�Թϲ�����

Senate Republicans ended a demoralizing week on Thursday with their leaders determined to press ahead with a vote to begin debating health care next week, but with little progress on securing the votes and no agreement even on which bill to take up. With President Trump urging them to move forward on their seven-year quest to erase the Affordable Care Act, Republican senators on Thursday still had not decided whether to revive a proposal to replace former President Barack Obama’s health care law with one of their own, or to simply repeal it and work on a replacement later. (Kaplan and Pear, 7/20)

Sen. John Cornyn (R-Texas), the No. 2 Senate Republican, on Thursday said knowing what the Republican healthcare bill will be before a procedural vote is a "luxury we don't have." A Cornyn spokesman said the senator was referring to the open amendment process for the bill, which means that the final product could be altered. (Sullivan, 7/20)

Senate Republican leaders’ latest attempt to salvage support for a GOP health-care bill floundered Thursday as leaders struggled to explain to rank-and-file members what exactly they would be voting on next week. Senators left town for the weekend under a cloud of confusion after Senate Majority Leader Mitch McConnell (R-Ky.) reopened talks on a discarded plan to repeal and replace the Affordable Care Act under heavy pressure from President Trump. The White House intervention sparked a flurry of meetings and activity, but the rush produced no new evidence that the bill can pass. (Snell and Goldstein, 7/20)

U.S. Senate Republicans, scolded by President Donald Trump for failing to overturn Obamacare, tried to salvage their seven-year effort for a new healthcare law on Thursday, but leading senators indicated frustration over shifting goal posts. Trump on Wednesday told the Senate's fractured Republican majority to revive a bill to repeal and replace Obamacare that collapsed on Monday after Republicans from both moderate and conservative factions pulled their support. (Cornwell and Becker, 7/20)

On Thursday, the Senate unleashed yet another iteration of its effort to repeal and replace the Affordable Care Act, also known as Obamacare, and with it came another analysis from the nonpartisan Congressional Budget Office. If your head is spinning, you've got plenty of company, us here at Shots included. Here are the key versions of repeal and/or replace legislation so far this year. (Grayson, 7/20)

Julie Rovner of Kaiser Health News, Stephanie Armour of the Wall Street Journal, Sarah Kliff of Vox.com, and Margot Sanger-Katz of The New York Times discuss the ever-changing status of the Senate’s effort to “repeal and replace” the Affordable Care Act, and the Trump Administration’s efforts to undermine the working of the law. (7/20)

Sen. Rand Paul (R-Ky.) is opening the door to helping GOP leadership get a healthcare bill over a key procedural hurdle. The Kentucky Republican said on Thursday that he would support the motion to proceed to the House-passed healthcare bill, which is being used as a vehicle for any action, if he could get a deal on amendments. (Carney, 7/20)

Sen. Bob Corker reversed course Thursday and indicated he would support a bill the Senate plans to vote on next week to repeal parts of the Affordable Care Act without a replacement plan. Voting now to repeal the law in two years would give lawmakers the time needed to come up with a plan to replace it, the senator said in a statement Thursday morning. (Collins, Fletcher and Boucher, 7/20)

Mike Lee hears the chorus of critics, with blame from the establishment wing of the GOP cascading on the Utah senator for being the Republican that stopped Obamacare repeal. And he's ready to respond. In an interview in his Capitol Hill office Thursday, Lee said he was willing to be the lone senator to bring down his party’s health care bill because it did not do much to stop Obamacare in its tracks. (Everett and Haberkorn, 7/21)

Republican leaders pushed toward a Senate vote next Tuesday on resurrecting their nearly flat-lined health care bill. Their uphill drive was further complicated by the ailing GOP Sen. John McCain's potential absence and a dreary report envisioning that the number of uninsured Americans would soar. (7/20)

Senate Majority Leader Mitch McConnell, R-Ky., is still expected to hold a vote to proceed on some form of legislation to repeal Obamacare next week, despite the fact that Sen. John McCain likely won’t be back in Washington to cast his vote. The Arizona Republican senator's absence, in addition to the GOP members who have announced their opposition to the bill, makes it even harder for McConnell to round up the votes to pass a bill. (Collins, 7/20)

With just two votes to spare, every senator matters. McCain’s inability to flash his trademark thumbs up or thumbs down when he strides into the chamber to cast his vote could seriously stymie the Republicans on key legislation. (Mascaro, 7/20)

“We're really working to try to get agreement but obviously yeah it's more challenging without him,” said Sen. John Hoeven (R-N.D.). McCain, who was not in Washington this week after having a blood clot removed from above his left eye, may return. (Carney and Bolton, 7/21)

Battling brain cancer, John McCain on Thursday vowed to return to the Senate, leveling fresh criticism at the Trump administration and aiming a good-natured dig at Republican and Democratic colleagues shaken by news of his diagnosis. “I greatly appreciate the outpouring of support — unfortunately for my sparring partners in Congress, I’ll be back soon, so stand-by!” McCain said in a tweet. Showing no signs of stepping back from political and national security battles, he issued a statement slamming the Trump administration over its Syria policy. (Cassata, 7/20)

Mr. McCain, 80 years old, has been absent from the Senate this week after surgery last Friday for a blood clot above his left eye. Doctors determined that the blood clot was associated with a glioblastoma, an aggressive type of cancer that can be hard to cure. Treatments include a combination of chemotherapy and radiation. (Hughes and Andrews, 7/20)

John McCain, with his short fuse and lashing tongue, is not always an easy man to like, or to get along with. The Arizona senator acknowledged as much in a wry tweet he dispatched Thursday morning — candor and self-deprecation always being two of his strongest, most appealing suits. “I greatly appreciate the outpouring of support,” McCain wrote hours after revealing he had been diagnosed with an aggressive form of brain cancer. “Unfortunately for my sparring partners in Congress, I'll be back soon, so stand-by!” At a time of bone-deep political division, the two-time Republican presidential hopeful is a rare unifier. (Barabak, 7/20)

Being told you have cancer is never welcome, but being told you have a glioblastoma tumor is especially scary. This is the news that longtime Arizona Sen. John McCain got after he had a blood clot removed above his left eye on Friday. A glioblastoma is the same type of tumor that killed Sen. Edward M. Kennedy in 2009. It also was responsible for the death of Beau Biden, son of then[-Vice President Joe Biden, in 2015. (Netburn, 7/20)

Doctors use words like "aggressive" and "highly malignant" to describe the type of brain cancer discovered in Arizona Sen. John McCain. The cancer is a glioblastoma, the Mayo Clinic said in a statement Wednesday. It was diagnosed after doctors surgically removed a blood clot from above McCain's left eye. Doctors who were not involved in his care say the procedure likely removed much of the tumor as well. (Hamilton, 7/20)

Glioblastoma, the brain cancer that Sen. John McCain has, is invariably — and accurately — described as aggressive and as having a poor prognosis: Not even Sen. Edward Kennedy or Beau Biden, with access to the best care and most cutting-edge therapies in the world, beat it. Recent advances, however, have persuaded some scientists that effective treatments are on the horizon — and some might even help McCain live longer than earlier patients did. (Begley, 7/21)

The latest version of Senate Republicans' legislation to repeal and replace the Affordable Care Act would leave 22 million Americans without health insurance coverage by 2026, the U.S. Congressional Budget office said on Thursday. (Alexander, 7/20)

The reworked bill would increase average premiums over the next two years, but reduce them starting in 2020 by 30 percent, the report estimated. But the policies would typically offer less coverage. And because the GOP measure would also eliminate federal subsidies that let insurers lower out-of-pocket costs for low-earners, the changes “would contribute significantly to a decrease in the number of lower-income people with coverage,” the budget office said. (Fram and Werner, 7/20)

The Senate Republican health bill promises lower premiums for consumers. To get there, it would require patients in standard plans to spend as much as about $13,000 upfront on their own care. The deductibles would be so high, in fact, that they’d violate maximums set in U.S. law, an analysis by the nonpartisan Congressional Budget Office said Thursday. Under Obamacare, by comparison, an individual in a standard plan would have a deductible of roughly $5,000. (Tracer and Edney, 7/20)

And it would increase costs for millions of sick and elderly Americans, the budget office estimates. Those costs could soar even further under another provision of the bill that would allow insurers to offer slimmed-down health plans that don’t offer the basic set of health benefits — including prescription drugs, maternity care and mental health services — currently mandated by the Affordable Care Act, also known as Obamacare. (Levey, 7/20)

Compared with earlier versions, it would give more money to states to help pay for insurance for high-cost patients and would preserve some Affordable Care Act taxes. It would still eliminate the law’s requirement that most Americans carry health insurance, phase out the law’s expansion of Medicaid and transform the rest of Medicaid funding. According to Congress’s nonpartisan budget scorekeepers, this version would have a greater impact on lowering the federal deficit — a $420 billion reduction between next year and 2026, compared with $321 billion under the previous form of the bill. The change is largely because the new plan would keep more Affordable Care Act taxes. (Goldstein, 7/20)

That gives Senate Majority Leader Mitch McConnell an additional $99 billion to dole out in funding sweeteners to entice balky Senate moderates to support the bill when McConnell hopes to hold a vote on the legislation next week. (Meyer, 7/20)

The impact of the new report is uncertain, however, as the CBO didn’t include a full analysis of an amendment from Sen. Ted Cruz (R., Texas) that would allow for cheaper but more bare-bones insurance plans because that analysis requires more time. (Armour, 7/20)

Senators have said it could take weeks for the CBO to score the Cruz amendment, raising the likelihood those numbers will not be available when the Senate votes next week. CBO officials said Thursday they are working on scoring the proposal, but wouldn’t speculate on when it might be finished. (Weixel, 7/20)

The provisions in the latest version of the Senate bill are much like the version scored at the end of June: It would end the individual and employer mandates, it would roll back the Affordable Care Act's Medicaid expansion and cut spending to that program by hundreds of millions of dollars, and roll back some taxes. However, this bill would not roll back Obamacare investment income taxes and payroll taxes that hit higher-income Americans. (Kurtzleben, 7/20)

Speaker Paul Ryan (R-Wis.) ripped the nonpartisan Congressional Budget Office (CBO) on Thursday, arguing the estimate that 22 million more people would be left uninsured over the next decade by a plan to repeal and replace ObamaCare is a "bogus" number. Speaking to reporters at an event at a New Balance factory in Lawrence, Mass., the GOP leader said the CBO's estimate simply means that many Americans would no longer buy health insurance because the government would no longer be forcing them to purchase insurance. (Bowden, 7/20)

Obamacare may escape another GOP repeal effort, but surviving a hostile administration could be a much tougher challenge. If a last-ditch repeal effort fails in Congress next week, all indications are the Trump administration will continue chipping away at the Affordable Care Act — if not torching it outright. (Demko and Pradhan, 7/21)

President Donald Trump's administration has ended Affordable Care Act contracts that brought assistance into libraries, businesses and urban neighborhoods in 18 cities, meaning shoppers on the insurance exchanges will have fewer places to turn for help signing up for coverage. Community groups say the move, announced to them by contractors last week, will make it even more difficult to enroll the uninsured and help people already covered re-enroll or shop for a new policy. (Johnson, 7/20)

The Trump administration has spent taxpayer money meant to encourage enrollment in the Affordable Care Act on a public relations campaign aimed at methodically strangling it. The effort, which involves a multi-pronged social media push as well as video testimonials designed at damaging public opinion of President Obama’s health care law, is far more robust and sustained than has been publicly revealed or realized. (Stein, 7/20)

Senate Republicans, scrambling to win support for their health-care bill, pushed a measure Thursday that they said could ease the impact of the bill’s Medicaid cuts on low-income people. Advocating for the new direction is a little-known health official who is now at the center of the health-care fight: Seema Verma, head of the Centers for Medicare and Medicaid Services, which oversees the two federal medical programs. (Radnofsky and Peterson, 7/20)

A Medicaid expert and close associate of Vice President Mike Pence has emerged as one of the most influential advocates of the Obamacare repeal effort. Seema Verma, who runs Medicare and Medicaid for the Trump administration, keeps a low public profile, but behind the scenes, she’s been guiding skeptical Republican senators and governors through the Obamacare repeal proposals and reassuring them that their states will do just fine under the new Medicaid financing system it envisions. (Haberkorn and Pradhan, 7/21)

At a lunch on Wednesday, President Trump tried to persuade some reluctant senators to endorse repealing the Affordable Care Act. During the meeting, he mentioned a provision in the Senate Republican proposal that allocates funding for opioid treatment, saying, "We're committing $45 billion to help combat the opioid epidemic, and some states in particular like that." But addiction treatment specialists warn that sum of money is far from enough to address a crisis that has escalated across the United States in recent years, killing tens of thousands of people. (Allen, 7/20)

Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week. The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. (Klivans, 7/20)

A new survey finds that many Georgia school systems fear that the proposed Medicaid cuts in Congress would hurt their special education programs – and the children they serve. Most school districts responding to the survey say they receive thousands of dollars in Medicaid funding to help offset the costs of their special education programs. (Miller, 7/20)

Nebraska hospitals are crying foul over a pair of recent decisions by state Medicaid officials that are hurting hospital finances. One saddled hospitals with the biggest share of budget-cutting payment changes. The other left in place errors in the Medicaid hospital payment formula that date to 2014. Together, the decisions will cost hospitals more than $21 million a year in state and federal funds, with most of the impact falling on the 27 largest hospitals. (Stoddard, 7/21)

Five years ago, the Affordable Care Act had yet to begin its expansion of health insurance to millions of Americans, but Jeff Brahin was already stewing about it. “It’s going to cost a fortune,” he said in an interview at the time. This week, as Republican efforts to repeal the law known as Obamacare appeared all but dead, Mr. Brahin, a 58-year-old lawyer and self-described fiscal hawk, said his feelings had evolved. “As much as I was against it,” he said, “at this point I’m against the repeal.” (Zernike and Goodnough, 7/20)

It took just three questions before someone asked whether health insurance should be the basis of a health care system at all. Nearly everyone in the room raised their hands when [Sen. Claire] McCaskill asked who would favor extending Medicare coverage to everyone, of any age. The idea of a single-payer system for American health care is a non-starter for conservative lawmakers and think tanks, but has grown in popularity among the general public. A recent Politico poll found that 44 percent of respondents would support a federal health care program for everyone. (Bouscaren, 7/20)

As the "repeal and reform" effort stalled this week in the Senate, Majority Leader Mitch McConnell, R-Ken., and President Trump floated an alternative strategy: repeal the Affordable Care Act (ACA) without a replacement. Although Republicans have promised to repeal Obamacare for years, it appears there are not enough votes in the Senate to do it. (Zdechlik, 7/21)

A growing number of Americans think the GOP should give up its attempts to repeal and replace ObamaCare, according to a new survey. A CNN poll conducted by SSRS finds 35 percent of respondents think President Trump and GOP lawmakers should abandon their plans to repeal and replace ObamaCare. (Savransky, 7/20)

Protesters staged a small but boisterous rally Thursday outside a New Balance sneaker factory in Massachusetts where U.S. House Speaker Paul Ryan was expected to discuss Republican plans for tax reform. The rally took place across from the factory in a historic mill building in Lawrence along the Merrimack River. More than 100 demonstrators held signs and shouted slogans criticizing Republican efforts to repeal former President Barack Obama’s health care law. (Marcelo, 7/20)

Republicans and Democrats could be forced to work together to fix the Affordable Care Act if repeal-and-replace is doomed. ... Assuming Senate Republicans can't find the votes for a full repeal, are there middle-ground ways to improve Obamacare after the political dust settles? (Koff, 7/20)

Senate Majority Leader Mitch McConnell will move next week on a measure to dismantle the Affordable Care Act, but, predicting failure, other senators are already talking about areas of compromise between Republicans and Democrats. ... Democrats signaled they were ready to talk too. (Pugh and Clark, 7/21)

Planned Parenthood and other groups sued Texas on Thursday over a new ban on a second-trimester abortion procedure, the state's first major anti-abortion measure since the U.S. Supreme Court struck down a law that had prompted more than half of its abortion clinics to close. (Weber, 7/20)

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

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

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

Facilities commonly referred to as “crisis pregnancy centers,” many of which are faith-based, will be required to post a sign telling patients they are not health-care facilities, under a new rule approved Thursday by the King County Board of Health. After emotional public testimony, mostly against the signs, nine of 10 board members voted for the rule saying their action was meant to bring transparency and accurate information to pregnant women. (Young, 7/20)

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

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

Overdose cases have deluged St. Elizabeth emergency departments this year, escalating to more than double the number the six hospitals had seen by this time last year. The hospital system released the second quarter heroin-overdose reversal numbers on Thursday. (DeMio, 7/20)

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

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

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

A report out Thursday by the Centers for Disease Control and Prevention about homicides and women provides some disturbing numbers about just how common this is. Homicide is the fifth leading cause of death for women ages 18 to 44. In 2015 alone, 3,519 women and girls were killed. More than half of these killings were perpetrated by current or former boyfriends, husbands or other intimate partners. (Cha, 7/20)

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

Temporary tattoos aren’t just for style anymore. Scientists have developed a new wearable sensor that looks and feels like a henna tattoo but can monitor electrical muscle activity and body temperature, too. (Pattani, 7/20)

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

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

Tobacco companies want U.S. regulators to bless smokeless tobacco as a safer alternative to smoking, as cigarette consumption falls. In its campaign, Big Tobacco has unusual supporters: some public-health advocates. (Maloney, 7/21)

Clyde Boyce has been hospitalized 14 times in the past four years. Boyce, 61, survived two strokes and five operations to unblock arteries around his heart, including three procedures in which doctors propped open his blood vessels with stents. He takes 18 pills a day and gets injections every two weeks with a powerful drug to lower cholesterol. (Szabo, 7/20)

Working long hours may increase the risk for atrial fibrillation, or irregular heartbeats that can lead to serious cardiovascular complications, a new study in the European Heart Journal found. Lengthy work hours have been shown in several previous studies to increase the risk for cardiovascular disease. (Bakalar, 7/20)

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

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

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

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

Physicians, researchers, activists and legislators across the U.S. are working to understand why preeclampsia is rising faster than other chronic conditions and prevent it. ...And according to Dr. Anupam B. Jena, internal medicine physician and professor at Harvard Medical School, and his colleagues, preeclampisia increased “from 2.4% of pregnancies in 1980 to 3.8% of pregnancies in 2010.” (Cheatham, 7/20)

Lawmakers approved a new rule designed to grant more due process rights to mental health patients who are transferred to the state prison. But as advocates for mental health reform argued these new protections should not have to exist in the first place. (McDermott, 7/20)

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

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

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

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

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

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

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

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

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

Orlando’s Westminster Towers retirement community hired a company to treat its water systems Thursday after a former resident contracted Legionnaires’ disease. Experts from Nalco Water flushed out the pipes using a process called hyperchlorination, which raises the levels of chlorine in the water, Westminster communications director Wes Meltzer said. (Padro Ocasio, 7/20)

Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients... Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. (Dolin et al., 7/1)

We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted. (Li et al., 7/1)

Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings... Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient's (or his/her guardian/conservator's) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions. (Rothenberg et al., 7/19)

We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients’ experiences, and Medicare expenditures in demonstration sites versus comparison sites... Demonstration sites had higher rates of medical-home recognition and smaller decreases in the number of patients’ visits to federally qualified health centers than did comparison sites, findings that may reflect better access to primary care relative to comparison sites. (Timbie et al., 7/20)

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

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

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

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

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

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

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

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

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

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

Focus, America, focus. The most urgent task right now is to make sure a stake is driven through the heart of the Republican effort to gut Medicaid and balloon the ranks of the uninsured. I know that the Russia investigations are charging ahead, with Capitol Hill appearances by members of President Trump’s inner circle scheduled for next week. I know that Trump gave an unhinged interview to the New York Times on Wednesday, bizarrely undermining his own attorney general. I know that one of the few remaining giants in Washington, Sen. John McCain (R-Ariz.), has received a tough medical diagnosis. (Eugene Robinson, 7/20)

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

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

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

The U.S. has some of the most expensive medicine in the world, with health-care spending now almost 18 percent of gross domestic product. But why? And might we hope to get this spending down? Unfortunately, expensive health care is embedded in the American way of life -- more specifically, the American desire to live it up with high consumption. (Tyler Cowen, 7/20)

The rehashed House GOP budget blueprint wants to reshape Medicare into more of a Medicare Advantage model, which now covers some 19 million Americans. What does that mean? Funding for the guaranteed part of Medicare would be shifted into the privatized scheme. You'd receive a fixed stipend or "premium support" to buy a private policy on an exchange. (John Wasik, 7/19)

In 1991, after nearly 10 years of recurring wracking pain in my lower abdomen, I walked into a hospital in Helsinki, Finland. I wasn't a Finnish citizen and wasn't, at that time, married to one. I was an American writer visiting my Finnish boyfriend, working temporarily in Helsinki. An admitting nurse listened to my symptoms and guessed my problem — a diagnosis that received preliminary confirmation by ultrasound within the hour. (Anne Korkeakivi, 7/20)

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

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

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

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

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

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

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

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