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President Trump’s budget proposal and the recent House health legislation included substantial reductions in Medicaid. Understandably, those cuts have focused attention on the potential effect on coverage for lower-income individuals. But there’s another important and related conversation that needs attention: how much flexibility should states have in redesigning the federal-state Medicaid program? (Butler, 6/14)

Nearly one in five adult children at some point provide care for at least one elderly parent, according to a new study by the Center for Retirement Research at Boston College. The burden is particularly demanding for daughters, who spend as much time on such care as spouses of older adults, and as much time as sons, in-laws, grandchildren and other relatives combined. (6/15)

Senate Republicans continue to negotiate the details of their health-care reform, and one measure of progress is that their opponents are more manic and disingenuous. Progressives who used to deride the GOP for incompetence are now panicked that they may really succeed, and thus the faux tantrums. The distortion du jour is that the GOP is operating “in secret.” This week Minority Leader Chuck Schumer accused Republicans of working “behind closed doors, writing a bill they won’t let the public read. . . . Today, no Member of Congress can read the bill because we don’t know what it is.” (6/14)

House Republicans are angry with President Trump for blurting out an inconveniently candid view of their health-care bill, Politico reports today. Trump reportedly told a closed-door gathering of GOP senators that the House repeal-and-replace bill is “mean” and called on them to make it “more generous.” This promptly leaked, and a lot of people are noting that Trump undercut House Republicans politically and provided Democrats with ammo for a thousand attack ads. (Greg Sargent, 6/14)

Senate Majority Leader Mitch McConnell once had passionate views about how carefully Congress should consider sweeping changes to the health-care system. “Fast-tracking a major legislative overhaul such as health care reform or a new national energy tax without the benefit of a full and transparent debate does a disservice to the American people,” McConnell said in 2009, referring to the two big issues of the moment. Democrats using such means, he added, “would make it absolutely clear they intend to carry out their plans on a purely partisan basis.” Republican hypocrisy is now so rampant that it’s typically ignored or, worse, granted the political class’s all-purpose form of absolution: “Everybody does it.” (E.J. Dionne, 6/14)

A new health care system affecting millions of families is being designed right now in closed-door meetings attended by a small group of Republican senators and their aides. Access to insurance, needed treatments and affordable premiums are being bargained away in exchange for the few votes needed to drag the American Health Care Act over the finish line. Given the narrowest of margins in the Senate, the fate of the AHCA is likely to be decided by one of several senators you might have never heard of, and by a handful of raw deals that are being dangled in front of them. (Andy Slavitt, 6/15)

Mitch McConnell has never let concerns about hypocrisy get in the way of advancing his legislative agenda. Now, while the media and American citizens are fixated on each daily warp of the soap operatic presidency of Donald Trump, McConnell has huddled behind locked doors with his Republican loyalists and favored lobbyists to assemble a healthcare scheme that will disassemble Obamacare. (David Horsey, 6/14)

The Trump administration recently petitioned the U.S. Court of Appeals in Washington for a three-month delay in a federal case that will have a significant effect on the future of the Affordable Care Act. It could undermine the stability of individual health insurance markets nationwide. (Dianne Feinstein, Kamala Harris and Diana Dooley, 6/14)

When the U.S. House finally sent the Republicans’ American Health Care Act to the Senate on May 4, consensus was that it was dead on arrival. One reason, as even President Donald Trump this week acknowledged — six weeks after holding a Rose Garden ceremony to celebrate it — is that the House bill is “mean.” It turns out the bill wasn’t DOA; it was only sleeping. (6/14)

Sen. Jerry Moran of Kansas met with 500 constituents at a town hall meeting Monday in Lenexa, the biggest such assembly of his career. Voters are paying attention — not only to what Moran and his colleagues say, but to what they do. Sen. Jerry Moran walked into a town hall buzz saw Monday morning, one with about 500 razor-sharp sets of teeth ready to slice him to ribbons. (Dave Helling, 6/15)

Everyone agrees prescription drugs are too expensive, but what to do about it? One popular idea—supported in the past by President Trump, and by 80% of the public in some polls—is for Medicare to negotiate lower drug prices directly. But such negotiation would work only if there were some limitations on the drugs available to patients, raising many questions about the feasibility of creating a national formulary. Would beneficiaries accept that? (Walid F. Gellad, 6/14)