�Թϲ�����

A feeling of pessimism is settling over Senate Republicans as they head into a weeklong Memorial Day recess with deeply uncertain prospects for their push to repeal Obamacare. Senators reported that they’ve made little progress on the party’s most intractable problems this week, such as how to scale back Obamacare's Medicaid expansion and overall Medicaid spending. Republicans are near agreement on making tax credits for low-income, elderly Americans more generous, but that might be the simplest matter at hand. (Everett and Haberkorn, 5/25)

The Congressional Budget Office’s latest analysis of the health-care overhaul bill passed by House Republicans underscored for their GOP colleagues in the Senate that they need a different version. They just don’t know yet what it will look like. “We’re not going to pass that bill in the Senate,” Sen. Marco Rubio (R., Fla.) said of the legislation passed by the House earlier this month dismantling and replacing much of the Affordable Care Act. But the Senate’s bill, he added, is a “work in progress.” (Peterson and Armour, 5/25)

Shortly after President Trump took office, Senator Mitch McConnell of Kentucky, the majority leader, met privately with his colleagues to discuss the Republican agenda. Repealing the Affordable Care Act was at the top, he said. But replacing it would be really hard. Mr. McConnell was right. (Steinhauer and Pear, 5/26)

As lawmakers trooped out of the U.S. Capitol on Thursday and headed home until early June, Senate Republicans told reporters they were making progress, but were still nowhere near finalizing a deal on a major overhaul of the Obama health law...��But the schedule is already squeezing Republicans, as there are four work weeks in June, plus three in July – then Congress is scheduled to leave for a five week summer break that lasts until Labor Day. (Dupree, 5/26)

Republicans trying to dismantle former President Barack Obama’s health care overhaul have run into the same problem that bedeviled him. Quality health insurance isn’t cheap, especially if it protects people in poor health, older adults not yet eligible for Medicare, and the poor. Something has to give. (Alonso-Zaldivar, 5/26)

Health insurers are calling on Senate Republicans to maintain ObamaCare’s protections for people with pre-existing conditions as they draft their replacement bill.��The Affordable Care Act forced health insurers to adjust to a remade individual market that now prevented them from denying people coverage or charging them more based on pre-existing conditions. Those rules are known as guaranteed issue, and community rating. ��(Sullivan, 5/25)

Senate Republicans are weighing a two-step process to replace Obamacare that would postpone a repeal until 2020, as they seek to draft a more modest version than a House plan that nonpartisan analysts said would undermine some insurance markets. Republicans -- in the early stages of private talks on the Senate plan -- say they may first take action to stabilize premium costs in Obamacare’s insurance-purchasing exchanges in 2018 and 2019. Major insurers have said they will leave the individual market in vast regions of states including North Dakota, Iowa and Missouri. (Litvan, 5/25)

Bill Cassidy, the first-term Republican senator from Louisiana, thinks the House’s Obamacare repeal bill failed to consider the impact it will have on one crucial constituency: patients. A medical doctor whose political life was forged in the aftermath of Hurricane Katrina and during decades working in a charity hospital, Cassidy wants a more robust replacement for Obamacare, one that lives up to Donald Trump’s campaign promise to replace it with a law that covers more people at a lower cost. (Dennis, 5/25)

Earlier this month, a day after the House of Representatives passed a bill to repeal and replace major parts of the Affordable Care Act, Ashleigh Morley visited her congressman’s Facebook page to voice her dismay. “Your vote yesterday was unthinkably irresponsible and does not begin to account for the thousands of constituents in your district who rely upon many of the services and provisions provided for them by the ACA,” Morley wrote on the page affiliated with the campaign of Rep. Pete King (R-N.Y.). “You never had my vote and this confirms why.” (Ornstein, 5/25)

Senate Republicans have started writing their Obamacare repeal bill — even though few decisions have been made about how to resolve the biggest policy disagreements. Senate Budget Chairman Mike Enzi, whose committee oversees the budget process that the GOP is using to fast-track the repeal effort through the Senate, told POLITICO he’s starting to draft the legislation. (Haberkorn, 5/25)

"Over the break, initial legislation will be drafted and then we’ll have more time, actually have a basis to discuss" specific policies, Sen. Ron Johnson (R-Wis.) said Thursday after leaving a meeting of the Senate Republicans’ healthcare working group. "We’ve had the discussions. It's time to draft a bill, and we’ll move forward on that when we get back."��(Weixel, 5/25)

Johnson said he didn’t expect the draft legislation to be made public because it was still too early in the process. Democrats have slammed Republicans for writing their bill behind closed doors and for not moving through the typical committee process in the Senate. (McIntire, 5/25)

The new Congressional Budget Office report on the American Health Care Act, the House GOP replacement for Obamacare, demonstrates how difficult it is to craft a complex law that affects one-sixth of the U.S. economy. There are many variables — and unforeseen outcomes — that can undermine even the most carefully crafted policy initiative. As a service to readers, we are going to explain one surprising element of the CBO report — that in some states, the law’s efforts to protect people with preexisting medical conditions might end up undermining the individual insurance markets so much that effectively there is no protection at all. (Kessler, 5/26)

Republicans senators conceded Thursday that a scathing analysis of the House GOP health care bill had complicated their effort to dismantle President Barack Obama's health care law. "It makes everything harder and more difficult," Sen. Dean Heller, R-Nev., said of a Congressional Budget Office analysis projecting that the House bill would cause 23 million Americans to lose coverage by 2026 and create prohibitively expensive costs for many others. (5/25)

Health care groups that represent doctors and patients are warning members of Congress that the House Republicans' plan to overhaul the Affordable Care Act would hurt people who need insurance most. The groups are responding to the latest assessment by the nonpartisan Congressional Budget Office, which concluded that the proposed American Health Care Act would leave 23 million more people without health insurance than under current law and would cut the deficit by $119 billion over 10 years. (Kodjak, 5/25)

About one in six people who are sick or have suffered from chronic health conditions will pay more for health insurance that covers less under the House-passed legislation to replace the Affordable Care Act —��if they’re able to get insurance at all, the Congressional Budget Office concluded in a new report on the bill. (O'Donnell, 5/25)

Greg Gianforte, a wealthy Montana Republican who was charged with assaulting a reporter on Wednesday, nonetheless won the state’s lone seat in the House of Representatives on Thursday, according to The Associated Press, in a special election held up as a test of the country’s political climate. ...��Mr. Gianforte’s success underscored the limitations of the Democrats’ strategy of highlighting the House’s health insurance overhaul and relying on liberal anger toward President Trump, at least in red-leaning states. (Martin and Burns, 5/25)

Yet Gianforte's single-digit win paled to Trump's 20-point romp in Montana in November, a sign that Republicans will have to work hard to defend some of their most secure seats to maintain control of Congress. The race ultimately turned on the weaknesses of both Gianforte and his opponent, folk singer and Democrat Rob Quist, making it tough to use as a barometer for the nation's political mood. (Calvin and Riccardi, 5/26)

Mr. Gianforte began the race as a weakened candidate, having lost the governor’s race in 2016 in a campaign that portrayed him as an out-of-state millionaire. Still, the Republican remained ahead of Mr. Quist in most polls, if only by single-digit margins. That lead was jeopardized when the Gallatin County sheriff on Wednesday night charged Mr. Gianforte with misdemeanor assault after he allegedly assaulted a reporter, Ben Jacobs of the Guardian, who had asked him about the GOP health-care bill at his campaign headquarters. (Hook and Epstein, 5/26)

After an intense focus on Montana in the run-up to Thursday’s vote, much of the attention is now likely to shift back to Georgia, where Democrat Jon Ossoff is looking to pick off the seat formerly held by now-HHS Secretary Tom Price in a June 20 special election against Republican Karen Handel. (Debenedetti, 5/26)

There was likely good reason why Greg Gianforte, successful��Republican candidate for Congress from Montana, lost his cool on the eve of the election — scuffling with a reporter, breaking the man’s glasses and ending up with a misdemeanor assault charge: He, like many Republicans these days, walks a perilous line when talking health care. (Webber, 5/26)

People shopping for insurance through the Affordable Care Act in yet more regions could face higher prices and fewer choices next year as insurance companies lay out their early plans for 2018. Blue Cross and Blue Shield of North Carolina is asking regulators for a 23 percent price hike next year because it doesn’t expect crucial payments from the federal government to continue. That announcement comes a day after Blue Cross and Blue Shield of Kansas City said it will leave the individual insurance market next year, a decision that affects about 67,000 people in a 32-county area in Kansas and Missouri. (Murphy, 5/25)

North Carolina's largest health insurer is requesting a nearly 23 percent rate increase for its ObamaCare exchange plans for 2018, citing uncertainty over the future of the law. BlueCross BlueShield of North Carolina requested an average rate increase of 22.9 percent for coverage purchased on and off the exchanges. The company said in a statement that while it felt the increase was too steep, it was necessary due to the assumption that federal cost sharing reduction (CSR) subsidies won't be made next year. (Weixel, 5/25)

As a not-for-profit insurer, Blue KC doesn’t pay dividends to shareholders. Rather, if income exceeds expenses, the profits are put in reserve to offset losses in future periods. According to current Blue KC CEO Danette Wilson, the recent losses were unsustainable, and sticking with the exchange no longer was a viable option. (Stafford, 5/25)

White House Office of Management and Budget Director Mick Mulvaney on Thursday testified that the Trump administration does not believe $1.4 trillion worth of cuts it is proposing for Medicaid would affect children, the disabled or the elderly. Under questioning from Sen. Angus King (I-Maine) at a Senate Budget Committee hearing, Mulvaney argued that the cuts would simply slow the growth of Medicaid spending, not cut the program. (Elis, 5/25)

Fireworks erupted Thursday when President Trump’s budget chief sparred with a Senate panel over the administration’s proposed 2018 budget, most notably trading barbs with Sen. Bernie Sanders, I-Vt., over potential cuts to entitlement programs. ... Sanders also blasted the budget’s steep cuts to antipoverty programs, noting that they come at the same time the Trump administration is pushing for tax cuts that benefit the wealthy. He particularly criticized the proposed repeal of the estate tax. “Answer the question: The wealthiest family in America gets a $52 billion tax break as a result of the estate tax,” Sanders told Mulvaney. “Tell the American people why you think that’s good when you cut Medicaid and you cut programs for kids.” In his response, Mulvaney noted that it is difficult to predict the expected impact of the tax cuts on wealthy Americans. (Bahl, 5/25)

Just how much does the Trump administration want to cut Medicaid? No one -- including the White House -- is really sure. $600 billion? $800 billion? Or a stunning $1.4 trillion over the next decade? "It's north of $610 billion, but it's not $1.4 trillion," according to a senior official from the White House Office of Management and Budget. ... Mulvaney told lawmakers on Wednesday that the reduction in Medicaid spending from the president's budget and the House bill can't be added together because they "contain some of the same factors." Bottom line: We don't know how much the Trump budget would cut from Medicaid. ... The confusion has left many health care and budget experts across the political spectrum guessing at the figure. (Luhby, 5/23)

One unlikely group could be affected by the divestments in Medicaid outlined in the American Health Care Act, AHCA, passed by the House. Nearly one in 10 U.S. veterans rely on Medicaid either as their primary or secondary source for healthcare coverage and could lose access to care, according to a report by Families USA, a left-leaning healthcare advocacy group. (Christ, 5/25)

If President Donald Trump has his way, hundreds of thousands of Arizona’s poor would either lose access to food and health care or the state’s taxpayers would have to fork over a lot more in taxes. The proposed cutbacks to programs like food stamps, welfare and Medicaid in Trump's proposed federal budget could complicate the tax-cutting agenda of Gov. Doug Ducey, who would be pressed to find significantly more cash��to preserve the safety net in Arizona or face the reaction to abandoning the state's high poverty population. (Hansen and Pitzi, 5/25)

He slept next to his son's ashes most nights back when Kraig Moss first met Donald Trump. In a hall packed with Iowa voters, the presidential candidate looked the middle-aged truck driver in the eye and vowed to fight the opioid crisis that killed his only son two years earlier. (5/26)

It’s called being “dope sick” — when someone’s tired of getting high and no longer wants to spend the day searching for drugs. Addiction medicine physician Sarah Bagley sees kids who already have reached that stage... By the time they’re at the CATALYST Clinic at Boston Medical Center, a program designed to treat young people struggling with substance use, their lives have started to unravel. (Atoji Keene, 5/25)

Legislation to battle heroin and opioid overdoses in Maryland with education, prevention, treatment and law enforcement was signed into law Thursday by Gov. Larry Hogan. Matt and Cheryl Godbey, whose 24-year-old daughter Emily died in November from a fentanyl overdose, came from Frederick, Maryland, for the bill-signing ceremony. Matt Godbey applauded a new law that will bring stiffer penalties to drug dealers who knowingly sell fentanyl resulting in a death. Fentanyl is a painkiller that is often combined with heroin, with deadly results. (Witte, 5/25)

Cody Xiong cracked open his door, saw the investigator on his porch and 'fessed up, authorities say. “I guess,” Xiong said, “you are here for the opium.” The investigator wasn't. But suddenly, he was intrigued. What��followed was a massive opium bust, based entirely on a North Carolina poppy grower who thought prematurely that the jig was up. (Wootson, 5/25)

Federal postal and State Department officials pushed back Thursday on a congressional proposal��sponsored��by Ohio U.S. Sen. Rob Portman to require��advanced electronic tracking of all��packages and large envelopes mailed to the United States .Portman and others in Congress say would help��law enforcement stop��deadly opiates from reaching��dealers and users in a drug epidemic that last year��killed 666 people��in Cuyahoga County��--��more than in homicides, suicides and car crashes. (Koff, 5/25)

The National Institutes of Health is in hot water again with the House Energy and Commerce Committee over a scandal that occurred nearly two years ago at one of the agency’s main research institutions. On Thursday, the panel broadened its probe into safety and compliance issues at the NIH Clinical Center, a research hospital located on the agency’s campus in Bethesda, Maryland. In a letter sent to Director Francis Collins and obtained by Roll Call, the committee requested a larger swath of documents not yet provided by the agency. (Williams, 5/25)

Former North Carolina Rep. Renee Ellmers has landed a job in the Trump administration as director for the Department of Health and Human Service’s regional office in Atlanta. Ellmers started her job Wednesday, the News & Observer in Raleigh reported. Ellmers was the first Republican member of Congress endorsed by Trump, but lost her primary race last year to fellow Republican Rep. George Holding after redistricting. (Garcia, 5/25)

A family tree can reveal a lot, especially if it belongs to a microscopic troublemaker with a knack for genetic shape-shifting. DNA sleuthing can outline the route an emerging pathogen might take once it makes landfall in the Americas and encounters a wholly unprotected population. It’s a modern take on old-fashioned public health surveillance strategies that focused on the exhaustive collection and analysis of samples from the field. Now they’ve been bolstered by rapid genome sequencing — and the result can be a picture of an epidemic rendered in exquisite detail, and in near-real time. (Healy, 5/25)

In advance of the summer travel season, New York City health officials��on Thursday��stepped up warnings to would-be parents about the threat of contracting Zika, a mosquito-borne virus that has been linked to serious birth defects in babies and, in some cases, in utero deaths. (West, 5/25)

A quarter of all infants in the United States born with defects related to the Zika virus were born to women in New York City, city health officials announced on Thursday, a stark reminder of the dangers posed by the virus. Looking ahead to summer and the threat of the resurgent virus spreading through the Caribbean, the New York City Department of Health said that 402 pregnant women had been infected with the virus and that 32 infants had been infected with the virus and 16 of them had Zika-related birth defects since last spring. (Santora, 5/25)

Despite the toxic ingredients commonly found in e-cigarettes and other vaping products, many adults don't think secondhand e-cigarette aerosol poses a risk to children, according to a report published Thursday by the Centers for Disease Control and Prevention. About one-third of adults surveyed didn't know if secondhand aerosol caused harm to children, and 40 percent of the adults said this kind of exposure caused "little" or "some" harm to children. (Columbus, 5/25)

Nearly three dozen consumer, environmental and public health groups on Thursday pressed privately held In-N-Out Burger to make good on its vow to set time lines for phasing out the use of beef raised with antibiotics vital to human health. Some 70 percent of antibiotics needed to fight infections in humans are sold for use in meat and dairy production. Medical researchers say overuse of the drugs may diminish their effectiveness in fighting disease in humans by contributing to the rise of dangerous, antibiotic-resistant bacteria often referred to as "superbugs." (Baertlein, 5/25)

If you’re one of the almost two billion active users of Facebook , the site’s blend of gossip, news, animal videos and bragging opportunities can be irresistible. But is it good for you? A rigorous study recently published in the American Journal of Epidemiology suggests that it isn’t. Researchers found that the more people use Facebook, the less healthy they are and the less satisfied with their lives. To put it baldly: The more times you click “like,” the worse you feel. (Pinker, 5/25)

Perhaps the biggest budget skirmish that remains unsolved this year is how California should spend revenue from the tobacco tax voters approved last fall. Gov. Jerry Brown wants to put that money to expand overall spending on Medi-Cal, which provides subsidized healthcare for the poor. But the some of initiative's backers, namely doctor��and dental groups, have cried foul, arguing that money is meant to go to increasing payments for providers. (Mason, 5/25)

Forty-two percent of emergency room visits in Massachusetts in 2015 were for problems that could have been treated by a primary care doctor, according to the state's Health Policy Commission. This state agency, which is charged with driving down costs, says a 5 percent cut in avoidable emergency room trips would save $12 million a year; 10 percent fewer such visits would save $24 million. (Bebinger, 5/25)

Insufficient services, a complex funding system and deep state budget cuts have increasingly stranded developmentally disabled children in hospital emergency departments over the past year, often for weeks at a time, two state advocates told legislators Thursday. Sarah Eagan, Connecticut’s child advocate, and Ted Doolittle, the state’s healthcare advocate, said the problem is centered almost exclusively on children with “complex diagnoses,” meaning they face a combination of developmental and intellectual disabilities and mental health conditions. (Phaneuf, 5/25)

Doctors, parents, city leaders and healthy home advocates took turns Wednesday telling the Ohio Senate Finance subcommittee on Health and Medicaid why they oppose an amendment to the state budget that would strip municipalities of authority to create local efforts to address childhood lead poisoning... Rep. Derek Merrin, a Republican who represents parts of Lucas and Fulton counties, proposed the amendment last month and has argued that a fractured system of rules that change from city-to-city is not only unfair to landlords but doesn't give all children in Ohio equal protection from lead exposure. (Dissell and Zeltner, 5/25)

ens of thousands of rape kits are sitting on shelves in police and sheriff’s department evidence rooms nationwide. And no one has tested them to see what crimes they could help solve. A bill by Assemblyman David Chiu (D-San Francisco) would help determine how many of those unanalyzed exam kits exist in California, part of a national backlog that federal officials have grappled with for nearly two decades. (Ulloa, 5/26)

A new law will allow Kansas crisis centers to treat involuntary mental health patients for up to 72 hours, but it isn’t clear if lawmakers will fund it. Gov. Sam Brownback on Wednesday signed House Bill 2053, which allows crisis centers to treat people deemed a danger to themselves or others because of a mental health or substance use disorder. The bill had passed the House unanimously and passed the Senate 27-12 after some amendments.��Lawmakers didn’t allocate funding for additional crisis center beds before they left for the Memorial Day weekend, although they have yet to finalize a budget. (Wingerter, 5/25)

With a state deadline looming, some California hospitals still need to retrofit or rebuild so that their structures can withstand an earthquake — and money remains a challenge. Some hospital officials are turning to voters to raise money, while others are pursuing more innovative financing schemes.About 7 percent of the state’s hospital buildings — 220 — are still designated as having the highest risk of collapse following an earthquake, according to the Office of Statewide Health Planning and Development. That’s a slight drop from 251 buildings a year ago. (Ibarra, 5/26)

To ease chronic bottlenecks in countywide mental health services, Hennepin County Medical Center (HCMC) is nearing completion of a new 16-bed home that will help people with mental illnesses transition back into the community after acute hospital stays. The Victorian-style home, located at 3633 Chicago Av. in south Minneapolis, will provide short-term housing and treatment for adults who are stable enough to be discharged from a hospital psychiatric unit but who may need more therapy and social support before returning to their regular homes and jobs. (Serres, 5/25)

It was only after her doctor recommended she get an abdominal MRI that a New Orleans woman learned just how costly it can be to have a medical procedure without first shopping around.��The woman, who asked to remain anonymous in order to discuss her health, said her doctor suggested the MRI to help her understand a hereditary condition that might affect her years from now. A month later, the day before the test, she got a call from Tulane Medical Center asking how she planned to pay for it, she said. (Lipinski and Zurik, 5/25)

In recent private negotiations between the Texas House and Senate about which public programs to fund and how to fund them, state lawmakers opted to kill a $3 million initiative to rehabilitate victims of sex trafficking. That ended hopes from child welfare advocates that 2017 would be the first year in recent memory in which state lawmakers might set aside funds specifically intended to help victims who were sold for sex. (Waltersn, 5/25)

To serve the refugee community in Akron's North Hill, AxessPointe Community Health Centers will provide a weekly healthcare clinic at the Exchange House. The Exchange House, created by the Better Block Foundation, serves as a community center for the large refugee population, predominantly Bhutanese, which travels mostly on foot and has a large number of children and senior citizens. (Conn, 5/25)

Five days a week, a team of nurses and a rotating cadre of pediatricians, nutritionists and dentists at the Gilbert Community Clinic see not just schoolchildren but Walker County residents of all ages...��Although the idea of a general medical clinic on the grounds of a public school sounds novel, it’s not a new idea in Georgia. (Park, 5/25)

Last year, Meals on Wheels programs brought nearly 4 million meals to 28,000 seniors living in Georgia. But federal support for this program could shrink under President Trump’s proposed budget. If the federal portion of funding for the program is cut, the effects will reverberate in tiny towns like Chickamauga, where Betty Richardson delivers lunches every week. (Male, 5/25)

[Alex] Pantelyat, 34, a Johns Hopkins University neurologist (and, not so incidentally, an accomplished violinist) is a co-founder and co-director of the Center for Music & Medicine, an emerging collaboration between the Johns Hopkins medical community and the Peabody Institute.��The mission, he said, is to combine the expertise of faculty members in both camps toward a pair of ends: integrating music and rhythm into medical care and improving the health of musicians worldwide.��More than 80 Johns Hopkins faculty members across dozens of disciplines have affiliated themselves with the center, the first of its kind in the eastern United States. (Pitts, 5/26)

Arizona's new law mandating paid sick leave starts July 1, and employers had better be prepared for it. Businesses and non-profit groups could face penalties for failing to keep adequate records or post sufficient notice, and they could incur��damages for failing to provide paid sick time. Employers who retaliate against workers exercising their rights could face fines of at least $150 per day, say attorneys at Gallagher & Kennedy, a Phoenix law firm that held a workshop to alert employers of the requirements. (Wiles, 5/25)

Lynne Meccariello, unit support supervisor of the neonatal intensive care unit and a liaison for the hospital’s volunteer services department, describes the cuddling program as providing “developmental care and comfort to babies when their parents can’t be there.” Meccariello says holding a sick baby reduces pain and provides warmth, and the cuddler encourages “self-soothing” – children’s ability to comfort themselves when they aren’t being held. (George, 5/25)

Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? ... In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 5/17)

40 810 adult travelers were included [in an observational study in U.S. pretravel clinics]; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]). (Hyle et al., 5/16)

Conventional wisdom holds that health care cost growth is high and the Affordable Care Act (ACA) has done little to address the problem. However, overall increases in national health expenditures (NHE) since the law passed have been lower than anticipated, premiums and premium growth in the ACA’s health insurance marketplaces are high in some states but quite low in others, and growth in Medicare and Medicaid spending per enrollee has been very modest. NHE are still high, now at 18.3 percent of gross domestic product .... In this brief, we attempt to address several misconceptions about recent spending increases; these misconceptions are centered in three areas: the recent and projected growth in NHE the levels and recent growth of ACA marketplace premiums the recent and projected spending growth in the Medicaid program. (Holahan et al., 5/25)

Using the 2013-2015 American Community Survey, this brief finds improvements for both parents and children in uninsurance, Medicaid/CHIP participation, and the number who are eligible for Medicaid/CHIP but not enrolled. Uninsurance fell nationally and in nearly every state, and the number of eligible but uninsured children fell to 2.1 million – declining by over half since 2008. Children’s participation reached 93.1 percent in 2015 (exceeding 90 percent in 36 states), while participation among parents rose to 80.2 percent, with larger gains between 2013 and 2015 in expansion states than nonexpansion states. Participation grew among every subgroup of children and parents examined. (Kenney et al., 5/17)

Medicaid, the Title X Family Planning Program, and Section 330 of the Public Health Service Act (PHSA) are the leading sources of federal funding for the over 10,000 safety-net clinics across the country that provide reproductive health services to low-income women, men, and teens. The Trump administration and the Republican leadership of the 115th Congress have proposed to block federal Medicaid funds from going to Planned Parenthood .... Changes to these programs and funding to the clinics that provide family planning services could limit the availability of contraceptive services, STI screenings and treatment, and preventive cancer screenings, along with other primary care services to low-income women. ... One in three low-income women reported that they obtained birth control from a family planning clinic such as Planned Parenthood or another health center or public health clinic. (Ranji et al., 5/11)

The gory details of the Congressional Budget Office’s report on the House legislation to “repeal and replace” Obamacare are, in many ways, superfluous. The bill’s flaws, substantive and otherwise, have long been evident. Less clearly understood, though equally disturbing, is the larger political context. (5/25)

Most of the news coverage highlighted the CBO’s estimate that 23 million fewer Americans would have health coverage in 2026 under the bill. But in 2026, most current House Republicans will be lobbyists and strategic consultants — and some future Congress would get the blame. In political terms, the scariest CBO number was that 14 million fewer Americans would be without health insurance next year. And many of these suddenly uninsured people just might remember whom to blame when they cast their 2018 ballots. (Walter Shapiro, 5/26)

Glendale resident David Cannizzaro has had asthma since he was 7. Prior to Obamacare, his healthcare strategy was to see the doctor as little as possible so his insurer wouldn’t notice his preexisting condition and decide to raise his rates or drop his coverage. Now that Republican lawmakers are advancing a bill that would repeal the Affordable Care Act and potentially allow insurers to jack up premiums for people with preexisting conditions, Cannizzaro, 49, said he’s once again living in fear. “It’s very, very scary,” he told me. (David Lazarus, 5/26)

Republican senators who are being asked today about the brutal Congressional Budget Office score of the health-care plan that passed the House have a ready answer: That doesn’t have anything to do with us. Numerous senators released statements saying that the CBO score just shows that the American Health Care Act (AHCA) is a radioactive fungus, which is why they’re starting over on their own bill. (Paul Waldman, 5/25)

The new Congressional Budget Office score of the American Health Care Act is devastating. In 2026, 23��million fewer Americans would be insured with it than without it. The response of the secretary of health and human services and other defenders of the Republican bill? Attack the Congressional Budget Office. I had the honor of running the CBO a decade ago and will be the first to admit it’s not perfect. But it’s also far better than the alternatives, and most of the critiques are off base. (Peter Orszag, 5/25)

Seventeenth century playwright William Congreve famously wrote that hell has no fury like a woman scorned. House Republicans may feel some of that heat once their constituents find out the healthcare bill they passed could make maternity coverage vastly more expensive and harder to obtain. It’s widely known that the House GOP’s proposed American Health Care Act would bar federal funding for Planned Parenthood, which provides many reproductive and maternal health services to lower-income women across the country. Less well understood is that an amendment to the AHCA would also allow states to lift the mandate that insurers include maternity coverage in all the policies they sell to people in the individual and small-group markets (i.e., everyone not covered by a large company health plan). (Jon Healey, 5/25)

Women make the majority of decisions about care and insurance for our families, and we generally consume more healthcare than men. As a result, women have a lot at stake when it comes to the laws that govern American healthcare and insurance. In 2010, the Affordable Care Act — Obamacare — made it illegal for insurers to charge women more than men and mandated that insurance plans cover women’s preventive care, including birth control, with no copay. Therefore, some now suggest repealing the Affordable Care Act would be detrimental for women’s health. But the opposite is true: Repeal will afford women greater choice and lower costs when it comes to insurance plans, doctors and care. (Hadley Heath Manning, 5/25)

One of 13 Republican senators drafting a new health care bill, Pennsylvania Sen. Pat Toomey favors whittling down Medicaid expansion funding. As Medicaid is the largest payer for medication-assisted treatment for substance use disorders nationwide, he will influence the care available to poor heroin and opioid-addicted adults in Pennsylvania and nationwide. (5/25)

Fred Upton is a 16-term congressman who may or may not be interested in becoming Michigan's next U.S. senator. But there are almost certainly some Republican U.S. senators interested in becoming the next Fred Upton. A grandson of Whirlpool Corp. co-founder Frederick Upton, Rep. Upton is among the wealthiest members of Congress. Until 2016, he served as chair of the House Committee on Energy and Commerce. (Brian Dickerson, 5/25)

California Democrats now number more than 8 million for the first time, hold every constitutional office, and command a supermajority in the Legislature because we reflect the values of the citizens of our state.But we are not resting on our laurels, far from it. While President Donald Trump and Republicans in Congress are talking about slashing health care for 23 million Americans, California Democrats re-emphasized their belief that health care is a right, not a privilege, as we pursue Medicare for all with Senate Bill 562. (Eric Bauman, 5/25)

Iowa is now 14 months into its experiment with privatized Medicaid management. ... Privatization is a slow-motion train wreck, with providers across the state closing up shop or taking out loans to make payroll because the checks from Medicaid are slow to arrive and patient services are being paid at a lower rate. At the same time, the managed care organizations that Iowa hired to administer Medicaid say they are losing millions, and need an enormous increase in funding in order to make ends meet. This was not only predictable, it was predicted. (5/25)

In what could be a disturbing portent, Blue Cross Blue Shield of Kansas City on Wednesday announced it was pulling out of the Obamacare health exchanges in 2018. The decision will leave 67,000 people in 25 Missouri counties and two Kansas counties with no option for private insurance, subsidized or not, under the Affordable Care Act. Blue Cross Blue Shield announced it had lost nearly $100 million on Obamacare policies since 2014; only last year did it take in more premium money than it paid out, and overhead costs pushed the Blues into the red. (5/25)

There is plenty to criticize, or even be outraged by, in the 2018 budget unveiled this week by the Trump administration��without having to resort to the hackneyed end-of-the-world rhetoric used by advocates and interest groups — and, alas, too many journalists — in response to every proposed cut in government spending. (Steven Pearlstein, 5/25)

For journalists covering domestic policy, this past week poses some hard choices. Should we focus on the Trump budget’s fraudulence — not only does it invoke $2 trillion in phony savings, it counts them twice — or on its cruelty? Or should we talk instead about the Congressional Budget Office assessment of Trumpcare, which would be devastating for older, poorer and sicker Americans? There is, however, a unifying theme to all these developments. And that theme is contempt — Donald Trump’s contempt for the voters who put him in office. (Paul Krugman, 5/26)

But there’s a giant hole in Medicare coverage, a hole that many aging American seniors eventually fall into: Nursing home care isn’t generally covered, and neither is full-time assistance at home. But if you live to 65, there’s a 40 percent chance you’ll enter a nursing home in the future. And it’ll cost you $80,000 to $90,000 a year on average. So where does that money come from if Medicare won’t pay? The answer is Medicaid, the other government insurance program, the one more often associated with the poor than the elderly. About 60 percent of nursing home residents rely on Medicaid. Which means that if the Republican plan to slash $834 billion from Medicaid goes forward, it could have a devastating impact on seniors with critical health needs. (Evan Horowitz, 5/25)

Whhen the White House unveiled its 2018 budget on Tuesday, plenty of Democrats were quick to characterize it as stingy and cruel. Among the exhibits for the prosecution was the plan for Social Security Disability Insurance, whose projected outlays the administration would cut by 5 percent by 2027. White House budget director Mick Mulvaney started the argument in March. "It's the fastest growing program," he asserted. "It grew tremendously under President Obama. It's a very wasteful program, and we want to try and fix that." He was promptly accused of factual sloppiness and heartlessness, and some of the criticism was justified. But Mulvaney is onto a real problem that demands attention. (5/25)

Cutting health care for the poor is a dream come true for many congressional Republicans. And that’s not an exaggeration, but a direct quote: “So Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this” since college, House Speaker Paul Ryan said in March. So, what are food stamp recipients who do work but don’t earn enough to feed their families to do? Get “the right mind-set,” says HUD head Ben Carson, since poverty is largely “a state of mind.” (Melinda Henneberger, 5/25)

Genetic information is becoming ubiquitous in research and medicine. The cost of genetic analysis continues to fall, and its medical and personal value continues to grow. Anticipating this age of genetic medicine, policymakers passed laws and regulations years ago to protect Americans’ privacy and prevent misuse of their health-related information. But a bill moving through the House of Representatives, called the Preserving Employee Wellness Programs Act (H.R. 1313), would preempt key protections. Because the bill, which was sent to the full House by the Education and the Workforce Committee in March, would substantially change legal protections related to the collection and treatment of personal health and genetic information by workplace wellness programs, it should be on the radar screens of physicians, researchers, and the public. (Kathy L. Hudson and Karen Pollitz, 5/24)

People with health insurance tend to think of safety-net hospitals the way airline travelers think of the bus: as a cheaper service they would use only if they had to. But without these essential hospitals — which specialize in the care of our country’s most medically and financially vulnerable, particularly the uninsured — our entire health care system would be in danger. (Ricardo Nuila, 5/26)

America's opioid epidemic is not manufactured hype; it's real. Prescription painkillers are now more widely used than tobacco. Opioids were to blame for 31,000 overdose deaths in 2015, a 300 percent increase from 1999. Of the top ten drugs involved in overdose deaths, half are prescription opioids. (Ross Pomeroy, 5/25)

For serious or life-threatening disease, the Food and Drug Administration (FDA) can approve drugs on the basis of surrogate end points that are “reasonably likely to predict clinical benefit,” through its accelerated approval review track. This pathway, which dates back to the early 1990s, was designed as a response to the demand for faster drug development in the context of the HIV/AIDS crisis. Since then, the accelerated-approval program has expanded to include oncology products and drugs for other diseases, now accounting for about 10% of new drug approvals. (Walid F. Gellad and Aaron S. Kesselheim, 5/25)

California’s mentally ill children need clearer laws when going through the juvenile court system...��While competency laws exist for juveniles suffering from mental illness, there are no clear, prescriptive guidelines for juveniles on the delivery and duration of services like those that exist in the adult system. Because of this gap in the law, these very vulnerable children languish in juvenile halls, unable to receive the mental health treatment they desperately need. (Mark Stone and Laura Garnette, 5/25)

For decades, too many of Greater Cleveland's babies have been dying before their first birthday. In 2015, Cuyahoga County had an overall infant mortality rate of 10.5 deaths per 1,000 live births, nearly double the national rate. (5/25)

Scientific research is a critical national investment, providing strong economic and societal benefits that improve our quality of life. In Northeast Ohio, investments in scientific research and environmental protection have helped spur the growth of our local biotechnology and fuel cell industries, enhance our world-leading hospitals and universities, and revitalize the Cuyahoga River and Lake Erie. Yet the White House's budget proposal seeks to walk away from these investments, threatening our nation's ability to ensure a more prosperous future, healthy people, and a healthy environment. (Anne Jefferson, 5/26)

From flashy tech start-ups in Silicon Valley to modernized insurers in New York, everyone wants to “disrupt” health care. In practice, this is immensely more challenging than it sounds. Electronic health records (EHRs), more than a decade ago, were expected to revolutionize how health information is stored and shared. Yet, even today, 36 percent of office-based EHRs don’t permit secure messaging between patients and physicians, and 37 percent do not even allow patients to view their records. (Paul Howard, Yevgeniy Feyman and Amy Shefrin, 5/25)

For millennia the heart was thought to be the seat of emotions — the source of love, of course, but also kindness and courage. To lose heart is to lose the fight, and perhaps even one’s life. In a literal sense, a weak heart means death. Unfortunately, sudden cardiac arrest is the leading natural cause of death in the United States. (Kamal Patel, 5/25)