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Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law’s mandate that most Americans have health insurance. The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment. (Pear and Kaplan, 6/22)

The bill would reverse the ACA’s expansion of Medicaid, a move that could affect millions of people, and would for the first time limit states’ overall Medicaid funding from Washington. It also would eliminate the requirement in the 2010 law that most Americans sign up for health insurance, and provide instead less-robust tax credits than the ACA to help people afford insurance. It would repeal hundreds of billions of dollars in taxes on businesses and high-income households and retroactively cut taxes on capital gains. (Armour, Peterson and Radnofsky, 6/22)

The Republican measure phases out the federal funding for ObamaCare’s expansion of Medicaid, which has provided coverage for about 11 million people in 31 states. (Sullivan, 6/22)

Already, the version of the bill the House passed last month included drastic reductions in Medicaid outlays of about $834 billion over 10 years. GOP senators' own version of the bill, which they made public Thursday, could go even further over the long term. Both the House and Senate bills aim to set a per-person cap on Medicaid spending in each state. That cap would adjust annually to take into account inflation. Through 2025, both bills would adjust the cap based on a measure of how rapidly medical costs are expanding — a measure known as the CPI-M. Starting in 2025, however, the Senate bill would change the formula, instead funding Medicaid based on a measure of how rapidly all costs are rising (technically, the Consumer Price Index for urban consumers, or just CPI-U). (Ehrenfreund, 6/22)

Since its inception in 1965, the federal government has matched state spending for Medicaid. The new bill would shift much of that burden back to states. (Rovner, 6/22)

Governors in several states that opted to expand Medicaid are wary of the Senate Republican plan to end the added federal funding for it within seven years. The proposal released Thursday calls for a slower phase-out of the Medicaid expansion than a bill adopted by the House. Yet it still would force those states to figure out what to do about the millions of lower-income Americans who used it to gain health coverage. (6/23)

"That's a big deal. It's a big shift," said John Corlett, president of the Center for Community Solutions, who also served as a director of Ohio's Medicaid program. "It means billions of dollars less in federal aid to states for their Medicaid programs." (Kurtzleben, 6/22)

The Senate bill, called the Better Care Reconciliation Act of 2017, would exclude disabled children, breast and cervical cancer patients and children covered under the Children's Health Insurance Program from the Medicaid cap formula. Experts say, however, that it would be difficult or impossible to protect any beneficiaries from the effects of the per capita cap structure, because states would receive fixed federal payments and have to make tough choices about cutting eligibility, benefits and payments to providers. (Meyer, 6/22)

Congress is moving fast toward repealing the Affordable Care Act, with an eye on revamping Medicaid, the health insurance program for low-income people. But most Americans say the program — which Republicans call a “broken system” — is working well on the national level and within their states. That’s according to a monthly tracking poll released Friday by the Kaiser Family Foundation. (Luthra, 6/23)

On the day Senate Republicans unveiled their health care bill, some military veterans say what the GOP rolled out is "un-American." Veterans from across Tennessee said they're speaking out on behalf of 2 million veterans nationwide who they think will lose or see reduced health care coverage because of the move by Congress to repeal and replace the Affordable Care Act, known as Obamacare. Led by 36-year retired Marine Corps veteran Lt. Gen. John Castellaw, who lives in rural Crockett County in West Tennessee, he and others said the proposed health care bill would potentially boot millions of veterans off health care that many depend on to supplement coverage or just give them access to doctors. (Lowary, 6/22)

President Trump famously called the House plan to repeal and replace Obamacare “mean” — entreating Senate Republicans to make their version of the bill more generous. Just hours before the Senate unveiled its draft legislation, he repeated that plea. “I’ve been talking about a plan with more heart. I’ve said, ‘Add some money to it,'” Trump told a crowd in Iowa Wednesday night. (Mershon, 6/22)

Republicans have vowed for months to undo the Affordable Care Act and stave off the collapse of the nation’s most fragile health insurance markets, which serve people who buy coverage on their own. In the Senate, that turns out to be a short-term goal. Legislation that the Senate’s GOP leaders finally disclosed on Thursday would keep billions of dollars flowing — but only for two years — to health plans that have been begging for continued help with the expense of millions of lower-income customers in ACA insurance marketplaces. After 2019, the payments would stop. (Goldstein, 6/22)

Senate Republicans’ proposal to replace Obamacare would provide $50 billion over four years to stabilize insurance exchanges in addition to cost-sharing subsidy payments through 2019, according to a person familiar with the plan. ... It also would provide $62 billion allocated over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items. (Dennis and Litvan, 6/22)

The Senate Republican healthcare reform bill would appropriate $50 billion over four years to try to stabilize ObamaCare’s exchanges. Republican senators agree that the insurance markets are collapsing because of ObamaCare, but there have been disagreements over whether the markets need to be stabilized before the law is repealed. The stabilization money, combined with the continuation of ObamaCare’s cost-sharing reduction subsidies through 2019, could lead some conservatives to say the bill keeps too much of ObamaCare. (Weixel, 6/22)

The bill would sunset in two years subsidies for people who purchase insurance on an exchange. Most of the more than 6 million Americans benefiting from the help may not be aware they’re getting it, since the subsidy goes directly to the insurer who then lowers the cost-sharing requirements for a plan. Without the subsidies, insurers would need to raise rates an estimated 20% to make up for the loss, experts have estimated. But the bill also includes funding for states to reduce insurance costs in other ways. (Groppe, 6/22)

Currently, there's a maximum and a minimum level of income at which a person qualifies for federal help. The Senate bill would remove that minimum, meaning that everyone who makes less than 350 percent of the federal poverty level would qualify for insurance subsidies. That change is aimed at one outcome of Obamacare that nobody — neither critics nor supporters — ever intended. As planned, everyone making less than the minimum required for subsidies would qualify for Medicaid, which the law sought to expand nationwide. But when the Supreme Court gave states more freedom to decide whether they would expand the program, many states didn't. That left a coverage gap in many states and left approximately 2.6 million people in a maddening paradox: They made too much money to qualify for Medicaid but too little money to qualify for insurance subsidies. (Johnson, 6/22)

Senate Republicans praised the Affordable Care Act replacement bill they presented Thursday as preserving coverage for people with cancer, mental illness and other chronic illness. But the legislation may do no such thing, according to health law experts who have read it closely. (Hancock and Bluth, 6/22)

The ACA’s protections for people with costly pre-existing medical conditions would stay in place. That means insurance companies couldn’t deny people with pre-existing conditions health coverage or charge them higher premiums. Under the House bill, insurers in some states could charge sicker people higher premiums, which conservative House lawmakers argued could help lower premiums for other people. But Senate lawmakers rejected that idea. States could get waivers to roll back benefits that must now be required under the ACA, and that could leave people with certain medical conditions paying more for their coverage. (Hackman, 6/22)

The bill's impact on personal health care costs would be uneven: Premiums would likely go down for younger people, but older people would pay more. Out-of-pocket costs to cover insurance deductibles and co-payments would go up. For those who believe the government is too involved in health care, the Senate bill stands as an overdue course correction. But those who believe health care is a right will see it as a step back. (Alonso-Zaldivar, 6/23)

The Senate plan, like the House bill, would allow insurers to charge their older customers up to five times as much as younger customers for the same health plan. That’s an expansion of the so-called age band in Obamacare, which allows insurers to charge older customers no more than three times as much as younger ones. In two years, the Senate plan would also eliminate a key subsidy program that helps cover out-of-pocket medical bills for low-income consumers. (6/22)

People getting subsidies to help buy health insurance would see at least three sharp changes — tied to both age and income — that could dramatically affect how much they pay for coverage if the Senate Republican health plan becomes law. The Senate bill released Thursday would reduce the income thresholds that determine eligibility, change the amount people who receive help pay toward their insurance premiums and peg subsidies to less generous coverage. (Appleby, 6/22)

The health-care bill that Senate Republicans released Thursday would eliminate critical funds for core public health programs that make up about 12 percent of the budget for the Centers for Disease Control and Prevention. The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease. (Sun, 6/22)

Health insurance executives stand to be the sole beneficiaries of a small provision in Republicans' bill to repeal and replace the Affordable Care Act. Both the House and Senate repeal measures would free insurance companies from a part of the Affordable Care Act — also known as Obamacare — that effectively makes it more expensive for them to pay their CEOs. (Ehrenfreund, 6/22)

The Senate GOP’s health-care bill would offer $2 billion for opioid addiction treatment for one year, falling short of the $45 billion over 10 years some Republican senators wanted. The funding’s inclusion in the Senate version of the health-care overhaul comes after weeks of protest from House and Senate Republicans who feared steep cuts to Medicaid would worsen an already growing opioid crisis, with Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia leading the push. (Nunn, 6/22)

The Senate Republicans’ Better Care Reconciliation Act would significantly affect health coverage for many Americans, whether through the individual insurance market or Medicaid. Here are a few examples of how. ... The Senate bill provides $2 billion in fiscal 2018 for substance abuse treatment and recovery, but eventually it would take away much more by rolling back Medicaid expansion in 2020, capping federal payments to states and allowing them to change what qualifies as an essential service. Right now, all insurers and Medicaid must offer drug treatment benefits that are on par with their benefits for physical conditions. If this man’s state decided that substance abuse treatment was no longer an essential service, coverage for that care could be eliminated. (McGinley, Bernstein and Sun, 6/22)

The health care bill unveiled by Senate Republicans on Thursday includes funding to help tackle the nation’s opioid crisis — but dramatically less than the amount sought by two GOP senators and recovery advocates. Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.) at one point had requested $45 billion over the course of a decade to keep the battle against opioids on the nation’s front burner. The bill instead would allocate only $2 billion, all in 2018. (Facher, 6/22)

The Senate’s bill allocates $2 billion in 2018 for treatment and services related to the epidemic of people addicted to prescription pain pills and heroin. As many as 65,000 Americans died of drug overdoses last year, the majority of deaths caused by opioids. Only 1 out of 10 Americans with a substance use disorder gets treatment, according to Howard Weissman, executive director of the National Council on Alcoholism and Drug Abuse based in Olivette. (Liss and Bernhard, 6/22)

But Sen. Lamar Alexander, R-Tenn., said the bill increases resources to fight the opioid crisis and that some senators are likely to lobby for additional funding when the legislation goes to the Senate floor next week. "It’s by far the largest amount Congress has ever appropriated in one year for opioids,” Alexander said in an interview. (Buie, 6/22)

Senate Republicans' new health bill cuts taxes by nearly $1 trillion over the next decade, mostly for corporations and the richest families in America. It uses a budget gimmick to comply with Senate rules against adding to the federal government's long-term debt. (Ohlemacher, 6/23)

The long-awaited Obamacare replacement plan from Senate Republicans wouldn’t do much to preserve coverage for millions of poor and working-class people, but it would deliver tax cuts to the wealthiest Americans. To appeal to their moderate members, GOP leaders initially faced pressure to maintain some of the Obamacare taxes that funded expanded Medicaid coverage. Instead, the Senate version mirrors the House bill in seeking to repeal almost all of the Obamacare taxes, which largely affect the highest earners. (Kapur, 6/23)

The bill also knocks down many of the ACA’s taxes, including a 3.8% tax on investment income. The Cadillac tax would be retained but wouldn’t go into effect until 2026. It would end a tax on indoor tanning, repeal limits on contributions to flexible-spending accounts and stop taxes on health-insurance premiums.The tax on medical devices would also be repealed. (Armour, 6/22)

The Senate draft healthcare bill unveiled Thursday takes a similar approach to ObamaCare's taxes as the House bill — repealing most of them with the exception of the Cadillac tax. The Cadillac tax, which applies to high-cost health insurance plans, would be delayed until 2026 in both the Senate and House bills. The tax is unpopular with both Republicans and Democrats and has never taken effect. However, the tax has been estimated to raise a significant amount of revenue that could help pay for other provisions in the bills. (Jagoda, 6/22)

The Senate health bill released Thursday strips federal Medicaid funding from Planned Parenthood Federation of America for one year and tightens restrictions on abortion coverage, creating potential sticking points for centrist senators. The Planned Parenthood measure, which mirrors a provision in the House version of the bill, would disqualify the network of women’s health clinics from receiving federal Medicaid funding, stripping the organization of hundreds of millions of dollars and potentially forcing some clinics to shutter. (Hackman, 6/22)

The Senate healthcare bill, revealed Thursday, defunds Planned Parenthood for one year, despite concerns that the move would not meet budget rules. The GOP bill follows the same language in the House-passed healthcare bill in blocking Medicaid reimbursements to Planned Parenthood, which provides women's healthcare and abortion services. Two Republican senators, Lisa Murkowski (Ala.) and Susan Collins (Maine), have already suggested they may not support the bill if it defunds Planned Parenthood. (Hellmann, 6/22)

Abortion rights advocates were dismayed when Senate Republicans on Thursday released the draft of their health care bill, which retains language from the House bill to effectively defund Planned Parenthood for one year and prohibit certain tax credits from being used for marketplace insurance policies that cover abortion. These provisions were at risk for being cut due to concerns that the language could encounter parliamentary issues. During the reconciliation process, provisions must have a budgetary impact. The Byrd rule prohibits including language that is designed primarily to make a policy change rather than for budget reasons. (Raman, 6/22)

A provision that would require New York state to pick up the county share of Medicaid costs has been included in the U.S. Senate Republican health care bill, which was released Thursday morning. The idea behind that piece is that if counties are alleviated of the Medicaid burden they currently shoulder, they can look to reduce property taxes. But state officials have estimated that should that provision become law, the state would be out $2.3 billion beginning in 2020. That provision, authored by GOP Congressmen John Faso of Kinderhook and Chris Collins of western New York, is a carryover form the House’s American Health Care Act. (Hamilton, 6/22)

Counties in New York would be off the hook for paying for Medicaid costs under the U.S. Senate's health care bill Thursday, which included a controversial measure that was part of the House bill approved last month. ... Counties have said the change would alleviate them of having to pay about 13 percent of the state's overall Medicaid cost — and thus it would provide property-tax relief to residents. "We are on track to ending the Obamacare nightmare, and I am pleased with the progress made today to bring vital reforms and the largest property tax reduction ever enacted to western New York," Collins said in a statement. (Spector, 6/22)

Many low-income adults across the nation could lose Medicaid expansion coverage under the Senate's Obamacare replacement bill — but in Illinois those losses could come three years earlier because of a state law. About 650,000 Illinois residents could lose their Medicaid expansion coverage in 2021, if the Senate bill becomes law and a state statute, meant to keep Illinois' Medicaid expenses in check, remains in place. (Schencker, 6/22)

The Senate's health care proposal repeals taxes, restructures and caps Medicaid funding, while immediately giving state insurance commissioners leeway to change plan benefits. At its core, the proposal works to reduce the federal government's health care expenditures by giving states more autonomy — and thus financial exposure — to craft insurance regulations and how Medicaid works in their states, experts said. (Fletcher, 6/22)

Virginia legislative budget leaders had a quick response to a new health care plan proposed by Republicans in the U.S. Senate — please don’t do what you just did. The Republican co-chairmen of the Joint Subcommittee for Health and Human Resources Oversight said Thursday that the Senate’s current proposal “fails to address the inequities in the federal funding allocation between states” for the Medicaid program that Virginia has operated in partnership with the federal government for a half-century. (Martz, 6/22)

A proposal to slash funding to Medicaid could be the only opportunity to shrink the federal deficit in a divided Congress, Gov. Dennis Daugaard said Thursday. The Republican governor said shrunken Medicaid funding laid out in the Better Care Reconciliation Act, shared Thursday by a group of Senate Republicans, could create needed savings for the federal government. "That might be the only way that we will ever get control of spending," Daugaard said. (Ferguson, 6/22)

For the first year in history, over half of all visits to Sacramento County’s emergency rooms in 2016 were paid for using Medi-Cal, the state’s insurance program for the poor that was expanded by the passage of the Affordable Care Act, often called Obamacare. So what happens to those people if Obamacare is repealed by the U.S. Congress? (Xu, 6/22)

If the Obamacare revision the U.S. House of Representatives passed in May became law, the Georgia hospital to lose the most Medicaid funding would be Children’s Healthcare of Atlanta at Hughes Spalding, according to a new analysis by the Georgia Budget and Policy Institute. ... Children’s hospitals are particularly reliant on Medicaid, since unlike adults, most low-income children in Georgia can be covered under the program. Children’s Healthcare at Hughes Spalding gets about 65 percent of its revenues from Medicaid, GPBI said. (Hart, 6/22)

Shortly after the 142-page bill was distributed, more than a half-dozen GOP lawmakers signaled concerns or initial opposition. McConnell, R-Ky., has little margin for error: Facing unanimous Democratic opposition, "no" votes by just three of the 52 GOP senators would sink the legislation. McConnell, eager to approve the legislation next week, indicated he was open to changes before it reaches the Senate floor. But he said it was time to act. "No amount of 11th hour reality-denying or buck-passing by Democrats is going to change the fact that more Americans are going to get hurt unless we do something," he said. (Fram and Alonso-Zaldivar, 6/23)

Within just a few hours, four key conservative senators — Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Rand Paul of Kentucky — jointly announced they could not possibly vote for the bill as is, unless it more fully guts the Affordable Care Act. Likewise, centrists withheld their support unless they can push the bill the other way, as they mull the fallout from leaving millions more Americans uninsured. (Mascaro, 6/22)

The quartet wields enough influence to sink the legislation should they all choose to vote against the bill. Senate Majority Leader Mitch McConnell has signaled he will bring it to the chamber floor for a vote late next week. Under the fast-track budget procedure known as reconciliation that the GOP is using to advance the bill, McConnell can afford only two defections, which would give him 50 votes and allow Vice President Mike Pence to break the tie. (Williams, 6/23)

After weeks of secretive talks, Senate Majority Leader Mitch McConnell finally unveiled his proposal to dramatically reshape the health-care industry knowing full well that — as currently written — it lacks the votes to win approval. But using a time-honored tactic of congressional leadership, the Kentucky Republican decided it was time to call the bluff of his GOP colleagues. (Kane, 6/22)

"Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor," Paul, Cruz, Johnson and Lee said in a joint statement. "There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs." (Kelly and Collins, 6/22)

Paul defended the statement on Thursday, saying it would force GOP leaders to negotiate. (Reid, 6/22)

Cruz gave flyers to fellow Republicans with his demands: letting states design coverage without getting a federal waiver, allowing consumers to buy insurance across state lines, and allowing insurers that meet federal mandates to also sell other plans that don’t comply. (Dennis, Litvan and Tracer, 6/22)

Cruz is pushing for an amendment to allow catastrophic, low premium plans, but it's not clear if the parliamentarian will allow them, according to Republicans. (Cancryn, Everett and Haberkorn, 6/22)

Cruz, who has a history of creating trouble for GOP leaders, has positioned himself in recent weeks as something of a consensus-builder within the Senate GOP conference on health care. (Livingston, Evans and Duehren, 6/22)

The early opposition of Senate conservatives is a blow to the bill but doesn’t mean it’s dead yet, even though Republicans control only 52 seats and can afford no more than two defections and still pass the measure. (Bolton, 6/22)

The Tea Party-aligned group FreedomWorks also said in a statement that the bill doesn't live up to promises by Senate Majority Leader Mitch McConnell, R-Ky., of a full repeal of the ACA. "Unfortunately, the Senate bill is an amendment to ObamaCare, not a repeal of it," said FreedomWorks President Adam Brandon. (Taylor, 6/22)

No Republican senators definitively said they would vote against the bill, instead focusing attention on the provisions that would need to be changed to earn their vote. President Trump predicted the final product is “going to be great” — but only after some more negotiations take place. (Sullivan, Snell and Eilperin, 6/22)

For Senate Republicans, the only thing worse than voting on a controversial health care bill may be not voting on it. The GOP has been vowing to repeal the Affordable Care Act almost from the day it was passed, hammering the issue through four successive elections — campaigns in which Republicans managed to win control first of the House, then of the Senate and finally the White House last year. (Page, 6/22)

As of Thursday afternoon, nine GOP senators have indicated they oppose or have concerns with the bill. If three vote against it, the bill would fail. (Phillips, Fischer-Baum, Schual and Uhrmacher, 6/22)

Every Democrat is expected to oppose the bill, which means three Republican “no” votes would block it. Here is where every senator stands so far. (Parlapiano and Benzaquen, 6/22)

The Senate GOP health-care bill is facing intense scrutiny from several of the majority party's own members. One faction consists of centrist Republicans, many of whom hail from states that have seen a growing share of residents with health insurance. (Rust and Shin, 6/22)

Sen. Dean Heller (R-Nev.), the most vulnerable Republican senator facing reelection next year, said he has “serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. Sen. Susan Collins (R-Maine), another centrist, criticized the bill’s effort to rein in Medicare costs starting in 2025 by imposing indexing it to a lower inflation measure than what House Republicans used in their bill. “It is lower than the cost of medical inflation and would translate into literally billions of dollars of cuts and that would mean states would be faced with very unpalatable cases of restricting eligibility or allowing rural hospitals to go under," she said in a statement. (Bolton, 6/22)

When it comes to the “discussion draft” to replace Obamacare that U.S. Senate Republicans unveiled Thursday, Missouri’s two senators could not be farther apart. Republican Sen. Roy Blunt praised the measure, claiming it would address the “disaster” that is Obamacare, the name by which the Affordable Care Act is commonly known. Democratic Sen. Claire McCaskill blasted the bill, saying it’s “exactly what you’d expect when the future of health care gets negotiated in a secret backroom deal. You get a bill that hikes costs for working families, strips protections from Missourians who’ve been sick before, and slices critical resources for rural health care and anti-opioid efforts.” (Margolies, 6/22)

Iowa's two U.S. senators didn't immediately commit themselves Thursday to their party's newly unveiled plan to scale back Obamacare, but they both voiced support for the need to make major changes to the nation's health care system. Sens. Chuck Grassley and Joni Ernst, both Republicans, said they would withhold judgment on the health reform bill until they’ve studied the document, which Republican colleagues wrote behind closed doors. (Leys, 6/22)

Ohio's top-ranking Republicans declined Thursday to endorse Senate Republicans' bill to replace Obamacare, saying they had "concerns" about a plan to phase out Medicaid expansion. Gov. John Kasich and Sen. Rob Portman both support the expansion of Medicaid to low-income, childless adults in Ohio. (Thompson, 6/22)

All Arizona eyes turn now to Sens. John McCain and Jeff Flake. Will they or won’t they go along with the Senate’s plan to make America’s health-care system great again? (Roberts, 6/22)

House conservatives are keeping a close watch on how Senate GOP leaders plan to change a bill intended to become the first major health law of the Trump administration. While waiting for Thursday’s unveiling of the Senate's draft, conservatives raised concerns about concessions expected to be made to moderates in that chamber. “It’s moved to the left. We expected some of that,” Rep. Mark Meadows, R-N.C., the chairman of the conservative House Freedom Caucus, told CQ Roll Call on Wednesday evening. “It’s just a question of how far it’s moved to the left.” (Young, 6/22)

The Senate is about to release its plan to overhaul health care. Steve Inskeep talks to Republican Rep. Buddy Carter of Georgia about how the bill might be different from the House version. (Inskeep, 6/22)

Senate aides expect that Majority Leader Mitch McConnell (R., Ky.) will bring the health bill as soon as Tuesday, shortly after the CBO score has been released. The first vote will be on a motion to proceed to the bill, which would need a simple majority to advance the bill. That means Mr. McConnell needs at least 50 votes, with Vice President Mike Pence on hand to break a tie. (Peterson, 6/22)

A Congressional Budget Office analysis of the Senate bill’s cost and impact is expected next week. The repeal legislation that passed the House of Representatives, the American Health Care Act, would leave 23 million people without health coverage and slash Medicaid’s budget by $834 billion over ten years, the CBO found. (Pugh and Douglas, 6/22)

A look at the next steps. (6/23)

Senate Republicans on Thursday unveiled a draft of their plan to repeal and replace the Affordable Care Act, which they expect to vote on next week. The bill is similar to the one passed by the House in May, but it makes several significant alterations, including deeper cuts and structural changes to Medicaid, a program that insures one in five Americans, including two-thirds of nursing home residents. (Park and Sanger-Katz, 6/22)

The Senate’s sweeping Obamacare repeal has the same overarching goals as the House-passed American Health Care Act, including an overhaul of Medicaid, striking many of the Affordable Care Act’s insurance regulations and coverage mandates and getting rid of Obamacare taxes. But the chambers diverge in some important ways. (Bettelheim, Millman, Frostenson, 6/22)

Republicans in the Senate on Thursday unveiled their plan to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step towards achieving one of the Republican party's major goals. (Grayson, Hurt and Kodjak, 6/22)

The Better Care Reconciliation Act, like the American Health Care Act, radically revises Medicaid, but it is closer to the Affordable Care Act on how it approaches subsidies to buy individual insurance. Both the House and Senate bills eliminate taxes that paid the costs to cover more people through Medicaid and to subsidize individual plans. (Lee, 6/22)

When it comes to managing Republicans’ best interests, Senator Mitch McConnell of Kentucky, the majority leader, rarely loses. So it is possible that Mr. McConnell views the potential failure of a hastily written health care bill as an eventual boon. ... Mr. McConnell plays his strategic cards so close to the vest that a queen of hearts must be tattooed on his tie. (Steinhauer, 6/22)

The shrewd Kentuckian has made himself practically the sole arbiter of the bill and will be largely responsible for the outcome, whether it's a win, a loss, or a win that turns into a loss over time as unpopular consequences of the legislation take hold. McConnell decided to keep the bill close, writing it in secret with a close circle of aides and eschewing committee hearings, despite grumbling from fellow Republicans. GOP senators were largely in the dark until the legislation was unveiled Thursday and were still getting briefed, without seeing copies of the bill, when it was posted publicly online. (Werner, 6/23)

McConnell’s strategy has been a slow burn, allowing his members to vent in private party discussions while gradually writing a bill that takes in their considerations over the past six weeks. He’s had more than 30 meetings with his members about taking down the 2010 health law, intended to give his members more input and get them comfortable with the product. Johnson, for example, doesn’t even serve on the two committees that oversee health care policy, so the process has empowered him more than he might have been through regular order. People close to McConnell believe Lee’s staff has been read in more than any other member on the chamber’s complicated parliamentary procedures that constrain what is possible under reconciliation. (Everett, 6/22)

Dozens of people protested the newly proposed Republican health-care legislation outside the Capitol Hill office of Senate Majority Leader Mitch McConnell (R-Ky.) on Thursday — a demonstration that resulted in the arrest of 43 disability advocates. U.S. Capitol Police spokeswoman Eva Malecki said officers warned the demonstrators to “cease their unlawful activities” or risk being arrested. Those who did not comply were arrested and charged with crowding and obstructing. (Stein, 6/22)

U.S. Capitol Police officers removed several people protesting Thursday morning in front of Senate Majority Leader Mitch McConnell’s (R-Ky.) office, shortly after the Senate GOP released its ObamaCare repeal bill. The protesters, some of them in wheelchairs, had planned to stage a "die-in" protest to oppose the bill. Tweets from the scene show Capitol Police officers blocking the hallway outside McConnell's office, as protesters gathered to protest the new healthcare bill. Another tweet shows police carrying a protester who refused to leave on her own. (Delk, 6/22)

President Donald Trump tweeted Thursday evening that he is “very supportive” of the health care bill crafted by Senate Republican leadership, departing from an earlier more cautious approach by his White House communications team. The president’s support for the bill — which proposes Medicaid cuts, and an end to the 2010 health care law’s individual mandate — comes as Senate leaders must win over several conservative senators who on Thursday announced they have concerns with the measure. It is unclear whether Trump’s support will help bring those conservatives on board. (Bennett, 6/22)

Trump said Wednesday night at a campaign-style rally in Cedar Rapids, Iowa, that he had told senators to “add some money to it” to produce a healthcare bill with “heart.” Asked Thursday morning whether the Senate draft met that standard, the president suggested some changes were needed. "A little negotiation, but it's going to be very good," he told reporters. (Levey and Mascaro, 6/22)

President Donald Trump called four conservative holdouts who could wreck Senate Republican leaders’ health care bill “good guys,” saying there is a “narrow path” to win their support and pass the measure. ... During an interview on “Fox & Friends” taped Thursday at the White House and aired Friday, Trump appeared eager to avoid offending any of the holdouts. The president, as he did as a candidate, is not afraid of personally besmirching a political foe — but when it came to Paul, Johnson, Cruz and Lee, Trump had nothing but praise and understanding. “They’re four good guys and they’re friends of mine,” the president said. “We have four very good people, and it’s not that they’re opposed. “They’d like to get certain changes,” he said, “and we’ll see if we can take care of that.” (Bennett, 6/23)

The plan is “not a health care bill,” Obama declared in a 939-word message to his nearly 53 million followers on Facebook. “It’s a massive transfer of wealth from middle-class and poor families to the richest people in America.” The 44th president did not mention his successor, Donald Trump, but his scathing criticism and urgent tone — imploring his supporters to speak out against the “fundamental meanness at the core of this legislation” — set up a direct public fight with the current White House occupant over the future of the nation’s health care system. (Nakamura, 6/22)

"Simply put, if there’s a chance you might get sick, get old, or start a family — this bill will do you harm,” he added. “And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.” (Conway, 6/22)

Obama’s assertion of the bill’s “meanness” echoes remarks from President Trump, who reportedly told GOP senators at a meeting last week that the House measure was “mean” and that the Senate bill should be more generous. (Greenwood, 6/22)

The minority leader, Chuck Schumer of New York, and nearly 30 of his Democratic colleagues sped to the floor to lambaste the 142-page health care bill that was released less than an hour before by Republicans. They quickly outlined their objections that they had been pushing for weeks: Deep cuts to Medicaid, a lack of protection for pre-existing conditions, tax breaks for the wealthy. “It’s every bit as bad as the House bill. In some ways, it’s even worse,” Schumer said. (Kim and Schor, 6/22)

House Minority Leader Nancy Pelosi (D-Calif.) denounced the Senate’s health-care bill Thursday as “mean and heartless.” It was a direct challenge to President Trump, who has called the House version “mean” behind closed doors after publicly celebrating its passage. Speaking at a weekly news conference, Pelosi said the bill would cause “millions and millions and millions of people” to lose their health care, “inflict great suffering on veterans, on seniors, on working families, on rural communities” and “clobber the states” by making them unable to fund their Medicaid programs. (Viebeck, 6/22)

Sen. Bernie Sanders (I-Vt.) on Thursday slammed the plan put forth by Senate Republicans to repeal and replace ObamaCare, saying the legislation “is even worse than expected.” “The bill Republicans announced today is even worse than expected and by far the most harmful piece of legislation I have seen in my lifetime,” Sanders said in a statement. (Shelbourne, 6/22)

For weeks, a small group of Republicans in the U.S. Senate have been secretly crafting health-insurance legislation in response to the House of Representatives bill that President Donald Trump recently called "mean." Now the Senate GOP's effort is out in the open: the bill wouldn't repeal the Democrats' controversial 2010 Affordable Care Act (a.k.a. Obamacare) but it would eliminate most of its taxes while arguably softening the House bill's Medicaid cuts and rollback of safeguards for people with preexisting conditions. (Perry, 6/22)

Bodhi Bhattarai, who suffers from a rare genetic neuromuscular disease, uses an expensive wheelchair to move around, giving the 3-year-old Concord boy a level of independence his parents once thought he’d never have. Now the couple is worried again, after Senate Republicans unveiled a health care bill Thursday that some fear would strip coverage from those with pre-existing conditions. New Hampshire Democratic Sen. Jeanne Shaheen cited this concern on the Senate floor, showing a picture of Bodhi sitting next to his mother. (6/22)

As Republican leaders in the U.S. Senate today revealed a draft of health care legislation they say will stabilize individual insurance markets, Democrats from Michigan and elsewhere attacked it as mean-spirited and stingy, saying it will hurt lower-income families and seniors. “Frankly, we’d like to have a ceremony and light this on fire,” U.S. Sen. Debbie Stabenow, D-Mich., said on the Senate floor, waving a copy of the 142-page draft legislation as she argued against the bill, which is intended to repeal and replace the 7-year-old Affordable Care Act, also known as Obamacare. (Spangler, 6/22)

Hospitals panned the Senate’s latest health reform efforts on Thursday, blasting the chamber’s newly released draft legislation as a draconian and devastating contraction of funds that support health care for low-income Americans and children. Every major hospital association criticized the draft, including the American Hospital Association, the Federation of American Hospitals, and America’s Essential Hospitals. AHA and FAH both called for the Senate to scrap its draft and start over. (Mershon and Blau, 6/22)

Hospital trade groups had one message to the small group of Senate Republicans who released their health bill after two months of closed-door meetings: “Go back to the drawing board. ”While U.S. hospital and other health-care stocks rallied Thursday, with a sense of relief that the spending reductions contained in the plan weren’t as deep, or fast, as investors anticipated, the biggest hospital associations in the country lambasted the proposal. The Better Care Reconciliation Act, which would replace Obamacare, puts the health of millions of poor, elderly, disabled and chronically ill patients at risk, said Rick Pollack, chief executive officer of the American Hospital Association. (Mattingly and Lauerman, 6/22)

Leading healthcare advocacy groups are urging the Senate to make substantial changes to its healthcare plan released Thursday, warning it could have negative consequences for people across the country. The proposal includes deep cuts to Medicaid and fundamentally reshapes the program from an open-ended government commitment to a system of capped federal payments that limit spending. (Roubein and Hellmann, 6/22)

Major health care industry groups largely fell into two camps on Thursday when Republicans released their Affordable Care Act repeal: There were those groups that criticized the bill, and those that preferred to say nothing at all. For the health insurance industry, the bill is a mixed bag. The major trade association for health insurers, America's Health Insurance Plans, declined to issue a specific response to the bill, saying they were still evaluating it. But the proposed legislation contains several provisions that the industry has been fighting for, including a tax repeal worth $145 billion over 10 years to the industry and a guarantee that billions of dollars of federal subsidies would be paid in 2018 and 2019 to stabilize plans in the Affordable Care Act's marketplaces before they are phased out. There are also two funds, adding up to $112 billion over a decade, to stabilize the market and make insurance more affordable. (Johnson, 6/22)

Senate Republicans’ health overhaul carries big risks for many health-care companies because of its cutbacks to federal Medicaid funding and the uncertain impact of its broad changes to individual health-insurance markets. The bill contains elements that will immediately be seen as wins for some companies—particularly the repeal of a tax on health-insurance plans and of a levy on medical devices, both of which have been strongly opposed by those businesses. But the proposed changes to Medicaid will be bad news, particularly over the long term, for hospitals and other health-care providers, as well as for insurers that manage Medicaid business, as those funds are curtailed, analysts and industry executives said. (Wilde Mathews and Evans, 6/22)

The branded-drug industry, which was pilloried by conservatives for supporting then-President Barack Obama’s health-care overhaul, is playing it safe as Republicans move to undo the measure. The Pharmaceutical Research and Manufacturers of America, the trade association for brand-name drug companies also known as PhRMA, has avoided taking a position on the Republican bill released Thursday. (Rockoff, 6/22)

U.S. healthcare stocks posted sharp gains on Thursday, with hospitals and insurers climbing after Senate Republicans released a draft bill to replace Obamacare, while a recent surge in biotechnology shares showed no signs of slowing. (Krauskopf, 6/22)

Hospital stock prices jumped on Thursday as investors reacted to the Senate's proposal for repealing and replacing the Affordable Care Act. Shares of Tenet Healthcare Corp. were up 7%, or $1.22, to $18.90 on the day. Community Health Systems' shares rose 5% to $9.27. Shares in HCA, the nation's largest investor-owned hospital chain, were up 2% to $86.14. And Universal Health Services and LifePoint Health advanced 2% and 3%, respectively. (Barkholz, 6/22)

More Americans approve of the Affordable Care Act than the House Republican bill to repeal and replace it, but many still want Congress to find some way to fix former President Barack Obama’s signature health-care law, a new Wall Street Journal/NBC News poll finds. (Hook, 6/22)

Forty-eight percent of participants in the poll said they thought the House bill was a bad idea, while just 16 percent said it was a good idea. The rest were unsure or had no opinion, according to the poll of 900 people, which was conducted by phone from June 17-20. (Siu, 6/22)

Roughly three in 10 likely voters in Colorado age 50 or older support the U.S. House-passed version of the American Health Care Act, according to a poll released Thursday by the AARP that also found the state’s residents are overwhelmingly against cutting Medicaid funding. The survey found that 81 percent of likely Colorado voters age 50 or older don’t want any Medicaid dollars cut — including 70 percent of Republicans and 91 percent of Democrats. (Paul, 6/22)

Senate Republicans’ health care bill to replace the Affordable Care Act, released Thursday, would lead to millions of Californians losing health coverage, paying more for insurance or seeing their benefits scaled back, according to health policy experts. The measure would impose steep cuts in the Medi-Cal insurance program that provides benefits to 14 million Californians — nearly a third of the state’s population. (Ho, 6/22)

The U.S. Senate's health care plan garnered mixed reviews in Texas on Thursday. Some applauded its sweep, others offered tepid support, and still others voiced outright disgust as they accused the bill of balancing tax cuts on the backs of the state's most vulnerable. The 142-page "discussion draft," titled the Better Care Reconciliation Act of 2017 and authored in secret by Senate Republicans, in essence repeats much of the U.S. House bill that narrowly passed last month. (Deam, 6/22)

Senate Republicans Thursday released their plain to repeal and replace Obamacare, aiming to reduce government-paid healthcare benefits, give more power to states and cut taxes for some people. The Senate Republican blueprint would restrict using tax credits, or subsidies, for insurance that covers abortions except in the case of rape or incest, and bar states for one year from using Medicaid money to pay Planned Parenthood. (Koff, 6/22)

Legislation unveiled by Senate Republican leaders to dismantle President Barack Obama's health care law ran into swift internal opposition Thursday, throwing into doubt the GOP's ability to make good on a years-long campaign promise to roll back the program. Hours after the bill was made public, four conservative senators announced their opposition, saying the measure doesn't go far enough to unwind Obamacare. Maryland Gov. Larry Hogan, meanwhile, joined a chorus of centrist Republicans who are concerned about how the legislation would affect their states. (Fritze and McDaniels, 6/22)

Senate Republicans’ release of their health care proposal highlighted what is likely to be a key issue in the race for governor, especially if Congress and President Donald Trump sign off on legislation giving states more latitude to set their own approach. Ed Gillespie, the GOP nominee for governor, said in a statement that he looks forward to “thoroughly reviewing” the proposal’s effect on Virginia. (Cain, 6/22)

Georgia political leaders, including Gov. Nathan Deal, have expressed concern about that conversion, if the federal spending is pegged to the states’ per-enrollee spending. With Georgia ranking 45th among states in Medicaid spending per enrollee, a capped structure would create a disadvantage by locking Georgia in at its historically low spending rate, the Georgia Budget and Policy Institute pointed out in a new study. (Miller, 6/22)

For weeks, the Senate has been working on a secret health care bill. As of Thursday, the secret's out. (O'Keefe and Chakrabarti, 6/22)

Kansas U.S. Sen. Pat Roberts is not enthusiastic about the Senate’s version of the Obamacare replacement bill. Nevertheless, he supports it. “This is not the best possible bill, it’s the best bill possible under very difficult circumstances. So, you don’t have any other alternative, I don’t think,” Roberts told reporters minutes after leaving a Thursday morning meeting where the bill, which was drafted in relative secrecy, was explained to Republican senators. (Mclean and Wingerter, 6/22)

As U.S. Senate Republicans were unveiling their Affordable Care Act replacement plan Thursday, Lawrence resident Mike Oxford was lying on the floor of Senate Majority Leader Mitch McConnell’s office. Oxford has limited mobility because of a lower-back injury and neurological impairments and is the executive director of the Topeka Independent Living Center. (Marso, 6/22)

Senate Republicans have not revealed details of their plan to replace the Affordable Care Act, or Obamacare, but that didn’t stop a group of protesters from gathering on Wednesday at Sen. Marco Rubio’s Orlando office... The group of around 20 protesters outside of Rubio’s office said the American Health Care Act would help the rich, while taking away health care insurance for millions Americans. (Ninno, 6/22)

Humana Inc will not return to the individual insurance market after it exits the Obamacare exchanges this year, a market that Republicans are trying to repeal and replace through new legislation, Humana's top executive said on Thursday. (Humer, 6/22)

At this time last year, Minnesota’s individual health insurance market was in a state of collapse. This year’s state? Uncertainty. The individual health insurance market covers around 170,000 Minnesotans who don’t get insurance through an employer or a government program. It’s been plagued by skyrocketing premiums and insurer turmoil in recent years, and was only barely saved from total collapse in 2016. (Montgomery, 6/22)

Six companies requested to sell health insurance in Florida through the Obamacare exchanges. The average rate increase requested by the companies is 17.8 percent. (Ochoa, 6/22)

Scientists think there may be a few things you can do to keep dementia at bay: train your brain, keep your blood pressure under control and stay active. According to a report published Thursday by the National Academies of Sciences, Engineering and Medicine (NASEM), there is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (Toy, 6/22)

In drawing its qualified conclusions, the panel cited research released last summer suggesting that a program of highly targeted brain-training reduced the risk of cognitive decline or dementia by nearly half over 10 years. It cited a wide range of findings that link dementia to conditions — such as hypertension, diabetes and stroke — in which the health of blood vessels large and small is compromised. And it touted a welter of research that has linked sedentary lifestyles to a wide range of ills, and higher levels of physical fitness with better physical, cognitive and mental health. (Healy, 6/22)

To anyone who’s aware that efforts to develop Alzheimer’s drug treatments have met failure after failure, and to have therefore decided that prevention is the only hope, a U.S. panel of experts issued a sobering message on Thursday: Don’t count on it. From physical activity to avoiding high blood pressure to brain training, a 17-member committee assembled by the National Academies of Sciences concluded, no interventions are “supported by high-strength evidence.” Instead, some high-quality studies found that one or another intervention worked, but other equally rigorous studies found they didn’t. (Begley, 6/22)

If you want to avoid shingles — a condition that comes with a painful rash — there is a vaccine available. But studies have shown that protection generated by the vaccine declines quickly. A new vaccine, however, is being considered for approval, and if and when the Food and Drug Administration gives it the green light, its may hit the market with a highly desirably preferential rating from an influential panel of vaccine experts. (Branswell, 6/22)

Women in their 40s at average risk for breast cancer should talk to their health care provider about the risks and benefits of mammography before starting regular screening at that age, according to guidelines released Thursday by the American College of Obstetricians and Gynecologists. (Hobson, 6/22)

Scientists finally have a better idea why certain meals send you running for the bathroom. The discovery provides insight into the connection between your gut and brain and may point toward new therapies for intestinal disorders such as irritable bowel syndrome. (Gallegos, 6/22)

Thanks to Sigmund Freud, we all know what it means to dream about swords, sticks and umbrellas. Or maybe we don't. "For 100 years, we got stuck into that Freudian perspective on dreams, which turned out to be not scientifically very accurate," says Robert Stickgold, a sleep researcher and associate professor of psychiatry at Harvard Medical School. "So it's only been in the last 15 to 20 years that we've really started making progress." (Hamilton, 6/22)

Earlier this week, an influential group of experts in preventive care affirmed that children age 6 and older should be screened for obesity and referred to intensive treatment when necessary. While the Affordable Care Act requires that nearly all plans cover such treatment, most kids don’t have access to programs featuring exercise, nutrition and counseling, according to an editorial published in JAMA Internal Medicine. (Andrews, 6/23)

We had some questions about California’s high-profile bill to establish a single-payer system, in which the state would foot the bill for nearly all healthcare costs of its residents. So we looked into the proposal, asking who would be covered, how it would be paid for and other basic questions about how it would work. Times readers sent us their own questions about about SB 562, the measure by state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego). Many were rooted in their personal experiences. They asked about how this would change their coverage on Medicare, having health issues while traveling or concerns about access to treatment. The variety of the questions underscored that a single-payer proposal like the one being debated in Sacramento is an enormously complex undertaking. (Mason, 6/23)

The owner and a worker at a Lansdowne assisted-living home where 16 residents were found in a facility licensed for four beds have been charged with multiple criminal counts of neglect and reckless endangerment, the Baltimore County prosecutor's office announced Thursday. Dione Griffin, owner of Griffin's Loving Care Assisted Living, and Dijon Lee, Griffin's 25-year-old daughter and an employee at the home, were indicted last week by a county grand jury and each charged with six counts of vulnerable adult neglect, according to the state's attorney's office. (Haq, 6/22)

A Suffolk Superior Court jury on Thursday awarded more than $22 million to a cancer scientist who sued Steward Health Care System for breaching her contract and causing an unusual series of events that led to the destruction of her laboratory. The jury sided with the scientist, Lynn Hlatky, who argued that Steward broke its agreement when it spun off her research lab at St. Elizabeth’s Medical Center in 2013 and stopped supporting her work. (Dayal McCluskey, 6/23)

A federal judge signaled Thursday he is likely to force major changes at Wisconsin's juvenile prison, saying it appears the state excessively uses solitary confinement, pepper spray and handcuffs on teen inmates. (Marley, 6/22)

The state mental hospital cannot keep up with an unexpected surge in court-ordered competency evaluations for accused criminals, the Colorado Department of Human Services said Thursday in asking for relief from a long-standing lawsuit. The department filed to invoke “special circumstances” in a case lodged against the state by Disability Law Colorado. State officials informed the advocacy group in a letter Thursday that the mental hospital cannot hold up its end of the settlement agreement, which requires jail inmates to receive mental health evaluations or treatment within 28 days of receiving paperwork from a judge. (Brown, 6/22)

The sexually transmitted disease syphilis is making a resurgence in New Hampshire after almost disappearing a decade ago, and doctors are being warned to look out for it. Health care “providers haven’t seen syphilis for a long time. It may not be on their mind to test for it. That’s one of the reasons we wanted to get the word out there,” State Epidemiologist Dr. Benjamin Chan said.From January through May of this year, 42 cases of syphilis were reported, more than twice the state’s five-year average of 20 cases during those months, according to Chan’s office. (Brooks, 6/22)

City health and public safety officials have already been trained to issue Narcan nasal spray, which can be used in an emergency to reverse the effects of an opioid overdose. And now, Mayor Martin J. Walsh will learn how to issue it as well. (Valencia, 6/22)

Over the years we become increasingly dependent upon the benefits of prescription drugs and other medications to relieve pain, treat illnesses and save lives. Yet, when no longer needed, these same medications can turn deadly. (Bradley, 6/22)

Miami’s fledgling needle-exchange program — approved by lawmakers with the goal of helping addicts stay disease free — has been praised by health authorities and the county’s top police departments... So it was a surprise when the program reported this week that a Miami police commander and three others officers showed up at the Overtown facility to proclaim that the department didn’t support needle exchange and “would continue to arrest our participants.” (Ovalle, 6/22)

Two children have died this year in incidents involving parental maltreatment in Hennepin County, just as the county is increasing its child protection workers and overhauling its system to better protect children and provide help sooner to families. County leaders hope that more staffers and new programs will help prevent child abuse while shrinking the number of child protection reports, which reached a record high of 20,000 in 2016 — nearly double the number from 2008. (Smith, 6/23)

People experiencing food insecurity – not knowing where their next meal will come from – mostly live around downtown Atlanta and south of I-20. But that's changing. A new analysis finds that food insecurity will increase more quickly in the suburbs to the east and west as numbers decrease in-town. (Samuel, 6/22)

It would be a big mistake to call the legislation Senate Republicans released on Thursday a health care bill. It is, plain and simple, a plan to cut taxes for the wealthy by destroying critical federal programs that help provide health care to tens of millions of people. (6/23)

After weeks of speculation and secret meetings, on Thursday Senate Republican leaders unveiled their version of the plan to repeal and replace the Affordable Care Act. On the surface, this bill and its optics are unbelievably bad. It cuts health benefits for millions of poor and disabled Americans, increases costs for the elderly and others, and slaps a temporary Band-Aid on the Obamacare insurance markets. And it surely fails to deliver on President Donald Trump’s promise to make insurance both better and more affordable. Oh, and fewer than one in five Americans support the bill’s close cousin that has already passed the House. (Sarah Binder, 6/22)

The “health-care bill” that Republicans are trying to pass in the Senate, like the one approved by the GOP majority in the House, isn’t really about health care at all. It’s the first step in a massive redistribution of wealth from struggling wage-earners to the rich — a theft of historic proportions. (Eugene Robinson, 6/22)

After weeks of secret negotiations, Senate Republicans on Thursday took the wraps off their plan to repeal and replace Obamacare. It deserves the old surgeon general's warning about cigarettes: This product may be hazardous to your health. Like its House counterpart, the Senate plan would end insurance coverage for millions of people, probably tens of millions. It's hard to know for sure, because the plan has yet to be evaluated by the non-partisan Congressional Budget Office. (6/22)

The Senate Republicans’ health bill that was made public today is a Jekyll-and-Hyde plan: in some ways kinder than the House Republican plan, and in some ways meaner, to use President Donald Trump’s yardstick. Overall the plan will benefit the wealthy and young adults, but hurt larger numbers of people who are old or poor. (Drew Altman, 6/22)

Senate Republican leaders released on Thursday a draft health-care bill, supposedly designed to repeal and replace the Affordable Care Act. It includes a range of mostly unwise and ungenerous changes to the nation’s health-care system, but it might, if enacted, end up as mostly a massive, unpaid-for tax cut for wealthy people and industries with pull on Capitol Hill. (6/22)

Senate Republicans finally revealed on Thursday why they’ve been crafting their Affordable Care Act repeal in secret. As the newly released draft shows, it’s a rollback of health coverage for millions of Americans that could cost the lives of tens of thousands a year. But make no mistake: This is not a healthcare bill. It’s a tax cut for the wealthiest Americans, paid for by a reduction in government funding for healthcare. The measure would constitute one of the largest single transfers of wealth to the rich from the middle class and poor in American history. (Michael Hiltzik, 6/22)

With the release of the Senate’s “Better Care Reconciliation Act of 2017 (BCRA),” the public finally gets a glimpse of legislation crafted in utter secrecy for the past two months, and now we know why. Despite the fanfare and feigned earnestness of the upper chamber’s efforts to improve on the “mean” House-passed American Health Care Act (AHCA), the Senate bill would be disastrous for low-income families, patients with pre-existing conditions, children, and the aged, while undermining health care security for virtually everyone else. (Billy Wynne, 6/23)

The nation has been waiting with bated breath for the Senate to unveil its version of the House health-care bill. Okay, maybe not the nation. But a whole lot of health-care wonks have, and this morning, we finally got a look at the thing. (Megan McArdle, 6/22)

The 142-page Senate health care bill revealed Thursday was written in secret by 13 white men with little or no expertise on health care issues and no advice from doctors, hospitals or health economists, let alone from the public... We can only hope a few Republicans care enough about the health of women, children and the elderly to join Democrats in stopping this travesty. (6/22)

If you squint a little and tilt your head just the right way, the health care plan Republican senators introduced Thursday has a familiar look to it: It’s Obamacare-lite. Or at least Obamacare-ish. The Affordable Care Act subsidies that allow low-income people to afford policies? They’re in the Senate plan, although at slightly lower levels than Obamacare. (6/22)

It is no surprise that the proposed Senate Republican bill to repeal and replace the Affordable Care Act, finally dragged into the light Thursday, is horribly wrong-headed. Any “reform” of Obamacare that is driven by a desire, above all, to cut taxes by hundreds of millions of dollars for rich people is sure to leave many other Americans worse off. The Senate GOP plan would leave tens of millions more Americans without insurance, result in higher premiums for older Americans, and allow insurance companies to water down benefits to joke status. (6/22)

On May 4, the U.S. House of Representatives resurrected Republican efforts to enact major health care legislation by narrowly passing the American Health Care Act (AHCA). A growing body of analytic work, including a Congressional Budget Office (CBO) assessment delivered on May 24,1 paints a dismal picture of how the AHCA would affect the health care system. The CBO analysis shows that the legislation would reduce the number of people with insurance coverage by 23 million, while narrowing coverage or increasing its cost for millions more. The resulting budgetary savings would finance tax cuts that would accrue disproportionately to high-income families. These effects contrast starkly with President Donald Trump’s promises that health care legislation would cover more people while lowering costs for families. (Matthew Fiedler, Henry J. Aaron, Loren Adler and Paul B. Ginsburg, 6/22)

Seven years ago, Democrats imposed Obamacare on our country. By nearly any measure, it has failed and no amount of 11th hour reality-denying or buck-passing by Democrats is going to change the fact that more Americans are going to get hurt unless we do something. (Sen. Mitch McConnell, 6/22)

Senate Republicans released their draft bill to repeal and replace ObamaCare on Thursday, and Majority Leader Mitch McConnell is hoping for a vote next week. The binary choice now is between pushing past the media and Democratic flak to pass a historic achievement, or wilting under the pressure and ratifying the ObamaCare status quo. (6/22)

The hotly-anticipated Senate Republican health care bill came out on Thursday morning. The airwaves quickly filled up with predictable talking points from both sides. But once the dust settles, it will emerge that the Senate bill will have far-reaching effects on American health care: for the better. (Avik Roy, 6/23)

On page 64 of the bill, it says that if a state spends 25 percent more than average per patient, Washington will reduce its Medicaid contribution by up to 2 percent the next year. (So, if were scheduled to grow by 2.4 percent, it might only grow by .4 percent). If a state spends 25 percent less than average, it will see its contribution increased by 2 percent. Essentially, states — including much of the Northeast — would be penalized for being generous, in order to fund more Medicaid spending in states that are not. It's only a one-year penalty — so it's not designed to ratchet down funding for, say, New York or Massachusetts over time. But “it really is hurting states that, for a variety of reasons, have higher spending per beneficiary,” Edwin Park of the Center on Budget and Policy Priorities told me. (Weissmann, 6/22)

Three million and $1.6 trillion. The first number represents an estimate of the children who would lose healthcare coverage under the bill Republican senators worked on in secret and finally unveiled on Thursday. The second number reflects the total amount of Medicaid cuts — in the form of the elimination of the Medicaid expansion for working families that was part of the Affordable Care Act, capped federal spending for Medicaid and additional cuts proposed in the president’s budget — that would go to pay for tax breaks for billionaires. (Henry A. Waxman, 6/22)

Members of the U.S. Congress are currently attempting to make significant changes to our nation's health care laws. These changes would decrease the care people on Medicaid receive for the first time its history. (Gregory V. Palmer, 6/22)

In many small towns across Alabama, the Great Recession of 2008 is still visible in empty storefronts, shrunken paychecks and lives put on hold. Unfortunately, those rural communities will soon be dealt another devastating blow if Congress cuts federal funding for our state's Medicaid program. Medicaid is a critical lifeline for 24 percent of Alabama's rural and small-town residents, and the deep cuts to Medicaid being considered right now by Congress would have a harmful and disproportionate impact on our children, seniors and families in need. (Jim Carnes, 6/22)

As a pediatrician in training, I know firsthand the importance of ensuring children have access to affordable, comprehensive health care coverage. I stand with the American Academy of Pediatrics in urging the Senate to forge a new path forward to protect children's coverage. (Jennifer Kusma, 6/22)

Senate Republican Leader Mitch McConnell's proposed evisceration of the Affordable Care Act -- crafted secretly behind closed doors and unveiled only today, yet seemingly destined for a Senate vote in just a few days -- is not much different from the heartless version Republican Speaker Paul Ryan got the House to pass. The Senate bill, like its House-passed template, is in essence a tax cut for high-income people that will be paid for by taking health care coverage away from low-income people -- and denying opioid addiction treatment to millions, a dreadful burden in states like Ohio where the opioid epidemic is raging most intensely. (6/22)

The AHCA would cut $840 billion from Medicaid over the next 10 years. It would decimate millions of Americans’ access to health care, particularly in rural areas. The bill leaves “millions of the sickest, most under served populations in our nation without coverage,” the National Rural Health Association says, “further escalating the rural hospital closure crisis.” (6/22)

More than 500,000 Wisconsin children are covered by Medicaid. These children, along with the 750,000 older, disabled and low-income Wisconsinites who rely on Medicaid, are now in jeopardy. Recently, the House of Representatives voted to cut the program by 25% over the next 10 years. (Lynn Breedlove, 6/22)

In case anyone was wondering what would happen if a handful of fairly wealthy, well-insured men gathered in a room and quietly tried to reinvent the $3-trillion U.S. healthcare system without any input from medical experts, patient advocates or others who know what they’re talking about, the U.S. Senate stepped up Thursday with the answer. (David Lazarus, 6/22)

No one seems to like the Senate health-care bill. Liberal wonks detest it. At least four Republican Senators claim they aren't prepared to support it, while other colleagues grumble about it. The White House, whose chief executive promised he wouldn't cut Medicaid, as this bill does, is balking. But the Senate bill is very similar to the bill passed last month by the House. And the reason for that similarity is pretty basic: Both bills accomplish what Republicans want. (Francis Wilkinson, 6/22)

Next week, Republicans want the United States Senate to vote on a bill that would restructure our nation’s entire healthcare system — a system that makes up one-sixth of the American economy. This bill would affect the lives of nearly every American, from our parents or grandparents in need of caregiving, to our children struggling with asthma or opioid addiction, to our spouses battling cancer. And we only just received the full text on Thursday, a week before the vote on the bill. (Sen. Kamala D. Harris, 6/23)

President Trump says the Senate health-care bill needs more negotiation. (So what foolish lawmaker would sign onto it now?) Planned Parenthood, hospitals, every Democratic lawmaker and a number of conservatives have panned the bill. Conservatives and libertarians oppose the bill because, to a greater extent than the House bill, it temporarily props up Obamacare. Already four Republicans — Sens. Rand Paul (Ky.), Ron Johnson (Wis.), Ted Cruz (Tex.) and Mike Lee (Utah) — have said they cannot support it because it does not fully repeal Obamacare or do enough to lower costs. (Jennifer Rubin, 6/22)

The hope for the Senate Republican health care plan was that it would be more humane than its House counterpart, which President Trump labeled "mean." It may be, but only in the sense that it’s more humane to shoot someone in the leg than to shoot them in the head. (Montel Williams, 6/23)

A normal legislative process allows time for journalists and citizens to digest the consequences of major legislation. But even now that the Senate bill has been released, a larger problem remains. (Philip Rocco, 6/22)

Like my predictions about what a Republican win in the 2016 election would mean for U.S. health policy, my expectations about the ease and speed of passing an Affordable Care Act (ACA) replacement bill during President Donald Trump’s first 100 days in office have not exactly come to fruition. But given the Republican focus over the past 7 years on “repealing and replacing” the ACA and Trump’s promise to make health care reform an early focus of his administration (at one point, he suggested having Congress meet even before his inauguration), Congress’s attention to the issue has not been surprising — even if it’s not directly in line with Trump’s dominant campaign theme of “making America great again.” Indeed, it’s been argued that the economy and jobs would have been a politically easier first target than health care — an argument that was made retrospectively for the Obama administration as well. (Gail R. Wilensky, 6/22)

The internal GOP debate on how to replace Obamacare is essentially one of priorities. What is more important, saving money or saving lives? Senate and House Republicans may be surprised to learn that for their idol, Ronald Reagan, this was never a question at all. Throughout his life, Reagan always cared more about saving lives than saving money. (Henry Olsen, 6/22)

The Senate GOP leadership calls its proposal to overhaul Obamacare the “Better Care” act. But better care for whom? Not for the working poor. The bill’s new premium subsidies for those not covered by large employer health plans would be less generous than they are now, pushing recipients into policies with higher deductibles and co-pays. And when the new subsidies begin in 2020, the bill would end the second set of subsidies that the Affordable Care Act provided those near the poverty line to offset their out-of-pocket costs. (6/23)

If the GOP proposal becomes law, then it’s likely out-of-pocket costs for people buying coverage through healthcare.gov or one of the state exchanges would tend to be higher, not lower ― unless these people were able and willing to pay even more in premiums. ... The essential reality of the repeal effort ― one worth keeping in mind over the next few days, amid all the legislative negotiation over policy details ― is that Republicans want to reduce government spending on the poor and middle class. And less government spending for these people means, almost inevitably, that they will pay for a greater portion of their medical care. Either fewer will have insurance, the insurance they have will offer less protection, or both. It’s just a question of who suffers and how. (Jonathan Cohn, 6/22)

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions. The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. (Margot Sanger-Katz, 6/22)

I’m 35 years old. I didn’t go to college after high school. Instead I got a job in insurance, and I’ve spent half my life on the business side of keeping people healthy. Only once have I felt that the industry took positive steps toward insuring America, and that was when Obamacare mandated it. I assumed Donald Trump’s presidency would doom the law. A Republican replacement, which could cut off insurance for millions of people, may pass the Senate as soon as next week. And I fear that most Americans, who don’t really worry about their health until they get sick, won’t be willing to fight against it. (Justin Ordonez, 6/23)

It’s true. This feels like the center of the opioid crisis in America. But so do West Virginia and Maryland and Massachusetts and hamlets with such names as Pleasantville, Welch and Delray Beach. It is foolish to deny this is a catastrophe; ridiculous to think it is not affecting every American family. Believing that overdosing and addiction only happen to the poor and disadvantaged or celebrities such as Prince and Carrie Fisher is even worse than arguing that extreme droughts, floods, blizzards and other anomalies — such as the air being too hot for planes to get enough lift to take off — are not related to climate change. (Ann McFeatters, 6/23)

America’s addiction crisis is the defining public health challenge of our time. In 2015, more than 52,000 Americans died of drug overdoses, the majority related to opioids — far more than died from car accidents. More than 20 million Americans live with substance use disorders, leading to immeasurable suffering for individuals and families and costing our nation a staggering $442 billion in health care costs, lost productivity and criminal justice expenses. (Vivek Murthy, 6/22)

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, 6/21)

On Wednesday, Anthem Blue Cross Blue Shield announced it would pull out of Wisconsin’s health insurance market, making it the fifth health insurer to leave the state’s marketplace since the implementation of President Barack Obama’s disastrous health care law, ironically coined the Affordable Care Act. This devastating development will leave thousands of Wisconsinites without their preferred health insurance at the end of this year — another blow to a state that’s been hit repeatedly with a string of knocks dealt by the repercussions of Obamacare. (Jim Sensenbrenner, 6/22)

At age 15, I developed an unquenchable thirst and frequent urination, and lost 20 pounds. I had developed Type 1 diabetes, an autoimmune disease that destroyed my body’s ability to produce insulin. Without insulin, I would have eventually developed a condition called diabetic ketoacidosis, which is lethal without (and even sometimes with) treatment. Years later, I’m a practicing endocrinologist. I could never have imagined back when I first started taking insulin that one day I would have so many patients who could not afford the medication because of skyrocketing prices. When the drug was discovered in 1921, the original patent was sold to the University of Toronto for $1 so that no one else could patent it and “secure a profitable monopoly.” (David M. Tridgell, 6/22)

Opioid addiction is driving predictions that more Americans will die this year from drug overdoses than the more than 58,000 who lost their lives in the Vietnam War. Something has to change. Missouri Attorney General Josh Hawley’s lawsuit against three top U.S. opioid manufacturers is a welcome counterpunch against this national public health crisis. (6/22)

Grrocery stores can't tax SNAP purchases. That makes total sense. SNAP — the Supplemental Nutrition Assistance Program, informally known as food stamps — is funded with public money, so the government would simply be taxing itself. This simple rule has greatly complicated the rollout of Cook County's new sweetened beverage tax and prompted a flurry of rule changes in the a penny-an-ounce levy set to take effect July 1. (Eric Zorn, 6/22)

Retirees can look forward to the largest Social Security cost-of-living adjustment next year since 2012 -- but don’t break out the champagne just yet. For many, higher Medicare premiums will take a big bite out of their raise. The 2018 Social Security cost-of-living adjustment (COLA) will not be announced until October, but inflation trends point toward an increase of about 2 percent, according to a recent forecast by the Senior Citizens League. That would be a welcome change compared with the 0.3 percent bump in 2017, and 2016 when no COLA was made. (Mark Miller, 6/22)

What if you wanted to start a business, but first you had to convince a government board that there was a need for your services? And to top it off, your potential competitors could show up to a hearing and argue that nobody needs your business? It sounds unfair and absurd, but that is exactly what Iowa and 27 other states do to doctors. Iowa makes it a crime for doctors like me to open up a new surgery center without obtaining special permission known as a “certificate of need” or CON from the state’s Health Facilities Council. (Lee Birchansky, 6/22)

There are more than 50 petabytes of data in the health care realm today. Analysis and the creative use of big data may likely hold the answers to solving many public health problems and curing chronic disease. Today, new technologies are rapidly being developed for the collection of biometric data directly from patients. Digital health has become the new frontier in medicine and billions of dollars are being invested every year by both government agencies as well as the private sector. Emerging digital health tools collect and archive big data and provide opportunities for researchers to ask important questions that will likely lead to the development of new and improved treatments. (Kevin Campbell, 6/23)

Recently, Secretary of Veterans Affairs David J. Shulkin announced that the VA will overhaul its decades-old electronic patient record system. Rather than simply revamping the old system, and in an effort to provide better, more streamlined care for veterans, the VA will upgrade to a commercial system. (Todd Graves, 6/22)

For someone suffering cardiac arrest, saying “every second counts” may seem trite – but it’s true. Every minute without CPR and defibrillation decreases the person’s chance of survival between 7 percent and 10 percent, according to the American Heart Association. Accordingly, quick action is imperative to save as many lives as possible. (6/22)

“What is the best way for me to get involved politically?” Since last November’s election, I have fielded this question frequently from fellow residents as well as medical students. Many of them have never been politically active, having assumed that the arc of progress would continue uninterrupted, and so, understandably, have focused instead on a demanding training process that largely treats advocacy as extracurricular rather than as a core competency. Now, recognizing the myriad ways in which politics and policy influence the health care we deliver, many trainees feel a new sense of urgency to get involved. (Elizabeth P. Griffiths, 6/22)