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President Trump was fed up with the grind of health care legislation, and at a dinner with Republican senators on Monday at the White House, he let them know it. He told the lawmakers how annoyed he was with one Republican who was not there, Senator Rand Paul of Kentucky, who had gone on television over the weekend to oppose a Senate health care bill that once held the promise of victory for Mr. Trump. It is one thing to vote no, Mr. Trump told the group, according to one of the guests. It is another, the president said, to go on all of the Sunday shows and complain about it. The scene on Monday night was an exasperating end for Mr. Trump to a month of negotiations between the White House and Senate Republicans in an effort to repeal the Affordable Care Act, President Barack Obama’s signature domestic legacy. (Steinhauer, Thrush and Pear, 7/18)

By any measure, the collapse of the Senate health-care bill represents an epic failure for the Republican Party and a major embarrassment for President Trump. The crusade that animated — and bound — conservatives for seven years proved to be a mirage, an objective without a solution. Power comes with consequences. There is no way to spin to those who were promised that the Affordable Care Act would be repealed and replaced once Republicans held full power in Washington that what has happened is the fault of forces outside the party. This has been a GOP undertaking from start to finish. It is as though Republicans unknowingly set a trap and then walked into it without having prepared escape routes. (Balz, 7/18)

At the heart of the failed Senate effort to repeal parts of the Affordable Care Act were irreconcilable differences over the proper role of entitlements and how far the party should go to pursue its small government mantra. Both wings of the GOP revolted — senators who rejected steep cuts to Medicaid, a health program for low-income Americans, and others who felt the cuts were not deep enough. (Paletta, 7/18)

So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what's next? (Elving, 7/19)

Vice President Pence arrived at the National Governors Association summer meeting with one mission: to revive support for the flagging Republican plan to rewrite the nation’s health-care laws. He failed. Instead of rousing cheers on the waterfront in Providence, R.I., Pence was greeted with an icy air of skepticism Friday as he pitched the legislation, which would reduce federal Medicaid funding and phase out coverage in dozens of states. (Costa, Snell and Sullivan, 7/18)

In 2010, Democrats passed a sweeping health-care bill that polls showed to be unpopular with no support from the other party. In 2017, Republicans sought to do the same. Each party touted the respective merits of its bills, but here is a look at some of the differences that meant one passed and the other stumbled. (Bendavid, 7/18)

In less than 14 hours, Senator Majority Leader Mitch McConnell's plan to hold a repeal-and-delay vote on Obamacare died. Three of the five female Republican senators said they would not agree to open debate on a bill that would cut off subsidies for low- and moderate-income buyers in the individual market and end the Medicaid expansion. With that, the Senate's effort to repeal Obamacare without a replacement lacked majority support, even with an assist from the vice president. (Lee, 7/18)

Seven years of Republican vows to “repeal and replace” the Affordable Care Act came to a crashing halt Tuesday, when it became clear that the Senate could not muster the necessary votes for any of three separate proposals that have been under consideration. The failure, at least for now, breaks one of the key promises Republicans have made to their voters since 2010, when the ACA first became law. (Rovner, 7/18)

The U.S. health care debate is not for the faint-hearted. For the second time in less than a decade, Americans have been asking tough questions about proposed big changes in how they get health insurance. Here are seven memorable moments from the debate over whether to repeal and replace the Affordable Care Act. (7/19)

It was men who started it. It may be women who finished it. The Senate effort to repeal the Affordable Care Act, a process that began with 13 Republican men drafting a plan behind closed doors, collapsed Tuesday, as three Republicans said they would not support an ultimately futile attempt to simply roll back the current health care law without a replacement. (Huetteman, 7/18)

Hours after GOP leaders abandoned a bill to overhaul the law known as Obamacare, their fallback plan — a proposal to repeal major parts of the law without replacing them — quickly collapsed. A trio of moderate Republicans quashed the idea, saying it would irresponsibly snatch insurance coverage from millions of Americans. “I did not come to Washington to hurt people,” tweeted Sen. Shelley Moore Capito (R-W.Va.), who joined Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) in opposing immediate repeal. (Eilperin, Sullivan and O'Keefe, 7/18)

“To just say, ‘Repeal and trust us—we’re going to fix it in a couple years,’ that’s not going to provide comfort to the anxiety that a lot of Alaskan families are feeling right now,” GOP Sen. Lisa Murkowski of Alaska told reporters. “There is enough chaos and uncertainty already.” (Peterson, 7/18)

Collins of Maine told reporters that repealing the law now and then hoping for a replacement "would create great anxiety for individuals who rely on the ACA." She said she would oppose bringing a repeal bill up for debate. "I believe it would cause the insurance markets to go into turmoil." (Litvan and Dennis, 7/18)

Further, Sen. Pat Roberts of Kansas tells NPR's Susan Davis, there are probably "five or six" Republicans in total who are against the motion. (Neuman, 7/18)

But McConnell said Tuesday evening that he would hold a vote to proceed to the bill "early next week," which would put senators on the record even if the vote's outcome was preordained. McConnell said the vote was "at the request of the president and vice president and after consulting with our members." (Kim, Haberkorn and Everett, 7/18)

“For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the ObamaCare repeal bill early next week," McConnell said from the Senate floor on Tuesday night. (Carney, 7/18)

The replacement bill's language is based on the repeal bill that that passed by the House and Senate in 2015 but was vetoed by President Barack Obama. Here's how the repeal would have changed the Affordable Care Act, compared with the House and Senate bills. (Kodjak, Hurt and Grayson, 7/18)

Republicans on Monday abandoned their latest effort to replace the Affordable Care Act, and some — including President Trump — are now considering an attempt to repeal President Obama’s signature health care law without a replacement bill. Any effort to simply repeal Obamacare is likely to be blocked, but what would happen if the landmark 2010 heath care bill was repealed? (Rocheleau, 7/18)

Republicans have long campaigned on repealing the healthcare system put in place by Democrats, but faced immense opposition as popularity for the program rose to more than 50 percent in recent months. Despite the botched attempt, Republican candidates in Ohio might be able to breathe a sigh of relief. (Richardson, 7/19)

Ohio Republican U.S. Sen. Rob Portman was not one of the members responsible for this outcome. Portman indicated that he, too, could have concerns with a straight repeal, and his sentiments appeared to reflect concerns of colleagues. (Koff, 7/18)

Louisiana Sen. Bill Cassidy stopped short of saying he would vote against U.S. Senate Majority Leader Mitch McConnell's latest proposal to repeal the Affordable Care Act with no immediate replacement. But Cassidy also wouldn't say he would support McConnell's effort either in an interview Tuesday (July 18). Instead, the Republican senator said he would continue to pursue the health care replacement plan he put together with South Carolina Sen. Lindsay Graham, also a Republican. A few weeks ago, he had been working with Maine Sen. Susan Collins, another Republican, on a health care replacement strategy as well. Neither plan assembled by Cassidy has gained traction with the rest of the Senate.  (O'Donoghue, 7/19)

For months, Maryland Gov. Larry Hogan has mostly avoided the political storm raging in the nation’s capital, skirting questions about President Donald Trump and the policy changes his new administration has embraced. But on health care, Hogan appears to be finding his voice. For the second time in as many months, the centrist Republican governor who has eschewed national politics weighed in directly about his party’s faltering efforts to repeal Obamacare — arguing Tuesday that the latest push by Senate leaders could leave millions without insurance. (Fritze, 7/18)

Colorado Gov. John Hickenlooper joined his Republican counterparts Tuesday — including Ohio Gov. John Kasich and Nevada Gov. Brian Sandoval — in urging the U.S. Senate not to repeal Obamacare without a replacement. “Congress should work to make health insurance more affordable by controlling costs and stabilizing the market, and we are pleased to see a growing number of senators stand up for this approach,” Hickenlooper and 10 other governors said in a written statement. “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later.” (Paul, 7/18)

Gov. Rick Scott, whose political career is largely defined by opposition to the Affordable Care Act, still wants Republicans to repeal the federal health care law despite their apparent failure to do so... The statement appears at odds with President Donald Trump’s solution, to “let Obamacare fail,” in light of the Senate GOP’s inability to pass its own health care bill, dubbed the Better Care Reconciliation Act. (Rohrer, 7/18)

Mr. Trump declared that his plan was now to “let Obamacare fail,” and suggested that Democrats would then seek out Republicans to work together on a bill to bury the Affordable Care Act. If he is determined to make good on that pledge, he has plenty of levers to pull, from declining to reimburse insurance companies for reducing low-income customers’ out-of-pocket costs to failing to enforce the mandate that most Americans have health coverage. “It’ll be a lot easier,” Mr. Trump said at the White House. (Kaplan, 7/18)

“I think we're probably in that position where we'll let ObamaCare fail,” he told reporters in the Roosevelt Room. “We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it. We'll let ObamaCare fail and then the Democrats are going to come to us.” (Fabian, 7/18)

President Trump on Tuesday put blame on Democrats and "a few Republicans" for the collapse of the Senate GOP's healthcare bill. "We were let down by all of the Democrats and a few Republicans," Trump tweeted. "Most Republicans were loyal, terrific & worked really hard. We will return!" (Savransky, 7/18)

President Donald Trump is trying to save the GOP's near-dead effort to repeal Obamacare. The president has invited all 52 GOP senators to the White House for lunch on Wednesday to see if he can revive the GOP's moribund plans to repeal and replace the 2010 health law. (Everett, 7/18)

Trump stayed largely on the sidelines as Majority Leader Mitch McConnell struggled unsuccessfully to round up support to make good on the GOP's years of promises to repeal and replace former President Barack Obama's health care law. But with McConnell's third and final effort — on a repeal-only bill — looking like it, too, had collapsed, Trump urged McConnell to delay a make-or-break vote until early next week. (Werner and Fram, 7/19)

It was a far cry from "The buck stops here." President Donald Trump, dealt a stinging defeat with the failure of the Republican health care bill in the Senate, flipped the script from Harry Truman's famous declaration of presidential responsibility and declared Tuesday, "I am not going to own it." He had tweeted earlier, "We were let down by all of the Democrats and a few Republicans." (Lemire, 7/19)

In early May, when Senate Republicans began working on health-care legislation, they quickly turned away from two spectacles: the unpopular House bill and the president of the United States’ premature White House Rose Garden celebration of its passage. Instead, Senate Majority Leader Mitch McConnell (R-Ky.) decided to work up a different bill inside his Capitol office — and left Trump on the sidelines, where he happily stayed. (Kane, 7/18)

As the blame game launches on the Senate health-care bill, there is perhaps no more illustrative example of President Trump's role in the negotiations than this: It's Monday evening. A second version of the Republicans' bill is in danger of flatlining. Two GOP senators are opposed to it, almost a dozen have expressed serious concerns with it, and if just one more Republican opposes it, it's game over for an Obamacare overhaul. Trump is having dinner at the White House with seven Republican senators to talk health care. Of the seven, only Steve Daines (Mont.) had publicly expressed concerns about the bill. (Phillips, 7/18)

One week before the election, Donald Trump traveled to the Philadelphia suburbs to deliver a health-care policy speech that was light on details and heavy on grand promises and dramatic warnings. In a hotel ballroom in King of Prussia, his running mate, Mike Pence, introduced him as a dealmaker, fighter and winner “who never quits, who never backs down.” Trump promised to “convene a special session” of Congress as soon as he was sworn in — an idea that confounded many, as Congress was already set to be in session — so that lawmakers could “immediately repeal and replace Obamacare.” All of this would happen “very, very quickly,” he said. (Johnson, 7/18)

President Trump's extensive Twitter history — 35,300 tweets and counting, stretching back to 2009 — virtually guarantees that there's a past tweet to serve as an ironic exclamation point for just about any moment of the Trump presidency. It happens so often that there's a running Internet joke that Trump is actually “a time traveler sent to warn us about himself.” But at no point in Trump's tenure has the president found himself contradicted so much by his own prior tweets as the (perhaps) final implosion of his Obamacare repeal aspirations, which he made a major issue in his campaign. (Ingraham, 7/18)

The Trump administration pushed hard -- and ultimately unsuccessfully -- to convince reluctant senators and governors to support the Senate GOP’s ObamaCare repeal effort. Its two top health officials and Vice President Mike Pence became fixtures in closed-door GOP conference meetings on Capitol Hill, along with other key advisors such as Budget director Mick Mulvaney and White House Chief of Staff Reince Priebus. (Weixel, 7/18)

President Donald Trump is now more likely than ever to end his first year in office without a single major legislative accomplishment. His Obamacare repeal collapsed Tuesday. He won’t even release the broad outlines of his tax overhaul plan until September. The last time Washington did a major tax bill, in 1986, it took more than a year. A $1 trillion infrastructure plan is little more than a talking point. Congress ignored his budget proposal. Republicans are as divided on all of these issues as they are on health care. Lawmakers haven’t even given him money to build his border wall. (Sink and Dennis, 7/19)

He’s 71, holds down an incredibly stressful job, and is overweight. He doesn’t exercise. His eating habits are less than ideal. And to top it all off, he doesn’t get enough sleep. For anyone walking into a doctor’s office with those symptoms, stern warnings to change one's lifestyle are sure to follow. (O'Donnell, 7/17)

When the banner Republican effort to scuttle and rewrite President Barack Obama's health care law crumbled this week, the falling debris popped a hefty dent into Senate Majority Leader Mitch McConnell's image as a dauntless legislative tactician three chess moves ahead of everyone else. (7/19)

The failure of Obamacare repeal marks Mitch McConnell’s lowest point as Senate GOP leader. Despite having a Republican in the White House, full GOP control of Congress and seven years of campaign promises — “pulling out Obamacare root and branch,” as the Kentucky Republican famously declared — McConnell acknowledged this week that he didn’t have the votes to even start debate on replacing the 2010 Affordable Care Act. (Bresnahan and Everett, 7/18)

When Sens. Mike Lee and Jerry Moran decided they were in ready to disrupt the GOP rewrite of the health care law, they chose President Donald Trump's favorite medium. They could not support Senate Republicans' plan, the somewhat unlikely pair of conservatives tweeted at 8:30 p.m. Monday night, giving no heads up to the White House or Senate leaders before pressing send. The story behind the statement reveals two senators willing to be branded as bill killers and seemingly unconcerned with trying to soften the blow with party leaders. (Daly, 7/19)

Kansas Sen. Jerry Moran is nobody's idea of a rabble-rouser. A Republican stalwart with a low-key style and reputation for caution, his decision to publicly torpedo the latest Senate GOP plan to overhaul health care raised eyebrows. The contrast is sharp between Moran and Utah's Sen. Mike Lee, the other senator who scuttled the Republican plan Monday night. Lee is a tea party favorite once willing to shut down the federal government to stymie former President Barack Obama's health care policies. (Hanna, 7/18)

For a public official unaccustomed to the limelight, U.S. Sen. Jerry Moran can’t seem to avoid it when it comes to the national healthcare debate. Moran’s Monday night tweet announcing his opposition to the latest Republican health bill triggered “breaking news” alerts on cable news channels. And it briefly won him praise from the demonstrators who stage weekly protests outside his Olathe office. They cheered when Leslie Mark, an organizer for Indivisible KC, picked up a bullhorn and shouted “Thank you Senator Jerry Moran,” to kick off Tuesday’s event. (McLean, 7/18)

Republicans are expressing embarrassment, fear and frustration as party leaders concede that their years-long promise to erase much of Barack Obama's Affordable Care Act is all but dead. Conservative activists blamed establishment Republicans who control Congress. Establishment Republicans blamed a lack of leadership from their president. And the Republican president blamed "a few Republicans" and all Democrats for blocking his agenda. (Beaumont, 7/19)

As the seven-year Republican effort to repeal the Affordable Care Act crashed on the threshold of the Senate, President Trump offered his party a rescue strategy. Step one: Blame Democrats. Step two: Win more seats and try again. (Weigel, 7/18)

“The way I look at it is, in ’18 we’re going to have to get some more people elected,” Mr. Trump said in the Roosevelt Room in the White House. “We have to go out and we have to get more people elected that are Republican.” (Hook and Radnofsky, 7/18)

The anger commenced not long after Tuesday’s collapse of the Senate GOP bill to replace Obamacare. The Senate Conservatives Fund promised to "identify, recruit, and fund conservative challengers” to GOP lawmakers who vote against a clean repeal.It’s no empty threat in a Republican Party that’s seen a handful of incumbents defeated — or nearly-defeated — in primaries in recent years. (Isenstadt and Debenedetti, 7/19)

A top conservative group is threatening primary challenges to senators who vote against a repeal of ObamaCare after Senate Republicans failed to coalesce around a replacement plan. Former Virginia Attorney General Ken Cuccinelli, who now serves as the president of the Senate Conservatives Fund, drew the line in the sand on Tuesday, soon after reports surfaced that Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a repeal vote even though it's already clear he doesn't have the votes to pass it. (Kamisar, 7/18)

Medicaid may be the next “third rail” in American politics. Resistance to cutting the health care program for the poor has emerged as a big stumbling block to Obamacare repeal, and Republicans touch it at their political peril. “If they’d gone ahead ... clearly I would think we’d be seeing a transfer of power in a year and a half,” said John Weaver, a GOP strategist for Ohio Gov. John Kasich, who has called the Medicaid overhaul proposals of his fellow Republicans “unacceptable.” (Pradhan, 7/19)

Washington politics often revolves around numbers. And no number is more important that the “baseline.” When politicians talk about “spending cuts” or “tax cuts,” they are measuring against a baseline. But it’s a process open to manipulation and hypocrisy, so here’s an explanation. (7/19)

Congressional Republicans’ plans to repeal and replace — or even just repeal — Obamacare may be on hold for now, but four Pennsylvania mothers of chronically ill and seriously disabled children said Tuesday they can’t afford to let up on their efforts to preserve the public program that pays for their children’s care. As guests of the Pennsylvania Health Access Network (PHAN), a statewide health consumer advocacy group, the women spoke out about what cuts to Medicaid – a part of virtually all the GOP’s proposals – would do to working families like theirs. Although Medicaid is most often thought of as a health-care provider for the poor, it also funds care for people with severe conditions that would not be fully covered by private insurance. (Giordano, 7/19)

While controversy rages in Washington and around the country over the Republican effort to kill Obamacare, Maryland leaders are anxiously watching in fear of what they may confront down the road. Total repeal of the Affordable Care Act would deprive state government of $1.3 billion in Medicare and Medicaid payments next year — a staggering amount. Some 1.1 million Marylanders on Medicaid — most of them disabled, children or elderly — could be at risk of losing their health insurance. (Rascovar, 7/18)

In a joint effort with the Georgia Department of Education, the Department of Community Health board voted to approve a nursing services reimbursement program that would draw an estimated $48.6 million in additional federal dollars, assuming no major changes to Medicaid. There were 1,629 nurses and 307 unlicensed health care and clinic workers in Georgia schools last spring. (Tagami, 7/18)

Senate Democrats are still hanging tight on the same message as the GOP’s seven-year push to repeal Obamacare careens off course: Drop the one-party approach and work with us to fix the health care law. Even the five Democratic senators facing re-election battles next year in states President Donald Trump turned bright red are showing no interest in making deals before Republicans abandon their attempt to push through repeal with a bare majority. (Schor and Kim, 7/18)

Fueled by the Senate Republicans’ failure to repeal and replace the Affordable Care Act, Democrats are ramping up their calls for GOP leaders to reach across the aisle in search of bipartisan fixes to former President Barack Obama’s signature domestic achievement. “It's time to move on. It’s time to start over,” Senate Minority Leader Charles Schumer (D-N.Y.) said Tuesday morning on the chamber floor. (Lillis, 7/18)

House Minority Leader Nancy Pelosi, the San Francisco Democrat and chief architect of the Affordable Care Act, offered Democratic help. Acknowledging that the law, commonly referred to as Obamacare, needs to be “updated,” she urged the Trump administration and the GOP Congress to stop threatening to withhold vital payments to insurers to cover high-cost patients and other actions that have destabilized some insurance markets. “We would have been working with them from day one,” Pelosi said in an interview Tuesday. “Call it something else, name the provision something else, save face, get yourself a victory, but protect the American people.” (Lochhead, 7/18)

Sen. Elizabeth Warren (D-Mass.) said Tuesday she isn't declaring victory over the collapse of the Senate Republican healthcare bill, pointing to the GOP's long history of working to repeal key provisions of ObamaCare. "I’m not doing a touchdown dance over health care today. This zombie bill has come back from the dead over [and] over again," Warren wrote on Twitter. (Beavers, 7/18)

Centrist House Republicans and Democrats huddled on Tuesday and discussed healthcare in the wake of the collapse of Senate GOP efforts to repeal ObamaCare, multiple sources told The Hill. Members of the GOP’s Tuesday Group and the New Democrat Coalition met in the Capitol, part of a periodic gathering of the two moderate groups. But healthcare dominated the meeting, participants said. (Wong and Lillis, 7/18)

“We will have demonstrated that Republicans by themselves are not prepared at this particular point to do a replacement and that doesn’t mean the problems all go away," McConnell said. "You’ll have to look at our committee chairmen and their ranking members." (McIntire, 7/18)

Centrist Democratic Sen. Joe Manchin (D-W.Va.) is organizing a bipartisan group of senators who are former governors to discuss possible bipartisan action on healthcare, with a meeting planned for Tuesday night. The meeting comes as talk of bipartisan action to stabilize ObamaCare markets is picking up in the wake of the collapse of the Republican healthcare bill. (Sullivan, 7/18)

Tuesday afternoon, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) indicated he would convene hearings soon to explore ways to develop more-limited healthcare legislation. (Levey and Mascaro, 7/18)

With the GOP’s plan to repeal Obamacare near collapse, the Republican chairman of the Senate health committee announced Tuesday he will convene hearings to look for ways to stabilize the individual insurance market. Sen. Lamar Alexander, R-Tenn., said the hearings are needed to help millions of Americans who will be unable to buy insurance unless Congress acts. (Collins, 7/18)

Now what? Senate Republicans are scrambling to pick up the pieces after their attempt to repeal and replace the Obama-era health care law collapsed a second time. (7/18)

The Republican health care bill, at least for now, is dead. So what happens next? Senate Republicans have already announced plans to pivot to legislation that would repeal much of the Affordable Care Act without spelling out a replacement plan, after two additional GOP senators defected from the party’s controversial plan to simultaneously repeal and replace parts of the law. President Trump, too, tweeted his support for that approach. (Mershon and Facher, 7/18)

Republicans could soon find themselves in a situation they didn’t expect: shoring up rather than dismantling the Affordable Care Act. With the demise of the Senate Republican health push, a growing number of lawmakers and governors from both parties say the urgent next step is to bolster the ACA insurance exchanges, which have suffered from rising premiums and fleeing insurers. (Armour, 7/18)

Senate Minority Leader Charles E. Schumer (D-N.Y.) on Tuesday blasted President Trump’s vow to “let Obamacare fail,” saying it shows a “lack of leadership” and could be politically perilous for Republicans in next year’s congressional elections. Speaking just hours after the dramatic collapse of GOP plans to repeal the Affordable Care Act, Schumer said Democrats remain willing to work with Republicans to shore up insurance markets and enact broader fixes to the current health-care law. But that didn’t stop him from tweaking Trump. (O'Keefe and Sullivan, 7/18)

The morning after Republican efforts to repeal and replace Obamacare seemed to die, two Ohioans summed up the lay of the land. One is U.S. Rep. Jim Jordan, a Tea Party icon who has tried to get rid of the Affordable Care Act, or ACA, for years. Repeal it outright, and do it now, Jordan, from rural Champaign County, told CNN this morning. (Koff, 7/18)

For four successive congressional campaigns, Republicans have exploited frustrations about the Affordable Care Act with considerable electoral success, and the GOP won the White House last November with a gauzy promise by candidate Donald Trump to replace it with something "beautiful." But six months later, Senate Majority Leader Mitch McConnell pulled the repeal-and-replace bill from consideration late Monday in the face of certain defeat. (Page, 7/18)

Stunning as it is to witness the demise of the Republicans’ health reform effort, perhaps the most surprising piece is who played the role of executioner... In the end, it was brought down by two of the more reliably conservative voices in the Senate chamber — and just days after Senate majority leader Mitch McConnell accepted demands to move the bill dramatically right-ward. (Horowitz, 7/18)

The stunning collapse of ObamaCare repeal on Tuesday forced Republicans to confront a sobering reality: Their party and agenda are in a deep hole, and it’s not going to be easy to get out. Republicans have campaigned on repealing and replacing ObamaCare for the past seven years but find themselves unable to deliver on that promise despite having unified control of Congress and the White House. (Sullivan, 7/18)

Donald Trump holds a fuse in his hands — and he could decide to light it and blow up Obamacare insurance markets as soon as Thursday. That’s the deadline for sending out the next monthly Affordable Care Act subsidies to health plans to defray the cost of care for individuals with low incomes. The president has toyed for months with the idea of stopping the payments to force Democrats to the negotiating table to avoid the prospect of millions of vulnerable Americans losing access to health coverage. (Demko and Dawsey, 7/18)

The health insurance industry’s Obamacare drama reached a climax on Tuesday, but it isn’t over. With Senate Republicans’ failure to advance their bill to replace Obamacare, insurers are facing a summer of uncertainty. President Donald Trump’s administration won’t commit to making critical payments under Obamacare. Health plans have pulled out of some markets, and raised rates in others. And there’s always the chance that Republicans could revive their effort to repeal the law. (Tracer, 7/18)

A failed Republican effort to replace Obamacare raised new concerns on Tuesday for U.S. health insurers over whether the government will continue to fund billions of dollars in medical benefit subsidies. The healthcare bill under consideration in the U.S. Senate would have settled the funding question, but was scrapped after Republican leaders were unable to rally enough party members to win approval. (Humer and Abutaleb, 7/18)

With the Senate’s health care overhaul dead in its current form, Obamacare lives another day. That leaves a familiar Georgia face, Health and Human Services Secretary Tom Price, in charge of implementing the law, one that he’s vilified for the last seven years. (Hallerman, 7/19)

The implosion of the Senate Republicans’ health-care ambitions leaves the Affordable Care Act intact for the moment — but immediately creates worrisome unpredictability for the 10 million Americans who buy health plans through the law’s insurance marketplaces. These consumers could face a rocky few months at the least, as the insurers on which they rely decide how to respond to the political chaos. Some companies could become more skittish about staying in the marketplaces for 2018, while others could try to ratchet up their prices depending on how events in Washington unfold. (Goldstein and Winfield Cunningham, 7/18)

For the health-care system, it’s back to square one. Insurers, hospitals and state officials are facing the prospect that the Affordable Care Act will remain the law of the land for now at least, but they also are left with huge questions about how key aspects of the law will be handled under the Trump administration as deadlines loom for insurers’ decisions about next year. (Wilde Mathews and Evans, 7/18)

Consumers would feel the impact immediately if Republicans repeal "Obamacare" with no replacement. Problems could start this fall for customers buying individual health policies, say independent experts, with more insurers likely to exit state markets around the country, and those remaining seeking higher rates. (Alonso-Zaldivar, 7/19)

Despite repeated attempts by Senate Republicans to dismantle the Affordable Care Act, the healthcare debate in Washington appears to have collapsed — for now. The United States has much room for improvement when it comes to healthcare, experts said. “The U.S. spends more on healthcare, but we don’t have the same health outcomes [as other countries],” said Cynthia Cox, associate director at Kaiser Family Foundation, a nonprofit organization that researches national health issues. (Etehad and Kim, 7/18)

UnitedHealth Group's second-quarter earnings soared as the nation's largest insurer dove deeper into government-funded health coverage like Medicare and Medicaid and continued to distance itself from the turbulent Affordable Care Act insurance exchanges. (Murphy, 7/18)

UnitedHealth Group Inc. is putting its Obamacare struggles behind it just as Republicans in the Senate are trying to do the same. The biggest U.S. health insurer reported second-quarter results Tuesday showing expanded membership as it moved away from the Affordable Care Act and added customers mainly in the government funded programs for the elderly and poor: Medicare and Medicaid. The company largely quit Obamacare going into this year, after racking up losses selling policies to individuals last year. (Tracer, 7/18)

The House Veterans Affairs Committee will discuss in a closed meeting Tuesday night a roughly $4 billion extension to a private medical care program known as the Veterans Choice Program, committee leaders confirmed to CQ. Lawmakers need to enact legislation moving more money into the program, as funding is projected to run out by mid-August, VA Secretary David Shulkin told lawmakers at an appropriations hearing in June. Shulkin was criticized by lawmakers for administratively diverting care requests to other programs, absent more money. (Mejdrich, 7/18)

House appropriators working on the Labor-HHS-Education spending bill turned down a number of White House proposals in a report released Tuesday, including the administration's request to limit administrative costs for the National Institutes of Health and boost funding for apprenticeships...The report comes a day before the full House Appropriations Committee is scheduled to mark up the $156 billion spending bill that would provide $5 billion less than the 2017 enacted level (PL 115-31).  At Wednesday’s markup, Appropriations Committee Democrats plan to offer amendments to save the $286 million Title X Family Planning Program and stop other funding cuts to women’s health programs. (Wilkins and Siddons, 7/18)

Needle exchange programs for drug users could be coming to six counties across the state, including Anne Arundel and Baltimore counties, as state health officials work with local leaders to stop the spread of infectious diseases in the face of the heroin epidemic. The efforts are being lead locally and are at various stages of formation, but state officials are encouraging the programs and offering technical assistance and some funding, said Onyeka Anaedozie, deputy director of the Maryland Department of Health’s Infectious Disease Prevention and Health Services Bureau. (Cohn, 7/18)

A Florida state attorney is voicing alarm after a 10-year-old boy died last month with a dangerous opioid mixture in his system — making him one of the youngest victims in the state's drug epidemic. (Bever, 7/18)

New research into opioid addiction from the Hazelden Betty Ford Institute and the University of Maryland School of Public Health addresses the issue of doctors over-prescribing drugs. The report also discusses growing evidence that doctors are still prescribing opioids to patients with a higher risk of abuse at a higher rate than they are to others. (Weber and Erickson, 7/18)

A Franklin County board agreed Tuesday to spend $5 million more to address one of the major concerns of emergency workers who respond to heroin overdoses in the county. Too often, rescuers rushed overdose cases to hospitals, but the patients walked right back out to use again because there was no room for them in treatment facilities. (Perry, 7/19)

Does it really take an expensive brain scan to diagnose Alzheimer's? Not everybody needs one but new research suggests that for a surprising number of patients whose memory problems are hard to pin down, PET scans may lead to changes in treatment. (7/19)

A significant portion of people with mild cognitive impairment or dementia who are taking medication for Alzheimer’s may not actually have the disease, according to interim results of a major study currently underway to see how PET scans could change the nature of Alzheimer’s diagnosis and treatment. (Bahrampour, 7/19)

In nursing homes and residential facilities around the world, health care workers are increasingly asking dementia patients questions: What are your interests? How do you want to address us? What should we do to celebrate the life of a friend who has passed away? (Wang, 7/19)

Baseball, hot dogs, apple pie and … diabetes. That’s right. The metabolic condition is about as American as you can get, according to a new national report card on diabetes released Tuesday by the Centers for Disease Control and Prevention. (Kaplan, 7/18)

Over the past decade, Americans have soured on artificial sweeteners. Once heralded as sweet substitutes for sugar without as many belt-busting calories, people once couldn't get enough sucralose and aspartame. But recently, people have started looking at the molecules with increasing suspicion, amid studies that linked them to increased belly fat — and bogus but widespread rumors that they led to things much worse. (Wootson, 7/18)

The wrong kind of exclusively plant-based diet, one that includes a lot of refined grains and sweetened beverages, can actually increase the risk of coronary heart disease, according to a new study from Harvard University. On the other hand, reducing your intake of animal products while boosting your consumption of fruits, vegetables, and whole grains, and continuing to indulge modestly in animal foods, can do you nearly as much good as a healthy vegan diet—and even more good than one that includes a lot of French fries and pasta. (Shanker, 7/18)

Usually, the corpses are already underground, not because they’ve been buried, but because they are prairie dogs. In the throes of plague, they crawled down into their burrows to die at home. Wagner isn’t there for their bodies. He’s more interested in the fleas that transmitted plague in the first place. Sometimes, like their dead hosts, they too are beneath the earth, and he needs to coax them out. At other times — when he’s investigating what he’d call a “hot site”— the blood is gone from the corpses, the fleas have begun to starve, and they’ve jumped their way to the surface to wait for another mammal to pass by. (Boodman, 7/19)

As the prevalence of childhood conditions like asthma and diabetes have risen, nurses treat a wide range of problems. Still, only an estimated 40 percent of U.S. schools have a full-time nurse, according to the National Association of School Nurses. But now telemedicine — virtual doctor visits over video — is increasingly helping nurses do their jobs. Telemedicine programs are making inroads in schools, where a student referred to the nurse can be plopped in front of a screen and connected with a physician. Special computer-connected otoscopes and stethoscopes allow doctors to check ears, noses, throats, and heartbeats from afar. (Samuel, 7/19)

Too often, people return home from the hospital only to find themselves heading back soon after. Sometimes the need arises because, despite the best care, it is difficult to slow the progression of disease. But other times, it's because we in the health care system fail to communicate, coordinate and orchestrate the care that people need to successfully make the transition from hospital to home. (Dharmarajan and Krumholz, 7/18)

Two decades ago, Luis Antonio Cabrera received devastating news: He likely had only three months to live. The Puerto Rican truck driver, then 50, had attributed his growing leg pain to spending so many hours on the road. The real culprit was a malignant tumor in his left kidney that was pressing on nerves from his lower spine. (Andalo, 7/18)

Acknowledging widespread concern on campus, USC President C.L. Max Nikias said Tuesday the university would “examine and address” a report in The Times that its former medical school dean abused drugs and associated with criminals and drug users. Nikias, speaking about the controversy for the first time in a letter to the campus community, said that “we understand the frustrations expressed about this situation” involving Dr. Carmen A. Puliafito and “we are working to determine how we can best prevent these kinds of circumstances moving forward.” (Parvini and Hamilton, 7/18)

A day after Gov. Dannel P. Malloy all but invited disabled recipients of state services to lobby for a new budget, some did: They targeted him in a demonstration that ended with the arrest of five protesters in his outer office at the Capitol. State Capitol police issued summonses for third-degree trespassing to five protesters, three of whom arrived in either wheelchairs or a motorized scooter, after they refused to leave. (Werth and Pazniokas, 7/18)

In June, Baker announced a suite of proposals to rein in MassHealth spending — including shifting 140,000 low-income people from MassHealth onto commercial insurance plans. ... Now, the governor has given them a two month deadline to take another look at his reforms, or face additional budget cuts elsewhere. (Bruzek and Chakrabarti, 7/18)

For the nearly 700 rural hospitals in the United States on the brink of financial collapse, relatively small amounts of money can be the difference between life and death. ... Rural America’s dwindling populations make it nearly impossible to keep these community institutions afloat. (Sable-Smith, 7/19)

Since the Boston Globe's report on unsanitary and dangerous conditions at the VA Medical Center in Manchester appeared over the weekend, attention has turned in part to the hospital's "four-star" rating... The ratings that result are based on improvement. (Biello, 7/18)

All around Valerie Joseph, there is a fleet of Uber cars rolling by on New York City streets. But though she could really use the ride-hailing app, Ms. Joseph said she does not bother because Uber has so few wheelchair-accessible cars to dispatch. “It’s plain unfair,” said Ms. Joseph, 41, who relies on a wheelchair. (Hu, 7/18)

Koenig is a Manchester Republican and the main sponsor of abortion legislation that’s being considered in the Missouri legislature’s current (though interrupted) special session... Among other things, Koenig’s bill would allow Missouri’s attorney general to file lawsuits if a clinic violates the state’s abortion laws. (Rosenbaum and Mannies, 7/18)

Western Health Advantage, the managed-health plan founded by Sacramento and Solano County doctors in 1996, is further expanding its coverage in the Bay Area and will partner with providers in the UCSF medical system and John Muir Health to cover more populous counties, CEO Garry Maisel said Tuesday. ... Those North Bay counties are home to roughly 911,132 residents, according to January 2017 population estimates by the California Department of Finance, compared with 4,429,303 in the counties now being added: San Francisco, San Mateo, Alameda and Contra Costa counties. (Anderson, 7/18)

Kade and Kallan Maresh were sickened by a shiga toxin-producing bacteria on July 9, eventually sending them into acute kidney failure. State health officials are investigating the source for the E. coli that eventually led to hemolytic uremic syndrome (HUS), a complication of the bacterial infection. (Smith, 7/18)

St. Louis Park on Monday became the second city in Minnesota to approve raising the age at which people can buy tobacco from 18 to 21... It increases the fines for tobacco vendors who sell to underage buyers from $250 to $500 for an initial violation and from $500 to $1,000 for a second. (Otarola, 7/18)

Two Democratic lawmakers and a liberal advocacy group criticized Gov. Scott Walker on Tuesday for accepting a donation from a marijuana trade group on behalf of the Republican Governors Association at the same time he's championing drug testing for Medicaid and food stamp recipients. The state's budget-writing committee approved Walker's proposal to drug test able-bodied adults who want public assistance in May. (Price, 7/18)

More than eight months after adult recreational use marijuana was approved by Massachusetts voters, a group of state lawmakers has reached a compromise bill making changes to the law, setting the stage for the opening of retail cannabis shops on July 1 of next year... <span>Both the House and Senate are expected to approve the compromise later this week, with the bill likely landing on Gov. Charlie Baker's desk before the weekend.</span> (Brown, 7/18)

The proposal takes aim at a controversial drug discount program, known as the 340B program, which is designed to boost revenues for hospitals that primarily serve low-income patients. The program requires drug makers to offer those hospitals sizable discounts on certain drugs. The hospital can then bill Medicare and other insurers at regular reimbursement rates when patients take the drugs, banking the extra savings to spend elsewhere. (Mershon, 7/14)

The 340B program requires drug makers participating in the Medicaid program to give deep discounts on outpatient drugs to hospitals that treat low-income patients. ... But the use of the program has exploded in recent years, with many hospitals that provide little charity care to uninsured patients among the heavy users. (Teegardin, 7/14)

Hospital officials say they're worried the CMS won't fairly distribute savings the agency says would be generated by a $900 million cut to the 340B drug discount program. Last week, the CMS proposed paying hospitals 22.5% less than the average sales price for drugs acquired under the federal program, which aims to reduce operating costs for hospitals that see a disproportionate share of low income patients. (Dickson, 7/18)

House Democrats are calling foul on Republican assertions that cuts to a little-known discount drug program will eventually reduce skyrocketing drug prices. At a hearing Tuesday, Rep. Diana DeGette (D-Colo.) said high drug prices should be investigated separately from the focus on oversight of the drug discount program, known as 340B. “I think we need an investigation, a robust investigation, and a series of hearings that explore in-depth the reasons for exorbitant cost of drugs and why the prices continue to rise,” DeGette said. (Tribble, 7/18)

All eyes are on Washington as the Senate grapples with health care legislation. Investors in drug companies should give some attention to state capitals, where a wave of bills designed to limit drug price increases are under consideration. Maryland is the first of about 30 states weighing such bills to pass a new law on drug pricing. The law, scheduled to take effect in October, outlaws “excessive” price hikes on generics and gives Maryland’s attorney general sweeping powers to roll back price hikes and fine companies for violations. Bills with similar enforcement mechanisms have been introduced in several other states, including New York, Missouri, Massachusetts, Maine, and Rhode Island. (Grant, 7/12)

West Virginia’s attorney general has joined three other states and the District of Columbia to sue six generic drugmakers, alleging they conspired to hike prices for a common antibiotic and a diabetes medication. Attorney General Patrick Morrisey says the allegations will be “pursued vigorously.” (7/17)

In a series of letters to the U.S. Army and several senators, Sanofi is denying that it rejected so-called fair pricing for a Zika virus vaccine that the company is developing with American taxpayer funds. The missives were sent as a growing number of federal and state lawmakers push the U.S. Army to negotiate a more favorable agreement with Sanofi, which is one of the world’s largest vaccine makers and has already received a $43 million U.S. research grant. (Silverman, 7/17)

Tim Pierotti, who once ran a consumer hedge fund for Martin Shkreli, said he had already lost faith in his boss by the end of 2012. Then a letter from Mr. Shkreli came to his home, addressed to his wife. “Your husband has stolen $1.6 million from me,” it read. (Clifford, 7/18)

Last month, the U.S. Supreme Court made it more difficult for people who file product-liability lawsuits against drug makers to engage in “forum shopping,” a practice in which someone files a lawsuit in a state where courts are seen as more hospitable to consumers. In that closely watched case, the court ruled hundreds of out-of-state plaintiffs failed to demonstrate a sufficient connection between injuries they allegedly suffered from a Bristol-Myers Squibb drug and company activities in California. The state has been a favorite venue for such suits, but the court noted the plaintiffs did not buy or ingest the drug there, and Bristol-Myers is not headquartered there. (Silverman, 7/18)

The most talked about strategies to bring down sky-high drug costs involve letting the government more aggressively negotiate prices with manufacturers and permitting the importation of lower-cost drugs from abroad. But neither idea has sufficient support on Capitol Hill to move this year. That’s why, for now, the only likely bipartisan solutions that could move the needle on drug prices involve promoting competition from lower-cost generic drugs. When a drug’s patent expires, it opens the door for other companies to copy it. Since the generic makers don’t have to recoup the research costs, they can offer much lower prices. Still, while policy improvements now under consideration in Congress could help, they’re not a panacea. (Siddons, 7/17)

The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable. (Allen, 7/18)

More than 4.4 billion prescriptions were filled in the United States last year, and the top 10 were all written for drugs now available in generic versions of pricier brand-name originals. Nearly half of all Americans are prescribed a drug at any given time. The most common ones, as you might expect, treat the most common chronic conditions — managing high blood pressure, for example, or controlling diabetes. Painkillers are also on the list, carrying with them the risk of substance abuse. But there are some surprises, too. (Blau, 7/19)

Alpharetta resident Robert M. Stevens has become all too familiar with the rapidly increasing cost of cancer drugs since 2006. That’s the year he began three rounds of chemo after his diagnosis of chronic lymphocytic leukemia. (Miller, 7/11)

Type 1 diabetics, armed with glucose meters and insulin pens, are caught in a delicate high-wire act. Too much glucose wreaks havoc on nerves and blood vessels, while too little causes dizziness and nausea. A Cleveland biotech company is trying to change that by delivering insulin to the liver, where it naturally goes. (Woosen, 7/17)

How’s this for a great deal? The United States government funded research and development of a new vaccine against Zika. But the Army, which paid a French pharmaceutical manufacturer for its development, is planning to grant exclusive rights to the vaccine to the manufacturer, Sanofi Pasteur, along with paying Sanofi up to $173 million. (Fran Quigley, 7/18)

The Food and Drug Administration was established to ensure the safety of food and medicines sold in the United States. That original charter seems to be ignored by the advocates of drug importation, who brush aside legitimate safety concerns to advance a political agenda. (Jim Greenwood, 7/14)

Pharmaceutical treatments and medical devices often have varying effectiveness depending on the indication for which they’re used: in oncology, for instance, response to a treatment varies with the type of tumor and stage of disease. The advent and proliferation of precision medicine in which biomarkers — whether genomic, proteomic, or structural — identify patients likely to receive greater treatment benefits only increase the range of variability in the effectiveness of the same product. (Amitabh Chandra and Craig Garthwaite, 7/13)

We've come a long way from President Donald Trump telling the pharmaceutical industry it was getting away with murder. His administration's Center for Medicaid and Medicaid Services (CMS) on Thursday proposed deep cuts to reimbursement rates for the 340B drug-discount program, which mandates big price cuts for "safety-net" hospitals that treat a lot of poor patients. (Max Nisen, 7/14)

President Trump likes to boast that he mastered the “art of the deal.” But one option his administration is considering to encourage lower drug prices, which surfaced in a recent draft executive order, may not be much of a deal for consumers. The concept has a clunky name — value-based pricing — but it’s fairly simple. One increasingly popular version works like this: A drug maker refunds some money to an insurer if its medicine fails to improve patient health or prevent a costly incident, such as a heart attack. (Ed Silverman, 7/17)

Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive? The past few years have seen a series of dramatic price hikes on essential off-patent medications, from albendazole to albuterol, digoxin to naloxone, Daraprim to EpiPen. In the storm of allegations and indignation that has followed each of these revelations, one explanation has remained consistent. To paraphrase Senators Susan Collins (R-ME) and Claire McCaskill (D-MO), who were the chair and the ranking member of the Senate Special Committee on Aging, firms that corner the market on off-patent medications and raise prices wildly often do so simply because they can. When the committee issued a 130-page report last December documenting the parallel strategies used by firms to engage in monopolistic price gouging on older essential drugs, the senators pointed out that these actions, though arguably unethical, have so far not been found to be illegal. (Jeremy A. Greene and William V. Padula,, 7/13)

After Donald Trump won the presidency, many Americans despondently wondered whether facts mattered anymore. Trump, after all, won the presidency despite a constant stream of falsehoods. He launched his political career with a lie about Barack Obama’s birthplace and just kept on lying, about almost every imaginable subject. He also admitted to being a sexual molester. He refused to release his tax returns, unlike every other modern nominee. And yet he was elected president of the United States. There was, and still is, ample reason for despondence. (David Leonhardt, 7/18)

For months, I’ve been watching in a sort of wonder as Republicans crafted the most unpopular major bill in living memory. Could they really mean to make a suicide charge at this --not some longstanding Republican goal, like dismantling the welfare state or slashing through the regulatory thicket, but pushing a sly parody of Obamacare even less likable than its awkward source material? When Republicans explained how this would actually be a strong campaign strategy for 2018, I had astonished flashbacks to Democrats saying the same thing in 2010 … and wondered when it was that people in Washington started believing their own press releases. Were we really due for the Republican version of the 2010 Democratic lemming run? (Megan McArdle, 7/18)

It wasn’t quite a wicked-witch-is-dead Munchkin happy dance, but the white noise of foregone conclusions drowned out Republicans’ relatively muted regret over their failure to repeal and replace Obamacare. It was never gonna happen. Not no how. (Kathleen Parker, 7/18)

Repeal and replace is dead. Again. Perhaps for good this time. But perhaps not. Here's what matters now: Will Republicans in Congress hear a sustained, effective push from the White House to revive a viable bill? Will Republicans in Congress hear a sustained, effective push from Republican-aligned interest groups? Will Republicans in Congress hear from rank-and-file Republican constituents who are outraged that the promise they ran on for the last seven years may disappear without a vote? (Jonathan Bernstein, 7/18)

It’s no excuse for Republican ineptitude, but there is little market in America, and none in the GOP apparently, for coherent health-care policy, to the modest degree that such a description can even apply in Washington. Republicans, and arguably American voters, don’t want an individual mandate. They do want coverage of pre-existing conditions. (Holman W. Jenkins Jr., 7/18)

Tellingly, the latest and perhaps last Republican strategy on health care is a measure that would repeal the Affordable Care Act in two years with no replacement in sight. So much for repeal-and-replace. Republicans did not have a viable alternative to the ACA when they staged their first repeal vote seven years ago. They don’t now, and in all probability would not in two years even if the repeal measure were to pass. (7/18)

It will come as a huge relief to millions of Americans that Republican lawmakers have struck out in their attempts to destroy the Affordable Care Act — at least for now. But this ideological exercise in futility has already done great damage to the health care system. (7/18)

The Senate health care bill is dead, and that’s at least in part due to overheated rhetoric from the left about Medicaid. Many of the over-the-top claims lacked important facts or context, and seemed primarily designed to scare people rather than prompt civil debate. (Chris Jacobs, 7/18)

At a meeting with GOP senators on Monday night, President Trump reportedly said that Republicans would look like “dopes” if they couldn’t pass a health-care bill. “If the Republicans have the House, the Senate and the presidency and they can’t pass this health-care bill, they are going to look weak,” Politico reports Mr. Trump said. “How can we not do this after promising it for years?” (William A. Galston, 7/18)

The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election. (James C. Capretts, 7/19)

With the Republican alternative to Obamacare dead, Republican Senate Majority Leader Mitch McConnell, as much a representative of the Republican establishment class as you will find in Washington, and President Donald Trump, leader of the populist rebellion, agreed that what Republicans needed to do is repeal the Affordable Care Act now and come up with some kind of alternative later. (David Mastio and Jill Lawrence, 7/19)

As the nation considers the utter collapse of the Better Care Reconciliation Act (BCRA), advanced by Senate majority leader Mitch McConnell, to repeal and replace the Affordable Care Act (ACA), some perspective is in order. Since President Donald Trump’s November 8th election, I have heard many people’s distress about the dire threats to the ACA that initially seemed so certain last November. (John McDonough, 7/18)

The GOP base will punish Republicans in upcoming elections if they fail to deliver on their promise to repeal the Affordable Care Act, or at least make an all -out effort to do so. That's the conventional wisdom, right? It was the political motivation behind Republican efforts to pass a widely unpopular repeal-and-replace plan, and then to consider a risky repeal-and-delay plan in the Senate. Except for one problem: When you look at the polling, the idea that the base will rise up and punish Republicans if they don't repeal the ACA appears to be exaggerated, and possibly even a political fiction. (Drew Altman, 7/19)

Affter Republicans spectacularly failed to gather enough votes to repeal and replace Obamacare, President Donald Trump should consider changing his slogan from "Make America Great Again" to "Hey, we tried." And somewhere, I am so sure, former President Barack Obama is smiling. (7/18)

This week’s failure of the Better Care Reconciliation Act, version 5.0 of the Republican health care plan, can best be understood by reviewing two famous statements Donald Trump made about health care policy. Very early in his campaign for president, Trump promised that the Affordable Care Act would be repealed and replaced with “something terrific.” (7/18)

You’d think that Republican leaders would have learned their lesson after a second failed attempt to pass the Better Care Reconciliation Act (BCRA) — the Senate GOP’s replacement for the Affordable Care Act. It should come as no surprise that a bill drafted in secret — without holding a single public hearing or garnering the support of a single health-care stakeholder — would face widespread condemnation. (Neera Tanden and Topher Spiro, 7/18)

Miillions of Americans whose healthcare coverage was imperiled can breathe a sigh of relief now that congressional Republicans’ reckless efforts to dismantle the Affordable Care Act have foundered. They can thank a handful of courageous moderates in the Senate Republican Caucus for being unwilling to repeal the ACA without having a replacement ready that wouldn’t make matters worse for their constituents. (7/19)

If the Affordable Care Act is the failure that Republicans Mitch McConnell and Donald Trump insist, then getting Congress to repeal and replace it wouldn’t be so difficult. In reality, the law, signed by Barack Obama in 2010, is not a failure, quite the opposite. It has brought security to millions of Americans for whom sickness previously meant bankruptcy or premature death. It has brought greater financial certainty to the hospitals and clinics that care for them. (7/18)

With Monday’s collapse of the Senate Republicans’ latest effort to repeal the Affordable Care Act, the GOP and the Trump White House are confronted with the question of what to do next, if anything, on healthcare. But that’s a question for Democrats, too. Although there’s a general perception that Democrats consider Obamacare to be the last word on healthcare policy, that’s never been true. The ACA was the product of compromise from its inception, and also something of an experiment. No one was sure how all its moving parts would work. (Michael Hiltzik, 7/18)

Now that the plan to "repeal and replace" Obamacare is dead and the plan to "repeal now, replace later" has expired ignominiously, what's the next treatment noted health care specialists Donald Trump, Paul Ryan and Mitch McConnell will try?... But instead of sabotaging the Affordable Care Act, Republicans should work with Democrats to shore up the insurance exchanges that are at the heart of the ACA. (David Haynes, 7/18)

Republican leaders in U.S Congress are the epitome of lost and dysfunctional. When it comes to health insurance, it is painfully clear they have no idea what they’re doing or seeking. The Affordable Care Act needs to be improved, and that should be lawmakers’ goal. But that seems impossible for this group of elected officials. Americans are tired of the shenanigans. (7/18)

The Republican Party’s effort to repeal the Affordable Care Act and replace it with something — maybe now, maybe a few years from now — stumbled to a predictable stalemate Tuesday. The GOP hates Obamacare. But after seven years of debate, Republicans still can’t agree on how to make it better. (7/18)

If ObamaCare’s expansion of Medicaid were measured merely by growth in enrollment and spending, California’s Medi-Cal program would rank as a huge success. Since 2012, Medi-Cal has added six million beneficiaries, primarily able-bodied adults of working age. Covering them last year brought California nearly $20 billion in additional federal funds. If Medi-Cal were a state, its population of 14 million would make it the fifth-largest in the U.S. The program’s $103 billion budget is about three times the size of Illinois’s general fund. (Allysia Finley, 7/18)

Now that the Senate replacement for the Affordable Care Act has gone down the toilet, where it belongs, perhaps President Donald Trump will fashion something that lives up to his campaign promises – a plan where every American will get the kind of care received recently by Sen. John McCain.T he Republican plan wasn’t close. (EJ Montini, 7/18)

They may have avoided the ditch, but Republicans have driven themselves into a cul-de-sac. After the failure in the Senate of their disastrous plan to replace Obamacare, Majority Leader Mitch McConnell now promises to make his colleagues vote instead on just a repeal of the Affordable Care Act. (7/18)

To paraphrase Mark Twain, reports of the death of Republican health-care reform are greatly exaggerated. Far from throwing in the towel, as some have reported, Senate Majority Leader Mitch McConnell is actually throwing a final Hail Mary pass in an effort to pass the Senate Republicans’ Better Care Reconciliation Act (BCRA). And he’s found an extremely clever way to do it. (Marc A. Thiessen, 7/18)

McConnell’s biggest challenge was getting 50 Republican senators to agree to vote for a “motion to proceed” on a bill that they disagreed with — knowing that it was unlikely to be amended in ways that would make a difference to their final votes given the split between Republican conservatives and moderates and given the Democrats’ refusal to cooperate. Instead of cooperation, Republicans would have to endure an onslaught of politically toxic Democratic amendments, as Senate Democrats forced them to cast one vote after another designed to make them look like monsters come Election Day. (Marc Thiessen, 7/18)

The sudden collapse of Kentucky Sen. Mitch McConnell’s healthcare bill on Monday was much more than a tactical setback for the Senate Republican leader once considered an unbeatable legislative wizard. It was a catastrophic failure for the GOP’s attempt to make one-party government work. It’s one thing to produce gridlock when control of Congress is divided. When one party manages to produce gridlock all by itself, something is seriously wrong. The setback means that Obamacare will almost certainly survive for the foreseeable future, despite seven years of GOP promises to repeal it. (Doyle McManus, 7/19)

This is what happens when you try to muscle through in six months — and in secret — what you could have done over seven years. You bear the brunt of the responsibility for the GOP’s disaster of a healthcare plan getting flushed down the tubes. This is what happens when you do anything, short of crawling under a rock, to avoid having to look your scared and angry constituents in the eye at town hall meetings. When you emerge from wherever you’ve been hiding, those constituents are still scared, still angry, having flooded your offices on the Hill with phone calls and emails to make sure you get the message. (7/18)

Moments after the latest Republican health care bill died Monday night, Senate Majority Leader Mitch McConnell proposed that Republicans instead repeal the Affordable Care Act immediately, but let it live for two years while they come up with a replacement. President Trump, at least initially, agreed in a tweet. (7/18)

Senate Republicans killed their own health-care bill on Monday evening, and some are quietly expressing relief: The nightmare of a hard decision is finally over, and now on to supposedly more crowd-pleasing items like tax reform. But this self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. (7/18)

With the announcement from Sen. Shelley Moore Capito (R-W.Va.) that she would not vote for repeal (at least as defined by the 2015 reconciliation bill that would leave 32 million more Americans uninsured) with no replacement, the whole dreary episode of Republican hypocrisy on Obamacare can come to an end. (Jennifer Rubin, 7/18)

Now that the GOP health bill has imploded in the Senate, it’s fitting, in a way, that President Trump is now demanding in a rage that Senate Republicans vote on straight repeal only. If that play fails, as many analysts seem to expect, it will neatly capture just how saturated in cruelty, dishonesty and bad faith the Republican approach — and, more recently, that of Trump — has been all along. (Greg Sargent, 7/18)

Donald Trump’s tantrum on Tuesday, when he said his administration would let the law fail after a Senate replacement plan collapsed, marks an astonishing abdication of responsibility. If the president follows through on his implicit threat to intentionally sabotage the health care market, Trump will inflict a needless burden on millions of consumers. (7/18)

The congressional effort to overhaul the health care system appears to be in shambles. But the current health care system lives on. And decisions the Trump administration makes about how to manage it could have big effects on who has coverage next year, and what it costs them. The Department of Health and Human Services is in charge of administering Obamacare, and so far the department’s staff has given many public indications that it does not enjoy such duties. (Margot Sanger-Katz, 7/18)

The Senate Republican bill to repeal and replace the health law lies in a smoldering heap. Some GOP lawmakers back a loopy repeal-now, replace-later-maybe effort that as of Tuesday already looked to be political toast. You can't replace something with nothing, or the promise of something later that you've failed to deliver today. (7/18)

The greatest trick any politician can pull off is to get his self-interest and his principles in perfect alignment. As Thomas More observed in Robert Bolt’s “A Man for All Seasons,” “If we lived in a State where virtue was profitable, common sense would make us good, and greed would make us saintly.” (Jonah Goldberg, 7/18)

There are those who insist Republicans must act as a team to repeal Obamacare. I agree — if the topic is repeal. Every Republican has run on repealing Obamacare for seven years, and all but one voted for clean repeal in 2015. Now we have a president who will sign it and is asking for us to send the same repeal bill to his desk, one that repeals with a two-year window to work with. We also have a majority leader who has said he will bring this vote to the Senate floor. (Sen. Rand Paul, 7/18)

Jerry Moran began Tuesday as a hero to Kansas moderates, the Sunflower State Republican who took a stand against a second Senate health care bill by criticizing “the closed-door process.” He listened to his constituents, they figured, being one of the few senators to have a town-hall meeting during the July 4 recess. Which makes the rest of the Tuesday so oddly interesting. (7/18)

Columbus — Washington’s approach to health care over the past decade is yet another example of our lawmakers’ increasing distance from the rest of America. First one party rams through a rigid, convoluted plan that drives up costs though unsustainable mechanisms that are now unraveling. Then the other party pursues fixes that go too far the other way — and again ignores ideas from the other side. (Gov. John Kasich, 7/18)

Workers who receive paid leave after the birth or adoption of a child experience significant benefits. They can bond with their child without having to worry about a steep reduction in household income. There’s evidence that parental leave can improve the health outcomes of children and mothers. At a time when both dual-earning and single-parent households are common, time off with pay fills a void that’s larger than in previous decades. (Michael Strain, 7/18)

Cigarette smoke contains more than 9,000 chemicals, including more than 60 carcinogens. According to the U.S. Food and Drug Administration, there are 93 harmful and potentially harmful chemicals found in tobacco products. (Yoojin Cho, 7/18)

It’s lucky that county-level prescription drug monitoring programs cover more than 60 percent of Missouri’s population. The statewide plan launched this week by Gov. Eric Greitens won’t accomplish much. But at least it’s a plan, meaning Missouri is no longer the only state without a PDMP. Greitens did something the Missouri Legislature, which hemmed and hawed for years, never did. But Greitens’ plan isn’t like those in any other state, falling short of the model by focusing on law enforcement and not the health of addicted Missourians. (7/18)

Dr. Carmen A. Puliafito, the former dean of the USC Keck School of Medicine, led quite a rollicking double life. According to a Times investigation, he was a highly respected doctor, administrator and prolific fundraiser for the university — but at the same time, according to explicit videos and interviews, he found time to party with a circle of criminals and drug users who said he used methamphetamine and other drugs with them. (7/19)