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With his bill to repeal the Affordable Care Act in deep trouble, Mitch McConnell, the Senate majority leader, raised an alternate possibility on Tuesday: Either Republicans come together, or he would have to work with Democrats to shore up the deteriorating health law. That raised a tantalizing prospect: bipartisanship. (Pear and Kaplan, 6/28)

Senate Minority Leader Chuck Schumer reiterated his pitch to President Donald Trump and Senate Republicans on Wednesday, calling for a bipartisan approach to fixing Obamacare as the GOP’s effort on its health care overhaul remains in limbo. “So, I’d make my friends on the Republican side and President Trump an offer: Let’s turn over a new leaf. Let’s start over,” the New York Democrat said on the Senate floor as he called on GOP leaders to drop their push to repeal the taxes that help fund the Affordable Care Act, along with their proposed $772 billion cut to Medicaid. (Easley, 6/28)

Senate Majority Leader Mitch McConnell is exploring options for salvaging the battered Republican health care bill, even as he confronts an expanding chorus of GOP detractors. That is deepening the uncertainty over whether the party can resuscitate its promise to repeal President Barack Obama's overhaul. (6/29)

Senate Majority Leader Mitch McConnell may have bought himself some time by delaying a vote on his embattled health-care bill, but he faces a difficult and narrow path in trying to deliver on seven years of promises to repeal Obamacare. After McConnell’s decision Tuesday to postpone a planned vote until mid-July, Republican leaders plan to spend the next few days haggling over changes to his draft health-care bill, which isn’t even a week old. The goal is to reach a deal by Friday so the Congressional Budget Office can scrutinize it over the July 4 recess, senators said. (Litvan, 6/28)

Senate Republicans are struggling mightily to find a path forward for their ObamaCare repeal bill, with infighting between moderates and conservatives threatening to create an impasse heading into the July Fourth recess. GOP leaders say they want to have an agreement on changes to the legislation by Friday, but senators said they made virtually no progress at a lunch meeting on Wednesday. In fact, the two sides appeared to grow further apart. (Bolton and Sullivan, 6/28)

Vice President Mike Pence on Wednesday promised that Congress and the Trump administration would "repeal and replace" Obamacare, despite setbacks in the Senate. Pence made the guarantee to a group of around 200 people at Tendon Manufacturing in Warrensville Heights, as well as to a private group of business owners he met with before the rally who expressed their frustration with the health care law. (Richardson, 6/28)

Senate Republicans' struggle to pass a health care bill is jeopardizing another one of President Donald Trump's top priorities: overhauling America's tax system. A day after Senate Majority Leader Mitch McConnell, R-Ky., delayed a vote on a bill to scrap much of Democrat Barack Obama's health law, questions lingered about whether congressional Republicans could pass big, complicated pieces of legislation. (6/29)

Senate Majority Leader Mitch McConnell is aiming to send a revised version of his health-care bill to the Congressional Budget Office as soon as Friday as he continues to push for a vote before Congress’s August recess. The effort reflects the tight timeline McConnell faces in his attempt to hold a vote in July — and the pressure he is under to change the bill to garner enough support to pass it. With both conservatives and centrists pushing different policy solutions, Senate leaders were struggling to craft a rewrite of the Affordable Care Act on Wednesday that would attract votes without torpedoing the CBO’s official score of how the legislation affects coverage levels and federal spending. (Sullivan, Eilperin and Snell, 6/28)

Senate GOP leaders are scrambling to put together a revised Obamacare repeal bill in the next 48 hours, even as some Republicans question whether they can bridge a huge divide between moderates and conservatives that has stalled the legislation. Having tossed a July 4 deadline to vote on the measure, leaders weighed a raft of policy changes proposed by holdout senators and expressed confidence a compromise was near. Others weren't so sure. (Haberkorn, Demko and Griffiths, 6/28)

Senate Majority Leader Mitch McConnell is working to win over Republican holdouts on his health-care bill after facing a revolt from conservatives and moderates who weren’t ready to act this week. Some of the holdouts may be easier to persuade than others. A few announced their opposition to his draft bill only after he delayed a planned vote. But others are more dug in. Several conservatives say the bill doesn’t go nearly far enough in dismantling Obamacare. Moderates worry about the phaseout of the Medicaid expansion, as well as the Congressional Budget Office estimate that 22 million fewer Americans would have health care in a decade under the bill, H.R. 1628. (Litvan, 6/29)

Senators from the two camps have vastly different ideas about what needs to be changed in the repeal-and-replace legislation, and it’s unclear what kind of compromise GOP leadership can present that would satisfy both sides. Conservatives want the bill to end as many ObamaCare regulations and taxes as possible, while the moderates want more federal spending on Medicaid. Lacking a clear path forward, Majority Leader Mitch McConnell (R-Ky.) delayed a vote on the bill until after the July Fourth recess. (weixel, 6/28)

Several Senate Republicans began to question Wednesday whether their health-care bill should repeal a tax on high-income Americans imposed by Obamacare when the legislation would scale back subsidies for the poor. Susan Collins of Maine and Mike Rounds of South Dakota both criticized the draft bill released by Majority Leader Mitch McConnell for repealing a surtax on net investment income imposed under Obamacare.  (Kapur and Dennis, 6/28)

A top GOP lawmaker is pressing leadership to rethink a tax break for high-income earners in the Senate health bill. Sen. Bob Corker (R-Tenn.) on Wednesday bashed the bill's repeal of a 3.8 percent tax on investment income for high earners. The Congressional Budget Office estimated that repealing that tax could cost the federal government $172 billion over ten years. (Hellmann, 6/28)

Senate GOP leaders seeking to recover from the cancellation this week of a vote on their health care bill are entertaining a range of requests from swing vote senators and opponents. Lawmakers spotted entering the office of Majority Leader Mitch McConnell of Kentucky on Wednesday included Dean Heller, R-Nev.; Shelley Moore Capito, R-W. Va.; and Bill Cassidy, R-La. The negotiations highlight the challenges McConnell and the Trump administration face after the setback with this legislation, which they hope to rewrite and send to the Congressional Budget Office as early as the end of this week. (Young and McIntire, 6/28)

U.S. Sen. Chuck Grassley wouldn’t say Wednesday how he would have voted on his party’s health-reform bill if it had come to a vote this week, as originally planned. “This bill is changing by the hour, and why would I talk about what I might do or might not do with a bill that’s changing?” the Iowa Republican told reporters in a conference call. Grassley added that it would be “very stupid of me” to say how he’d vote on a bill that isn’t done. (Leys, 6/28)

President Donald Trump on Wednesday suggested that “a big surprise” could be coming in the Republican effort to repeal and replace Obamacare, a tease that came hours after the president predicted that Senate Republicans are “going to get at least very close” to passing their stalled health care bill. “And just to do a little official business, health care is working along very well. We could have a big surprise with a great health care package. So, now they're happy,” Trump said, gesturing to a group of reporters during a meet-and-greet with the visiting World Series champion Chicago Cubs. (Nelson, 6/28)

When asked for further clarification about his remarks, the president repeated his claim about a big surprise. "We're going to have a great, great surprise," he said. (Beavers, 6/28)

Rand Paul and Susan Collins are on opposite ends of the Republican Party when it comes to health care, yet somehow the two senators both left this week’s Obamacare repeal meetings with President Donald Trump thinking he’s on their side. Paul wants to gut as much of Obamacare as possible and recalled after his one-on-one meeting that the president “realizes that moderates have gotten everything so far” on the health care talks. The centrist Collins, on the other hand, left a larger Tuesday gathering with the president sure that he still wants to make the bill’s health care offerings more robust, explaining that “he did leave me with that impression.” (Everett and Dawsey, 6/28)

President Trump argued in a tweet Wednesday that Democrats are misrepresenting Medicaid cuts in the Senate's ObamaCare replacement bill. While Medicaid spending would still go up every year under the bill, a new cap put in place by the legislation would mean that Medicaid spending would not rise as fast as medical costs. States would therefore either have to find more money in their own state budgets to put into the program or cut back on enrollment or services.The Congressional Budget Office finds that the bill would cut Medicaid spending by $772 billion over a decade. (Sullivan, 6/28)

Senate Minority Leader Charles Schumer (D-N.Y.) is asking President Trump to meet with Democrats to discuss a bipartisan deal on healthcare. "President Trump, I challenge you to invite us, all 100 of us, Republican and Democrat, to Blair House to discuss a new bipartisan way forward on healthcare in front of all the American people," Schumer said on Wednesday, referring to the President's Guest House. (Carney, 6/28)

Former House Speaker Newt Gingrich (R-Ga.) said President Trump will be able to push the Republican healthcare bill message after "somebody translates it," according to a Wednesday Associated Press report. Gingrich, who is a close Trump ally, also said GOP lawmakers have struggled to effectively communicate the new healthcare bill and address the complexities of health care policy because “nobody has served as a translator.” (Beavers, 6/28)

Congressional Republicans are stymied over health care. But after seven years of promising to repeal and replace former President Barack Obama's law, they risk political disaster if they don't deliver. Republicans anticipate a major backlash from GOP voters if they don't make good on the promises that swept them to control of the House and Senate and helped propel Donald Trump to the White House in last year's elections. (6/29)

In Virginia, Republican gubernatorial nominee Ed Gillespie is getting peppered with questions on the campaign trail about President Trump’s efforts on health care, and he has declined to take a clear position. In Maryland, Gov. Larry Hogan (R), who is up for reelection next year, says health-care plans being advanced by the Republican Congress “do not work” for his state, but he is still getting badgered by Democrats to speak out more forcefully against Trump. (Wagner and Nirappil, 6/28)

Republican efforts to craft a new health care bill just hit another roadblock: An avalanche of public polling data dropped Wednesday, showing support for the legislation is under 20 percent. That’s bad enough, but it’s not just the topline numbers that are near rock-bottom. Few voters think the bill will make the health care system or their own care better. And many of the policy changes in the various versions of GOP health legislation — like decreasing federal funding for Medicaid — are profoundly unpopular. (Shepard, 6/28)

Forty-five percent of voters disapprove of the bill, and another 17 percent don't know or have no opinion on it. (Savransky, 6/28)

More than half of Americans disapprove of Senate Republicans' plan to overhaul the nation's healthcare system, according to a Fox News poll out Wednesday. Fifty-four percent said they oppose the Senate GOP leaders' healthcare reform bill, while just 27 percent have a favorable opinion of it – a two-to-one margin.  (Greenwood, 6/28)

A new NPR/PBS NewsHour/Marist poll shows that while President Trump's approval rating has slipped, so too has confidence in Congress. The latest attempt to repeal and replace the Affordable Care Act is overwhelmingly unpopular. (Hobson, 6/28)

Only 16 percent of American voters approve of a Senate health care bill that would repeal and replace the Affordable Care Act, a new Quinnipiac University poll said. Even among Republican voters surveyed, approval ranged from 37 to 23 percent, “with overwhelming opposition among every other listed party, gender, education, age or racial group,” said the poll, released Wednesday. (Radelat, 6/28)

Sen. Dean Heller was sitting two seats away from President Trump and facing his grim-faced colleagues this week when he decided to crack a pointed joke. Heller — a square-jawed, ­sandy-haired moderate Republican — said the attack ads against him, paid for by a Trump-allied super PAC, should have used his own image instead of actor Matt Damon’s. There were scattered laughs, including a chuckle from Trump. But many of the Republican lawmakers lining tables in the East Room stayed mute. (Costa, Sullivan, Eilperin and Snell, 6/28)

For the past decade, Senate Majority Leader Mitch McConnell has forged a reputation as a closer on big deals. There was the Wall Street bailout just before the 2008 elections. There was the pact over the summer of 2011 to slash spending and avoid a federal default. And there was the 2012 New Year’s Eve “fiscal cliff” compromise to avoid huge tax increases. But this week, McConnell (R-Ky.) fell short in crafting a Republican plan to repeal portions of the Affordable Care Act and redraw vast amounts of Medicaid policy. Rather than suffer a humiliating defeat, McConnell told his GOP colleagues Tuesday that he would delay a vote until at least mid-July. (Kane, 6/28)

The now-delayed U.S. Senate healthcare overhaul bill would boost state spending on Medicaid by $565 million in 2022, according to an independent report issued on Wednesday, while credit agencies said it would cause states to face downward pressure on their credit ratings. Senate Republican leaders on Tuesday postponed the vote on the bill, which they hoped would take place before their July 4 recess. (Kelly, 6/28)

Senate Republicans’ health care fight is getting personal. Senate Majority Leader Mitch McConnell and Sen. Rob Portman, close allies and typically mild-mannered men, got into a heated exchange over Medicaid at a meeting earlier this week. (Bresnahan and Kim, 6/29)

Dewey Gorman, a 59-year-old banker who has struggled with opioid addiction, had just gotten out of the hospital in this tiny central Appalachian city when he heard the word from Washington: His fellow Kentuckian, Senator Mitch McConnell, had delayed a vote to repeal the Affordable Care Act. He felt torn about that. “It’s broken. It’s broken very badly,” Mr. Gorman said of former President Barack Obama’s signature health care law. “But if they want to take away insurance from 22 million people — a lot of them would come from these mountains. That would be devastating to our area.” (Stolberg, 6/28)

President Trump on Wednesday said that the Republican plan to change Medicaid would lead to an increase in spending, not a cut, accusing Democrats of having “purposely misstated” the facts. In a literal sense, he's right. The total amount of money spent on Medicaid under the Senate Republican plan would grow, albeit slowly, from 2017 to 2026. But the accounting he uses to show Medicaid spending is wildly divergent from the way budget analysts, policymakers and many lawmakers account for spending levels. (Paletta and Johnson, 6/28)

President Trump accused Democrats of lying about the projected Medicaid cuts in the Republican health care plan, but they didn't. They're just counting different things. (Jackson and Groppe, 6/28)

The Senate healthcare bill released last week would leave California short $115 billion for its Medi-Cal program between 2020 and 2027, according to a state analysis released Wednesday. The Medi-Cal program, which is jointly funded by the state and federal government, grew dramatically under the Affordable Care Act to cover 13.5 million Californians, or 1 out of 3 state residents. (Karlamangla, 6/28)

California risks losing $114.6 billion in federal funds within a decade for its Medicaid program under the Senate health care bill, a decline that would require the state to completely dismantle and rebuild the public insurance program that now serves one-third of the state, health leaders said Wednesday. The reductions in the nation’s largest Medicaid program would start at $3 billion in 2020 and would escalate to $30.3 billion annually by 2027, according to an analysis released by the state departments of finance and health care services. (Gorman, 6/28)

Air Force veteran Billy Ramos, from Simi Valley, Calif., is 53 and gets health insurance for himself and for his family from Medicaid — the government insurance program for lower-income people. He says he counts on the coverage, especially because of his physically demanding work as a self-employed contractor in the heating and air conditioning business. (O'Neill, 6/28)

The one near-certainty in GOP efforts to patch up their failed Obamacare repeal bill over the July Fourth break is that they will add more money to combat the opioid crisis. That may entice some moderate lawmakers to support the bill. But it will do little to fulfill Donald Trump’s campaign promise to address the crisis devastating so many communities. And it certainly won’t make up for the Medicaid cuts that many members of his own opioid commission oppose because tens of thousands of people who are addicted to the drugs would lose regular health coverage. (Karlin-Smith, 6/29)

[Chelsea] Carter estimates about 90 percent of the people that come into her clinic for treatment for substance use disorders are on Medicaid, the federal program for the poor that West Virginia chose to expand under the Affordable Care Act.The Senate health care bill would phase out that expansion and, over time, make cuts to traditional Medicaid as well (as compared to the anticipated spending under current law). (Keith, 6/29)

As with the House version that passed in May, Democrats have criticized the impact that the Senate bill, the Better Care Reconciliation Act (BCRA), would have on people with preexisting medical conditions. They argue that the BCRA would no longer protect Americans with preexisting conditions, despite the bill’s explicit ban on states waiving coverage based on preexisting conditions. Yet a Republican opponent of the bill criticized it for not repealing the protection enough. What is going on? ... here’s our guide to the debate over preexisting conditions in the Senate bill. (Lee, 6/28)

The superheated argument over the Republican drive to overhaul health care has not been the finest moment for accuracy. Here's a sampling of claims from both sides as Senate Republicans struggle to revive their stalled legislation. (Woodward and Drinkard, 6/29)

Senate Majority Leader Mitch McConnell's decision to delay a vote on a GOP health care plan is giving Democrats a big opportunity to seize the July 4 recess to dial up the pressure to kill the bill. Several outside progressive groups are planning campaigns over the congressional recess to highlight the stories of real Americans who could lose health care – and targeting vulnerable and moderate Republican senators with paid media, phone calls and protests. (Przybyla, 6/28)

The Senate GOP’s Obamacare repeal effort may have stumbled, but activists on the right and left hustled into action on Wednesday to try to shape the rewrite on one side — or kill the bill outright, on the other. Liberals capped their third straight day of massive demonstrations against repeal by drawing a thousand-plus demonstrators to the Capitol, while gearing up to pressure moderate GOP lawmakers in their home states during next week’s recess. (Schor and Cancryn, 6/28)

Eli Rubin and Gus Teschke want U.S. Sen. Debbie Stabenow to do more to stop Trumpcare from passing the Senate, saying it's the political hill that Stabenow and other Democratic senators need to be willing to die on. The two volunteers were among about 60 people protesting Wednesday morning on Fort Street in downtown Detroit. The members of the Ann Arbor Indivisible group brought signs and speakers to the rally to make their concerns heard. (Farrell, 6/28)

About 15 protesters gathered outside the Federal Courthouse Wednesday afternoon to voice opposition to Medicaid cuts contained in the health care bill under consideration by the U.S. Senate. One person, Pilgrim Tierney, was cited for disorderly conduct after refusing to leave the courthouse. (Oxenden, 6/28)

A handful of protesters were planning to spend a second night in U.S. Sen. Cory Gardner’s Denver office Wednesday, vowing to remain there until Gardner pledges to oppose the GOP’s plan to repeal and replace Obamacare. Nine people, many of them disabled, spent the night Tuesday, saying in social media posts that they were locked into the downtown Denver building after being threatened with arrest. Their number grew to 12 by Wednesday morning. (Worthington, 6/28)

On Tuesday, the fate of the Republicans’ attempt to undo the Affordable Care Act dominated news out of Washington. Phones rattled with alerts about the decision to delay a vote until mid-July. Camera crews jostled for shots of senators meeting with President Trump, then boarding a bus that took them past jeering protesters. A viewer tuning into Fox News that night hardly saw any of it. (Weigel, 6/28)

Anthem Inc. said it would stop selling Affordable Care Act marketplace plans in most of Nevada next year. The move together with the departure of a smaller insurer leaves 14 of the state’s counties poised to have no insurer on its exchange. (Wilde Mathews, 6/28)

Anthem Inc.’s decision to quit offering Obamacare plans in much of Nevada will leave large parts of the state without options on the health law’s exchanges. The health insurer, a one-time Obamacare stalwart, has accelerated its retreat in recent weeks, blaming in part the uncertainty about the fate of the health law in Washington for making it difficult to come up with plans and calculate premiums. In Nevada, officials including Republican governor Brian Sandoval called the situation a crisis on Wednesday. (Tracer and Recht, 6/28)

Insurance is all about predicting the future, so with the future of the Affordable Care Act in flux, uncertainty about what’s going to happen has made 2017 a tricky year for insurance companies. “Oh, it’s tough, because businesses don’t plan backwards. They plan forwards. They want to think about what the business is going to look like next year and two years out and three years out,” says Timothy McBride, a health economist at Washington University in Saint Louis. (Smith, 6/29)

Senate Republicans' healthcare bill to repeal and replace the Affordable Care Act would bolster the dwindling individual insurance market in the short term, but eventually cause enrollment to plummet, according to a report by ratings agency S&P Global. The Senate bill eliminates the financial penalty for individuals who don't purchase health insurance. Instead, the Better Care Reconciliation Act replaces the fine with a six-month waiting period that's unlikely to keep people enrolled, S&P analysts said. (Livingston, 6/28)

An estimated 420,000 Oregonians would lose their health care coverage by 2026 -- mostly due to Medicaid cuts -- if the Senate health care bill becomes law, according to a new state analysis. Republican boosters of the Senate plan say the bill is desperately needed to prop up an increasingly unstable insurance market. State officials argue the opposite -- that the estimated 150,000 Oregonians predicted to drop out of the individual insurance market over the next two years could plunge the market into a "death spiral." (Manning, 6/28)

Under a plan by a city council member in Ohio, people who dial 911 seeking help for someone who's overdosing on opioids may start hearing something new from dispatchers: “No.” In response to the opioid epidemic that swept the nation — including the small city of Middletown, population 50,000 — council member Dan Picard has floated an idea that has been called more of “a cry of frustration” than a legitimate solution. At a council meeting last week, Picard proposed a three-strikes-style policy for people who repeatedly overdose: Too many overdoses and authorities wouldn't send an ambulance to resuscitate them. (Wootson, 6/28)

The House Heroin Task Force is attempting to tackle the opioid crisis with a set of bipartisan bills that would alter medical record laws, fund new grant programs for prevention and awareness efforts, and increase accountability within the Department of Veterans Affairs. In other words, the legislators are doing what they can to address the epidemic — as long as Medicaid doesn’t come up. (Facher, 6/28)

The dealers were smuggling in bundles of cocaine and heroin, some of it hidden in secret compartments inside their cars. They carried thousands of dollars in cash and at least one firearm, all believed to be linked to their drug peddling in Santa Clarita. Over the last month and a half, a special team of Los Angeles County sheriff’s detectives based out of the Santa Clarita Valley station arrested 39 people on suspicion of narcotics possession and sales, officials announced Wednesday. The team also seized two pounds of heroin, $13,000 in cash and a stolen firearm in the operation. (Lau, 6/28)

The president of the Kentucky state Senate said Wednesday that he plans to file a motion to intervene in support of a legal effort by STAT to unseal documents filed in a case involving OxyContin maker Purdue Pharma. The secret documents were filed as part of a lawsuit by the state of Kentucky against Purdue Pharma that was settled in December 2015, with Purdue paying $24 million to the state. The documents include a deposition of Dr. Richard Sackler, a former president of Purdue and a member of the family that owns the company; internal emails about the marketing of the drug; minutes of strategy meetings; analysis by the company of clinical trials; and other documents. (Armstrong, 6/28)

Nearly a half-century into the “war on drugs,” with a new wave of opioid addiction at crisis proportions, a handful of commercial health insurers are beginning to cover methadone maintenance, the oldest and best-researched treatment for addiction to heroin and prescription pain relievers. Independence Blue Cross, the Philadelphia region’s largest insurer, will join the emerging trend in August, offering complete coverage with no co-pays. There are spaces available at local methadone clinics and the treatment is considered highly effective. (Sapatkin, 6/29)

As Baltimore struggles with skyrocketing overdose deaths linked largely to opioids such as heroin and prescription painkillers, state officials suspended the medical license of a local pain doctor for allegedly over-prescribing the highly addictive medications. According to an emergency order from the state Board of Physicians suspending the medical license of Dr. Kofi Shaw-Taylor, he gave "excessively high" amounts of opioid painkillers to some patients, while prescribing others both opioids and drugs to curb opioid addiction at the same time. (Cohn, 6/28)

Just how bad is air pollution for you? A study of more than 60 million Medicare recipients has found that even pollution levels below those generally considered safe increase the risk for premature death. Using satellite, meteorological and other data, plus data gathered from 3,805 monitoring stations maintained by the Environmental Protection Agency, researchers were able to accurately estimate daily air pollution levels nationwide. The study is in The New England Journal of Medicine. (Bakalar, 6/28)

The nationwide study of more than 60 million senior citizens linked long-term exposure to two main smog pollutants — ozone and fine particulate matter — to an increased risk of premature death. The analysis found no sign of a “safe” level of pollution, below which the risk of dying early tapered off. (Barboza, 6/28)

"We are now providing bullet-proof evidence that we are breathing harmful air," says Francesca Dominici, a professor of biostatistics at the Harvard T.H. Chan School of Public Health, who led the study. "Our air is contaminated." (Stein, 6/28)

It’s as predictable as taxes in April. Every year, the Fourth of July brings patriotic displays of color, smoke, and sound — and a slew of emergency room visits from burns and blast wounds. Federal researchers track data on those injuries year-round using the National Electronic Injury Surveillance System, a national probability sample of about 100 hospitals in the U.S. and its territories. Fireworks injuries don’t only happen in July, but they are, unsurprisingly, far more common in that month versus the rest of the year. (Brohnshrein, 6/29)

Intelligent children tend to live longer than their less gifted peers, a new study suggests. Scottish researchers began their study with 75,252 men and women born in 1936 — 94 percent of the Scottish population born that year — who had taken standardized intelligence tests in 1947. By 2015, they were able to confirm a cause of death for 25,979 of them; 30,464 were still living in Britain. (Bakalar, 6/28)

Here’s an idea whose time has come: A flu shot that doesn’t require an actual shot. For the first time, researchers have tested a flu vaccine patch in a human clinical trial and found that it delivered as much protection as a traditional jab with a needle. (Kaplan, 6/28)

More than 60 percent of cancer patients are older adults — and that will rise to 70 percent by 2040.  Yet seniors continue to be underrepresented in clinical trials, making it difficult to assess how treatments are likely to help or harm them. The newest evidence of the problem comes from a Food and Drug Administration analysis, which found that only 25 percent of patients participating in cancer clinical trials were 65 and older. The analysis, which has not yet been published, was presented at the American Society of Clinical Oncology’s annual meeting in June. (Graham, 6/29)

As summer begins, signaling peak time for insect stings, allergists across the U.S. are warning of a shortage of a little-known but crucial product — honeybee, hornet and wasp venom extracts used in shots that prevent life-threatening reactions. Supplies of the extracts — which are made from venom gathered by hand from millions of individual insects — have been scarce since October. That’s when one of two manufacturers in the U.S. shut down production after contamination problems. Doctors say they hope the situation will be resolved, but that’s not likely before next year. For now, they’re rationing doses for patients who need them most. (Aleccia, 6/29)

A U.S. Food and Drug Administration complaints database contains only 5,144 adverse events between 2004 and 2016 reported in connection with cosmetics, noted the study's senior author Dr. Steve Xu, a dermatologist with Northwestern University's Feinberg School of Medicine in Chicago... Cosmetics manufacturers aren't required to pass on health-related complaints to the FDA, Xu said. (Thompson, 6/28)

A decade after performing the world’s first bone marrow transplants to treat epidermolysis bullosa — a rare and potentially fatal skin disease — university researchers believe they have discovered a “powerhouse” new formula that advances their research, helps the body grow new skin and will allow patients such as [Jonathan] Pitre, 17, to live longer, less painful lives. (Olson, 6/27)

So far this year, Pinellas officials have reported eight suspected sleep-related infant deaths — almost as many as all of last year. And the number has been rising, from six deaths in 2011 to nine in 2015 to 10 last year, according to Bill Pellan, director of investigations for the medical examiner's office. (Kumar, 6/28)

The surprise decision by Assembly Speaker Anthony Rendon to block California’s single-payer health care bill, which the Democrat on Friday called “woefully incomplete,” has so infuriated the California Nurses Association — the bill’s sponsor — that the group has launched an aggressive campaign to pressure him to change his mind. The speaker says he’s even getting threats of violence online, directed at him and his family — a claim that a union spokesman on Wednesday dismissed as an attempt to distract the public from his actions. (Murphy, 6/28)

Anger over Assembly Speaker Anthony Rendon’s decision to shelve universal health care legislation in California has boiled into aggressive protests and even violent rhetoric against the Democratic leader. Rendon said Wednesday that he and his family have experienced “distressing” death threats since announcing late last Friday that the “woefully incomplete” Senate Bill 562 would not move forward this year. (Koseff, 6/28)

Department of Community Health officials audited employees and dependents on the plan, which covers 640,000 Georgians. It found that almost 16,000 dependents of plan members were receiving coverage even though they were ineligible. (Salzer, 6/28)

The nonprofit Hunger Impact Partners created the free app and launched it this summer, in partnership with the Minnesota Department of Education and Minneapolis Public Schools. Summer meal sites include community centers, libraries, food trucks in parks, churches and schools. (Prather, 6/28)

The Grady Health Foundation announced Wednesday that a giant biopharmaceutical company is donating $2 million to help renovate the Grady system’s HIV/AIDS center in Atlanta. The Grady Ponce de Leon Center, which opened in 1993, serves about 6,000 patients annually from a 20-county area that includes Fulton and DeKalb, which have the highest prevalence of HIV in the state. (Miller, 6/28)

After state lawmakers passed legislation governing Florida’s medical marijuana industry this month, local zoning regulations for dispensaries being considered in Miami Beach have stalled. The new state regulations pre-empt local governments from regulating medical cannabis dispensaries any more than they regulate pharmacies, blowing a hole in the zoning plans of Miami-Dade County and Miami Beach. (Flechas and Dixon, 6/28)

Hallmark Health System plans to significantly slash inpatient services at its struggling hospital in Medford beginning this fall, the company said Wednesday. Officials said they plan to close 50 of the 98 inpatient beds at Lawrence Memorial Hospital, including all 40 medical/surgical beds and all 10 intensive care beds. (Dayal McCluskey, 6/28)

Officials at the recently opened Memorial Hermann Cypress Hospital are seeking volunteers who are interested in helping out at the $168 million facility. Currently, the hospital's program includes 45 active volunteers. Positions are open to those who are retired, community members in the workforce, and college students. (Bradley, 6/28)

Every year, more babies are born in withdrawal from drugs — and as the nationwide opioid epidemic rages on, the problem has only gotten worse. Several regional hospital collaboratives around the state have worked to share best practices for caring for infants and mothers, but new funding in the state budget has allowed for the creation of the statewide Virginia Neonatal Perinatal Collaborative. (O'Connor, 6/28)

San Francisco has a mature infrastructure to help the homeless — from cutting-edge Navigation Centers that help people find shelter to a recent $100 million charitable donation to support the chronically destitute. Oakland is still experimenting with how to respond to the crisis. (Garfoli and Veklerov, 6/28)

A medical marijuana dispensary could move in among the retail shops on Newbury Street next summer, after the Boston City Council voted unanimously Wednesday to let the project proceed. The nonprofit that proposed the facility at 331 Newbury St., Compassionate Organics, will need additional approvals from the state Department of Public Health and Boston zoning and health officials before it can start selling cannabis to registered patients. (Adams, 6/28)

We've just seen three new polls on the Senate GOP's health-care bill, and each of them paints an increasingly dire picture for Republicans. Support for the bill is languishing between just 1 out of every 8 Americans and 1 out of every 6 Americans, according to polls from the Marist (17 percent), USA Today/Suffolk University (12 percent) and Quinnipiac University (16 percent). In each case, a majority opposes the bill. That's a level of popularity so low that it's difficult to believe the bill is being entertained. (Aaron Blake, 6/28)

In its current iteration, the Republican Party truly seems to believe that the solution to every problem involves throwing more money at rich people. This explains the health-care fiasco in the Senate, and it’s why President Trump and Congress have yet to address a single major problem the country faces. Everything is secondary to the GOP’s two opening legislative priorities: gutting Obamacare and passing a tax cut. (E.J. Dionne Jr., 6/28)

Moderate Republican Senators who floated their own healthcare bill months ago that allows states to keep the Affordable Care Act and Medicaid expansion intact now say they told you so. Back in January, GOP moderate Senators were clear they didn’t want to spend less on healthcare, particularly Medicaid, for those who gained coverage under the ACA’s expansion of that program. (Bruce Japsen, 6/28)

Scrambling for votes on their wildly unpopular health care bill, Senate Republicans find themselves with an unappealing choice. They can anger their base by ditching seven years of promises to repeal Obamacare. Or they can strip 22 million people — more than the population of Florida — of their health coverage. (6/28)

It's much too soon to start digging the grave for the Senate's attempt to "repeal and replace" Obamacare. It still has a chance, even if Mitch McConnell's decision to delay a vote suggests the chance is smaller than he thought at the beginning of the week. Obviously there would be political consequences for failing to deliver the party's top agenda item for seven years. But for whom? (Jonathan Bernstein, 6/28)

There was a revealing detail buried in the New York Times’s report on the Senate Republicans’ Tuesday evening trip to the White House to talk health care with President Trump. “A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan,” the Times’s Glenn Thrush and Jonathan Martin reported, “and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy, according to an aide who received a detailed readout of the exchange.” (Philip Bump, 6/28)

The Maine Republican and a few other GOP lawmakers stood their ground and, on Tuesday afternoon, forced Senate majority leader Mitch McConnell to delay a vote on his misbegotten health care bill, providing a reprieve to the nation’s poorest and sickest. The McConnell bill would have left an estimated 22 million Americans without health insurance, and its failure is a sign that the centrist wing of the GOP still has a pulse. (6/28)

Senate Republicans have an urgent reason not to give up on repealing and replacing the Affordable Care Act: They don't want to break their promise to the GOP base. But the most recent polls suggest the base may not care as much as Republicans think. The bottom line: A majority still supports the plan, but support has slipped, and there is some evidence that base Trump voters do not view repeal as a top priority — and many may not punish their representatives if they vote no. (Drew Altman, 6/29)

To suggest that Congress must choose between fixing the Affordable Care Act and passing the Senate’s Better Care Reconciliation Act misses a key point: Even if the Senate bill becomes law, we will still need to fix the ACA. The National Retail Federation supports the Senate bill because it would effectively repeal the employer mandate, eliminate the ACA taxes and expand flexibility for increasingly popular health savings accounts. The Senate should pass its bill as soon as it can. (Neil Trautwein, 6/28)

With the Senate effort to upend Obamacare suspended for the Fourth of July holiday, there’s a chance to step back and examine the assumptions behind Republicans’ longstanding objections to the social safety net — as well as the flaws in those assumptions. From Ronald Reagan’s invocation of a “welfare queen,” to Mitt Romney’s derision of “takers,” to the House and Senate bills to cut taxes for the rich by taking health insurance away from tens of millions of people, the premise of incessant Republican tax cutting is that the system robs the rich to lavish benefits on the poor. (6/29)

Donald Trump campaigned for the presidency on a pledge to provide health care that covered more people, provided better benefits, and cost less than Obamacare. That he would fail to deliver that unicorn was preordained -- not by his party's failure of nerve or Democratic obstructionism, but by the laws of mathematics, which are notoriously impervious to the wishful thinking of presidents. (Brian Dickerson, 6/28)

The Senate’s health care proposal made it clear that Republicans, despite their rhetoric, are not interested in market-based reform. Instead, they prefer pro-business, pro-privileged reform. With Senate Republicans planning to rewrite their bill, it’s hard to predict the details of the final proposal. Nonetheless, gauging the House and Senate bills, one can guess that the broad outlines of the final package will be similar. (Christy Ford Chapin, 6/29)

Don’t allow yourself to be distracted. While many of us are keeping a close eye on an investigation into alleged connections to Russia by President Donald Trump’s election campaign, there is a far more pressing and consequential story that deserves our attention. Senate Republicans have released their version of a health care bill to repeal the Affordable Care Act that is projected to result in about 22 million Americans losing their health insurance, according to the nonpartisan Congressional Budget Office. (Jon Mizrahi, 6/29)

In their ardor to undermine and abolish the Affordable Care Act, Republicans in Congress are causing inestimable damage. Specifically, they are damaging the United States’ reputation for reliability among private companies looking to do business with the government. This is not a partisan statement. One of us is a Republican, the other a Democrat. We differ on many policies, including health care reform. (Graig Garthwaite and Nicholas Bagley, 6/29)

The iceberg approaches for the Senate GOP's ship, but unlike with the Titanic, there is plenty of time to turn. Republicans slowed the engines and thus the speed by postponing a vote until after the July 4 recess, but they are still set to collide with the consequences of breaking a core promise to the voters who sent them to Washington. If the GOP does not disengage the country's health-care system from the disaster of Obamacare, we are headed for the misery of single-payer. This is the last chance to divert that outcome. (Hugh Hewitt, 6/28)

President Obama has been busy since leaving office. In February he was photographed kite surfing with billionaire Richard Branson in the British Virgin Islands. March brought a visit to Hawaii, followed by four weeks in French Polynesia and yachting with David Geffen, Oprah, Tom Hanks and Bruce Springsteen. (Karl Rove, 6/28)

Members of Congress are paid $174,000 a year, while members of Poland’s lower house of Parliament are paid $32,300 a year. Hmm. It looks as if we’re getting ripped off. Members of Congress seem to underperform compared to members of Parliament in Poland and across the democratic world. Conservatives are right to worry that feeding at the government trough breeds dependency and laziness. So I suggest we introduce pay for performance, using metrics like, say, health. (Nicholas Kristof, 6/29)

More than a third of Americans believe that Medicaid is akin to welfare, with the implicit subtext that racial and ethnic minorities are the principal beneficiaries. If that’s what they think, they’re dead wrong. Many more Medicaid recipients are white than black or Hispanic. Mick Mulvaney, a former congressman from South Carolina who is now the director of the Office of Management and Budget, promulgates the conservative view. (Thomas B. Edsall, 6/29)

The Congressional Budget Office has projected that the pending legislation before Congress would result in large cost savings, primarily by comparing the bills with how Medicaid enrollment would evolve if the ACA remained on the books. That comparison is important, but it obscures how many people would remain on Medicaid’s rolls. In fact, the CMS actuary projects that under the House bill, total Medicaid enrollment will stay roughly constant above 70 million people over the next decade. This is lower than it would be under the ACA, but higher than the enrollment population before the ACA was enacted (roughly 55 million). (Charles Blahous, 6/28)

With the Senate health-care bill delayed for now, the conservative and more centrist GOP wings need to bridge a philosophical gap to succeed. The outcome of this debate will define what the Republican Party stands for—and whether the problems of America’s entitlement state can ever be solved. (6/28)

The hysteria over the effect of Republican Obamacare replacement proposals on Arizona’s Medicaid program is badly overwrought. The accusation is routinely made that they will toss 400,000 Arizonans off the Medicaid rolls. (Robert Robb, 6/28)

Senate Republicans may not realize it, but their repeal-and-replace health-care legislation, if passed, would set the U.S. on the road to European-style price controls and rationing of prescription medications. This would follow fairly directly from the enormous cuts to Medicaid that the bill would impose. (Peter R. Orszag, 6/28)

I chose medicine as a profession to care for members of my community regardless of their income levels, disabilities or any other ways in which Congress’ health care legislation will divide the haves and have-nots. I will continue to devote myself fully to the care of all my patients. But I deeply lament that – if passed – this legislation will only make my work more challenging, ur system more overburdened, and my patients’ lives shorter and more difficult. (Nuriel Moghavem, 6/28)

First, my job as a small business owner has allowed me to watch the positive impact of the Affordable Care Act and the Medicaid expansion in Ohio and Kentucky directly. Second, my education in economics and business helped me understand that a healthy workforce is good for the economy. (Paul Neumann, 6/28)

Instead of discussing these viable solutions, conversations surrounding the American Health Care Act have legislators scrapping much of what worked about the ACA. Most alarmingly, the AHCA would impose per capita caps on Medicaid and reduce Medicaid funding by more than $830 billion over 10 years. (Bridget McCandless, 6/28)

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, 6/28)

In recent months, I lost two great personal and professional friends to depression and, ultimately, suicide — Raul Valdes-Fauli and Ervin Gonzalez. Both seemed to have the world in the palms of their hands: loving families, financial security, and professional success as a banker and lawyer, respectively. Now I know they also shared a similar mental anguish that became too much for each of them to bear. (Marlon A. Hill, 6/28)

Egyptian medical texts dated around 550 B.C. contain the earliest known descriptions of diabetes. Treatments for the disease throughout history included having patients drink their own urine, bleeding them, blistering them and administering opium to “reduce the despair” of impending death. (6/28)

On June 8, 2017, Delaware’s Democratic governor, John C. Carney, Jr, signed into law the first state abortion rights bill since the conclusion of the presidential campaign during which candidate Trump called for the abolition of Roe v Wade. Designed to ensure the legality of abortion in Delaware in the event that the landmark ruling is overturned by a reconstituted Supreme Court, Senate Bill 5 (SB 5) expunges a long-standing if unenforceable state abortion ban dating back to 1953. (Eli W. Adashi, 6/28)

There can no longer be any dispute: electronic cigarettes, also known as “vapes,” are significantly less harmful to health than traditional combustible cigarettes. Not only are they less harmful, they are more effective in helping adults quit their deadly cigarette habit than any other nicotine-replacement therapy. Despite this, some within the public health community continue efforts to eliminate these potentially life-saving products. San Francisco just passed a ban on the sale of flavored tobacco products, in part over concerns that fruit and candy-flavored e-cigarettes appeal to kids. But fears aren’t facts, and such efforts could have devastating consequences for public health. (Michelle Minton, 6/29)

Each fall, first-year medical students are introduced to the basics of confidentiality. The question is posed: “How many of you would friend a patient?” Watching from the back of the auditorium, I have yet to see a single hand flutter, much less shoot confidently into the air. I am waiting, I think, for the moment when the culture shifts before my eyes. Like my students, I feel a crawling discomfort at the thought of invading cyberspace to contact a patient online. I came of age with the internet: that is, old enough to have attended college Facebook-free but young enough to have been regularly chastised about the professional perils of social media. Unlike my students, however, I no longer hear it as a polar question. I accepted a friend request from a patient’s parents, and it forever changed my understanding of the practice of medicine. (Amy E Caruso Brown, 6/27)

Almost 50 years ago, New York Times reporter James Reston had an emergency appendectomy while traveling in China. His subsequent report that acupuncture produced substantial relief from his postoperative discomfort is widely credited with launching Western interest in acupuncture, although many Western medical practitioners have remained skeptical. Nevertheless, there has been steady progress in application of the methods of evidence-based medicine and modern neuroscience to these ancient practices, suggesting that acupuncture may have therapeutic benefit. (Josephine P. Briggs and David Shurtleff, 6/27)

California badly needs political heroes, and we just got one: Assembly Speaker Anthony Rendon. “Heroic” is not an adjective normally associated with a politician. But regardless of your politics, Rendon should be saluted. (George Skelton, 6/29)

Your Congress has made it illegal for Medicare to negotiate drug prices. Drugs can be bought from Canada for less than the co-pay for your Medicare, meaning, you are paying several times the retail price; plus, you are paying for the insurance that is supposed to cover the cost; plus, taxpayers are also paying for the cost of the program. (James Baker, 6/28)

You can’t talk about addressing the mental health crisis in this county without including the issues of homelessness and addiction. This is why a coalition of addiction and mental health experts from Hoag and St. Joseph hospitals, as well as local and state government officials, have been meeting to come up with a plan. No one facility or community can bear the burden, but networked campuses countywide just might. (Barbara Venezia, 6/28)