffs, who were moved from the normal federal employee health-care benefits program onto the Obamacare insurance exchanges as part of the 2010 health-care law.’ (F)

“Finance Committee Chairman Orrin Hatch of Utah, whose panel oversees both health care and tax policy, said he was ready to tackle taxes. “I think we are moving on to tax reform but that doesn’t mean we can’t do more than one thing at a time,” he said, adding that Senate Republicans should not vote on health care again unless there is “a reasonable chance of success.”” (G)

“A group of around 40 House Republicans and Democrats known as the Problem Solvers Caucus has endorsed an outline of ideas aimed at making urgent fixes to Obamacare. While there is no legislative text yet, members in the caucus are moving quickly to seize the defeat of a Senate bill last Friday to garner broader support for their proposals — and force the GOP to ditch its quest to gut the current health care law once and for all.
The group’s proposal includes mandatory funding for cost-sharing reduction payments; the creation of a stability fund; a repeal of the medical device tax; and increasing the employer mandate’s threshold so that companies with 500 employees or more, rather than 50, are required to provide workers with health insurance.” (H)

“The apparent demise of the Republican drive to scrap the Affordable Care Act may open the door to bipartisan fixes to the law. If it does, some of the proposals being touted by a bipartisan group of governors may get a hearing on Capitol Hill….
For example, the governors want the federal government to continue to provide subsidies to low-income Americans so they can afford to purchase insurance on the marketplaces. In 2017, the federal government is expected to give tax credits totaling $38 billion to about 9 million people.
The governors also insist that at least through 2018, the federal government should continue to make it easier for lower-income Americans who purchase coverage on the marketplaces to afford out-of-pocket expenses.” (I)

“Sen. Lamar Alexander, R-Tenn., the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced Tuesday that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. He publicly urged Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.
In the House, two Republicans, Reps. Tom Reed of New York and Charlie Dent of Pennsylvania, teamed up with Democrats to promote incremental health legislation that also would fund the cost-sharing subsidies.
The two moves were a remarkable response to the president’s repeated threats to send health insurance markets into a tailspin. They offered tangible indications of cooperation between the parties after Republican efforts to scrap the Affordable Care Act collapsed in the Senate last week, all but ending the seven-year Republican quest to overturn President Obama’s signature domestic achievement. Lawmakers from both parties concede that the health law needs improvement, as consumers face sharp premium increases and a shrinking number of insurance options in many states.” (J)

“Independent health-care experts agree that the Affordable Care Act has resulted in the lowest percentage of uninsured Americans ever and the slowest rate of inflation in health-care spending in 50 years. Incentives in the law are improving the quality of care, Medicare beneficiaries have saved nearly $27 billion on prescription drugs, nearly 600,000 unnecessary hospital readmissions have been prevented and the cost of premiums in the individual market today is almost exactly where the Congressional Budget Office predicted it would be eight years ago. The law is also projected to reduce federal deficits by more than a trillion dollars in coming years.
That’s an impressive record, but serious repairs are needed. While most marketplaces are stable, some are in danger of collapse. Costs are still too high for many families, and uncertainty over federal policy is making it treacherous for plans to price premiums accurately.
Both Republicans and Democrats have already proposed remarkably similar solutions targeted to solve these problems. They are affordable, not technically difficult to implement and would help families in all parts of our country. And they demonstrate that the law — and all the good it has done — doesn’t need to be destroyed to make needed improvements.” (K)

(A) McConnell on healthcare failure: ‘Feel better, Hillary Clinton could be president’, by JULIA MANCHESTER,
(B) McCain Voted Against Health Care Bill…Because it Would ‘Screw’ Arizona, by Cortney O’Brien Cortney O’Brien,
(C) 3 Things Trump Is Already Doing to ‘Let Obamacare Implode’, by By HAEYOUN PARK and MARGOT SANGER-KATZ,
(D) How to Repair the Health Law (It’s Tricky but Not Impossible), By REED ABELSON, ABBY GOODNOUGH and KATIE THOMAS,
(E) Daily on Healthcare: Angry Trump demands GOP Senate pass healthcare bill … but McConnell’s fundamental problem remains, by Philip Klein and Robert King and Kimberly Leonard,
(F) Trump threatens to end insurance payments if no health-care bill,
(G) Dejected Republicans on Obamacare repeal: Barring a miracle, ‘it’s over’, By Lauren Fox, MJ Lee and Ted Barrett,
(H) After collapse of Obamacare repeal in the Senate, growing calls for bipartisanship, MJ LeeDeirdre Walsh Profile, by MJ Lee and Deirdre Walsh,
(I) A Bipartisan Health Care Fix? Governors Have Some Ideas,
(J) Congress bypasses Trump on health care, by Robert Pear and Thomas Kaplan,
(K) How Congress can get a second chance on health care, by Nancy-Ann DeParle and Phil Schiliro,


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What Congress, President Trump and Former President Obama are saying about healthcare

“Politically, the collapse of the repeal effort is potentially devastating for Republicans. It leaves Trump without a significant policy achievement in the critical first six months of his presidency; it casts a pall over the party’s coming drives to pass a budget and overhaul the tax code; and it exposes GOP lawmakers to rising anger from their conservative base.
Substantively, it leaves much work undone. While the ACA has made health insurance accessible to millions of Americans, it has failed to contain rising costs, especially in the individual insurance market, where people without access to employer-provided coverage buy policies. Without federal action — and additional cash — those marketplaces could become unstable.”
“ “The vote last night presents the Senate with an opportunity to start fresh,” McCain said in a statement. Democrats, too, expressed interest in working across the aisle, especially on a plan to make federal cost-sharing subsidies permanent. The subsidies — which will total about $7 billion this year and $10 billion in 2018 — reimburse insurers for reducing co-payments and deductibles for certain low-income customers, reducing their out-of-pocket costs….” (A)

“House Republicans are fed up and openly blaming their Senate colleagues across the Capitol for torpedoing their party’s pledge to repeal and replace Obamacare.
They headed home for a five-week summer recess having failed on a key policy goal they vowed to get done once they controlled Congress and the White House. And things aren’t getting any easier as major fiscal fights are hanging over them this fall.
House Speaker Paul Ryan, who spent weeks urging his members to hold their fire and give Senate Republicans some space to get a health care deal, didn’t hide his frustration at a closed-door meeting in the Capitol basement on Friday. He effectively threw the Senate under the bus, telling his colleagues that the House of Representatives was the only arm of the government that was working.” Their overall message to voters: don’t blame us, it’s all the Senate’s fault.”(B)

““Trump, meanwhile, continued to express mainly hostility toward the ACA. On Friday, he unleashed a series of tweets blaming “3 Republicans and 48 Democrats” in the Senate who “let the American people down” by rejecting the latest overhaul proposal.
“As I said from the beginning, let ObamaCare implode, then deal. Watch!” Trump wrote. He also called for Senate Republicans to abolish the filibuster — a venerable Senate procedure designed to protect the minority party that requires contentious matters to receive the votes of at least 60 senators.”” (C)

“President Obama has always said we should build on this law, just as members of both parties worked together to improve Social Security, Medicare, and Medicaid over the years,” the statement continues. President Obama still believes that it is possible for Congress to demonstrate the necessary bipartisanship and political courage to keep delivering on the promise of quality, affordable health insurance for every American.” (D)


(A) Republican divided on whom to blame for health-care defeat, and what to do next, by Juliet Eilperin, Paul Kane and David Weigel,
(B) House Republicans rail on Senate GOP for torpedoing health care, by Deirdre Walsh, Phil Mattingly, MJ Lee, Kristin Wilson and Lauren Fox,
(C) Trump lashes out over healthcare reform failure, by: Barney Jopson and Sam Fleming,
(D) Obama speaks out after GOP health care bill failure,


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