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Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law. The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House. The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. (Winfield Cunningham, Eilperin and Sullivan, 6/21)

After weeks of closed-door meetings that angered Democrats and some Republicans, Senate Majority Leader Mitch McConnell planned to release the proposal Thursday. The package represents McConnell's attempt to quell criticism by party moderates and conservatives and win the support he needs in a vote he hopes to stage next week. In a departure from the version the House approved last month, which President Donald Trump privately called "mean," the Senate plan would drop the House's waivers allowing states to let insurers boost premiums on some people with pre-existing conditions. It would also largely retain the subsidies Obama provided to help millions buy insurance, which are pegged mostly to people's incomes and the premiums they pay. (Fram and Alonso-Zaldivar, 6/22)

Senate Republicans plan to release the draft at approximately 11 a.m. Thursday and hold a vote at the end of next week. Key parts could change as Republicans negotiate final details and try to come up with 50 votes they need to pass the bill. There are also unresolved questions about how much of the bill can be squeezed through the Senate’s strict budget rules governing the fast-track procedure called reconciliation that the GOP is using to avoid a filibuster. (Haberkorn, 6/21)

McConnell hopes to call a vote on the measure next week, all but daring Republican holdouts to oppose it and prolong what has already been a painstaking process to advance their promise to do away with Obamacare. “It will not be the best possible bill; it will be the best bill possible,” Republican Sen. Pat Roberts of Kansas said as he headed into a closed-door meeting. “We’ve been in the backseat of Thelma and Louise’s convertible for quite a while, and we’re getting pretty close to the canyon. It’s time for us to get out of the damn car.” (Levey and Mascaro, 6/22)

As the outlines of the Senate health bill come into focus with a vote expected next week, it is possible to see how the Senate approach may diverge from the House-passed version and also from the 2010 Affordable Care Act. The details will become clearer when the Senate bill is officially released Thursday, but some elements are already apparent, according to people familiar with the drafting of the bill. (Armour, 6/21)

The House-passed healthcare bill would end extra Medicaid expansion dollars in 2020, but some senators have pushed for a longer transition. Leadership recently proposed a three-year transition beginning in 2020, but a contingent of moderate senators is advocating for a seven-year phaseout. Two lobbyists told The Hill that the phase-out in the draft is likely to be over three years, but that timeline could be increased to five years next week if necessary to garner the support of more moderates. And when asked about a three- and seven-year phaseout, Sen. John Thune (S.D.) — the Senate’s No. 3 Republican — said it would be closer to the latter. (Roubein, 6/22)

Senate Republican leaders racing to finalize their health care bill want to preserve Obamacare’s central protections for people with pre-existing conditions to avoid the firestorm that nearly derailed the House’s repeal effort a few months ago. But Senate Leader Mitch McConnell can’t afford a conservative rebellion as he attempts to ram through an Obamacare repeal bill before the July 4th recess. (Cancryn, 6/21)

As in the House bill, states could receive waivers of some of Obamacare’s consumer protections including provision of “essential health benefits.” However, unlike the House bill, they couldn’t waive them for people with pre-existing health conditions. On abortion, the Senate bill, like the House bill, would ban funding for Planned Parenthood for one year. However, the measure won’t include abortion restrictions on the tax credits used in the insurance exchanges after the Senate parliamentarian ruled against their inclusion. Senate leaders are trying to work out an alternative approach. (Litvan, Kapur, 6/22)

No one other than Senate GOP leaders knows the details of their bill to repeal and replace the Affordable Care Act. But it's certain the bill would have a seismic impact on patients, providers and insurers if enacted. Senate Republicans would have to rewrite their bill if the Congressional Budget Office and the Senate parliamentarian say it doesn't meet budget savings targets necessary to pass the bill with a bare majority. The CBO score is expected early next week. (Lee, 6/21)

Who are the GOP senators working on the American Health Care Act behind closed doors? You’ve likely heard they are all white men chosen by Majority Leader Mitch McConnell. Here are some of their vital stats that may influence the outcome. (6/21)

The Senate majority leader, Mitch McConnell, Republican of Kentucky, made a vigorous and urgent argument this week to repeal and replace the Affordable Care Act. Speaking on the Senate floor Monday and Tuesday, he argued that drafting a replacement bill behind closed doors is not unusual, and discussed various criticisms of Obamacare.Here is an assessment. (Qiu, 6/21)

The opposition is coming both from conservative Republican senators, who believe the proposal doesn’t repeal enough of the Affordable Care Act, as well as GOP centrists, who are balking at steep cuts to Medicaid that would leave more people uninsured. The situation is fluid and could change, but the political double bind leaves GOP leaders with little room to maneuver. Lawmakers on both ends of the GOP spectrum are also increasingly joining Democrats in criticizing the lack of transparency and rapid-fire timeline for a vote. Senate Majority Leader Mitch McConnell (R., Ky.) plans to release draft legislation Thursday morning; many lawmakers said they hadn’t seen the bill’s text as of Wednesday afternoon. (Armour, Peterson and Radnofsky, 6/21)

It won’t immediately be clear if Cornyn and Senate Majority Leader Mitch McConnell (R-Ky.) have the votes until sometime next week, after a Congressional Budget Office analysis illustrates how many fewer Americans are likely to be insured by the bill and answers the crucial political question of whether premiums would be reduced. Republicans are hoping for broader buy-in from the healthcare industry Thursday than the House bill received, some senators said. Republicans also said they expected the bulk of the caucus will endorse the bill immediately, with leadership allies expected to give the legislation a quick jolt of momentum. (Everett, Haberkorn and Cancryn, 6/22)

At least one Senate Republican is already expressing strong concerns about the direction that the chamber’s GOP leadership is heading with its health care bill. The plan so far appears to revise, and not undo, a major component of the Democrats’ 2010 health law, argues Sen. Rand Paul, R-Ky. “There’s a great danger, from the point of view of somebody that thought we were repealing Obamacare, that we’re going to actually be replacing Obamacare with Obamacare,” Paul told reporters on Wednesday. (Young, 6/21)

Wisconsin Republican Ron Johnson objected Wednesday to his party’s plan to push an Obamacare repeal plan through the U.S. Senate next week. "I have a hard time believing anybody will have enough time to have a true evaluation and get (public) input on this by next week,” Johnson said in an interview Wednesday. (Gilbert, 6/21)

Sen. Ron Johnson (R-Wisc.) on Wednesday cast doubt on whether he would vote for the Republican ObamaCare repeal bill next week, pointing to the short timeframe to review the bill. “What I’ve told leadership very clearly is I’m going to need time, and my constituents are going to need time to evaluate exactly how this is going to affect them, so I personally think that holding a vote on this next week would definitely be rushed,” Johnson said on CNN. “I can’t imagine, quite honestly, that I’d have the information to evaluate and justify a yes vote within just a week.”  (Sullivan, 6/21)

Pennsylvania Sen. Pat Toomey, the region’s lone Republican, defended the GOP plan and its closed-door work crafting the bill. He said he expected the measure to include a version of his plan to scale back spending on Medicaid, the health program that provides coverage to millions of poor and disabled people. (Tamari, 6/21)

Sen. Bill Cassidy (R-La.) said on Wednesday that he wouldn't vote for a healthcare bill if he wasn't first able to read and study it. During an interview on MSNBC, Cassidy was asked whether he thinks he'll get the chance to see the GOP healthcare plan and decide whether it is satisfactory before a vote. "If I don't get to read it, I don't vote for it," he said. (Savransky, 6/21)

Senate Majority Leader Mitch McConnell (R-Ky.) on Wednesday was focused on winning the support of GOP centrists for an ObamaCare repeal-and-replace bill that his members are expected to see on Thursday. McConnell can only afford two defections, and votes from conservative Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) were in serious doubt as GOP leaders sought to appease moderate Republican demands. (Bolton, 6/21)

Abortion flared up Wednesday as the latest hot-button issue to complicate passage of a bill to repeal and replace the Affordable Care Act, which Senate Republican leaders hope to unveil on Thursday and pass next week. The repeal bill approved last month by the House would bar the use of federal tax credits to help purchase insurance plans that include coverage of abortion. But senators said that provision might have to be jettisoned from their version because of complicated Senate rules that Republicans are using to expedite passage of the bill and avoid a filibuster. (Pear and Kaplan, 6/21)

While no final decision will be made by the parliamentarian until there is a formal bill, she has given strong indications that the abortion language will not make the cut. (Sullivan, 6/21)

Senate Majority Leader Mitch McConnell has promised that senators will get unlimited opportunity for amendments in any health care floor fight next week. Senate Democrats aren’t so sure. Riled-up liberal activists are urging Democrats to effectively filibuster the GOP’s health care bill by attacking it with hundreds of amendments. But Democratic senators are floating the prospect that McConnell will move to cut off the vote-a-rama if he feels Democrats are putting up votes on amendments purely as a delay tactic — a maneuver that would effectively be tantamount to a legislative nuclear option. (Kim, 6/21)

Republicans could make a small, but significant change to historic Senate procedure in order to advance their legislation to rework the U.S. health insurance system, a move that could have notable impact on the future of the chamber’s operations. GOP leaders are sending signals that, if necessary, they plan to invoke a seldom-used rule included in the Congressional Budget Act that would allow Budget Chairman Michael B. Enzi of Wyoming to skirt a decision from the chamber’s parliamentarian, a key gatekeeper for the budget maneuver known as reconciliation that Republicans are using to advance their health insurance measure. (Williams, 6/21)

President Donald Trump is starting to whip votes for the Senate health bill, but he could find his influence there is more limited than in the House of Representatives, where he cajoled, cursed and wooed members to vote for his top campaign promise. Aides to Senate Majority Leader Mitch McConnell were set to brief White House staffers Wednesday evening on the details of the bill they’ve been writing in secret, before it is expected to be made public Thursday. The president is expected to endorse their plan to repeal Obamacare. But even with Trump’s help, the bill faces a perilous path in the Senate. (Dawsey, Everett, Palmeri and Johnson, 6/21)

As Senate Republicans prepare to unveil their version of an Obamacare alternative, President Trump expressed his hope for a final plan “with heart.” “I can’t guarantee anything, but I hope we’re going to surprise you with a really good plan,” Trump said at a campaign-style rally in Cedar Rapids, Iowa, on Wednesday night. (Memoli, 6/21)

The White House launched an ObamaCare repeal-and-replace web page on Wednesday that criticizes the healthcare system, though it does not include any details about a GOP healthcare plan. The page was posted one day after Senate Majority Leader Mitch McConnell (R-Ky.) promised his GOP colleagues that they would have a draft legislation by Thursday, followed by a Senate floor vote next week. Republicans are looking to speed up the process of repealing and replacing ObamaCare as a closed-door group of Republican senators works to make changes to the House-passed GOP's American Health Care Act before voting in the upper chamber. (Beavers, 6/21)

Surrounded by several fellow Democrats in a meeting room in the Capitol Visitors Center, Sen. Ron Wyden (Ore.) lashed out Wednesday afternoon at Republican plans to refashion federal health policies, contending that they would “hit rural communities like a wrecking ball.” But the plans that Wyden was condemning at an all-Democratic hearing were not part of a Senate bill. In a weird twist, his derision was aimed at the legislation that House Republicans narrowly adopted last month to erase major aspects of the Affordable Care Act. (Goldstein and Eilperin, 6/21)

The message — tell Republican U.S. Sen. Cory Gardner to vote against the GOP-led health care bill in the Senate — was ready to take flight over tens of thousands of people at Wednesday’s Rockies game. Instead, the banner — emblazoned with the words “Senator Gardner: TrumpCare hurts women” — will remain on terra firma, the victim of mechanical problems with the plane that was set to fly it. (Aguilar, 6/21)

Planned Parenthood is planning a wave of nationwide protests to dissuade the Senate from including language in the ObamaCare repeal bill that would defund the nonprofit organization. The organization says its message at Wednesday night's rallies, taking place in at least 20 states, is simple: “Do not take away my health care.” (Bowden, 6/21)

About 25 Ohioans staged a sit-in in U.S. Sen. Rob Portman's office Wednesday to demand more transparency, including hearings and town hall-style meetings, on the Senate effort to repeal and replace Obamacare... Portman was at a Senate committee meeting during at least part of the protest, which did not appear to disrupt his schedule. (Koff, 6/21)

When U.S. Senate Republicans unveil their plan to overhaul America's healthcare system, they will face a skeptical public that already does not buy the justification for an earlier version that passed the House of Representatives, according to a Reuters/Ipsos poll released on Wednesday. The June 9-13 poll shows that a majority of the country thinks the American Health Care Act would be harmful for low-income Americans, people with pre-existing health conditions and Medicaid recipients. (Kahn, 6/21)

Enough insurers are planning to sell coverage on the Affordable Care Act's insurance exchanges next year to keep them working — if only barely — in most parts of the country. Competition in many markets has dwindled to one insurer — or none in some cases — and another round of steep price hikes is expected to squeeze consumers who don't receive big income-based tax credits to help pay their bill. (Murphy, 6/21)

Insurers hit a major deadline Wednesday: They must inform regulators in 39 states whether they will sell insurance on many Affordable Care Act marketplaces and, if so, how much they would like to charge. It's something of a moment of truth for the Affordable Care Act's marketplaces, whose health depends in large part on the participation of private insurers. And so far, states are seeing mixed results: One major insurer has made a big pullout, while a different one announced it would expand into new states. (Johnson, 6/21)

While the Wednesday deadline does not represent a final commitment by any insurer, “it will be a good indicator of the health of these markets,” said Sabrina Corlette, a research professor at Georgetown University. House Speaker Paul D. Ryan, whose home state of Wisconsin was among those Anthem plans to exit, pointed to the decision as reason the Republicans needed to pass their overhaul of the health care legislation. “This law has failed our state,” he said. “Obamacare is clearly collapsing, and we have to step in before more families get hurt.” (Abelson, 6/21)

But while some companies are jumping ship, others are jumping in — like New York startup Oscar, and Centene, based in St. Louis. Why do these companies see this moment as an opportunity when many others are fleeing? (Adams, 6/21)

The Senate vote on a bill to repeal and replace the Affordable Care Act is, according to conventional wisdom, one week away. And we still don't know what's in the bill. Not having concrete information is deeply uncomfortable for a journalist like me. But for lots of people, like those who work in the insurance industry, not knowing what's in that bill is a bigger deal. (Kodjak, 6/21)

Anthem Inc., the stalwart that has stuck with Obamacare longer than most other large health insurers, is shrinking its participation in the program and pulling out of two more states’ marketplaces. Anthem announced its exit from Wisconsin and Indiana on Wednesday, the deadline in many states for U.S. insurers to file their premium rates if they wish to participate in the Affordable Care Act next year. The insurer said it will leave the two individual insurance markets because uncertainty has become too great to continue offering plans. (Tracer and Edney, 6/21)

The largest U.S. health insurer, which sells Blue Cross Blue Shield plans in 14 states including New York and California, for months has said that uncertainty over the payments used to make insurance more affordable could cause it to exit markets. (Grover, 6/21)

Anthem cited a volatile insurance market in its latest pullback announcement, and it said that planning and pricing for ACA plans “has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance,” including around the cost-sharing payments. The company previously said it would stop selling marketplace plans in Ohio next year. (Wilde Mathews, 6/21)

Anthem said its decision does not affect its health plans for employers, its Medicare Advantage plans or Medicaid plans. It also will continue to renew its so-called transitional plans that were sold before March 2010 and December 2013. Those plans, which are not available to new customers, cover about 4,500 people in Wisconsin. (Boulton and Romell, 6/21)

Anthem will pull out of the ObamaCare exchanges in Indiana and Wisconsin next year, the insurance giant announced Wednesday. Anthem cited uncertainty surrounding how the Trump administration will handle the Affordable Care Act (ACA) as one reason for leaving. (Hellmann, 6/21)

An insurance startup is expanding its reach in five state ObamaCare exchanges amid uncertainty over the Affordable Care Act's future. In a blog post, the insurance startup Oscar said it was working in the states because it sees a business opportunity despite turmoil surrounding former President Obama’s signature law, which Republicans are seeking to repeal. (Roubein, 6/21)

Oscar Insurance Corp. plans to begin selling health plans on the Obamacare marketplace in Tennessee in 2018 and expand its offerings in other states where it’s already operating. The closely held insurer will expand into new areas of Texas and California, according to a blog post Wednesday by Mario Schlosser, the chief executive officer. The company will also return to the New Jersey market that it earlier dropped. (Lauerman and Tracer, 6/21)

Insurance company Oscar Health announced Wednesday that it will expand coverage to surrounding and nearby counties, bucking a national trend of insurers scaling back coverage amid uncertainty surrounding federal health care policy changes. Oscar Health was founded in 2012 by Joshua Kushner, brother to President Donald Trump’s son-in-law Jared, and has a market value of around $2.7 billion. (Pound, 6/21)

Next year, Blue Cross Blue Shield of Kansas City will leave the individual health care marketplace in Missouri that was set up under the Affordable Care Act. And when it does, about 18,000 patients in 25 western Missouri counties will lose their health insurance. If those enrollees sign on to Healthcare.gov this fall to buy a replacement plan, they may have no options to choose from. That's because those 25 counties could become "bare." If that happens, Missouri will be the first state to have bare counties since the health care exchanges were established in 2013. Insurance companies leaving the marketplace, coupled with uncertainty over the health law’s future, have left thousands of Missourians who buy insurance on their own in a “wait and see” mode. Although other states have coaxed insurance companies to stay, Missouri’s regulators have not publicly shared their plans to rectify the situation. (Bouscaren, 6/21)

After months of worry, Colorado Insurance Commissioner Marguerite Salazar said Wednesday that no insurers are backing out of the state’s health care exchange for 2018, but consumers in the individual insurance market should expect to pay more. Salazar said nine companies filed plans with the state this week to offer individual insurance plans in 2018. That includes all seven insurers currently offering plans on Connect for Health Colorado, the state’s health insurance marketplace where all the plans sold meet Affordable Care Act requirements and are eligible for federal tax credits to help pay the premiums. (Ingold, 6/21)

As s U.S. Senate leaders prepare to unveil their plan to remake the Affordable Care Act over time, Maryland officials must press ahead with the system as it stands for hundreds of thousands of residents. The Maryland Insurance Administration held its first hearing Wednesday on the large rate increases being sought by three insurance carriers selling health plans to individuals on the state exchange. The hearing came as another carrier decided to pull out of the market. Cigna Health and Life Insurance Co. follows UnitedHealthcare, which stopped selling plans last year. (Cohn, 6/21)

Farm Bureau Health Plans will not sell individual Affordable Care Act insurance next year as a surge in 2017 membership threatens the company with heavy losses. The company covered 25,046 Tennesseans with its ACA-compliant plans as of the end of May. The company projects it could lose more than $15 million on those members by the end of 2017, according to a letter it sent to the state's insurance commissioner dated June 21. But the losses are only one factor in its decision. (Fletcher, 6/21)

American teens may be becoming more conservative about sex. According to a new Centers for Disease Control and Prevention report reflecting data from 2011 to 2015, about 42 percent of girls and about 44 percent of boys ages 15-19 reported that they'd had sex. Both numbers continue a gradual decades-long decline: In 1988, 51 percent of girls and 60 percent of boys in the same age group answered affirmatively on the question of sexual activity. (Cha, 6/22)

Teen abstinence isn’t becoming any more popular, but more teens are using contraception the first time they have sex, according to a new report published Thursday by the Centers for Disease Control and Prevention. The report found that 42 percent of teen girls and 44 percent of teen boys have had sex. Those numbers have stayed steady over the past 15 years. But as the teen birth rate continues to tumble, the way teens choose to use contraception has changed. (Thielking, 6/22)

The Advisory Committee on Immunization Practices is meeting here this week. The committee is composed of experts who guide policy on how vaccines should be used in the United States. The group’s votes have real-world implications on the vaccines that are available to Americans. They also have implications for the companies that make the vaccines ACIP reviews. On Wednesday, the committee voted to update its recommendations on influenza vaccines to be used in the upcoming 2017-18 season. There were winners and losers. (Branswell, 6/21)

The US Department of Health and Human Services found that depression affects almost half of all mothers with kids in Head Start, which provides low-income children early-education and other social services. Silverstein, who serves as associate chief medical officer for research and population health at BMC, is part of a research team that partnered with Action for Boston Community Development’s Head Start program to develop a model to prevent maternal depression. (Guerra, 6/21)

Dr. Robert Califf,  former commissioner of the Food and Drug Administration, said Wednesday the current clinical trial system isn’t working and outlined his vision for a future system based on high-quality evidence and widespread data sharing. “Beyond early phase intensive mechanistic exploratory trials, I think the clinical trials enterprise has gone awry,” he said, speaking at a conference on clinical trials hosted by the New York Academy of Sciences, “It’s become unnecessarily expensive, cumbersome, arcane, and it’s causing, I think, a search for alternatives partly out of desperation, because the way it’s being done now isn’t answering the questions people are most concerned about.” (Caruso, 6/21)

Soon after graduating high school in 2016, Lauren Seitz joined her Westerville, Ohio, youth music ministry group to sing at churches and nursing homes in Ohio, West Virginia and North Carolina. The eight-day trip included a white-water rafting experience in North Carolina that would prove deadly. Colin Evans told WBNS-TV he shared a raft with Seitz that day at the U.S. National Whitewater Center, an outdoor recreational park in Charlotte that features a man-made white-water river ride. (Wong, 6/21)

The idea for Wolf & Friends started with a feeling familiar to all mothers: Uh-oh. In 2014, Carissa Tozzi had been told her son, Wolf, who was 4 at the time, might have “sensory issues,” a catchall term that could mean anything from not liking the feeling of clothing tags to being capable of a full-on freakout when the lights are too bright. Mrs. Tozzi, a brand consultant and Pinterest enthusiast, eagerly dived into the world of therapy websites to find products that might help her boy. It didn’t go well. (Newman, 6/21)

New Jersey Gov. Chris Christie amped up pressure on the state’s largest health insurer on Wednesday, blasting what he said are systemic failures by the company while pushing for legislation he has proposed to give the state more control over its finances. At a news conference, the governor said Horizon Blue Cross Blue Shield of New Jersey has been the subject of repeated state-enforcement actions for more than a year, including a $15.5 million fine levied on Monday. (King, 6/21)

The Ohio Senate on Wednesday passed a $65.4 billion two-year state budget after making more than 150 changes to the bill passed by the House, setting the stage for a week of behind-the-scenes maneuvers and compromises between the two chambers... Senate Republicans closed the anticipated $1 billion gap through cutting state agency spending across the board, eliminating with unspent funds and trimming Medicaid administration costs. (Borchardt, 6/22)

The foster care system in Kansas has problems, but a national child welfare group sees one area where it could lead the way for other states. Tracey Feild, director of the child welfare strategy group at the Annie E. Casey Foundation, said work on childhood trauma by KVC Kansas, one of the state’s two foster care contractors, could be a model for others. The Casey Foundation sponsors the annual Kids Count report and other child-focused research. (Wingerter, 6/21)

UT Health San Antonio has received more than $2.3 million from the Max and Minnie Tomerlin Voelcker Fund to study treatments for cancer and heart disease... In addition to the five individual awards, UT Health also received $75,000 for a pilot study on the molecular mechanisms of anticancer drugs. (Pound, 6/21)

A new Georgia State University study has found that one of the areas with high incidence of inflammatory breast cancer is in South Georgia... They found  that South Georgia; Dallas, Texas; and communities in  North Carolina appear to contain the bulk of the “hot spots.” (Miller, 6/21)

A decade of health-care reform had filtered more people than ever into hospitals and doctor’s offices, but preventive care stayed out of reach for most of the 11 million people in the country without legal status... The health of 11 million people was left to a patchwork of charity and community clinics. It was a safety net full of holes:The UCLA Center for Health Policy Research found that undocumented immigrants are significantly less likely than legal immigrants to see a doctor, visit the emergency room or report themselves in good health. (Woods, 6/21)

The Massachusetts House of Representatives passed an expansive rewrite of the voter-approved marijuana legalization law Wednesday night — a bill that would alter major aspects of the referendum backed by 1.8 million voters just seven months ago... The House bill would sharply raise total pot taxes to a mandatory 28 percent, from a maximum of 12 percent in the ballot question. (Miller, 6/21)

Here's what we know right now about the health-care plan Senate Republicans are working on: They want to pass it next week. That's just about it, and all we can say for sure. While there have been some leaks and rumors about what might be in it, that's all they are. There haven't been any hearings or legislative text for anyone to analyze. It's been a backroom process that, whether there's any cigar smoke or not, has been more secretive, according to the Senate's historian emeritus, than any other in the past 100 years. (Matt O'Brien, 6/21)

"There's not a chance,” Mitch McConnell said in 2014. "After castigating [former Senate Majority Leader] Reid for crowding out the rest of us and shielding his actions from public view, I assure you we're not going to turn around and do the same thing.” Hypocrite. McConnell is now writing a Senate Trumpcare bill in secret. (Guthrie Graves-Fitzsimmons, 6/21)

For every childhood birthday I can remember, my paternal grandparents gave me a $25 U.S. Savings Bond. To relieve the monotony of this annual exercise in disappointment, I accepted the proffered envelope each year with a flamboyant show of sarcastic speculation. (Brian Dickerson, 6/21)

Remember when Obamacare was written “hastily,” “behind closed doors” in “secret” negotiations, so that Democrats could “jam” an unpopular health-care bill through Congress? Remember when this showed that they “didn’t care what was in it” and that they had betrayed the “trust” of the American people? Remember when “the issue of health reform” was “too important to not take the time to get it right”? (6/21)

Senate Republicans have reached a trying time indeed in their repeal-and-pretend — excuse me, repeal-and-replace — effort on the Affordable Care Act. It’s that delicate period when lawmakers must say absurd things with a straight face. (Scot Lehigh, 6/21)

Republicans who wrote a health care bill behind closed doors call it a repeal of Obamacare. But the legislation could fundamentally transform another federal health program that provides coverage to far more Americans than the insurance exchanges created by the Affordable Care Act. It’s called Medicaid. The GOP plan that the House narrowly passed in May would cap how much the U.S. pays for Medicaid, the public health insurance program for the poor. That’s never happened before. And it's a big deal—more than one-fifth of Americans depend on Medicaid for health care. (John Tozzi, 6/22)

Senate Republicans are divided on how they want to address the Affordable Care Act’s (ACA) expansion of Medicaid. Not surprisingly, Senators from states that expanded coverage under the ACA are pressing to continue that funding as long as possible. Senators from non-expansion states are more willing to roll back federal support without a lengthy transition. Resolving this disagreement is central to finding a way forward to passing a full repeal and replacement of the ACA in the Senate. (James C. Capretta, 6/22)

The Senate’s version of the House-passed American Health Care Act will almost certainly include a fundamental change in the way the federal government contributes to Medicaid. Over time, that new structure would result in deep cuts in the federal contribution to Medicaid and ultimately reduce long-term care benefits for frail older adults as well as younger people with disabilities. These changes may give states important new flexibility in how they provide these supports and services. But they may also mean that states will slow or even reverse their shift toward delivering assistance in community settings and revert to providing care in nursing homes. (Howard Gleckman, 6/21)

Iowans, regardless of background or political affiliation, want children to receive the medical care they need to reach their full potential. That is a value shared by nearly all Americans. Just a few years ago former Gov. Terry Branstad led a bipartisan effort to expand Medicaid and fill one of the last gaps in our children’s health coverage. Today almost every Iowa child has access to basic health insurance. That is a true Iowa family value. The same commitment Americans make to covering seniors through Medicare should apply to healthcare coverage for children. Just as we honor and care for our parents and grandparents who built and protected this country, we should equally honor and care for our families whose children will build and protect our country’s future. (Stephen Stephenson, 6/21)

As congressional Republicans continue to work on a bill intended to replace the Affordable Care Act, we can expect a lot of rhetoric and commentary about Obamacare’s imminent demise, fueled by news reports about insurers withdrawing from state ACA exchanges. And I’ll wager that much of that conversation will center on the premise that insurers are pulling out because they’ve been unable to enroll enough young, affluent Americans — the so-called “healthy wealthies”— to offset the costs of covering older, sicker populations. The problem is, that’s not true. (Mark Nathan, 6/22)

The California Senate recently voted to pass a bill that would establish a single-payer healthcare system for the entire state. The proposal, called the Healthy California Act, will now be taken up by the state Assembly. The plan enjoys widespread support — a recent poll commissioned by the California Nurses Assn. found that 70% of all Californians are in favor of a single-payer plan — and with good reason. Under Healthy California, all residents would be entitled to decent healthcare without having to pay premiums, deductibles or copays. (Robert Pollin, 6/21)

Governor Charlie Baker and state business leaders seem to have reached a compromise on the thorny question of how to deal with companies that shunt employees onto MassHealth, the state’s Medicaid program. There will be fines, though not as steep as Baker originally proposed, and only for a limited time. (Evan Horowitz, 6/22)

About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined. For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50. (Nicholas Kristof, 6/22)

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

Summer officially is here and, in Florida, we are already feeling record-breaking temperatures. The heat and humidity common to our region is bringing back the threat of Zika. Cases of the disease continue to be reported regularly, and because of that we urge pregnant women to stay vigilant and get tested for this life-altering virus. There is currently no vaccine to prevent Zika virus infection. (Manuel Fermin, 6/21)

Statistics from the 2016 Hunger Atlas, published by the University of Missouri’s Interdisciplinary Center for Food Security, paint a bleak landscape. They show Missouri ranks among the top 10 states with the highest percentage of households classified as food insecure or having very low food security. Almost half a million Missourians experience hunger at some point over the calendar year, the report found. We have to do better. (Todd Schnuck, 6/22)

Recently I attended ... a weekly symposium that affords members of the faculty, house staff, nursing, pharmacy, and technical staff the opportunity to empathize and support one another in discussions of the “social and emotional” and ethical issues encountered in providing care to patients, their families, and each other. The topic was a complaint by a patient who stated she “could not understand” her physician “because of her accent” and that the doctor was late because “she is from Iran” and “doesn’t know the rules of this society.” ... These stories stimulated several attendees to describe many similar experiences and the emotions they have elicited. It became apparent that rude and racist behaviors by our patients and their family members are increasing in frequency and ruthlessness. Our staff have been subjected to slurs by patients and families, targeting their gender, ethnicity, place of birth, apparel, speech characteristics, or skin color. (Douglas G. Merrill, 6/20)

The postpartum period is one of the critical time points in a woman’s life that often places her at risk for obesity and obesity-related health conditions. Postpartum weight retention (defined as a retained weight of 4.5 kg at 6-12 months after delivery) affects an estimated 25% of the 4 million women in the United States who give birth each year. ... Effective interventions are needed for these at-risk patient populations to stop the cycle of weight gain and adverse maternal and child outcomes. (Adam Gilden Tsai and Wanda K. Nicholson, 6/20)

In this issue of JAMA, the US Preventive Services Task Force (USPSTF) recommends that clinicians screen for obesity in children and adolescents aged 6 to 18 years and refer those with an age- and sex-specific body mass index at the 95th percentile or greater to comprehensive, intensive behavioral interventions (B grade). This recommendation confirms what pediatric primary care clinicians and others do in the everyday care of children: monitor growth, counsel on healthy lifestyles, and refer when appropriate. Well-child care began with maternal education and use of child weighing stations in the late 1800s to address malnutrition. Today, many overweight and obese children and adolescents have a different type of malnutrition, and assessing growth and development has become increasingly important. (Rachel L. J. Thornton, Raquel G. Hernandez, Tina L. Cheng, 6/20)

The city’s doctor is retiring at the end of the year. Dr. Teresa Long was on the front lines fighting to protect the health of Columbus residents against threats such as bioterrorism, flu, measles or mumps outbreaks, poor food sanitation, HIV, tobacco use, obesity or crib death. And that’s just a sampling of the critical efforts that the good doctor has tackled in her 30 years at Columbus Public Health. (6/22)

Seven years after its soldiers sparked the world’s worst cholera epidemic in Haiti, the United Nations is finally preparing to close its MINUSTAH peacekeeping mission there. As Nobel Peace laureates committed to the U.N.’s ideal of universal human rights, we are deeply concerned that the victims of MINUSTAH’s catastrophic actions remain without justice and reparations, despite U.N. promises to repair the harm it has caused. (Adolfo Perez Esquivel, Jody Williams, Shirin Ebadi, Rigoberta Menchu Tum and Betty Williams, 6/21)

When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had General Paralysis of the Insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the retarded Poll Tax. (Saurabh Jha, 6/19)