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The Republican health care push was declared dead Wednesday morning. By afternoon it had a breath of life. Legislation in Washington can assume Frankenstein-like qualities. On the cusp of a humiliating and politically disastrous defeat, President Trump and the Senate majority leader, Mitch McConnell, took extraordinary resuscitative measures on Wednesday to pump oxygen back into their badly fading effort to overturn the Affordable Care Act. They somehow managed to stave off its imminent demise. (Hulse, 7/19)

Republicans struggling to agree on healthcare legislation to overhaul Obamacare obeyed U.S. President Donald Trump's orders to try to swiftly reach a deal but were unable to resolve their differences in a long, late-night meeting. (Abutaleb and Cowan, 7/20)

The Republicans initially planned to bring in chiefs of staff and health care wonks to advance the negotiations. White House Chief of Staff Reince Priebus was expected to join and help push the disagreeing GOP senators to yes. But as the senators kept talking, they reevaluated their plan and decided not to allow staff in and keep the room to members only. Priebus strolled out of Sen. John Barrasso’s office, as did White House legislative director Marc Short. The senators would keep talking amongst themselves. Talks “narrowed down to try to figure out what is causing members not to be able to vote in favor or problems they have with the bill,” said Sen. Jerry Moran (R-Kan.), who opposes the GOP’s latest repeal and replace draft. “It had merit and it’s something that should have been taking place.” (Everett, Kim and Haberkorn, 7/19)

Thune and Sen. Roy Blunt (R-Mo.), both members of Senate leadership, expressed optimism about injecting new life into the process following a closed-door lunch with President Trump earlier in the day. It is not clear what approach Senate Republicans will take in the negotiation. (Carney, 7/19)

McConnell appears to believe that if he can get the Senate to agree to open debate on an ObamaCare measure, he’ll have an opportunity to clear legislation by grinding away at his members. As the pressure intensifies, he clearly hopes that opposition will fall away. But he first must get past the motion to proceed. (Roubein, 7/20)

A bill the Senate plans to vote on next week to repeal parts of Obamacare without a replacement would make the insurance market unstable, raise premiums and increase by 32 million the number of uninsured people, according to an analysis released Wednesday by the non-partisan Congressional Budget Office. While repealing billions of dollars in taxes imposed under Obamacare to pay for expanding health coverage to millions more Americans, the legislation would still decrease deficits by $473 billion over 10 years because of the spending reductions. (Groppe, 7/19)

The nonpartisan scorekeeper’s report projects that 17 million people would lose insurance in the first year after a partial repeal that includes ending Obamacare’s Medicaid expansion and repealing most of the taxes tied to the law. Premiums would jump 25 percent over that same period as insurers grapple with the effective elimination of Obamacare’s requirement that everyone purchase coverage. (Cancryn, 7/19)

The analysis also estimates that premiums for individual policies would rise by 25 percent next year if the number of people buying such policies plummets and concentrates sicker people in that insurance pool. (Goldstein, 7/19)

One reason premiums would sharply increase is that the legislation – which would voted on in the Senate under a process known as reconciliation – is unable to repeal certain ACA provisions that do not have a budgetary impact, the CBO said. So the “repeal” bill would leave some ACA mandates in place. (Radelat, 7/19)

The repeal-and-delay bill cuts less out of Medicaid than BCRA because while it ends the enhanced match for Medicaid expansion—which led to 12 million people getting coverage—it does not change the financing to Medicaid for the children, disabled adults, parents of young children and elderly people on the program. The enhanced match would only last in 2019 and 2020. The six-percentage-point increase for home health care waiver activities would also disappear at the beginning of 2020. (Lee, 7/19)

The CBO report examines the effect of repealing most of the health law without a replacement system in place. Mr. McConnell has called for a vote early next week on a motion that would allow such a repeal bill to be debated, a tactic he and Mr. Trump pursued after at least four Republican Senators said they couldn’t support moving forward on a Senate bill that sought to repeal and replace much of the law, also known as Obamacare, at the same time. (Armour, 7/19)

Senate Majority Leader Mitch McConnell has said the Senate would consider the measure if the chamber clears a procedural vote early next week to advance to debate on the House-passed health care bill (HR 1628). The measure would effectively repeal the law’s individual and employer mandates by retroactively making the associated penalties zero.The measure would repeal the optional Medicaid expansion beginning in 2020. Also beginning in 2020, it would repeal the law’s subsidies for insurance purchased on the individual exchanges. (McIntire, 7/19)

The unfavorable score of the repeal-only bill could help jumpstart discussions about returning to the repeal-and-replace legislation. A previous CBO score of the Senate’s repeal-and-replace bill estimated that 22 million people would lose insurance over the next decade. (Weixel, 7/19)

The administration dismissed the CBO analysis, saying its methodology is flawed. “This score fails to take into account the president’s full plan, which includes a replacement for Obamacare and administrative actions to reduce costs and expand access to quality, affordable care,” the White House said in a statement. (Edney and Tracer, 7/19)

The CBO estimates that legislation that repeals key pillars of the Affordable Care Act (aka "Obamacare") would trim $473 billion off the federal deficit, but result in 32 million fewer insured Americans in the next decade. It would also see premiums rise, and likely force private insurers to abandon the individual market. And nearly every Republican has already voted for it. (Davis, 7/19)

On Wednesday, the Congressional Budget Office released its estimates on an amendment to H.R. 1628 that would repeal the Affordable Care Act outright. (7/19)

Americans overwhelmingly want lawmakers of both parties to work out health care changes, with only 13 percent supporting Republican moves to repeal "Obamacare" absent a replacement, according to a new poll. Although a deep partisan divide endures over the 2010 Affordable Care Act, people may be less far apart on what policymakers should try next, says the Associated Press-NORC Center for Public Affairs Research survey. (Swanson and Alonso-Zaldivar, 7/19)

Americans aren't enthralled with "Obamacare" and they definitely don't like the Republican plans offered in Congress, so what does the public want the government to do about health care? A new poll suggests the country may be shifting toward the political left on the issue, with 62 percent saying it's the federal government's responsibility to make sure that all Americans have health care coverage, while 37 percent say it is not. (Alonso-Zaldivar and Kellman, 7/20)

President Trump ordered senators back to the negotiating table on Wednesday for a last-ditch effort to repeal and replace the Affordable Care Act, just one day after angrily accepting the measure’s demise and vowing to allow President Barack Obama’s signature domestic achievement to crater. (Davis, Kaplan and Haberkorn, 7/19)

Lecturing fellow Republicans, President Donald Trump summoned GOP senators to the White House Wednesday and told them face-to-face they must not leave town for their August recess without sending him an "Obamacare" repeal bill to sign. Senators responded by vowing to revive legislative efforts left for dead twice already this week. (Werner and Fram, 7/19)

"I don't think we should leave town unless we have a health insurance plan," Trump said during a White House lunch attended by 49 of the 52 Republican senators. "We shouldn't leave town until this is complete, until this bill is on my desk." (Jackson, 7/19)

At the lunch, the president also threatened electoral consequences for senators who oppose him, suggesting that Sen. Dean Heller (R-Nev.) could lose his reelection bid next year if he does not back the effort. The president also invited conservative opposition against anyone else who stands in the way.“ Any senator who votes against starting debate is really telling America that you’re fine with Obamacare,” Trump said. (Sullivan, Snell and Nakamura, 7/19)

“If you have declared war on the ACA and have let everyone know it, how do you convince someone that where it fails, it’s not your fault?” another GOP lobbyist and former congressional aide said. (Clason, 7/19)

But the public tongue-lashing from Trump might not be well received by Republican senators, many of whom believe he has failed to master the details of the healthcare proposal and did little to sell it. (Fabian, 7/19)

Senate Majority Leader Mitch McConnell (R., Ky.) said after the White House lunch that a vote on that motion would happen next week, regardless of whether it was expected to pass, and that he had “every expectation” of trying to eke out a bill with majority support after that. “I want to disabuse any of you of the notion that we will not have that vote next week,” Mr. McConnell said. (Radnofsky, Peterson and Armour, 7/19)

John Cornyn of Texas, the No. 2 Senate Republican, said Wednesday, “I think based on the discussions we had today that there’s more optimism that we could vote on a repeal and replace bill, rather than just a repeal bill." He added, "But if there’s not agreement then we’ll still vote on the motion to proceed" to debate the simple repeal measure. (Litvan, Dennis and Pettypiece, 7/19)

Former Trump campaign aides Corey Lewandowski and David Bossie met with Sen. Mike Lee to talk health care on Tuesday, a source familiar with the conversations confirmed. The two former top Trump campaign officials tried to convince the conservative Utah Republican to reverse course on his opposition to the latest Obamacare replacement bill written by Senate Majority Leader Mitch McConnell. (Everett, 7/19)

President Trump thought he could sell balky Republican senators like Ron Johnson of Wisconsin on the Senate health care bill through pleasantries, cajoling and, ultimately, some Oval Office muscle. But Mr. Johnson could not be charmed. He could not be outbargained. And he could not be scared into supporting the measure for the sake of a president whose inability to bend fellow Republicans toward his political will has become a liability for his young presidency. (Thrush and Haberman, 7/20)

After efforts to repeal the Affordable Care Act collapsed, President Trump pressed Republican lawmakers to keep their seven-year promise by demonstrating a sales pitch they could use: point out the flaws of the current law and “sell our plan.” Here’s an assessment. (Qiu, 7/19)

President Trump did not do much to sell the Senate health care bill before its failure. But he gave the sale a shot Wednesday in the White House before cameras and a captive audience of nearly all the Republican senators. His comments were at times confusing, and in some cases, outright incorrect. It shows the challenge for a president who doesn't dive deeply into policy to sell his agenda. (Kurtzleben, 7/20)

A Health and Human Services analysis of Sen. Ted Cruz's proposal to let insurers sell plans that don't comply with Obamacare regulations appears to back up the Texas Republican's claim that the idea would lower premiums across the individual insurance market. But the internal report relies heavily on a so-called proprietary model that offers little insight into its calculations, raising immediate concerns about how the agency came to its conclusions. (Cancryn, 7/19)

Contradicting the opinion of most policy experts, a draft report from the Trump administration forecasts better enrollment and lower premiums for everyone who buys their own health insurance if a controversial amendment proposed by Sen. Ted Cruz of Texas were to become law. The draft surfaced just as Republican senators were lunching with President Donald Trump on Wednesday to talk about the next steps in the health care debate. (Appleby and Rovner, 7/19)

The Trump administration pressed its case to revive the Senate’s stalled health overhaul using a rosy estimate of the effects of an amendment offered by Texas Senator Ted Cruz designed to win over wary conservatives. The estimate said Cruz’s proposed amendment to the Senate’s Better Care Reconciliation Act would offer consumers cheaper plans and result in more people buying health insurance than under the status quo, according to a Department of Health & Human Services document obtained by the Washington Examiner. The plans would come with extremely high deductibles, according to the analysis, and might not cover some basic services. (Tracer, 7/19)

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, told moderate GOP senators at a White House meeting Wednesday that the administration is willing to hammer out a new Medicaid proposal. The latest proposal, which senators are calling a “Medicaid wrap-around,” would give states more flexibility to use Medicaid funding to cover the healthcare expenses of people outside the program who face high healthcare costs. (Bolton and Sullivan, 7/19)

In a bold move to revive their healthcare bill, Senate Republican leaders are getting ready to propose giving $200 billion in assistance to states that expanded Medicaid, according to a person familiar with internal Senate negotiations. The huge sum would be funded by leaving in place ObamaCare’s net investment income tax and its Medicare surtax on wealthy earners, according to the source briefed on the proposal. ... The windfall for Medicaid expansion states would come on top of a proposal that Seema Verma, the administrator of the Centers for Medicare and Medicaid, made to moderate GOP senators at a lunch meeting at the White House on Wednesday. (Bolton, 7/19)

A GOP strategy of attaching a major Medicaid overhaul to their health care bill has made it more difficult for Republicans to make good on their seven-year promise to roll back the 2010 health care law, budget experts say. “Had Medicaid been not a part of the House bill or the Senate bill, I think we would be having a much different discussion than we’re having today,” said G. William Hoagland, a senior vice president at the Bipartisan Policy Center and longtime Senate aide on budget issues. (McIntire, 7/19)

Tymia McCullough fidgets in front of a mirror in her hotel room as her mom, Susie Pitts, puts the final touches on her hair and nervously drills her on what she is going to say when she gets to Capitol Hill. "And this is where you let them know that Medicaid is what?" Pitts asks. "Health assurance," Tymia responds."Health insurance that does what?" "It pays for the need to see your doctor," Tymia says. (Kodjak, 7/19)

In the Netherlands, the government sought to give people more “skin in the game” in its national health system. The idea — long supported by U.S. conservatives, even for poor people on Medicaid — is that when patients have to shell out some cash for their care, they won’t seek unnecessary services. In 2012, the Dutch government imposed mandatory co-payments for mental-health care on adults but not children .... The result: Adults’ use of regular mental-health services abruptly dropped 13.4 percent for both severe and mild disorders. The decline was even sharper for poor people. For children, who had no co-pay, there was no appreciable change. (Sapatkin, 7/19)

One of the primary reasons the Senate Republicans' proposal to repeal and replace the Affordable Care Act failed to get enough votes is because of how it would have cut Medicaid spending. Children's hospitals are particularly concerned about the possibility of Medicaid cuts, and the impact on children. (Young, 7/19)

People who work at hundreds of rural hospitals are also watching [the national debate on a health care bill] closely. Those hospitals have struggling budgets that were propped up by the massive influx of poor people who gained taxpayer-funded health insurance. The transformation has been especially dramatic in Kentucky, where rural hospitals are not just a lifeline for patients who may not have the means to travel far for the help they need. They also sustain local economies, providing jobs and services that people there have come to see as indispensable in some of the nation's poorest and most isolated communities. (Beam, 7/19)

Clinton attorney Ronald Morton helps the elderly protect their stuff — sometimes so they can use Medicaid to pay for long-term, end-of-life health care as opposed to spending their savings. ... While Mississippi lawmakers discuss cracking down on the state's growing Medicaid rolls by vetting applicants more closely, this is not a scenario that enters the conversation. ... In Mississippi, three out of four nursing home residents receive Medicaid benefits. That's 13 percent more than the national average. But it is difficult for Medicaid officials to determine how much of an impact "Medicaid planning" has on the state. ... [Morton] says, most of his clients are middle class. (Wolfe, 7/20)

Health advocates are warning that dentists across Iowa may stop accepting Medicaid patients because of the state's move to shift management of the dental system to for-profit companies. A clause in the new contracts signed with those for-profit management companies says dentists who accept Medicaid can't discriminate against patients based on their eligibility to enroll in the program. (Clayworth, 7/18)

Iowa’s shift to a privately managed Medicaid system continues to draw more detractors than fans, a new Des Moines Register/Mediacom Iowa Poll shows. Forty-seven percent of Iowa adults think the state should go back to having a state-run Medicaid system, according to the poll. Thirty-seven percent think the state should continue to have private companies run the program. Sixteen percent are unsure. (Leys, 7/19)

House conservatives are launching a late effort to force their colleagues to vote on an outright repeal of Obamacare. Leaders of the hard-line House Freedom Caucus on Wednesday evening will jump-start a process intended to force the measure — a mirror of the 2015 repeal proposal that President Barack Obama vetoed — to the floor as early as September. (Cheney and Bade, 7/19)

Rep. Tom Garrett (R-Va.) filed a special rule on Wednesday to start the process of triggering a vote, a GOP aide said. The measure will have to wait at the House Rules Committee for at least a week, meaning any vote wouldn’t be until after the August break. "This is a message to House leadership that we support their best efforts and we want to work with them to continue to move the ball forward to do what we all said we wanted to do," Garrett said at a press conference with other Freedom Caucus members. (Marcos, 7/19)

GOP infighting intensified Wednesday as conservative leaders vowed to punish "traitorous" Republicans for abandoning promises on health care and activists lined up to run against the party's own congressmen across the nation. (7/19)

Conservative leaders on Wednesday called Republican senators who opposed recent GOP healthcare legislation "traitors" who need to keep their promises to the grassroots base. FreedomWorks is planning on giving healthcare holdouts a “Freedom Traitors Award" that will be delivered to the offices of “senators who refuse to vote for the repeal," according to Vice President of Legislative Affairs for FreedomWorks Jason Pye on a conference call reported by CNS News. (Delk, 7/19)

Senator John McCain, the 2008 Republican presidential nominee known for his independent streak over more than three decades representing Arizona in the Senate, has brain cancer, his office disclosed Wednesday night in a statement from the Mayo Clinic. Mr. McCain, 80, has a glioblastoma, one of the most common but also one of the most malignant brain tumors. It can be treated with chemotherapy and radiation, but medical experts said it almost always grows back. (Hulse, 7/19)

“It’s a very aggressive tumor,” said Dr. Joseph Zabramski, a neurosurgeon at Barrow Neurological Institute in Phoenix not involved in McCain's treatment. “In general, it is a tumor that has relentless force. You can slow it down but not stop it.” (Nowicki, 7/19)

“The senator and his family are reviewing further treatment options,” the statement added, saying McCain’s “underlying health is excellent.” (Barabak, 7/19)

McCain’s significance inside Congress is hard to overstate — and his absence, however long, will reverberate across the Capitol. The Arizonan’s illness leaves Senate Majority Leader Mitch McConnell (R-Ky.) — and by proxy President Trump, who has openly mocked the Arizona senator — with 51 votes, the barest of majorities at a time when Republicans are divided on such issues as health care, taxes and defense spending. (Sullivan, Demirjian and Kane, 7/19)

Abrupt news that Arizona Sen. John McCain was diagnosed with brain cancer sent shock waves through an all-Republican meeting late Wednesday on the health care effort. Amid words of concern and encouragement for their GOP colleague, lawmakers acknowledged the difficulty his extended absence would place on the effort to overhaul the U.S. health insurance system. ... “Obviously, I think more people are worried about his health than thinking about the math, but you know, you understand the math,” Tennessee GOP Sen. Bob Corker told reporters about McCain. “Obviously, it makes things difficult.” (McIntire and Williams, 7/20)

Glioblastoma, the cancer with which Sen. John McCain (R-Ariz.) has been diagnosed, is a highly lethal malignancy that killed Sen. Edward Kennedy (D-Mass.) and Beau Biden, the son of former vice president Joseph Biden. Here is what you need to know. (McGinley, Sun and Bernstein, 7/19)

Senator John McCain has been diagnosed with the aggressive brain cancer glioblastoma, his office said on Wednesday. McCain had undergone surgery to remove a blood clot above his left eye last week, and a subsequent pathology report of that tissue found that it was cancerous. “The Senator and his family are reviewing further treatment options with his Mayo Clinic care team,” the release says. (Begley, 7/19)

While there’s been a wave of new cancer treatments that are changing the outlook for certain types of tumors like skin cancer and some blood cancers, the brain continues to be a difficult organ to treat, largely due to the blood-brain barrier, a membrane that protects the brain from foreign invaders, but also prevents many drugs from crossing. (Chen and Sobczyk, 7/19)

Senate Majority Leader Mitch McConnell (R., Ky.) issued a brief statement late Wednesday calling Mr. McCain, who was a POW during the Vietnam War, a hero to Senate Republicans and to the country. “He has never shied from a fight and I know that he will face this challenge with the same extraordinary courage that has characterized his life,” Mr. McConnell said. “We all look forward to seeing this American hero again soon.” (Hughes, 7/19)

President Trump, former presidents Barack Obama, Bill Clinton and George H.W. Bush, members of Congress and other Washington officials put aside bickering and partisan gridlock Wednesday night in a show of support for Sen. John McCain (R-Ariz.), who announced he was diagnosed with a brain tumor. (Horton, 7/19)

President Trump released a statement saying, "Senator John McCain has always been a fighter. Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. Get well soon." (Farrington, 7/19)

Lawmakers encouraged Sen. John McCain (R-Ariz.) and shared well wishes after it was announced Wednesday night that he had been diagnosed with a form of brain cancer. "John McCain is a hero to our Conference and a hero to our country," Senate Majority Leader Mitch McConnell said in a statement Wednesday night. "He has never shied from a fight and I know that he will face this challenge with the same extraordinary courage that has characterized his life." (Delk, 7/19)

Key ObamaCare subsidies to insurers will be paid this month, the White House confirmed to The Hill on Wednesday, one day before the deadline to make July's cost-sharing reduction (CSR) payments. The administration has not made a commitment beyond this month.The payments help low-income people afford the co-pays, deductibles and other out-of-pocket costs associated with health insurance policies. Insurers have called the payments critical, saying that without them, they would have to massively increase premiums or exit the individual market. (Weixel, 7/19)

You might expect that health insurance companies have been holding their breath, waiting to see what’s next. But it turns out many of the larger insurers don’t make much of their money selling insurance in the individual market. (Gorenstein, 7/19)

With Republican efforts to repeal Obamacare all but dead for the foreseeable future, attention has returned to the state of the Affordable Care Act, which is in limbo. While Republicans like to say the law is collapsing, the reality is far more complicated. Four years after it began offering coverage, Obamacare provides insurance to about 12 million people through private policies purchased on exchanges. Although the system is working as intended in many parts of the country, some insurance marketplaces are beset by serious problems, with insurers raising premiums or pulling out altogether. (Tracer and Recht, 7/20)

Health insurance markets created by the Affordable Care Act may not be on the verge of collapse, but President Donald Trump could nudge them in that direction by following through on his plan to let the Obama-era law fail. (Murphy, 7/19)

The New Hampshire Insurance Department is seeking a federal waiver aimed at lowering the price of health insurance for next year’s Obamacare plans, but Governor Chris Sununu opposes part of the Department’s idea for how to do it. ... In (very) simplified terms, a reinsurance program creates a pool of money that would then be used to reimburse insurance companies when their policyholders need extremely high-priced medical care. (Bookman, 7/20)

Tennessee's insurance commissioner is using her platform as the president-elect of a national insurance agency to urge the U.S. Senate to take quick action to make sure the individual insurance market does not crumble under the pressure of uncertain political reform. In particular, Julie Mix McPeak is calling on lawmakers to fund a subsidy known as cost-sharing reductions (CSR) through 2019 and allocate $15 billion for programs to offset costs associated with high-risk enrollees. McPeak outlined the proposed measures Wednesday in a letter to Senate leaders from the National Association of Insurance Commissioners, of which she is president-elect. (Fletcher, 7/19)

Capitol Hill’s health care heartburn has made its way to Georgia, where local stakeholders have been left anxious, confused and evaluating their own next steps after the Senate GOP’s effort to repeal and replace Obamacare came to a screeching halt. Local insurance companies urged Congress for action and certainty — and to do it quickly. (Hallerman, 7/19)

The Budget Committee plan faces opposition from both hard-core conservatives and more moderate Republicans even as it advanced through the GOP-controlled panel on a party-line 22-14 vote. It remains short of the votes required to pass through the House and advance to the Senate, where further complications await. The plan proposes deep cuts to safety net programs like Medicaid and food stamps and reprises a controversial Medicare plan strongly opposed by President Donald Trump — though Republicans are expected to only try to deliver on a small fraction of the cuts. (Taylor, 7/20)

The House Budget Committee on Wednesday agreed to bake in hundreds of billions in Medicaid cuts from its ACA repeal bill to the budget resolution, plus an additional $114 billion in cuts over 10 years. The committee's Republicans' unanimously approved the decision with no Democrats on board. The budget resolution, which is the foundation for passing tax reform in the Senate without Democratic votes, also assumes Medicare will reduce spending by $487 million from 2018 to 2027. (Lee, 7/19)

The House Appropriations Committee approved on Wednesday a $156 billion Labor-HHS-Education spending bill for fiscal 2018 that would boost spending for the National Institutes of Health while eliminating funding for Planned Parenthood and other family planning services. Committee members voted 28-22 to send the bill to the House floor after an 11-hour markup that saw 40 amendments proposed but few agreed upon. Two Republican members were not in the room to vote. The bill is $5 billion below current enacted levels (PL 115-31) and about $21.6 billion more than the White House proposed. (Wilkins and Siddons, 7/19)

An internal investigation of problems at New Hampshire’s only hospital for veterans recently found “no substantial or specific danger to public health” even though 11 members of the medical staff alleged a wide range of problems, from flies in an operating room to veterans permanently disabled due to neglect. But the top official at the VA on Wednesday pledged to disregard the June report’s conclusions and conduct a new “top-to-bottom review” of conditions at the Manchester VA Medical Center following a Globe Spotlight report describing the whistle-blowers’ charges. (Estes, 7/20)

Just days after he placed leaders at the Manchester Veterans Affairs Medical Center on leave, U.S. Secretary of Veterans Affairs David Shulkin is under fire for saying he hadn’t known about complaints of substandard care at the facility. U.S. Sen. Jeanne Shaheen sent a letter to then-Manchester VA leader Danielle Ocker in September 2016 – to which Shulkin was copied – regarding “significant concerns with the quality of care provided at the hospital.” (Duffort, 7/19)

A clogged toilet in a first-floor restroom at McGuire Veterans Affairs Medical Center in Richmond caused a backup and subsequent leak of contaminated water on Monday that spilled into a basement area where medical instruments are sterilized, a spokesman said. The affected area was evacuated immediately as hospital safety personnel worked to determine the cause of the spill, spokesman Patrick Gordon said in an email release. (Parker, 7/19)

Facing a predicted tidal wave of dementia sufferers, researchers across the United States are launching an ambitious clinical trial to test whether a package of low-tech life hacks can do something no pill or therapy currently can: prevent or delay cognitive impairment in Americans. (Healy, 7/19)

In a landmark report, scientists have endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible. (Graham, 7/20)

For decades, police have kept silent about the toll trauma takes on them, their families and their careers. One result, according to researchers, is that they have higher suicide rates than the general population. To change that, police departments across the country are turning to nonprofit or state-funded programs that help cops cope by connecting them to their peers and to mental health professionals. (Mindy Fetterman, 7/20)

Nearly half of all U.S. counties already lack a practicing OB-GYN. The American Congress of Obstetricians and Gynecologists projects a shortage of up to 8,800 OB-GYNs by 2020. And Pew Trusts predicts the nation could be 22,000 practitioners short in the decades that follow...The Doximity report, which looked data from more than 30,000 OB-GYNs practicing in the nation’s 50 largest metro regions, found the cities with the highest risk of a shortage had a confluence of doctors retiring early and few younger doctors replacing them. (Blau, 7/20)

A Facebook message pops up on my phone screen. “What’s going on in your world?” It’s from a robot named Woebot, the brainchild of Stanford University psychologist Alison Darcy. Woebot seems to care about me. The app asks me for a list of my strengths, and remembers my response so it can encourage me later. It helps me set a goal for the week -- being more productive at work. It asks me about my moods and my energy levels and makes charts of them. (Chen 7/20)

Despair over economic and social status is likely not to blame for a startling rise in death rates among middle-aged white Americans, according to a new study from researchers at the University of Colorado. After years of decline, mortality rates across the country have begun to increase, and life expectancy in some parts of the country is falling. The new study, though, pushes back on the popular narrative that this trend is the result of a loss of hope among middle-class whites. That narrative suggests despair has led to health problems, self-destructive behavior and earlier deaths. (Ingold, 7/19)

Fewer Americans are trying to lose weight compared with three decades ago, according to a surprising study published recently in the Journal of American Medical Association. This comes at a time when obesity rates nationwide are still climbing, along with chronic diseases linked to obesity. (Shah, 7/20)

The United Nations says that for the first time in the AIDS epidemic, more than half of all people with HIV are on drugs to treat the virus. AIDS deaths are also now close to half of what they were in 2005, according to the U.N. AIDS agency, although those figures are based on estimates and not actual counts from countries. (7/20)

In 2015, Zion Harvey became known to the public as the youngest person in the world to go through a successful bilateral hand transplant. Zion, who was 8 at the time, captured hearts with his upbeat attitude toward life and his wise-beyond-his-years expositions — on everything from losing both of his hands to an infection at age 2 to why he wanted to adopt a dog — in a widely shared video by the Children's Hospital of Philadelphia. The film documented Zion's life before the surgery and the complicated, high-risk procedure he underwent to gain a pair of new hands. (Wang, 7/19)

Key Missouri lawmakers say a prescription drug monitoring program that Republican Gov. Eric Greitens created through an executive order doesn't go far enough and that legislation is still needed. (7/19)

The Bureau of Workers’ Compensation’s board of directors has approved a rule that discourages surgery and opioid use in favor more conservative therapy for lower-back injuries. That includes physical therapy, chiropractic care and rest, anti-inflammatories, ice and other nonsurgical treatments. (Williams, 7/19)

The FBI last week seized patient records of Dr. Steven Simon, an Overland Park pain physician with ties to Insys Therapeutics, an opiate manufacturer at the center of a federal case that alleges prescriber kickbacks and insurance fraud... The owner of the pain clinic, Dr. Srinivas Nalamachu, said FBI agents showed up there with a search warrant for the medical records of every patient whom Simon had prescribed oral forms of fentanyl, a powerful synthetic opioid. (Marso, 7/19)

Tania Corchado was already quite happy with the health care promised her family for the next nine years, a plan that would be the envy of many Americans. But once she got a peek at where it would be delivered — with no paperwork or, even better, a promise of never having to wait for a doctor — she was itching to make some appointments. (McGeehan, 7/19)

Federal prosecutors have asked a judge to block abortion foes from impeding access to Kentucky's only abortion clinic in a pre-emptive move ahead of vigils against the facility. (7/19)

Addressing scores of bewildered and at times angry students, the dean of USC’s medical school said Wednesday that the university had launched multiple internal investigations into the conduct of his predecessor after The Times reported that he associated with criminals and drug abusers who told of using methamphetamine and other drugs with him. (Parvini, Pringle, Hamilton and Elmahrek, 7/19)

Craig Cordola, a longtime Memorial Hermann Health System executive, is leaving to head operations at Ascension Texas, a network of hospitals in Austin and Waco, officials with both institutions said Wednesday. Cordola has been with Memorial Hermann for 14 years, most recently as senior vice president of the health system and president of its West Region, which includes its hospitals in Memorial City, Katy and Cypress. (Deam, 7/19)

Three northwest Houston hospitals will soon be under new management, as population growth continues to expand health care in the region. Tomball Regional Medical Center has been purchased by HCA Holdings Inc., said Sylvia Saumell-Baston, marketing manager at Tomball Regional Medical Center. HCA is a Nashville-based provider of health care services, which operates 171 hospitals and 119 surgery centers in the United States and the United Kingdom. (Santana, 7/19)

With some cities across the country bracing for potential OB-GYN shortages, a new study assessing OB-GYN staffing in major metro areas shows that Columbus is well-equipped. The study was released Thursday by Doximity, a professional social network for physicians and advanced-practice clinicians designed to enhance collaboration among health-care professionals. (Smola, 7/20)

The Wisconsin Justice Department has agreed to extend a court-ordered deadline for Waukesha to fully comply with federal and state safe drinking water standards for radium until the city switches to a Lake Michigan water supply in 2023... The Waukesha Water Utility is allowed under a Waukesha County Circuit Court order to blend water from deep and shallow wells to meet the standards. (Behm, 7/19)

A medical marijuana chain opened the doors to its first dispensary in the city on Wednesday morning... St. Petersburg will mark Trulieve's third location in the Tampa Bay area — following openings in Clearwater and Tampa — and its ninth in the state, with dispensaries in Edgewater, Jacksonville, Miami, Pensacola, Tallahassee and Lady Lake. (Putterman, 7/19)

The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took health-care policy or the need to bring coverage to millions of Americans seriously. But their bungling also demonstrates that the intense attention to Obamacare over the past six months has fundamentally altered our nation’s health-care debate. (E.J. Dionne, 7/19)

Like pop-up dolls, across the length of Barack Obama’s presidency, Republicans voted to “repeal” the law that bears his name—ObamaCare. He laughed at them then, and he’s laughing now. No repeal and no replace. They can’t even do repeal and punt. For Democrats, this doesn’t quite make up for losing the election to Donald Trump, but it has to help. Schadenfreude can’t get much better than watching the Republican Party self-humiliate with an abject inability to win while controlling the House, Senate and White House. (Daniel Henninger, 7/19)

Let's put aside for now the extent to which the Affordable Care Act would "fail" without active measures by the White House and the Republican Congress to undermine the state marketplaces; for that matter, ignore the extent to which active Republican resistance, such as the various lawsuits against the law and the decision by many Republican governors to not expand Medicaid, is responsible for a fair number of problems in the first place. Let's just stipulate for the sake of argument that Trump is correct and the law is doomed if his administration and Republicans in Congress adopt a passive stance of watching and waiting. (Jonathan Bernstein, 7/19)

Having failed to repeal the Affordable Care Act, President Donald Trump is now stating openly that his plan is to let Obamacare fail instead. 1 Although the end result may be the same, there’s a vast difference between these two options, constitutionally speaking. Repeal is a normal legislative initiative, completely within the power of Congress and the president. But intentionally killing a validly enacted law violates the Constitution’s order that the president “shall take care that the laws be faithfully executed.” (Noah Feldman, 7/19)

At a minimum, if Trump lives up to his threat not to enforce the Affordable Care Act, it will lead to yet more lawsuits against him and his administration like those that have led federal courts to find his Muslim ban unconstitutional. Shirking his constitutional obligation to faithfully execute the laws, and thereby imperiling the health care market and the well-being of millions of Americans, will only bring the nation closer to a constitutional crisis. (Edward Markey, 7/19)

It’s been a bad week for male separatists. In Washington, D.C., the all-male Republican Senate leadership, which chose not to invite any female senators to their working-group meetings on repealing the Affordable Care Act, watched in frustration as their bill fizzled after those women declined to support it. Sen. Majority Leader Mitch McConnell, demonstrating that overconfidence and sexism often go hand-in-hand, had insisted the bill could succeed without women senators’ input. “Nobody’s being excluded based upon gender,” he said. “Everybody’s at the table.” Sure, if your definition of everybody is “13 middle-aged guys in ill-fitting suits.” (Ann Friedman, 7/20)

After Senate Republicans’ second version of a health-care bill collapsed Monday under the weight of more than a dozen senators (male and female) who had concerns, Senate Majority Leader Mitch McConnell decided to just vote on repealing Obamacare without a replacement... And it was Senate Republican women who killed it. (Amber Phillips, 7/19)

It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet. “We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly. “Er, doctor?” Janet says. “I think my heart is on my left side, not the right.” (Nicholas Kristof, 7/20)

Republican efforts to repeal and replace the Affordable Care Act have failed, largely because their legislation did so much more. In their hubris they sought to also dismantle the traditional Medicaid that predated the law by 45 years, something Speaker Paul Ryan had admitted was a dream since his fraternity kegger days. And it was the Medicaid cuts that forced Republicans into their worst public contortions. (Brendan Williams, 7/19)

Let’s be clear and up front: President Donald Trump is primarily responsible for this week’s collapse of Obamacare reform. There are other suspects: Sen. Rand Paul, who demanded full repeal and would not compromise. And Senate Majority Leader Mitch McConnell, who cloaked reform efforts in single-party secrecy. Moderates such as Sen. Susan Collins played a role, as did Sens. Mike Lee of Utah and Jerry Moran of Kansas, who drove stakes into the heart of the preferred reform bill Monday night. And, of course, the liberal mainstream media. Might as well throw us in. But the failure is Trump’s. (Dave Helling, 7/19)

I owe my liberal Democratic friends an apology. For years they have been saying the congressional GOP was just passing Obamacare repeals for show, and that they didn’t have a valid replacement bill. I defended them, thinking, naively perhaps, that they really did want to repeal the Affordable Care Act, popularly known as Obamacare, and that one of the many bills they had proposed would unify the party and it would pass with a Republican majority in Congress and become law with a Republican president’s signature. (J. Brandon Thompson, 7/19)

After eight years of promising voters fix for the ACA’s high deductibles and paltry provider networks, the Republican House and Senate delivered a bill that would have worsened nearly everything that most people hate about health insurance. Their failure is our calling to envision something better and unite behind it. (Miles Howard, 7/20)

Obamacare regulations have destroyed this market for most Americans. Unless heavily subsidized or seriously sick, the only plans now available are lousy value propositions. (Robert Robb, 7/19)

Without enough votes to pass the U.S. Senate’s proposed health reform bill, we’re still hearing calls to simply repeal the Affordable Care Act — including from President Donald Trump. If successful, an outright repeal would greatly harm Kansans and create instability in our insurance markets. (Michael Munger, 7/19)

Physicians, like our nation, have strong, diverse opinions about the Affordable Care Act and efforts underway to repeal it. As a physician, dean and president of the American Osteopathic Association, which represents more than 129,000 osteopathic physicians (DOs) and medical students, my mandate is to support policies that will ensure patients are better off in the future than they are today. (Boyd R. Buser, 7/19)

The American Health Care Act is dead. So are the Better Care Reconciliation Act and a repeal of Obamacare without a replacement, as both have sufficient opposition to be dead on arrival. With the Republicans’ efforts for health care reform reduced to smoldering ruins, now what? (7/20)

In December 2015, a Boston Globe investigation of Massachusetts General Hospital (MGH) sparked investigations into concurrent and overlapping surgery. Overlapping surgery refers to operations performed by the same primary surgeon such that the start of one surgery overlaps with the end of another. A qualified practitioner finishes noncritical aspects of the first operation while the primary surgeon moves to the next operation. This is distinct from concurrent surgery, in which “critical parts” of operations for which the primary surgeon is responsible occur during the same time. There is general agreement that concurrent surgery is ethically unacceptable and is prohibited for teaching hospitals under the Medicare Conditions of Participation. Overlapping surgery is common, ranging from having trainees open and close incisions to delegating all aspects of the operation except the critical parts. (Michelle M. Mello and Edward H. Livingston, 7/18)

Imagine a world without antibiotics. A simple cut or scrape could become life-threatening. Childbirth would be much more dangerous, for both mother and child. We could return to tuberculosis the old-fashioned way: with just a dose of fresh air. If we don’t get antibiotic resistance under control, this world could become our reality again. (Tanya Parish, 7/20)

Drawing comparisons to a “moonshot” in health care is usually reserved for breakthroughs like curing cancer. Perhaps less hyperbolic, though no less impactful, is the idea of transforming care for high-need patients—people with multiple, and often interconnected, medical, social, and behavioral health needs. Better care for these patients is also a promising approach to reining in health care costs, a bipartisan health policy priority. ( Dave A. Chokshi, 7/19)

Vaccines are frequently cited as one of the greatest successes in the history of public health. The World Health Organization estimates that vaccines for diphtheria, pertussis, tetanus, and measles save between 2 million and 3 million lives annually. However, in recent years, parental resistance toward childhood vaccinations has increased.1 Many parents have become concerned and distrusting of scientific evidence about vaccinations. As a result, cases of vaccine-preventable diseases have reemerged in the United States and other countries. Unvaccinated and undervaccinated individuals are susceptible to disease and increase the risk of transmitting diseases even to those who are fully vaccinated. (Mary C. Politi, Katherine M. Jones and Sydney E. Philpott, 7/18)

Earlier this month, my wife Tracy and I explored on horseback for three days the Big South Fork National River and Recreation Area — a gem of the national park system in east Tennessee. As we rode the trails, experiencing the gently flowing creeks, the quiet wooded paths, the inspiring sounds of birds and kids playing along the way, we delightfully soaked up the present, reflected fondly on the past and what it took to make our experience possible, but also worried about the future. (Bill Frist, 7/18)