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The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump. Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it. (Pear and Kaplan, 7/27)

The Senate voted 49-51 against the "skinny" bill, which would have repealed ObamaCare's individual and employer mandates and defunded Planned Parenthood. (Sullivan, 7/28)

"I do my job as a senator," McCain said after he left the Senate chamber, saying he voted against the Obamacare repeal bill "because I thought it was the right vote." ... Later, McCain issued a statement offering a more thorough explanation of his vote, saying that he has always believed that Obamacare should be repealed and replaced with a solution that "increases competition, lowers costs and improves care for the American people." (Bresnahan, Everett, Haberkorn and Kim, 7/28)

McConnell said at about 2 a.m. that it was "time to move on" rather than trying again to pass a GOP bill. He said he wants to hear ideas from Democrats about what to do next on health care. "What we tried to accomplish for the American people was the right thing for the country," McConnell, who was clearly shaken, said after the vote. "And our only regret is that we didn't achieve what we had hoped to accomplish. I think the American people are going to regret that we couldn't find a better way forward." (Kelly and Collins, 7/27)

Friday’s vote leaves Republicans without any clear next step in their monthslong effort to roll back the ACA and with no significant legislative accomplishment during President Donald Trump’s first seven months in office. “This is clearly a disappointing moment,” Senate Majority Leader Mitch McConnell (R., Ky.) said on the Senate floor moments after the vote. “I regret that our efforts were simply not enough this time.” (Peterson, Hackman and Hughes, 7/28)

With the vote on a “skinny” repeal bill, Republican leaders were trying what amounted to a legislative Hail Mary pass. But they could afford to lose only two party members, and three Republicans voted no: Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona. Here are some of the key lessons from the evening. (Kaplan, 7/28)

The GOP plan was to take the “skinny” bill to a conference with the House on a more substantial bill the House approved in May that would repeal and replace the ACA. With that path no longer available, and the failure to pass other proposals that would replace the Affordable Care Act, McConnell said, “Now it is appropriate to ask (Democrats) what their ideas are” to address escalating premiums and the flight of insurers from state ACA exchanges. (Radelat, 7/28)

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday. (Michael McAuliff, 7/28)

The plan would have revoked the current law’s mandate on individuals to buy insurance and end the requirement on employers who have 50 or more workers to provide insurance coverage. It would also have reversed the Affordable Care Act’s tax on medical devices. (Lochhead, 7/27)

The bill would mean 15 million more people would be uninsured next year than under Obamacare, with 16 million more in 2026, the Congressional Budget Office said in a report released late Thursday night. Premiums would jump 20% next year, compared to current law. (Lee, Fox, Barrett, Mattingly and Killough, 7/28)

When Senator John McCain of Arizona returned to Washington with a fresh scar from brain surgery, it was widely seen as a dramatic effort to help Republicans overturn Obamacare. President Trump had criticized Mr. McCain in the past and derided his military service, saying in 2015 of the former Vietnam prisoner of war, “I like people who weren’t captured.” But this week Mr. Trump welcomed him back to Washington. (Ramzy, 7/27)

The only certainty for senators on Thursday as they headed toward a showdown vote on a health care overhaul was that it would be a late night.Indeed, not until 2 a.m. Friday did the Senate finally stand down, after three Republicans voted against the so-called skinny repeal to reject their party’s push — and a yearslong promise — to scuttle former President Barack Obama’s signature domestic achievement. (Curtis, 7/28)

It was the most dramatic night in the United States Senate in recent history. Just ask the senators who witnessed it. A seven-year quest to undo the Affordable Care Act collapsed — at least for now — as Sen. John McCain (R-Ariz.) kept his colleagues and the press corps in suspense over a little more than two hours late Thursday into early Friday. Not since September 2008, when the House of Representatives rejected the Troubled Asset Relief Program — causing the Dow Jones industrial average to plunge nearly 800 points in a single afternoon — had such an unexpected vote caused such a striking twist. (O'Keefe, 7/28)

As Mr. McCain entered the chamber, Senate Minority Leader Chuck Schumer (D., N.Y.) was urging his colleagues to find common ground. From a corner of the Senate chamber, Mr. McCain quietly clapped. It would be one of his most visible final gestures before Mr. McCain, at about 1:27 a.m., stuck his thumb down and formally registered himself as the vote that would block the GOP health plan from advancing. That vote took a long time to come. For almost an hour, the Senate clerks refrained from gaveling the previous vote to a close as Republicans clustered around Mr. McCain. First, Sen. Lisa Murkowski (R., Alaska) squeezed him on the shoulder. Then, Sen. Susan Collins (R., Maine) joined them, laughing. Those were to be the only three Republican senators to vote against the GOP “skinny repeal” proposal, just enough to derail it—and with it the broader GOP effort to repeal and replace the ACA. (Hughes, 7/28)

Paul Ryan couldn’t persuade him. Neither could Mike Pence. And in the end, President Donald Trump couldn’t reel in John McCain either. The president made a last-ditch effort, calling the Arizona senator and key holdout on the GOP’s Obamacare repeal measure, as the bill’s fate hung in the balance, according to two sources familiar with the conversation. After Pence had spent about 20 minutes working McCain, the senator went off the floor to speak with Trump by phone, those sources said. (Kim, Everett and Haberkorn, 7/28)

What the hell was going on? Republicans finished writing something called a “skinny repeal” health-care bill over lunch Thursday and were trying to use it to repeal parts of the Affordable Care Act late at night. Would it pass? What would happen if it did? And what on earth is a vote-o-rama? (Answer courtesy of Sen. Claire McCaskill: “A vote-o-rama is really weird,” the Missouri Democrat said. “And dumb.” Thanks, senator.) (Terris, 7/28)

Sen. John McCain's “no” vote on the “skinny repeal” of the Affordable Care Act in the early hours of Friday was a decisive, and somewhat unexpected, vote. It was made all the more dramatic by the fact that it played out on television, right in front of our eyes. (Stevenson, 7/28)

He criticized GOP leaders throughout their internal healthcare deliberations for skipping committee hearings and markups, after Republicans criticized Democrats in 2009 for crafting ObamaCare behind closed doors. (Bolton, 7/28)

Capping his dramatic return to Capitol Hill while fighting brain cancer, Sen. John McCain cast the deciding vote to sink his fellow Republicans' so-called "skinny repeal" of the Affordable Care Act. McCain, R-Ariz., joined Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska and every Senate Democrat to bring down the bill on a 49-51 vote. (Nowicki, 7/28)

Shortly before Sen. John McCain entered the Senate chamber in the wee hours of Friday morning, reporters wanted to know how he'd vote. He instructed them to "watch the show." (Fox, 7/28)

It was a "no" that could barely be heard on C-SPAN, and a thumbs-down that viewers would not have been able to easily make out. But the moment was crystal clear for the dozens of reporters watching from the gallery above, who let out a collective gasp and made a stampede exit for the wooden double doors behind them to report the news. (Lee, 7/28)

Republican female senators whose disapproval of the GOP health-care effort has at times endangered its progress are facing an increasingly pointed backlash from men in their party, including a handful of comments that invoked physical retaliation. In the past week, Sen. Susan Collins (Maine) has been challenged by a male lawmaker to a duel. She and Sen. Lisa Murkowski (Alaska) were told that they and others deserve a physical reprimand for their decisions not to support Republican health-care proposals. Murkowski, who voted with Collins against starting the health-care debate this week, was specifically called out by President Trump on Twitter and told by a Cabinet official that Alaska could suffer for her choice, according to a colleague. (Viebeck, 7/27)

The White House is escalating its public feud with Sen. Lisa Murkowski (R-Alaska), a key swing vote who helped defeat the "skinny" ObamaCare repeal plan early Friday morning. Interior Secretary Ryan Zinke called Murkowski and Sen. Dan Sullivan (R-Alaska) on Wednesday and threatened to withhold federal support for key economic development projects in the state if Murkowski didn’t line up to support the GOP’s healthcare plans.  (Henry and Cama, 7/28)

Hours after President Trump criticized Republican Sen. Lisa Murkowski's vote on debating health care legislation, Secretary of the Interior Ryan Zinke reportedly called Murkowski and fellow Alaskan Sen. Dan Sullivan to say their state could run into trouble with the Trump administration. (Chappell, 7/27)

While it might have been a long shot given her earlier votes, Republicans might have still salvaged Murkowski's support. But that chance was probably lost when the Trump administration threatened the entire state of Alaska to try to coerce her into backing repeal. Collins seemed opposed to full repeal from the beginning of this process. But if anything, Texas Republican Blake Farenthold's threat to duel her solidified her position rather than weakening it. By the wee hours of Friday morning, as Republican senators huddled around her trying to win their votes, it was too late. (Serwer, 7/28)

The defeat ends — for now — the health care debate in Congress. The chamber adjourned following the defeat and there are no further Senate votes this week. In the short-term, the Senate intends to move on to defense legislation and the nomination of Christopher Wray to be the next FBI Director. In a written statement from McConnell's office after the vote, he seemed to indicate a GOP-only effort on health care may be dead. (Davis and Montanaro, 7/28)

Some senators in both parties said they hope the two sides can begin talks on shoring up the current health-care system, a debate that is expected to be handled by Senate committees overseeing budget, tax and health-care policy. “Maybe this had to happen to actually begin to have a conversation,” said Sen. Bill Cassidy (R-La.), who had tried brokering a bipartisan deal in recent weeks. (Eilperin, Sullivan and Snell, 7/28)

Sen. Charles E. Schumer of New York, the Democratic leader, said he looked forward to taking a bipartisan approach to healthcare reform. "It’s time to turn the page," he said. "We are not celebrating. We are relieved. "Shortly after the vote, President Trump responded on Twitter: “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!” (Mascaro, 7/27)

Senators walked off the floor around 2 a.m. Friday after the stunning defeat of a seven-years-long pledge to repeal and replace ObamaCare, leaving the lawmakers to face one inevitable question: whats next for healthcare reform? Three main answers emerged — bipartisan committee work, stabilizing the insurance markets and administration action to change the healthcare law. (Roubein and Hellmann, 7/28)

Sen. Lamar Alexander (D-Tenn.) has scheduled a hearing in the Senate committee that handles health matters, and that may be where the process begins. But it's not clear there are 12 Republicans who would be willing to spend more money to shore up a bill they have excoriated for seven years. Sen. Amy Klobuchar (D-Minn.) said she has faith in Alexander's ability to get complex legislation done. She noted that Minnesota and Tennessee had added reinsurance to their ACA markets, and she said that should be a priority nationally. (Lee, 7/28)

If anyone could have resuscitated the troubled Obamacare repeal and replace bill, it was Mitch McConnell, the steady and disciplined Senate Majority Leader with a track record of getting really tough things done. But after years of pleading, months of negotiating, and weeks of just barely edging the contentious bill forward, it suddenly died. The end was unexpected and dramatic, as McConnell watched Sen. John McCain -- his longtime friend and occasional political rival -- walk to the center of the Senate floor and turn his thumb down to vote "no." (Barrett, 7/28)

Senate Majority Leader Mitch McConnell expressed "regret" and "disappointment" immediately after the GOP failed to pass a minimalist Obamacare repeal bill early Friday, blaming congressional Democrats for not engaging "in a serious way" in the efforts to remedy the health care law. "I imagine many of our colleagues on the other side are celebrating, probably pretty happy about this," a stunned seeming McConnell said from the Senate floor. "But the American people are hurting and they need relief." (Lima, 7/28)

Ever since the November election, when the fate of her family’s health coverage was suddenly up for grabs, Meghan Borland has been consumed by each twitch and turn of the political debate. She has gone to protests, met with her congressman, lost sleep, shed tears. “My emotions are like a Ping-Pong ball being bounced back and forth between the players,” said Mrs. Borland, who, with her husband, owns a karate school in Pleasant Valley, N.Y., and whose younger daughter, Amelia, 2, is receiving chemotherapy for leukemia. (Hoffman, 7/27)

As lawmakers debate the future of the Affordable Care Act, farmers across the country are worried about their own futures, with health insurance a top concern. Three out of four U.S. farmers and ranchers said health insurance was an important or very important risk management strategy for their businesses in a recent survey led by the University of Vermont. (Shanker, 7/28)

Whatever happens to Obamacare in Washington, the rest of America will be left with a problem it’s had for decades: Health-care spending is growing at an unsustainable rate. Insurance and medical costs are draining the incomes of the middle class—tens of millions of people who earn too much to qualify for government-subsidized coverage, but not so much that they don’t feel the bite of medical bills—and nothing on Congress’s agenda is likely to fix that. (Tozzi, 7/27)

Martin Estacio was shelling out $800 per month for a health plan that didn’t fit his two-state lifestyle. The retired San Bernardino firefighter lives between Oklahoma and California. But his health insurance policy, purchased in Oklahoma, didn’t cover non-emergency care outside the state. (Bazar, 7/28)

Senate Republicans’ failure to pass their limited health bill is a relief for health insurers, but it leaves the companies struggling with increasingly urgent questions as they make decisions about participating in the Affordable Care Act’s exchanges. Insurers had already been pressing for legislation aimed at stabilizing the marketplaces, an idea that is likely to now move into the spotlight with the apparent collapse of Republicans’ efforts to repeal the ACA, also known as Obamacare. But it’s not clear that any bill can move forward fast enough to affect the markets for next year, as insurers must file rates by mid-August and make final decisions about participation by late September. (Wilde Mathews, 7/28)

Opponents of President Barack Obama's health care law who wanted to get rid of the penalty people were assessed for not having health insurance will have to wait longer for relief after the Senate early Friday defeated the GOP's scaled-back version of legislation repealing the Affordable Care Act. (Alonso-Zaldivar, 7/28)

Aetna's 2016 decision to drastically scale back its participation on the Affordable Care Act's insurance exchanges continues to haunt the insurer almost a year later.Hartford, Conn.-based Aetna was hit with a shareholder lawsuit this week that accuses its board of directors of breaching its fiduciary duties to the company and its shareholders by making false statements about the insurer's reasons for pulling out of exchanges in 11 states. (Livingston, 7/27)

Congressional Republicans and Democrats have reached agreement on a $3.9 billion emergency spending package to fill a shortfall in the Department of Veterans Affairs' program of private-sector care, seeking to avert a disruption to medical care for thousands of veterans. The deal includes additional money for core VA health programs, as well. Veterans' groups insisted this money be included. (7/28)

The House has passed a $788 billion spending bill that combines a $1.6 billion down payment for President Donald Trump’s controversial border wall with Mexico with a whopping budget increase for the Pentagon. ... “Every single dime the President requested to start building a wall on our southern border he’s going to get,” said House Majority Leader Kevin McCarthy, R-Calif. “Most importantly, we’re sending more to the VA to fix veterans’ health care and reform outdated VA systems.” (Taylor, 7/28)

[John] McCain’s diagnosis comes as the U.S. Department of Veterans Affairs is under increased pressure to broaden who’s eligible for Agent Orange-related compensation. During the war, the military sprayed millions of gallons of the herbicide in Vietnam to kill enemy-covering jungle brush, and in the process, may have exposed as many as 2.6 million U.S. service members — including McCain. (Ornstein and Hixenbaugh, 7/27)

Wait times for medical appointments at veterans facilities in eastern Colorado and the Denver area are among the worst in the nation, U.S. Department of Veterans Affairs data show. Front Range veterans have seen little improvement in the three years since a national scandal erupted over the problem. (Migoya, 7/27)

Starting this October, the CMS could begin cutting billions in federal funds meant to help hospitals with uncompensated care costs. The Affordable Care Act mandated that Medicaid disproportionate-share hospital funds be cut by $43 billion between fiscal years 2018 and 2025. (Dickinson, 7/27)

While the U.S. Congress continues to debate the future of Obamacare and Medicaid, Minnesota’s safety net clinics worry that they will lose $27 million in federal aid that helps pay for health care of the uninsured. Unless Congress acts by October to renew the funding, Minnesota’s 17 safety net providers would have to cut services and possibly close some of the more than 70 clinics across the state. (Howatt, 7/27)

The one rule about antibiotics that has been drilled into our heads for generations is that you absolutely must take the full course — or else something very bad might happen. Is it time to reconsider that advice? (Cha, 7/27)

The standing argument that failing to complete a course of antibiotics could fuel the rise of antibiotic resistance has little evidence, a group of United Kingdom researchers argue in a new paper. In an analysis published in the medical journal the BMJ on Thursday, they say that completing a course of antibiotics may instead increase the risk of resistance. (Rahim, 7/27)

Inspired by slug slime, scientists have developed a flexible adhesive that sticks to wet surfaces. This stretchy glue can be attached to a beating, bleeding heart and could someday replace stitches in wound repair. Other commercially available glues create strong but inflexible bonds or stretchy but weak connections. The slug-inspired glue cements tightly and it is held together by a stretchy matrix. (Gallegos, 7/27)

Li had been combing the scientific literature for clues to how to make a better surgical adhesive, something that could repair a delicate organ without causing the damage of stitches or staples, or the risk of air or fluid leaks. As he and his colleagues report Thursday in the journal Science, this slug-slime-inspired material could help a lot. Usually there's a trade-off between flexibility and stickiness, Li says. Super Glue works well on dry surfaces, but it's rigid and toxic, so it would never work for patching a beating heart or a bleeding wound. Other materials are flexible but not very sticky. And then there's defensive slug slime. (Bichell, 7/27)

The failure Thursday of an AstraZeneca combination immunotherapy in lung cancer is a humbling setback for the field — and a reminder that many questions remain unanswered. ... only about one-third of cancer patients benefit from treatment with these new therapies. (Feirstein, 7/27)

Michel Cadotte was charged with the second-degree murder of his wife of 19 years, Jocelyne Lizotte, who had Alzheimer’s disease. His lawyers have argued that it was an act of compassion, and his late wife’s sister testified at his bail hearing in June so that he could be released. (Boodman, 7/28)

Fear and concern are consuming the minds of many experts in the field of HIV control and it's not just because of the 1.8 million people that became newly infected with the virus, nor the 1 million who died of AIDS, in 2016. In fact, experts this week were heralding their progress against HIV during the ninth International AIDS Conference on HIV Science in Paris, with UNAIDS reporting last week that more than half of people living with HIV globally are now accessing treatment. Deaths have halved since 2005. (Senthilingam, 7/27)

The number of whooping cough cases in Indiana has doubled in the past year, state health officials warned on Thursday, urging parents to make sure their children are vaccinated. There were 136 confirmed cases of whooping cough in the state, including one that was fatal, in the first half of 2017 — compared with 66 cases, none of them fatal, in the first half of 2016, according to the Indiana State Department of Health. (Astor, 7/27)

For the first time in the United States, scientists have edited the genes of human embryos, a controversial step toward someday helping babies avoid inherited diseases. The experiment was just an exercise in science — the embryos were not allowed to develop for more than a few days and were never intended to be implanted into a womb, according to MIT Technology Review, which first reported the news. (7/27)

An Oregon scientist known for breaking barriers has done it again, successfully modifying DNA in human embryos, according to a report in Technology Review. Shoukhrat Mitalipov of Oregon Health & Science University targeted a gene associated with a human disease, surpassing work done in China, the report said. (Terry, 7/27)

Be Your Own Baby is not your mother’s birth control website. One of its slogans is “My uterus is a no baby parking zone.” The promotional video resembles a pop star’s music video. And it doesn’t shy away from young women talking about sex. (Newman, 7/27)

Research on the microbiome — mostly 40 trillion microorganisms of bacterial cells that populate the human body — increasingly backs up what parents like Grebe have known all along in their, well, guts. “The notion that most bacteria, or germs, are intrinsically bad — and must be killed by any means possible — is widespread,” say authors and leading microbiome scientists Jack Gilbert and Rob Knight in their new book Dirt Is Good, written with New York Times science reporter Sandra Blakeslee. (7/30)

Teenagers who were overweight at 17 were at significantly increased risk for developing colon cancer later in adulthood, and those who were obese were at increased risk for rectal cancer as well, according to a new report. (Rabin, 7/27)

Young people continue to listen to loud music on their headphones. But a reassuring new analysis found that hearing impairment rates among teens have dropped since an alarming spike in hearing loss was reported a decade ago. (Rabin, 7/27)

While Illinois' leaders waged a two-year budget battle, the state fell years behind in reimbursing medical providers for their services, skimping physicians and dentists even if their patients were up-to-date with their premiums. At public universities, officials and workers say some doctors and dentists, particularly those outside an insurance plan's provider network, increasingly asked patients to pick up the state's tab during the impasse. (Rhodes, 7/27)

The ACLU challenges that claim, saying psychologists should be held accountable for the methods they designed following the Sept. 11 terror attacks, including waterboarding and beatings. The sides plan arguments Friday in U.S. District Court in Spokane. (Bellisle, 7/27)

At a time of uncertainty and turmoil in the health insurance markets, today's announcement that -- for the first time in more than two decades -- all University Hospitals facilities and providers will become part of Medical Mutual of Ohio's SuperMed and Medicare Advantage networks is a huge win for consumers, for Cleveland and for the state. ...The decision ensures continuity of care for those already in the Medical Mutual's SuperMed and Medicare Advantage networks who have UH doctors but previously could not access services at UH hospital facilities at its main Cleveland campus. (7/27)

The revelations about Dr. Carmen Puliafito are an academic hospital’s worst nightmare — methamphetamine use, partying in the dean’s office, the doctor’s presence at the scene of a 21-year-old’s overdose. But the case of the University of Southern California eye surgeon and former medical school dean, as reported recently by the Los Angeles Times, raises a bigger question: Could it all have been prevented by random drug testing? (Ross, 7/28)

Medical students, nurses and other current or aspiring healthcare providers at Johns Hopkins Medicine are being trained in a new facility meticulously designed to help them hone their skills in a space that replicates what they'd actually see and experience in the field. The Johns Hopkins Medicine Simulation Hospital, a 13,000 square-foot, $6.8 million state-of-art facility opened earlier this year at the medical campus in East Baltimore. It features the normal array of operating, emergency and intensive care rooms and labs. (Brice-Saddler, 7/28)

Broward County residents can now receive same day, no-cost test results and treatment for sexually transmitted diseases and HIV/AIDS at the new Broward Wellness Center in Fort Lauderdale, opened Thursday by the AIDS Healthcare Foundation and the Florida Department of Health. ...The clinic started accepting patients last week and does not require insurance or any payment. (Runcie, 7/27)

If you suffer cardiac arrest and are taken by ambulance to UT Southwestern Medical Center in Dallas, you might become part of a medical experiment that tests different breathing assistance techniques used to revive you. You're probably unconscious, so this may be done without your permission. (Lieber, 7/28)

For decades, the 650,000 Northeast Ohio members of the SuperMed plan have had access to UH's community hospitals and physicians. But they could not use the main campus hospitals or Bedford facilities without risking out-of-network charges, due to an exclusionary contract that Medical Mutual had with the Cleveland Clinic. (Christ, 7/27)

Governor Charlie Baker declined to say Thursday whether he would veto legislation approved by the state Legislature that omits his administration’s plans for containing state health care costs. ...The governor had asked legislators to approve his cost-saving measures along with the new fees on businesses, which would raise an estimated $200 million in the fiscal year that began this month. (Dayal McCluskey, 7/27)

The Texas House has given early approval to a bill that would require physicians and health care facilities to report more details on abortions complications to the state — and would fine those that do not comply. ...The legislation is among Gov. Greg Abbott’s three abortion-related special session priorities. (Smith, 7/27)

A new report on bullying by workers in Pennsylvania health-care settings found just 44 examples in two years, but it looked only at cases that were documented and could be linked to patient safety. The new study was prompted by requests to the Pennsylvania Patient Safety Authority from health-care facilities that were concerned about how to address workplace bullying, said Kelly Gipson, a patient safety liaison and co-author. (Burling, 7/27)

The Texas House Appropriations Committee on Thursday unanimously approved two bills that would use the state’s rainy day fund to give current teachers a $1,000 pay raise as well as cut health insurance costs for retired teachers. House Bill 24, filed by Rep. Drew Darby, R-San Angelo, which would raise minimum salaries for teachers, librarians and counselors in statute as well as give them a $1,000 annual raise starting next school year, to the tune of $848 million over the next two years. (Chang, 7/27)

Brain surgeon and accused child molester 57-year-old James Kohut has lost weight in his 10 weeks at Santa Cruz County Jail, but appeared shaven with a fresh haircut at a hearing Thursday morning in Santa Cruz County Superior Court. ...Kohut faces 11 felonies and Brandon faces eight felonies linked with raping children and recording some of the acts in Santa Cruz County, according to court documents. (Todd, 7/27)

Governor Charlie Baker is set to sign the recreational pot measure on Friday, setting in motion a high-stakes, 11-month sprint to license retail marijuana establishments by next summer and regulate what’s expected to become a billion-dollar-a-year industry. But the pitfalls — legal, ethical, political, known, and unforeseen — are many. (Miller, 7/27)

Building off our previous analysis of the cost and coverage effects of BCRA, we estimate the 2022 costs of enrolling the Medicaid-expansion population in BCRA-compliant Marketplace coverage. ... Without the additional wraparound funding being considered, very few (1.3 million out of 13.3 million) people ... would enroll in BCRA Marketplace coverage because of the premium contribution requirements and the large cost-sharing requirements. (Blumberg et al., 7/24)

The RAND study involved 32,422 patients who were treated in the Veterans Affairs health system during 2007 and were identified in the medical record as having an opioid use disorder. Researchers analyzed their medical records to see whether seven possible measures of quality were related to deaths over the following two years. ... Researchers found that among patients whose medical care followed the three key quality measures, deaths dropped from about 6 percent to 4 percent over a one year period. (7/27)

Historic increases in prescription drug prices and spending are contributing to unsustainable health care costs in the United States. There is widespread public support for elected officials to address the problem...Congress and regulators can undertake a wide range of policy actions to begin to rebalance incentives for innovation and price competition, prioritize patient access and affordability, and maximize the availability of information to patients, providers, and payers. (Waxman, Corr, Martin et al., 7/10)

The ACA resulted in a large increase in the number of American workers who have health coverage for themselves and their families. Workers in industries that typically had the weakest coverage made the largest gains, and workers making salaries typically associated with lower coverage rates saw larger increases in coverage, showing that coverage gains under the ACA were well-targeted...Roughly 9.5 million working Americans under age 65, along with 5.2 million of their family members, gained health insurance coverage from 2010 to 2015 under the ACA. They represent 77 percent of all of those who gained coverage in the first six years of the ACA. (Garrett, Gangopadhyaya and Dorn, 7/20)

This study of 1 448 541 treatment records in the Netherlands found that a national reform that increased cost sharing led to reduced use of mental health care for severe and mild disorders, especially in low-income neighborhoods. Overall, this reduced use created net savings, but for patients with psychotic disorder or bipolar disorder, the reform was associated with costly increases in involuntary commitment and acute mental health care...Higher cost sharing for seriously ill and low-income patients could discourage treatment of vulnerable populations and create substantial downstream costs. (Ravesteijn, Schachar, Beekman et al., 7/19)

In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act (ACA) “dead.” Similarly, House Speaker Paul Ryan (R-WI) has claimed that the market is experiencing a “death spiral” reflecting fundamental flaws in the ACA’s design. These claims misdiagnose the situation. The ACA’s individual market structure — though not perfect — is sound and has succeeded in greatly expanding coverage. As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create needless turmoil. (Henry J. Aaron, Matthew Fiedler, Paul B. Ginsburg, Loren Adler and Alice M. Rivlin, 7/27)

Everyone who has been touched by the case of Charlie Gard is in a terrible position. This 11-month-old British boy, born with an extremely rare mitochondrial DNA disorder that has damaged his brain and left him unable to move his limbs, has been in a hospital for months. Now it appears he will never go home again, not even to die. His parents lost their fight in the British courts to bring him to the U.S. for an experimental treatment, and now they have been denied their request to let his family have his last hours at home. (Megan McArdle, 7/27)

There are lots of things wrong with the ACA: insurance subsidies were set too low; and the Obama administration let too many people stay on their old plans, limiting new insurance customers and leading to higher rates. ...But our conservative base considers this kind of teamwork blasphemous and insists on complete repeal as the only option. (Phil Heimlich, 7/27)

Maybe it’s time we as a country candidly acknowledge our deep divisions on health care policy and work to develop a framework on the fundamentals on which we can agree. I don’t believe we will ever get to sustainable, comprehensive reform strategies without a bipartisan approach. (Nick Turkal, 7/27)

In the short term, Congress should shore up the Affordable Care Act with bipartisan, commonsense improvements, such as a reinsurance program to stabilize the market for high-risk policyholders, legislation to make cost-sharing reductions permanent, and government permission to negotiate for lower prescription drug prices. But in the longer term, the time is right to think about ways to make access to health care truly universal and cover those who are still left behind. (John Garamendi, 7/27)

The president’s reference to “tremendous medical costs” is nothing but a smokescreen. A Defense Department study conducted by the Rand Corp. pegs the cost of all transgender-related treatments to an annual range of $2.4 million to $8.4 million. That translates to, at the very most, 0.13 percent of the $6.2 billion that the military spends on health care each year. That’s barely over one-tenth of 1 percent. (7/27)

Trump took to his usual public platform on Twitter earlier this week to suddenly announce an outright ban on transgender military service. If implemented, this would fully reverse the Obama era order to allow transgender people to serve openly (they’re already serving, and have been since the beginning). (Emily Mills, 7/27)

Trump later tweeted the U.S. “cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.”A report commissioned for the Pentagon in 2016 found transgender-related medical treatment would cost between $2.4 million and $8.4 million annually. In comparison, USA Today estimates Trump exceeded $8.4 million in taxpayer money on his fourth visit to Mar-a-Lago since his inauguration. (His fourth trip to the Florida resort came in early March; he’s made seven such journeys already in his presidency.) Regardless of whatever flimsy justification Trump offers, thousands of Americans who have pledged to fight for their country have now been deemed unworthy to serve by their commander-in-chief, a man whose orders they’ve sworn to uphold at the potential cost of their own lives. ((7/28)

Over the years, many studies have shown the benefits of regular physical activity to mood and mitigating the effects of stress. A 2014 study, in fact, found that for mild to moderate depression, the effect of exercise may be comparable with antidepressant medication and psychotherapy; and for severe depression, exercise seems to be a valuable complementary therapy to the traditional treatments. The study authors clearly state, “Physical exercise is an outstanding opportunity for the treatment of patients who have a mix of mental and physical health problems.” (Helen Durkin, 7/28)

He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable. Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to Optiflow to 100-percent BiPAP. A Cardizem drip was added to no avail. His next step would be intubation. (Debbie Moore Black, 7/27)

Last year in the St. Louis area alone, more than 700 lives were lost to fatal opioid overdoses. This is a breathtaking number. We lost 712 fathers, sons, mothers, daughters, sisters and friends, and as the death toll climbed, the Missouri Legislature again failed to pass a statewide prescription drug monitoring program. (Howard Weissman, 7/28)