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Senate Majority Leader Mitch McConnell says he plans to produce a fresh bill in about a week scuttling and replacing much of President Barack Obama's health care law. But he's also acknowledging a Plan B if that effort continues to flounder. (Schreiner and Fram, 7/7)

“No action is not an alternative,” McConnell said. “We’ve got the insurance markets imploding all over the country, including in this state.” Minority Leader Chuck Schumer, D-N.Y., jumped on the Republican leader's comments, saying McConnell "opened the door to bipartisan solutions." (Collins, 7/6)

His suggestion that he and his colleagues might instead try to bolster the insurance exchanges created under the ACA is at odds with Republican talking points that they are beyond repair. The marketplaces were built for people who do not have access to affordable coverage through a job, and at last count slightly more than 10 million Americans had health plans purchased through the exchanges. More than 8 in 10 customers bought their plans with federal subsidies the law provides. (Eilperin and Goldstein, 7/6)

A bill to strengthen the insurance markets would presumably need Democratic support to get 60 votes to overcome a filibuster. McConnell in the past has warned fractious GOP lawmakers that if the Republican-only repeal effort failed, he would be forced to work with top Democrat Chuck Schumer on legislation that conservatives would likely oppose much more than the GOP repeal bill. He repeated that after a White House meeting with the president last week. (Haberkorn, 7/6)

As Republican efforts to get rid of former President Barack Obama's health care law stall in the U.S. Senate, Kentucky's two senators are traveling the state to talk about it. They just aren't talking to each other. U.S. Sen. Rand Paul has emerged as one of the biggest obstacles to passing the Republican answer to the Affordable Care Act, adding another wrinkle in his complex relationship with Senate Majority Leader Mitch McConnell. (Beam and Schreiner, 7/7)

Republican have faced a wave of pressure over the July Fourth recess to oppose the legislation. They are set to return to Washington on Monday without an agreement on the path forward. (Carney, 7/6)

Kansas Sen. Jerry Moran faced tough questions Thursday at a town hall meeting in his home county packed with critics of Republican efforts to overhaul health care, showing that even a tiny town deep in Trump territory in a Republican state isn't isolated from the political discontent in Washington. (Hanna, 7/6)

Cheryl Hofstetter Duffy began by telling Senator Jerry Moran that she was a breast cancer survivor. Then she asked why the debate over the Affordable Care Act was focused on repealing and replacing the law, rather than simply making it better. When she finished, the crowd jammed into a community center on Thursday applauded. Mr. Moran, a Kansas Republican who came out last week against the Senate leadership’s repeal bill, picked up on the sentiment, lamenting that both parties were locked in opposition over health care, with Republicans pursuing repeal and Democrats saying, he said, “Not one inch are we giving.” “And so the rhetoric puts us into the corners of the ring,” he said, “and never a meeting of the minds.” (Kaplan, 7/6)

At Mr. Moran’s town-hall meeting, no one spoke out in support of the Republican bill, though one voter sharply criticized the 2010 law, calling it “socialized medicine.” Mr. Moran said that rather than continue to push a flawed bill, GOP leaders should pursue negotiations with Democrats, including public hearings and amendments from both sides. He spoke repeatedly about fixing or repairing the law, saying it has “benefited some people.” For Mr. Moran, the first GOP senator to sponsor legislation repealing the ACA after its passage in 2010, his stance marked a stark shift. (Hackman, 7/6)

Moran, the only Republican senator holding unscreened town halls on health care this week, revealed just how much his party is struggling to pass a bill — and even how to talk about it. The people who crowded in and around Palco’s community center aimed to prove that there was no demand for a repeal of the ACA, even in the reddest parts of a deep red state. (Weigel, 7/6)

The Urban Institute says about 120,000 residents in Kansas would lose coverage under the Senate Republican plan, which disproportionately hits the state’s older and more rural population, according to David Jordan, executive director of the Alliance for a Healthy Kansas. (Kim, 7/7)

Claire McCaskill took a quick poll Thursday in the middle of her seventh town hall in two days, asking constituents to raise their hands if they supported the Senate GOP’s Obamacare repeal plan. Two hands rose among the crowd of about five dozen in this deep-red county. When McCaskill asked the same question earlier Thursday at a public meeting in Moberly, another rural Missouri town where President Donald Trump won overwhelmingly, no one raised their hands. (Schor, 7/6)

A fundamental battle between hope and fear is playing out in Washington, D.C., right now, U.S. Rep. Jim Himes says – and President Donald J. Trump has chosen fear as his political tool... Though he began the night expressing hope in the fight against Republican efforts to repeal and replace the Affordable Care Act, fear worked its way to the forefront later in the evening as several successive speakers asked questions about crisis in government. (Constable and Werth, 7/7)

Leaders of Montana doctors, nurses and hospital groups today spoke out against the health care bill being proposed by Senate Republicans. ... The head of the Montana Hospital Association also said the bill would be bad for health care in the state, because it would reduce the number of people with health coverage. A representative of the state's biggest physician's organization said, thanks to the Medicaid expansion, they're now seeing people who had been unable to afford care, and those people would be left without coverage if the Senate bill passes. (Whitney, 7/6)

Standing in front of the Council for Alcohol & Drug Abuse Services on Spears Avenue, Corker spotted four pro-Obamacare signs — and two people. ... Eric Reese, 37, told the senator that his conservative colleagues in Washington were going to put together a plan that is simply too harsh for the poor and the deathly ill. To that, Corker offered a rebuttal. "There is no attempt to do away with the pre-existing condition issue (in place under the Affordable Care Act)," he said. "There is an attempt right now to build up the subsidy level so that people who are lower income can actually purchase health care." (Jett, 7/7)

Protesters who last week staged a 57-hour sit-in at Sen. Cory Gardner’s Denver office returned to the general vicinity Thursday with hundreds of allies, saying they would continue to make their voices heard until the Republican commits to a “no” vote on the Senate health care bill. The activists, clutching water bottles and sporting yellow T-shirts, gathered in the morning under pop-up canopies on the lawn outside Gardner’s office. They represented ADAPT, a Colorado-based national disability-rights organization, and more than a dozen other groups. (Baumann, 7/6)

Cruz has been engaged with 12 other colleagues in closed-door discussions on the legislation to repeal parts of the health care law. The senator who once spoke of the pressure to compromise is now welcomed by his colleagues for his willingness to do so. The quieter, behind-the-scenes style is a change for Cruz, according to his fellow lawmakers. Four GOP senators used the same word to describe his role: constructive. “It is welcomed,” said South Carolina Sen. Lindsey Graham, who was open about the disdain senators felt for Cruz. (Bowman, 7/6)

At an event Wednesday night, Texas Sen. Ted Cruz was met by about 150 protesters who oppose the Senate's efforts to repeal and replace the Affordable Care Act. On a hot evening, they stood outside a hotel in McKinney, a north Dallas suburb, shouting "shame on Ted" and "save Medicaid." (Goodwyn and Kelly, 7/6)

U.S. Sen. Ted Cruz held a lengthy but civil debate with a small group of hecklers defending former President Barack Obama's health care law in his home state's capital Thursday night — even as he expressed doubts about whether the Republican plan to repeal and replace it will pass the Senate. (Weissert, 7/6)

In the town halls and a flurry of media appearances this week across Texas, Cruz has been pitching his Consumer Freedom Amendment, which would allow insurers to continue selling plans that meet Obamacare requirements but also plans that do not comply with the law. The amendment has the backing of the White House and influential conservative groups, but it appears to be an open question — at best — whether some of his fellow Republicans in the Senate, especially the more moderate ones, could vote for it. (Svitek and Wilson, 7/6)

[One] attendee asked him if he would call "ObamaCare" the "Affordable Care Act," but the Texas senator said he wouldn't because he doesn't "believe in deceptive speech." "It is widely off by a large factor," he said. "If you look at what is happening with ObamaCare now people are hurting under it." Another attendee accused Cruz of stalling during a long story about his healthcare debate with Sen. Bernie Sanders (I-Vt.) on CNN, asking him: "You're filibustering. How are you going to improve healthcare?" Cruz also told an attendee that "death panels" "wasn't my term," after the GOP senator was asked if he remembered the phase. (Carney, 7/6)

Sen. Ted Cruz (R-Tex.) said Thursday that he agrees with President Trump: If Republican senators are unable to pass a bill to repeal and replace key parts of the Affordable Care Act, the Senate should vote on a narrower bill to simply repeal the law and work on a replacement later. “If we cannot bring the conference together and agree on repeal legislation, then I think President Trump’s absolutely right that we should pass a clean repeal,” Cruz told reporters. (Sullivan, 7/6)

Senate Minority Leader Charles Schumer (D-N.Y.) on Thursday called Sen. Ted Cruz's (R-Texas) amendment to the GOP healthcare plan “a hoax” that would increase the cost of healthcare. “Make no mistake, the Cruz amendment is a hoax. Under the guise of lowering premiums, it makes healthcare more expensive because deductibles and copayments would be so onerous that many Americans would pay much more out of their pockets than they pay today,” Schumer said in a statement. (Shelbourne, 7/6)

After a bitter rivalry during the 2016 presidential campaign, Sen. Rand Paul and President Donald Trump just can’t quit each other. And they are teaming up to confound everyone in Washington on the GOP’s attempts to repeal Obamacare. After Paul dubbed candidate Trump an “orange-faced windbag” and Trump questioned whether candidate Paul had a “properly functioning brain,” the two have begun to build a strong relationship. Trump has expended major energy courting Paul and they’ve developed what Paul calls a “good rapport.” They’ve played golf and chat regularly on the phone. (Everett and Dawsey, 7/7)

Republicans are struggling to pass a bill to repeal and replace the Affordable Care Act and one GOP Senator has a possible explanation for the holdup — albeit not a new one. "I didn't expect Donald Trump to win. I think most of my colleagues didn't. So we didn't expect to be in this situation," Pat Toomey, R-Pa., said Wednesday. Toomey's blunt answer came during a televised town hall in response to a question from an ABC news anchor about why the health bill has not passed given how vehemently Republicans have opposed the Affordable Care Act, also known as Obamacare. (Miller, 7/6)

Toomey, now playing a critical role in negotiations over the GOP health-care bill, spent most of last year criticizing Trump’s personal behavior and the fights he picked on social media. Toomey did not announce his support for Trump’s candidacy until polls closed in Pennsylvania on Nov. 8, fully aware that no Republican presidential candidate had won his state since 1988 — and assuming that Trump would continue the streak. (Kane, 7/6)

Senate Majority Leader Mitch McConnell famously promised to rip out Obamacare “root and branch,” a sentiment echoed by Republicans on the campaign trail for seven years. But Obamacare is proving harder to eradicate than kudzu, and Republicans may be stuck with major parts of Barack Obama’s legacy. (Demko, 7/6)

Conservative groups are warning GOP senators against keeping an ObamaCare tax on investment income in their healthcare bill, an idea that has gained some traction among lawmakers. GOP lawmakers have floated keeping ObamaCare’s 3.8-percent net investment income tax (NIIT) to help pay for more generous healthcare subsidies for low-income people. Democrats criticized an earlier version of the Senate’s ObamaCare repeal bill for eliminating the tax because it generally applies to high earners. (Jagoda, 7/7)

For the better part of a decade, “repeal and replace” has been Republican gospel, a political talking point and policy manifesto. Other issues that long served as the glue holding together the disparate GOP coalition — free trade, a deep and abiding suspicion of Russia, “traditional family values” — have loosened their grip on the party and its voters. (Barabak, 7/6)

Republican senators are downplaying the chances of a quick vote next week on their ObamaCare replacement bill amid divisions in the party over what the legislation should look like. "We're still several weeks away from a vote, I think,” Sen. Pat Toomey (R-Pa.) said at an event Wednesday.  (Sullivan, 7/6)

Former GOP Rep. Jason Chaffetz (Utah) said members of Congress are frustrated with Republican leadership for not living up to promises to voters and passing a healthcare bill. He said on Fox News that the GOP did not follow through on its promises to pass the healthcare bill despite having control over the House, Senate and the presidency. He said lawmakers promised to have a plan for repealing and replacing ObamaCare on Trump’s desk by the time he took office in January, but there is still no bill seven months later. (Eberhardt, 7/6)

Sen. Rob Portman is back in Ohio, promoting treatment for opioid abuse during this week's congressional break -- and being confronted by critics who fear he'll help slice health care benefits in a vote later this summer. Health care, and specifically the Obamacare repeal-and-replace proposals, is dogging the second-term Ohio Republican unlike any other bill he has had to vote on. (Koff, 7/6)

Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post discuss the latest on the Senate’s effort to “repeal and replace” the Affordable Care Act, and why it is so difficult to make popular changes, such as requiring insurers to cover people with preexisting health conditions. (7/6)

Among gunshot survivors, 51-year-old House Majority Whip Steve Scalise is an outlier. Such victims are more likely to be low-earning black men between the ages of 15 and 24. Scalise, who is white, does share one fundamental characteristic with these younger men: Being shot means he now has a pre-existing condition in the eyes of health insurers. For most people, that status could mean more financial suffering under a Republican rollback of the Affordable Care Act. (Woolley, 7/6)

In a blow to consumers insured on the state’s Obamacare exchange plan, Blue Cross Blue Shield of Georgia has proposed to raise rates an average of 40.6 percent in 2018. Blue Cross said that if policy in Washington weakens the exchange, it may even pull out of the Georgia Obamacare market. The insurance company is the only one left that insures residents in every county in the state under the Affordable Care Act, also known as Obamacare. (Hart, 7/6)

Georgia’s largest health insurer is requesting an average premium increase of 40 percent for individual coverage in the Affordable Care Act insurance exchange next year. Blue Cross and Blue Shield of Georgia is the only health insurer scheduled to deliver a product in all 159 Georgia counties in the exchanges, which are designed to offer coverage to people who don’t get job-based or government health plans. (Miller, 7/6)

Aetna Better Health, which the state of Illinois owes at least $698 million, has had enough.The subsidiary of the national insurance giant has given the state notice that it plans to terminate its Medicaid contracts, Aetna spokesman T.J. Crawford wrote today in an email. (Schorsch, 7/6)

A major insurer is threatening to leave the state's Medicaid managed care program if Illinois can't figure out how to pay it — a move that could force 235,000 Illinois residents to get new coverage. Aetna Better Health of Illinois President Laurie Brubaker said in a court filing last week that the state owes the insurer $698 million. (Schencker, 7/6)

Georgia’s public health commissioner, an obstetrician-gynecologist and two-time Republican candidate for Congress, is expected to be named the next director of the Centers for Disease Control and Prevention, according to multiple reports. Dr. Brenda Fitzgerald will replace Dr. Tom Frieden, who served as CDC director for eight years before stepping down in January. (Branswell, 7/6)

Fitzgerald, 70, an obstetrician-gynecologist who has headed that state's public health department since 2011, will succeed Tom Frieden. He stepped down in January after serving for eight years, longer than any director since the 1970s. Anne Schuchat, a veteran CDC official, has been serving as acting director. (Sun, 7/6)

In the end, the executive team at Endo International blinked. The drug maker has voluntarily agreed to withdraw its Opana ER opioid painkiller in response to an unusual request last month from the Food and Drug Administration over concerns the pill is too easily abused. (Silverman, 7/6)

The company said in a statement posted on its website it still believes in the efficacy and safety of Opana ER, or oxymorphone hydrochloride. The FDA said the request was the first time it had asked that an opioid pain medication be pulled because of "the public health consequences of abuse." (Almasy, 7/6)

North Carolina leaders unveiled a multi-part plan last week to combat the rise in opioid overdoses and substance abuse across the state. Gov. Roy Cooper called it “flexible” and said it would be updated frequently with new statistics and solutions. The plan calls for everyone to work together, from federal and state lawmakers to law enforcement, local health departments, pharmacists, physicians, businesses, philanthropic groups and community activists. (Knopf, 7/6)

The Mt. Juliet Police Department has equipped officers with opioid overdose kits to administer to people or fellow officers. The department purchased 90 kits for individual officers, two kits for K-9 units and two wall-mount kits for just over $6,300, Lt. Tyler Chandler said. (Humbles, 7/6)

By the time Elvis Rosado was 25, he was addicted to opioids and serving time in jail for selling drugs to support his habit.“I was like, ‘I have to kick this, I have to break this,’ ” he said. For Rosado, who lives in Philadelphia, drugs had become a way to disassociate from “the reality that was life.” He’d wake up physically needing the drugs to function. (Gordon, 7/7)

The amount of opioid painkillers prescribed in the United States peaked in 2010, a new federal analysis has found, with prescriptions for higher, more dangerous doses dropping most sharply — by 41 percent — since then. But the analysis, by the federal Centers for Disease Control and Prevention, also found that the prescribing rate in 2015 remained three times as high as in 1999, when the nation’s problem with opioid addiction was just getting started. (Goodnough, 7/6)

Overall opioid prescription rates have been falling in recent years, but the powerful drugs have become more plentiful in more than than 1 in 5 U.S. counties, a report released Thursday finds. The amount of opioids prescribed fell 18 percent between 2010 and 2015. But researchers found local differences, with opioid prescribing six times higher in some counties than others. (Stobbe, 7/6)

Anne Schuchat, the CDC’s acting director, expressed tempered optimism about the first national decline in opioid prescriptions that the CDC has reported since the crisis began in the late 1990s. She said the prescription rate is still triple the level it was in 1999 and four times what it is in some European countries. Even at the reduced prescribing rate, she said, enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks. (Bernstein, 7/6)

"The bottom line is that too many [people] are still getting too much for too long," says Anne Schuchat, the CDC's acting director. "And that is driving our problem with drug overdoses and drug overdose deaths in the country." (Stein, 7/6)

The CDC’s comprehensive report offers a mixed picture of progress in a national effort to reduce the availability of the prescription painkillers, which have been implicated in roughly half of the nation’s 33,000 opioid-related overdose deaths last year. (Healy, 7/6)

Fewer opioid painkillers are being prescribed to patients in half of U.S. counties, including most in Maryland, in recent years, but the amount remains three times what it was in 1999, according to new figures released Thursday by the U.S. Centers for Disease Control and Prevention. The CDC and other public health officials have sought to curb prescriptions of these potent, but addictive painkillers because they are seen as a key contributor to the nationwide overdose epidemic. Users become hooked on them and later turn to cheaper and more deadly street drugs such as heroin. (Cohn, 7/6)

Ryan Hampton was sitting at his computer at work when he began sweating, feeling sick and unable to concentrate. He went to the bathroom, splashed water on his face and called his friend for help.That was the day he realized he was addicted to opioids. Hampton, now 36 and living in Los Angeles, said the prescription for his pain medication had run out and he didn’t realize he would face withdrawal problems. (Connor, 7/6)

New York hospital said on Thursday that it has agreed to admit and treat the British baby at the center of a life-and-death debate after European courts ruled that he could be removed from life support against the wishes of his parents. New-York Presbyterian Hospital and Columbia University Irving Medical Center said in a statement that it would admit and evaluate Charlie Gard, 10 months old, who suffers from an extremely rare genetic disease called mitochondrial DNA depletion syndrome. (Begley, 7/6)

A leading academic medical center in New York City has offered to treat Charlie Gard, an 11-month-old infant in Britain who was born with a rare and fatal genetic disease. European courts have ruled that he should be taken off life support, as there are no effective treatments for his condition. His parents were denied permission to bring him to the United States for experimental therapy. (Rabin, 7/6)

A beautiful boy born 11 months ago is dying in London. The world watches as his parents battle to keep their child alive. Courts will not allow the hospital to release the baby, Charlie Gard, into the parents' custody so they can travel to try an experimental treatment. Across the ocean, many people are appalled or confused, and wondering: Could a similar situation happen in the United States? (Scutti, 7/6)

Gonorrhea is becoming harder and in some cases impossible to treat with antibiotics, the World Health Organization said. "The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them," said Teodora Wi, a human reproduction specialist at the WHO, in a news release. (Chavez, 7/7)

Despite decreases in cancer death rates nationwide, a new report shows they are higher in rural America than in urban areas of the United States. The report released Thursday by the Centers for Disease Control and Prevention found that rural areas had higher rates of new cases as well as of deaths from cancers related to tobacco use, such as lung and laryngeal cancers, and those that can be prevented by screening, such as colorectal and cervical cancers. (Sun, 7/6)

Many people think of dementia solely as a condition that causes memory loss. That’s one reason family caregivers may be so surprised and upset when older relatives start having major psychiatric symptoms such as hallucinations, delusions or paranoia, even though they are common features of dementia. (Burling, 7/6)

The number of PG-13 films with actors smoking jumped from 564 in 2010 to 809 in 2016, according to the report. Nearly half of all films that depicted smoking were designed as kid-friendly or youth-rated, according to the report from the University of California, San Francisco and the U.S. Centers for Disease Control Prevention as well as other groups. (Brassil, 7/6)

In Justin Devlin’s stories, his pain is the villain. He is the superhero in a wheelchair, kicking his illness to the curb, sentencing his constant pain to a lifetime behind bars. Writing “takes me away from the physical pain and the emotional pain. It gives me an escape,” said Devlin, who has a progressive genetic condition that limits his mobility. (Thielking, 7/7)

The first outpost of a company called Roam Fitness is the newest vestige of the hospitality industry’s response to growing demand from stressed-out travelers tired of sitting endlessly on airplanes, in cabs, and through business lunches, and of having little recourse to work out beyond the dusty treadmills in hotels’ tiny “fitness centers.” This includes a growing number of yoga rooms in airports, free day passes for hotel guests to neighboring full-service gyms — even hotel rooms equipped with private exercise bikes and weights. (Marcus, 7/7)

AnMed Health in South Carolina has agreed to pay the largest-ever settlement in a case brought under the federal law requiring hospitals to stabilize and treat patients in emergency situations. The not-for-profit, three-hospital AnMed system will pay nearly $1.3 million to settle federal allegations that in 2012 and 2013 it held patients with unstable psychiatric conditions in its emergency department without providing appropriate psychiatric treatment in 36 incidents. AnMed, based in Anderson, S.C., serves upstate South Carolina and northeast Georgia. (Meyer, 7/5)

Carmela Coyle, the longtime president and CEO of the Maryland Hospital Association, is stepping down from the post in the fall to head the California Hospital Association. Coyle has served in her current position for nine years. The executive committee of the Maryland association said it will begin a national search for her replacement. (McDaniels, 7/6)

Charles "Chuck" Stokes has been appointed president and CEO of the Memorial Hermann Health System, two weeks after he was promoted to the interim job following an abrupt shake-up atop the largest hospital network in the Houston area. (Ackerman, 7/6)

Charles Stokes is no longer the "interim" president and CEO of Memorial Hermann Health System, after the board on Thursday officially named him to the top job. He replaces Dr. Benjamin Chu, who abruptly retired two weeks ago to pursue a role crafting health and public policy. (Weinstock, 7/6)

Gov. Andrew Cuomo on Thursday launched an investigation into a hospital’s handling of a man who sought psychiatric care just days before he fatally ambushed a New York Police Department officer sitting in a mobile command post. “Under tragic circumstances such as these, it is critical to ensure all proper procedures and safeguards were taken,” Cuomo said Thursday in a statement. (7/6)

An inmate backed by pro-bono lawyers and a civil rights group is suing the Virginia Department of Corrections for allegedly failing to treat prisoners who have hepatitis C... The lawsuit specifically names Harold Clarke and Mark Amonette, the director and chief medical director, respectively, of the Department of Corrections. (O'Connor, 7/6)

A sweeping new bill passed by Oregon lawmakers will force taxpayers to assume some of the costs of abortions, even though many oppose the procedure, anti-abortion campaigners said Thursday as a legal expert predicted the measure will draw lawsuits. (7/6)

Missouri Gov. Eric Greitens has broadened his call for new abortion restrictions in the state and wants to ensure they would survive any potential court challenge, his spokesman said Thursday. (7/6)

Gov. Jay Inslee has signed a measure that creates a new agency to deliver services to vulnerable children and families. The Department of Children, Youth and Families — created under the bill signed Thursday by Inslee — will oversee several services now offered through the state Department of Social and Health Services and the Department of Early Learning, starting in July 2018. Starting in July 2019, programs offered by the Juvenile Rehabilitation office and the Office of Juvenile Justice in DSHS will also move to the new department. (7/6)

Parents of Children's Minnesota patients are trying to figure out how they are affected by the end of a contract between the medical system and the state's biggest health insurer. Children's terminated the contract Wednesday with Blue Cross Blue Shield of Minnesota. (Cox, 7/6)

Tit for tat? Or a case of unintended consequences? Cook County Sheriff Tom Dart’s office just got a letter from Cook County Board President Toni Preckwinkle listing 925 positions designated for layoffs — if a judge doesn’t allow a countywide sweet beverage tax to take effect by August. (Sneed, 7/6)

For the past 36 years, Gracechild led Resources for Independent Living in Sacramento, which assists people with disabilities in obtaining housing, technology, personal care and other help to live comfortable and productive lives. Outside of the office, she led protests, spoke at public meetings and pushed for legislation to benefit folks with little political clout. (Hubert, 7/6)

Since 1970, third-year dental students at UNC Chapel Hill have spent eight weeks in the summer going out into communities around the state and treating patients, many from low-income families, as part of the Dentistry in Service to Communities program. Forty-five years into this practice, the School of Dentistry’s Lewis Lampiris realized something was wrong. (Asmelash, 7/6)

In the latest case, Compassionate Care Hospice Group agreed to pay $2.4 million to resolve allegations that its subsidiary, Compassionate Care of Atlanta, paid kickbacks to five physicians to get them to refer patients and certify them as eligible for hospice services. The company then billed Medicare and Medicaid for those patients, the lawsuit alleged. (Norder, 7/6)

Another California doctor has been arrested on suspicion of sexually abusing children, some of whom were his patients, authorities said Thursday. Dr. Benjamin Shettell was booked on suspicion of sexually abusing eight minors ranging from 6 to 17, Redding police said in a statement. (7/6)

Officials from the Austin Police Department, Capital Area Private Defender Service, Travis County District Attorney’s Office and Bruce Budowle, a University of North Texas Health Science Center professor and consultant, toured the facility on Monday. They shared their findings, including pictures of the moldy boxes, with the Travis County Commissioners Court during a special meeting Thursday. (Goldenstein, 7/6)

Healthcare Georgia Foundation has announced grants totaling $770,000 to 11 partnerships in a program aimed at eliminating health disparities and achieving health equity in rural Georgia. The funding represents the first phase of the foundation’s Two Georgias Initiative, designed also to expand access to quality health care in rural Georgia. (Miller, 7/6)

Five state beaches will be equipped with floating wheelchairs, thanks to a partnership between a group of physical therapy students at Franklin Pierce University and SMILE Mass. Third-year student Adrienne Olney said she met Lotte Diomede, who co-founded Small Miracles in Life Exist, during the Abilities Expo in Boston in September of last year. Olney is a doctoral student and on the board of the physical therapy association for Franklin Pierce students. (Haas, 7/7)

Safety-net hospitals play a vital role in our health care system, delivering significant care to Medicaid, uninsured, and other vulnerable patients. The American Health Care Act (AHCA) would make changes to Medicaid that would substantially reduce federal funding, resulting in potential adverse effects on safety-net hospitals and the populations they serve. ... Beginning in 2020 the financial status of safety-net hospitals will deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. By 2026 total margins will drop to 0.5 percent compared with estimates under current law of 2.9 percent—representing an 83 percent reduction in net income for safety-net hospitals. Small rural safety-net hospitals and safety-net hospitals treating the largest proportion of low-income patients would be hurt the most. (Allen Dobson, Joan DaVanzo and Randy Haught, 6/28)

The Better Care Reconciliation Act (BCRA) was introduced in the Senate on June 22, 2017, and is now under debate. The bill would eliminate much of the Affordable Care Act. In this report, we present state-by-state estimates of the impact of the BCRA on health care coverage and costs. Nationwide, we find that there would be 24.7 million more uninsured people under the BCRA by 2022. Federal funding for Medicaid, premium tax credits, and cost sharing reductions would be $140.4 billion lower under the BCRA in 2022, while state Medicaid spending would increase by $565 million. (Blumberg et al, 6/28)

In 2015 an estimated 2.7 million people in the United States (1 percent of the population) died. Although decedents’ illness experience varies substantially, important trends in care at the end of life are evident. To identify the most pressing health care policy issues related to end-of-life care, we present a comprehensive picture of the epidemiology and care patterns of people in the last stage of life. We identify three key trends in end-of-life care: increasing diversity in the primary diagnoses of decedents, increases in multimorbidity and illness complexity among people with terminal illnesses, and shifts in patterns of care at the end of life and in sites of death. (Aldridge and Bradley, 7/5)

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. (French et al., 7/5)

Market competition levels were associated with a change in generic drug prices. Such measurements may be helpful in identifying older prescription drugs at higher risk for price change in the future. (Dave et al., 7/4)

Objectives: To compare how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. ... We found average spending on premiums and OOPC in enrolled plans exceeded such costs in the lowest-cost plan by $697 in 2013. Beneficiaries who remained in their plans for 6 or more years were most at risk of spending these higher amounts, paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment. For each year a beneficiary remained in their same plan, their additional spending in excess of the minimum cost choice increased by roughly $50. (Jacobs and Molloy, 6/29)

Objectives: Hospital Compare, a website maintained by CMS, allows comparisons of outcomes and processes of care but not of patient satisfaction for hospitals within the Veteran Affairs (VA) Healthcare System. Therefore, we sought to compare online hospital ratings between VA hospitals and their local affiliated hospitals.  ... VA hospitals had higher patient ratings than their non-VA affiliated hospitals, a finding not explained by bed size or teaching status. (Heidenreich et al., 6/28)

Who knows what — if anything — Senate Republicans will do about health care reform. But there is a fundamental truth that is being overlooked in all the hyperbolic rhetoric over Medicaid, mandates, subsidies, accessibility and taxes: Free markets would turn our ailing healthcare system into a dynamic, innovative cornucopia of better and ever more affordable care for all of us. We'll see if Washington can rise to the challenge of starting to remove the formidable obstacles to such a market where patients would be in charge rather than the third party payers of government, big insurers and big employers. (Steve Forbes, 7/7)

If the halting, messy debate over legislation to overhaul health care has taught us anything so far, it’s that when it comes to health care, Republicans don’t know what they want, much less how to get it. (Peter Suderman, 7/7)

With their sledge hammers pounding Obamacare, [congressional Republicans] cannot move fast enough to strip Americans of health insurance. After yet another break this week to rest up, they plan to return and resume attempts to destroy the law and the benefits it has provided millions of people. Some lawmakers view success as a desperately needed political "win." But Americans will be the losers. (7/6)

Republicans believe the problem with the health-care system is that Americans are forced to buy too much insurance, in plans that are too prescribed. Their solution is to give consumers more choices for what kinds of plans (including no plan at all) they can buy. ... But the health insurance market has some distinctive properties that mean too many choices can lead the whole market to unravel. This would leave nearly everyone — consumers, insurers and health-care providers — much worse off. (Catherine Rampell, 7/6)

Sen. Ted Cruz has a litmus test for his Republican Senate colleagues: Do they care more about cutting health insurance premiums than protecting people with preexisting conditions? Granted, Cruz (R-Texas) wouldn’t put it that way. But the amendment he’s seeking to add to the Senate GOP’s bill to “repeal and replace” the Affordable Care Act sets up a choice just that stark. (Jon Healey, 7/6)

The current health-care debate is often distilled into a series of binary choices for public consumption: good or bad, healthy or sick, help for the rich or help for the poor. As a result, a growing number of Americans are starting to believe that the GOP’s health-care legislation is a cruel ploy to hurt millions of Americans. This is in large part a messaging failure: Good policy must be sold with good arguments, and Republicans have not articulated their own vision of what the American health-care system should look like. (Juliana Darrow, 7/5)

Consider, in particular, Republican leaders’ strategy on health care. At this point, everything they say involves either demonstrably dishonest claims about Obamacare or wild misrepresentations of their proposed replacement, which would — surprise — cut taxes for the rich while inflicting harsh punishment on the poor and working class, including millions of Trump supporters. In fact, there’s so much deception that I can’t cover it all. But here are a few low points. (Paul Krugman, 7/7)

The battle we fight today should be about expanding coverage to millions more, not deciding how much coverage we should take away from people who already have it. Whether Congressional Republicans are successful in their repeal efforts or not, universal healthcare must be our goal. As President Trump realized all too late, healthcare is really complicated. But our priorities should not be: We must endeavor to provide quality, accessible care to every American. (Rep. Adam Schiff (D-Calif.), 7/6)

Healthcare industry leaders and patient advocacy groups are facing a sobering reality as Republican senators weigh whether to pass their bill to repeal and replace the Affordable Care Act. Their staunch opposition to the repeal along with broad public disapproval may not be enough to convince lawmakers to kill the bill. Several public opinion surveys last week found the Senate GOP's Better Care Reconciliation Act extremely unpopular, with weak support even among Republicans. (Harris Meyer, 7/6)

In the 1990s, there was plenty of teeth-gnashing by welfare reform opponents over changing the funding structure for cash assistance, implementing work requirements, and creating time limits – rhetoric that sounds eerily similar to much of the health reform coverage today. Mostly absent from the welfare discussion was the role that earned income tax credits (EITC) would play in reform. Similarly, in the current health care debates over Medicaid changes there is a lack of any reference to proposed tax credits. (Josh Archambault, 7/6)

I am a family medicine physician who has worked in Philadelphia and New York City for the past three years, and I know how the BCRA will affect trafficked people: it will unequivocally harm them. I know this because I run the Institute for Family Health’s PurpLE Clinic (Purpose: Listen and Engage) in New York City, which provides health care for human trafficking survivors. The survivors I work with are of all genders, ethnicities, ages. Some have been without necessary healthcare for years, facing complications from untreated infections, undiagnosed diseases, addictions and complex trauma. And every single survivor is uninsured or on Medicaid. (Anita Ravi, 7/6)

Children make up 70 percent of Kansas’ Medicaid population, and Medicaid is there for them. Through Medicaid, children receive well-child visits, vaccines, early treatment for illnesses and chronic medical conditions, therapies and hospital care when needed, which are so important if kids are going to be ready and able to succeed in school and in life. (Pam Shaw, 7/6)

The Senate’s revised health care plan is in the midst of hot debate. While the impact on middle- and low-income Americans has rightly received attention, it is important to bring up another economic impact: The bill would have a chilling effect on entrepreneurship. (Nina Dudnik, 7/7)

We at NFIB hope Sens. Portman and Brown remember that our small businesses employ more than 2 million Ohioans, serving as the engine that drives the state's economy. Obamacare, as it stands, impedes their ability to grow and add new jobs. (Roger Geiger, 7/6)

Democratic politicians are rapidly embracing single payer health care, and as they do, they’re being met with an utterly bogus criticism. Unfortunately, it’s coming not only from Republicans but also from misinformed members of the media. So before this goes any farther, we need to get a few things straight. (Paul Waldman, 7/6)

At some point, endless discussions of economic theory need to yield to blunt fact -- government health-care systems just seem to do better than the U.S. system. That is understandably a bitter pill for many free-market types to swallow. Faced with the superior performance of universal health-care systems, some supporters of a less regulated system have argued that the U.S. is somehow subsidizing the rest of the world. The most common of these arguments claims that high U.S. prices go to pay for innovation that the rest of the world copies for free. (Noah Smith, 7/6)

The uberization of senior services is all the rage. You can download an app and order up a home visit from a doctor. You can get home delivered groceries or prepared foods. And, of course, you can get a ride. While these services were designed primarily for the young and overworked, there are real potential benefits for older adults and others with disabilities. The most obvious: They have the potential to deliver critical supports to people with mobility issues. (Howard Gleckman, 7/5)

In the United States, the fight against infant mortality seemed slow but sure. Indeed, over the past decade, the rate at which babies died before their first birthday fell by 15 percent. But in recent years, progress in reducing overall infant mortality has stagnated. And for African Americans, we’ve actually lost ground, according to a study published this week in the Journal of the American Medical Association. The infant mortality rate for black babies hit 11.6 deaths per 1,000 births in 2012, but that number ticked up slightly higher in 2015 to 11.7. (Robert Gebelhoff, 7/6)