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Facing intransigent Republican opposition, the Senate majority leader, Mitch McConnell, on Tuesday delayed a vote on legislation to repeal the Affordable Care Act, dealing another setback to Republicans’ seven-year effort to dismantle the health law and setting up a long, heated summer of health care battles. (Kaplan and Pear, 6/27)

The surprise development leaves the legislation's fate uncertain while raising new doubts about whether President Donald Trump will ever make good on his many promises to erase his predecessor's signature legislative achievement. (6/28)

The GOP leader put on a brave face after an emergency meeting at the White House with President Trump and his conference, telling reporters that his members just needed a little bit more time. (Roubein, Sullivan and Hellmann, 6/27)

“Legislation of this complexity almost always takes longer than anyone would hope,” Senate Majority Leader Mitch McConnell told reporters. “But we’re pressing on.” McConnell said he opted to delay a planned vote on the Senate bill after several members asked for more time to review the sweeping legislation. (Haberkorn and Everett, 6/27)

Sen. John Cornyn of Texas, the chamber’s No. 2 Republican, said Tuesday afternoon that his GOP colleagues needed "a little more time" to work on their health care legislation. "It's a conversation and we haven't finished having our conversation," said Cornyn. (McIntire and Lesniewski, 6/27)

“It’s almost like we’re serving in the minority right now. We just simply don’t know how to govern,” said Rep. Steve Womack (R., Ark.). “How we’ve been given this opportunity to govern and we are finding every reason in the world not to is absolutely incredible to me.” (Peterson and Rubin, 6/27)

Looming in the recent memory was the House push to repeal the law. When plans for a vote on it collapsed in March, Speaker Paul Ryan conceded that Obamacare would remain in force. Weeks later, with some more wrangling and a deal with conservatives brokered by Rep. Tom MacArthur of New Jersey, the House narrowly approved a modified proposal. (Tamari, 6/27)

Three more Republican senators announced opposition to the Senate’s health-care bill on Tuesday — but only after Majority Leader Mitch McConnell (R-Ky.) announced he will delay a vote to begin debating the legislation. (O'Keefe, 6/27)

Republican Sens. Jerry Moran (Kan.), Shelley Moore Capito (W.Va.) and Rob Portman (Ohio) announced Tuesday afternoon that they will vote against the Senate GOP bill to repeal and replace ObamaCare in its current form. Moran said in a statement on Twitter that the bill "missed the mark," adding that he was "pleased" that the vote on the Senate bill was delayed by Republican leadership until after the July 4 recess. (Bowden, 6/27)

Sometime before 2 p.m. Tuesday, Senate Republican Leader Mitch McConnell yanked the Obamacare-repeal-and-reform bill from consideration, saying he wanted more time to work on it. It was obvious by then the bill couldn't pass.About two hours later -- after McConnell's announcement -- Sen. Rob Portman, an Ohio Republican who was on the fence, announced he was opposed to the bill and could not vote for it. (Koff, 6/27)

[Portman] said the Senate draft “falls short and therefore I cannot support it in its current form.” “In the days and weeks ahead, I’m committed to continue talking with my colleagues about how we can fix the serious problems in our health-care system while protecting Ohio’s most vulnerable citizens.” (Torry and Wehrman, 6/28)

Another moderate Republican, Sen. Lisa Murkowski of Alaska, welcomed the possibility that the legislation, opposed by the Senate’s 46 Democrats, could eventually be abandoned to open the way for a bipartisan effort to fix the Affordable Care Act, President Barack Obama’s signature 2010 health legislation. (Lochhead, 6/27)

U.S. Sen. Jerry Moran came out against a Republican health care bill Tuesday shortly after Senate GOP leaders announced plans to delay a vote until after July 4. Moran, a Kansas Republican, has emerged as a key vote in the fight over a Republican plan to repeal the Affordable Care Act, more commonly known as Obamacare, that would result in 22 million people losing insurance by 2026, according to an analysis by the Congressional Budget Office. (Lowry, 6/27)

After days of arm-twisting, Senate Republican leaders on Tuesday essentially conceded that they had not secured the votes to move forward on a massive overhaul of the American health care system and would pick up the issue again in July. Senate Majority Leader Mitch McConnell of Kentucky emerged with the updated plans from a lunch with other GOP senators, along with the news that the chamber's Republicans were headed to the White House for a meeting with President Donald Trump. (Livingston, 6/27)

Conservatives and liberals in Wisconsin both see hope in Republican Sen. Ron Johnson's steadfast refusal to back the current version of the GOP Senate health care bill. Although they disagree with the reasons for his opposition, liberals see Johnson's stand as a chance to sink the entire Republican effort to kill the existing health care law enacted under former President Barack Obama. (6/27)

Democrats quickly claimed victory on the discussion, but urged supporters to keep up pressure on a handful of undecided GOP senators over the upcoming recess. (Carney, 6/27)

Speaker Paul Ryan (R-Wis.) defended the head of the Congressional Budget Office (CBO) on Tuesday, just a day after the White House lashed out at the CBO’s estimate that the Senate GOP healthcare bill would leave 22 million more people uninsured during the next decade. Ryan expressed confidence in the integrity and impartiality of CBO Director Keith Hall, noting that then-Budget Committee Chairman Tom Price (R-Ga.) — President Trump’s current Health and Human Services secretary — was among the GOP leaders who hired Hall in 2015. (Wong, 6/27)

In a test of his leadership, Mr. McConnell now will need to bridge a divide between conservative Republicans, who say the bill retains too many of the ACA’s regulations to significantly lower premiums, and GOP centrists, who worry the legislation goes too far in cutting funding to Medicaid. (Armour and Peterson, 6/27)

The seasoned GOP leader will be aided by what amounts to a $200-billion piggy bank to push Republicans holdouts over the line. That’s the bill’s extra savings compared with the House version that McConnell can tap to provide perks to individual senators, from more opioid assistance to expanded tax-free health savings accounts. A similar strategy — delay and enticements — worked well in the House, where Republicans last month passed their healthcare bill on the third try. (Mascaro, 6/27)

Just how realistic a vote is after July 4 remains unclear. At least one senator who had publicly opposed the procedural vote McConnell had hoped to take Tuesday — Dean Heller (Nev.) — indicated that he was willing to reconsider his initial opposition, if the bill was going to be reworked. At the White House, Heller playfully but pointedly complained about a Trump-allied super PAC that was airing ads against him in Nevada. By Tuesday night, the group had decided to pull the ads, and Heller had signaled to McConnell that he would continue to engage — far from a “yes” vote, but open to discussing his concerns. (Sullivan, Snell and Eilperin, 6/27)

GOP leaders seemed surprised by the extent of the objections from within their party. At least five Republicans made clear ahead of time that they weren’t ready to advance the measure this week. and another three Republicans announced their opposition after McConnell delayed the vote. (Litvan, 6/28)

Republican Senator Susan Collins of Maine announced Monday night that she would vote against a procedural motion on the Senate health care repeal bill and said that unless the bill changed significantly she would vote against the bill itself. Majority leader Mitch McConnell should not even try to negotiate with Collins. (Pindell, 6/27)

Georgia’s two U.S. senators were planning to join many of their GOP colleagues at the White House Tuesday afternoon after Senate leaders abruptly hit the breaks on a health care overhaul they had been planning to bring to a vote later this week. Republicans David Perdue and Johnny Isakson both voiced support for their party leaders’ decision to take the July 4th recess to rework their Obamacare replacement legislation after it became clear there were not enough votes as written. (Hallerman, 6/27)

Mitch McConnell has little margin for error as he tries to salvage the Senate’s Obamacare repeal effort over the July 4 break. (Cancryn, 6/27)

Here’s what to expect as the debate on health care moves forward. (Jamerson, 6/27)

As Senate Republicans struggle to find the votes to repeal the Affordable Care Act, the architects of Obamacare have an idea to try if they fail. Just fix it. (Page, 6/27)

Senator Mitch McConnell of Kentucky, the majority leader, has long enjoyed a reputation as a master tactician. But when it comes to repealing the Affordable Care Act, he seems to have miscalculated in the first round of play. He assumed that his conservative and moderate colleagues would come together to make good on their seven-year promise to repeal the health care law, and quickly. (Steinhauer, 6/27)

Senate Republicans had no inkling of what they were walking into on Tuesday afternoon as they filed into the Mike Mansfield room on the Capitol’s second floor. Mitch McConnell’s 51 colleagues, from his most junior members to his closest lieutenants, fully expected the Senate to vote this week on the Senate GOP’s wounded Obamacare repeal bill. They knew the whip count was far worse than advertised but were ready for McConnell to either admit defeat or start a furious round of deal-making to try to win their support. They took McConnell at his word that a vote would occur, regardless of the result. (Everett, Haberkorn and Dawsey, 6/27)

For Republicans, Obamacare was always the great unifier. In a fractious party, everyone agreed that the Affordable Care Act was the wrong solution to what ailed the nation’s health-care system, with too much government and too little freedom for consumers. Replacing Obamacare has become the party’s albatross, a sprawling objective still in search of a solution. The effort to make good on a seven-year promise has cost the Trump administration precious months of its first year in office, with tax restructuring backed up somewhere in the legislative pipeline, infrastructure idling somewhere no one can see it and budget deadlines looming. (Balz, 6/27)

The White House and Senate Majority Leader Mitch McConnell (R-Ky.) are using a soft sell on Republicans as they try to save legislation repealing and replacing ObamaCare. McConnell told colleagues at a closed-door meeting on Tuesday that they would not vote on the healthcare bill this week, as GOP leaders had been promising for weeks. (Bolton, 6/27)

Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal Obamacare. Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar. (McAuliff, 6/27)

When Senate Majority Leader Mitch McConnell broke the news Tuesday afternoon, all the nervous buildup around the Senate health care bill vanished faster than a sticky, summer day in Washington, D.C., after a thunderstorm. Could McConnell really push the bill through the Senate before senators left town for the holiday? How many senators were balking now? Those and other questions disappeared — for now — when McConnell announced the Better Care Reconciliation Act would get no floor vote until after July 4. (Bluth, 6/27)

President Trump began his all-hands meeting with Republican senators at the White House on Tuesday by saying they were “very close” to passing a health care bill, just as efforts to fast-track a vote this week collapsed. If Republicans do manage to broker a deal — as Senator Mitch McConnell of Kentucky, the majority leader, pledged to do during a lively East Room back-and-forth with the president — it is not likely to be because of Mr. Trump’s involvement. Until Tuesday afternoon, the president was largely on the sidelines as the fate of one of his most important campaign pledges played out. (Thrush and Martin, 6/27)

Scrambling to line up support for the Republican health-care bill, President Trump got on the phone Monday with Sen. Mike Lee (R-Utah) and urged him to back the measure. The president’s personal plea was not enough. On Tuesday, Lee said he would vote against the bill. Senate GOP leaders later postponed the planned health-care vote because too many other Republican senators also opposed — for now, at least — legislation that would deliver on Trump’s campaign promise to scale back the law known as Obamacare. (Rucker, Costa and Parker, 6/27)

President Trump said that if the healthcare bill fails to pass in the Senate, he won't like it — but "that's OK." Trump spoke Tuesday at a gathering of Senate Republicans after their leaders delayed a vote on their healthcare bill until at least next month. Trump said, "This will be great if we get it done and if we don't get it done it's going to be something that we're not going to like and that's OK and I can understand that." (6/27)

“But I think we have a chance to do something very, very important for the public, very, very important for the people of our country that we love,” he added, before asking reporters to leave the meeting. (Conway, 6/27)

President Trump said Tuesday afternoon that Senate Republicans are getting “very close” to passing their embattled plan to repeal and replace ObamaCare, but added that if it fails, “that’s OK.” “I think the Senate bill is going to be great,” Trump said during a photo-op ahead of a meeting with nearly every Republican senator at the White House. “So we’re going to talk and we’re going to see what we can do. But we’re getting very close." (Fabian, 6/27)

Sen. Rand Paul came away from a meeting on Tuesday with President Donald Trump thinking that the administration would be willing to move the health care reconciliation package in his direction. Paul has called for more of a straight repeal of the 2010 health care law, rather than the partial repeal and replace represented by the measure crafted by Senate GOP leaders. He was not so sure how open Senate GOP leaders would be to his changes to the proposal to roll back the 2010 health care law, however. (Lesniewski, 6/27)

A once-quiet effort by governors to block the full repeal of the Affordable Care Act reached its climax in Washington on Tuesday, as state executives from both parties — who have conspired privately for months — mounted an all-out attack on the Senate’s embattled health care legislation hours before Republicans postponed a vote. At the center of the effort has been a pair of low-key moderates: Gov. John R. Kasich, Republican of Ohio, and Gov. John W. Hickenlooper, Democrat of Colorado, who on Tuesday morning called on the Senate to reject the Republican bill and to negotiate a bipartisan alternative. (Burns, 6/27)

GOP governors opposed to the Senate healthcare bill’s changes to Medicaid are exerting influence on their home-state senators, making it more difficult for Republican leaders to net the 50 votes they need to pass the legislation. The GOP governors could give cover to senators who oppose the bill, but they could also make it more difficult for a Republican senator to stake out a dissenting position. (Weixel, 6/28)

One in three California residents are covered by Medicaid, and California is thought to have the most to lose if Republicans gather enough votes to roll back major aspects of the Affordable Care Act. California would see the nation’s biggest increase in uninsured people by next year and face a $24-billion budget shortfall by 2026 because of reduced Medicaid funding, California's Democratic senators and Gov. Jerry Brown warned during a call with reporters on Tuesday. (Wire, 6/27)

The U.S. Senate’s health care bill would result in “devastating” Medicaid cuts to Connecticut, reaching $2.9 billion per year by 2026 and stripping tens of thousands of state residents of health care, Gov. Dannel Malloy said Tuesday. The Republican Senate plan, known as the Better Care Reconciliation Act, would shift the responsibility for providing a health care system to the 50 states, while reducing the amount of federal Medicaid money for those states. (Radelat, 6/27)

Ohio Gov. John Kasich doesn't get to vote in Congress. But while in Washington for a meeting, he reminded Congress during a news conference that the Senate healthcare bill "is unacceptable to me." (Koff, 6/27)

[Ohio Gov. John] Kasich did want to talk about the steep cuts to Medicaid contained in the bill Senate Majority Leader Mitch McConnell and a pursed-lipped cadre of Republican colleagues made public last week, and how the cuts would decimate poor and sick Ohioans. Kasich said the funding provided for Medicaid in the House health care overhaul bill passed in May was “really not adequate,” but that his state could “struggle through” with some flexibility. But he doesn’t feel that way about the Senate bill. “The amount of funding that they’re putting into Medicaid… is even less than what the House had,” Kasich said, “and what the House had was really not adequate.” (Connolly, 6/27)

It’s been a couple months since Democratic Gov. John Hickenlooper last spoke to Republican U.S. Sen. Cory Gardner about health care. But with Gardner still publicly undecided about a Senate health care bill, the Colorado governor vowed at a news conference Tuesday to personally reach out to the Colorado senator in an effort to get him to oppose the legislation. (Matthews, 6/27)

Republicans, under fire for proposing health care legislation that would reduce Medicaid funding by hundreds of billions of dollars, have embraced an old argument that taking money from a program is not a “cut.” At first glance, the new pitch to make their strategy more palatable seems at odds with the numbers. The Congressional Budget Office said on Monday that the “Better Care Reconciliation Act” would reduce Medicaid spending by $772 billion over a decade. By 2026, Medicaid enrollment would drop by 16 percent among people under the age of 65. So, are there cuts or not? (Rappeport, 6/27)

One of the sticking points among Republicans is how to rework the Medicaid program, which some states expanded under the Affordable Care Act. Lawmakers in those states are wary of rescinding the benefits to their constituents and facing a tougher road to re-election. Barrasso said covering childless adults gets away from Medicaid's original purpose and that states need the flexibility to design their own programs. (Lee, 6/27)

Hospitals, doctors and nursing homes have one last chance to shape a Republican bill to repeal and replace Obamacare they say will hurt millions of old, poor and sick Americans — and their own bottom lines. After being on the sidelines for much of the repeal debate, the groups see an opening in the meltdown of the Senate health care bill. They’re particularly worried about the legislation’s proposed deep cuts to Medicaid, the country’s largest insurance program, which covers 74 million people. (Cancryn and Demko, 6/27)

Republicans have wanted to repeal Obamacare for years -- but they've wanted to overhaul Medicaid for far longer. They are now getting their chance. The health care legislation working its way through Congress would do much more than its stated purpose of repealing and replacing Obamacare. It would make the most far-reaching changes and deepest cuts to Medicaid in the program's 52-year history. (Luhby, 6/26)

A provision in the Senate Republican health care bill that would expand Medicaid coverage of mental health treatment services would be undermined by broader Medicaid changes, experts say. Currently, Medicaid cannot reimburse for inpatient mental health or substance use treatment in facilities with more than 16 beds. The Senate draft bill would give states the option to cover some inpatient services at larger psychiatric hospitals for up to 30 days in a month and 90 days in a calendar year. The federal government would pick up 50 percent of the costs. (Siddons, 6/27)

The Ohio House and Senate plan to vote Wednesday on a budget bill that would freeze Medicaid expansion enrollment next year, a move Gov. John Kasich's administration says would result in 500,000 low-income Ohioans losing health insurance coverage. More than 725,000 Ohioans have received coverage through Medicaid, the joint state-federal health insurance program for poor and disabled Americans, since the state expanded eligibility in 2014 to those making up to 138 percent of the poverty level. (Borchardt, 6/27)

Ohio's GOP lawmakers have thrown down a challenge for Gov. John Kasich, who now must decide whether to veto their freeze of his Medicaid expansion — a freeze that could essentially kill the program for many lower-income adults. (Balmert, 6/28)

Millionaires would get tax cuts averaging $52,000 a year from the Senate Republicans' health bill while middle-income families would get about $260, according to a new analysis of the foundering bill. The analysis was done by the nonpartisan Tax Policy Center. It found that half of the tax cuts would go to families making more than $500,000 a year. (Ohlemacher, 6/27)

Senate Republican leaders on Monday unveiled a new provision in their health bill designed to prod people to maintain their insurance coverage, a tweak made after insurers had complained an initial version of the legislation threatened to undermine the individual insurance market.But industry officials say it isn’t clear how much the new clause would stabilize the markets or draw in the young, healthy enrollees insurers crave. (Wilde Mathews, 6/27)

Buried in the Senate Republican health bill is a possible boon for insurers: an end to the Affordable Care Act rule that forced them to spend the lion’s share of premiums on health care for enrollees. Under the ACA, the federal government requires insurers to spend 80% of premiums revenue, received for individual and small-business plans, on health costs. For large employer plans, the share is 85%. If an insurer doesn’t hit the required ratio, it has to rebate the extra money to customers. (Wilde Mathews, 6/28)

In its analysis of the Republican health care bill, the Congressional Budget Office said something confusing: The bill would lower the price of the average health plan, but health insurance would still cost much more for many people, especially for older Americans. (Park and Sanger-Katz, 6/27)

School superintendents across the country are raising alarms about the possibility that Republican health care legislation would curtail billions of dollars in annual funding they count on to help students with disabilities and poor children. (Brown, 6/28)

In Wisconsin, more than $187 million is spent on school-based medical services annually, and Medicaid currently provides a little more than $107 million, or 57% of the total cost, according to figures from Disability Rights Wisconsin. If the federal contribution is capped, and the state can't — or won't — pick up the additional portion, then the districts would have to pick up more of the costs. Wauwatosa's Ertl called that an unfunded mandate. (Oxenden, 6/27)

Senators, the United States is a sick country. Four years ago, a panel of experts convened by the Institute of Medicine and the National Research Council set out to assess the nation’s health compared with that of 16 other rich nations. Americans, they found, had the second-highest mortality from noncommunicable conditions — like diabetes, heart disease or violence — and the fourth highest from infectious disease. In terms of infant and maternal mortality, Americans are the worst off. (Porter, 6/27)

Los Angeles County officials gathered Tuesday morning to warn of the impact the Senate healthcare bill could have on the county, which is home to one out of every 20 of the nation’s Medicaid recipients. The Obamacare repeal bill unveiled last week would eliminate the mandate that all Americans have health insurance, alter the subsidies provided to people who buy insurance through the exchanges and undo several taxes on high-income Americans that are used to fund the Affordable Care Act. (Karlamangla, 6/27)

Since Senate Republicans released the draft of their bill to repeal and replace the Affordable Care Act last week, many people have been wondering how the proposed changes will affect their own coverage, and their family's: Will my pre-existing condition be covered? Will my premiums go up or down? (Kodjak, 6/27)

Planned Parenthood of California, which operates more of the organization’s health centers than any other state in the nation, would lose 73 percent of its operating budget under the health care bills that Republicans are pushing to replace the Affordable Care Act, its leaders said Tuesday. Planned Parenthood of Northern California, which operates 20 health centers San Francisco, Marin, Contra Costa and other counties between the Bay Area and the Oregon border, would face budget reductions of similar proportions. (Ho, 6/27)

Darlin Kpangbah receives free health insurance through Medicaid and is grateful for the coverage in case of accidents, such as when she tore a ligament in her leg a few years ago. “I feel like I’m injury-prone,” said Kpangbah, 20, who lives in Sacramento, Calif. Without insurance, she said, the injury “would’ve been huge to pay for.” Young adults like Kpangbah were among the biggest beneficiaries of Obamacare, which helped reduce the rates of uninsured millennials to record lows and provided millions of Americans with access to free or low-cost insurance as well as maternity care, mental health treatment and other services. (Gorman and Browning, 6/28)

Under a blistering sun, protesters let out a cheer on Tuesday across Capitol lawns as word spread that the Senate Republican leader had delayed a vote on repealing the Affordable Care Act. But amid the celebration, Democrats urged the crowds to keep the heat on lawmakers whose opposition to the health care overhaul could grow cold over the coming Fourth of July recess. (Chilkoti and Cochrane, 6/27)

“We’ve got to fight even harder over the Fourth of July and every day until we bury this atrocious bill,” said Sen. Chris Van Hollen (D-Md.), chairman of the Democrats’ 2018 Senate campaign efforts. “All of you: When your senators go back to their states, when they go to barbecues and parades, will you be there to tell them to kill this awful bill?” (Weigel, 6/27)

Senate Democrats are warning supporters that the fight to repeal and replace ObamaCare isn't over, even after Republicans delayed a vote on their bill until next month. "Over the next couple of weeks, we know that Leader [Mitch] McConnell will try to use a slush fund to buy off Republicans, cut back-room deals, to try and get this thing done," Senate Minority Leader Charles Schumer (D-N.Y.) told reporters on Tuesday. (Carney, 6/27)

Americans broadly disapprove of the Senate GOP's health care bill, and they're unhappy with how Republicans are handling the efforts to repeal and replace the Affordable Care Act, according to a new NPR/PBS NewsHour/Marist poll. Just 17 percent of those surveyed say they approve of the Senate's health care plan, the Better Care Reconciliation Act. (Taylor, 6/28)

Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, Covered California. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents. (Dembosky, 6/28)

Nearly two dozen protesters gathered across the street from Ted Cruz's offices in downtown Houston Tuesday afternoon to pressure the junior senator from Texas on his coming vote on the Republican healthcare bill. Cruz is seen as one of a handful of GOP senators whose vote would be critical to the legislation's passage. The senator has said he is not prepared to vote on the bill and reportedly has been serving as a mediator to make the bill more palatable to conservatives. (Kadifa, 6/27)

America First Policies had begun airing TV and radio ads on Tuesday savaging Heller for his planned ‘No’ vote, with spots charging that Heller had broken his “promise” to voters that he would dismantle Obamacare — a stunning attack on a member of the president’s own party and the most vulnerable Republican up for re-election in 2018. (Isenstadt, 6/27)

Heller is arguably the most vulnerable GOP senator running for re-election in 2018, since he is the only Republican running in a state that Democratic presidential nominee Hillary Clinton won in 2016.(Bowman, 6/27)

Three months ago, Republicans condemned political groups aligned with President Donald Trump for doing almost nothing to promote a health care bill. Now they think one of the groups may have gone too far. Senate Majority Leader Mitch McConnell decided Tuesday to call off a planned vote this week on a proposal to repeal and replace former President Barack Obama's health care law. Some on the Hill blamed the unexpected delay on aggressive tactics by America First Policies, a politically active nonprofit run by a former White House aide and Trump campaign veterans. (Bykowicz, 6/28)

Major health care industry groups have well-oiled war machines that they have regularly deployed to bolster — or torpedo — proposed policy in the past. But with the Senate health bill threatening to reshape a sector that makes up one-sixth of the American economy, many of the most powerful industry voices have been notably absent from the public debate. (Johnson, 6/27)

Powerful hospital and medical school lobbying groups are spending at least $1 million on television ads opposing Senate Republicans’ plan to repeal and replace Obamacare. The ads ask viewers to consider whether they’ll be among the millions of Americans projected to lose their health coverage under the Senate proposal, Rick Pollack, chief executive officer of the American Hospital Association, said Tuesday in a conference call with reporters. (Mattingly, 6/27)

Major veterans' organizations are voicing concerns about a Senate GOP bill to repeal the nation's health care law, fearing the impact of rising insurance costs and worried the underfunded Department of Veterans Affairs won't be able to fill the coverage gap. (Yen, 6/27)

Nursing-home executives are intensifying their opposition to the Senate’s health-care overhaul, concerned that the proposed multibillion-dollar cuts to Medicaid would gravely wound the industry. Before Senate Republicans postponed a vote on the legislation Tuesday, a conference call organized by the American Health Care Association drew nearly 800 participants. They were asked to contact their senators and representatives to discuss the bill’s potential impact, and to involve employees and family members of residents in the lobbying effort. (Simon, 6/27)

The bill passed by the House and the bill now before the Senate have prompted an array of organizations that try to work with Republicans and Democrats alike to take clear stands. ... The nonpartisan Congressional Budget Office estimated on Monday that the Senate bill would increase the number of people without health insurance by 22 million by 2026. (Boulton, 6/27)

An influential supporter of Republican leaders’ efforts to pass a health care and tax repeal package on Tuesday urged reluctant GOP senators to debate the controversial measure. The U.S. Chamber of Commerce announced it might include lawmakers’ votes on a motion to proceed to the health bill in its annual scorecard on legislators’ performance. The lobbying push is part of a broad effort by the Trump administration and its allies to overcome Republicans' hesitation on voting on the bill. (Young, 6/27)

The U.S. Chamber of Commerce urged Senate Republicans to repeal ObamaCare's "Cadillac Tax" on high-cost employer insurance plans in its healthcare replacement bill. The tax isn't slated to go into effect until 2020, and the current Senate draft would further delay its implementation until 2026 to comply with the chamber's budget rules. (Hellmann, 6/27)

The Club for Growth announced its opposition on Tuesday to the Senate GOP’s ObamaCare repeal-and-replace legislation, arguing it would make the United States' healthcare system worse. The conservative group said the Senate bill would actually “restore” ObamaCare by creating new mandates and imposing taxes. (Hellmann, 6/27)

In a post Tuesday on the Health Affairs blog, former Secretary of Health and Human Services Kathleen Sebelius calls the Republican health care plans passed by the House and proposed by the Senate “a very cruel war on the poor.” The post, co-authored with Ron Pollack, founding executive director of consumer health group Families USA, states, “By far, no demographic group would be hurt more by these legislative proposals than low-income people. They are the bulls-eye!” (Margolies, 6/28)

Sen. Elizabeth Warren said Tuesday that opposing the Republican health care bill wasn’t enough, and the Democratic Party should start running on a new national single-payer plan. “President Obama tried to move us forward with health-care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts,” she told the Wall Street Journal. “Now it’s time for the next step. And the next step is single payer.” (Breiner, 6/27)

Ms. Warren says her immediate focus is on fighting the Republican health-care legislation and mounting her 2018 re-election campaign. But she hasn’t been shy about seeking to pull fellow Democrats and those running in next year’s midterm elections to the left. Blocking the GOP rollback of provisions in the Affordable Care Act, Ms. Warren said, is not enough. She said Democrats on the ballot in the next two federal elections should back a national single-payer health-care plan. (Epstein, 6/27)

Senator Elizabeth Warren now says Democrats should endorse a government-run, single-payer health insurance system for the upcoming 2018 midterm elections and beyond, after suggesting four years ago the proposal was “politically unacceptable.” How did Warren’s position evolve? (Herndon, 6/27)

Opioids could kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates. Deaths from opioids have been rising sharply for years, and drug overdoses already kill more Americans under age 50 than anything else. STAT asked leading public health experts at 10 universities to forecast the arc of the epidemic over the next decade. The consensus: It will get worse before it gets better. (Blau, 6/27)

The spiral of opioid addictions and overdoses is unrelenting. But there are bright spots all across the country: Men and women working in classrooms and courtrooms, in private labs and public offices, in clinics and on the street — all trying to find the next big way to save lives. STAT has identified 12 potential game changers that could begin to bend the curve of the opioid epidemic. Some of these are experimental ideas, not yet subjected to rigorous clinical trials or peer review. But they’re intriguing enough that public health experts and addiction counselors are eager to learn more. (Blau, 6/27)

Initiated in the 1980s and until recently a small slice of the criminal justice system, drug courts now number more than 3,000, a sprawling network that touches half the counties in the country. ... Over the past five years, Alkermes has persuaded hundreds of them to favor Vivitrol injections. (MacGillis, 6/27)

President Trump’s commission on the opioid crisis has missed its first deadline. The newly created panel met for the first time on June 16, just 11 days before the White House’s ambitious due date for a preliminary report meant to outline federal strategies to curb the epidemic. An executive order that established the commission had set a 90-day deadline for the completion of that document. The deadline will come and go without a report being filed, and a commission teleconference originally scheduled for Monday evening has been rescheduled for July 17. (Facher, 6/27)

Hospital admissions for heroin overdoses have more than quadrupled since 2010 in Pennsylvania, with the upward trend getting even steeper in the past year, according to a new report that confirmed medical centers are seeing the same distressing patterns as coroners’ offices. The vast majority of the hospitalized patients last year — about 70 percent —  were between 20 and 39 years old, with an average age of 33. But 2 percent of patients were ages 15 to 19. (Sapatkin, 6/28)

Two new strains of fentanyl are so deadly, they may be immune to naloxone, also known as Narcan, the drug used to save those who have overdosed, the GBI said Tuesday in a news release. Acrylfentanyl and tetrahydrofuran fentanyl were not identified by the GBI until March, when the Forsyth County Sheriff’s Office submitted the drugs as part of forensic evidence. (Habersham, 6/27)

A pain clinic owner, an office manager and two doctors pleaded guilty and were sentenced this month for their roles in operating “pill mills” — years after federal agents raided three metro Atlanta clinics. ... Prosecutors in the case said the doctors knew, or should have known, that patients were misusing their prescriptions.  (Godwin, 6/27)

Baltimore officials are expected to approve a 15-year lease at the old Hebrew Orphan Asylum in West Baltimore, where they plan to open a center to help people addicted to heroin and other drugs so they're not taking up emergency room beds. The stabilization or sobering center at 2700 Rayner Ave. in Mosher would serve around 30 patients at a time, helping them sober up safely and then connecting them with long-term drug treatment and other social services. (Duncan, 6/27)

The White House has issued an earnest statement attributed to President Trump about HIV/AIDS in America. It is technically accurate, apolitical and strikes just the right notes in terms of being somber and optimistic at the same time. There's nothing exciting about the content of the four-paragraph statement. It simply reminds people that today is National HIV Testing Day, reviews some statistics about the epidemic and tells people why it's important to get tested. (Cha, 6/27)

{Every] year, some 300,000 people in the United States are diagnosed with Lyme disease, according to the CDC, and that number is on the rise. Some people wait months or years to get a correct Lyme diagnosis. And their cases highlight a problem: tests for Lyme in the first month of infection are frequently wrong. When diagnosed and treated early the infection is a simple one to get rid of, but left untreated it can cause a myriad of lingering symptoms, from severe arthritis to short-term memory problems. Now, a number of research groups are working to improve Lyme tests to catch infections in the early stages. One avenue being studied by the CDC aims to create a Lyme “signature” of small molecules in the blood — an approach that, in early testing, catches a dramatically higher share of early infections. (Caruso, 6/28)

There's a big push in the U.S. from pediatricians to have mothers of newborns breast-feed exclusively for at least six months. And many new moms want to. But only about 60 percent who start off breast-feeding keep it up for six months or more, according to the Centers for Disease Control and Prevention. (Doucleff, 6/27)

The Villages Regional Hospital did not sweat its decision to add hyperbaric oxygen therapy in 2013. Hyperbaric treatment, increasingly given to diabetics — many of them elderly with persistent wounds — involves breathing pure oxygen inside a pressurized air chamber typically for two hours each weekday, often for more than a month. Twenty outpatient sessions can bring a hospital $9,000 in revenue. (Galewitz, 6/28)

California health officials reported Tuesday that 111 terminally ill people took drugs to end their lives in the first six months after a 2016 law made the option legal in the nation's most populous state. The data was part of the California Department of Public Health's first report on the law since it went into effect June 9, 2016. (6/27)

A snapshot of the patients who took advantage of the law mirrors what’s been seen in Oregon, which was the first state to legalize the practice nearly two decades ago. Though California is far more diverse than Oregon, the majority of those who have died under aid-in-dying laws in both states were white, college-educated cancer patients older than 60. The End of Life Option Act made California the fifth state in the nation to allow patients with less than six months to live to request end-of-life drugs from their doctors. (Karlamangla, 6/27)

California’s End of Life Option Act went into effect June 9, 2016, allowing assisted suicide in the state after years of contentious debate. Each year, on or before July 1, the Department of Public Health must provide prescribed information on those who sought and used aid-in-dying drugs. (Anderson, 6/27)

Alabama's psychiatric care of state inmates is so "horrendously inadequate" that it violates the U.S. Constitution's ban on cruel and unusual punishment, a federal judge ruled Tuesday as he ordered the state to overhaul conditions. (6/27)

After court victories against abortion laws in Texas and Louisiana, a reproductive rights group filed a federal challenge on Tuesday of a Louisiana licensing law it blames for more than a thousand burdensome anti-abortion regulations. (6/27)

St. Louis Park is poised to become the second city in Minnesota to raise the tobacco sales age from 18 to 21, following the footsteps of neighboring suburb Edina. The City Council on Monday passed a first reading of an ordinance raising the sales age. If the second reading is approved July 17, the new restrictions would go into effect on Oct. 1. (Otarola, 6/27)

The program is run by The Breakfast Club, a local nonprofit that supports African-American women diagnosed with breast cancer. The “buddies” receive a small stipend to be a mentor, friend and guide to women undergoing nine months of treatment and follow-up care. (Bouscaren, 6/28)

The Memorial Hermann Health System, Houston's largest employer, is laying off another 350 employees, bringing its total to more than 460 this year. Memorial Hermann announced the layoffs Tuesday, the same day it notified most of the affected employees. The reduction, which represents less than 2 percent of Memorial Hermann's 25,000 employees workforce, affected people at all levels. (Ackerman, 6/27)

Glyphosate, the main pesticide in Monsanto’s Roundup weed killer that is used throughout Santa Cruz County, is receiving increased attention from state lawmakers concerned about its cancer-causing properties. In March, California became the first state to add glyphosate to the list of chemicals known to cause cancer. (Men, 6/27)

Osteopathic medical schools, whose numbers have doubled in the last 10 years, are in the middle of a huge push into smaller communities...These days, the care provided by D.O.s and M.D.s is typically so similar that most patients wouldn’t know the difference. But that hasn’t always been the case.At the root of osteopathic medicine is osteopathic manipulative treatment, a hands-on technique that looks like a cross between chiropractic manipulation and massage. There’s evidence this can help treat some kinds of pain. (Smith, 6/28)

Unlike old-school shelters, the Navigation Center offers 24-hour access, has storage for belongings, partners are allowed to sleep together, and pets may be brought inside. The big difference? The Navigation Center has case managers offering intensive help on a range of services, including treating addictions, obtaining identification cards and finding housing. (Knight, 6/27)

Thousands of feet above the Gulf of Mexico, Cristina Penton realized her baby boy was coming sooner rather than later.Penton said she began feeling contractions less than 20 minutes after she took off aboard Spirit Airlines Flight 971 from Ft. Lauderdale, Fla. on Saturday night. Within the hour, the flight had landed at Louis Armstrong International Airport, with Penton holding her newborn son in her arms. Once she knew something was wrong, Penton alerted flight attendants who found a pediatrician and a nurse on board and prepared to give an all-natural birth in the front row of the plane. Pilots re-routed the plane to New Orleans, but Penton's water broke in flight. Ten minutes later, Christoph Carsten Lezcano was born aboard the aircraft, 19 1/2 inches long and weighing seven pounds. (Rand, 6/27)

They had the numbers: six women who would describe in disturbing detail exactly how they were harassed, assaulted or made to feel uneasy by the unwanted advances of San Francisco venture capitalist Justin Caldbeck. Three of those women decided to identify themselves publicly — a risky move for victims of sexual violence or harassment, who are often dismissed, threatened or discredited in efforts to poke holes in their stories. (Lang, 6/27)

In Missouri, there are at least 22 ballot proposals aimed at persuading voters in 2018 to join that growing club of pro-pot states, an effort similar to a successful ballot drive last year in Arkansas. But all of this comes as U.S. Attorney General Jeff Sessions is calling for a crackdown on the growing number of states that appear to be ignoring the federal ban on pot. (Mannies, 6/27)

But now, the Food and Drug Administration is considering whether bombarding consumers with every last potential side effect might be overkill. The agency, which approves prescription drugs and oversees how they’re marketed, is proposing a new study to look at whether patients are being “over-warned” to the point that they stop paying attention...The United States and New Zealand are the only two countries to allow direct-to-consumer ads on TV. It’s big business: Drug companies spend about $5 billion a year on advertising, and a huge chunk of that is on TV. But federal officials strictly scrutinize those ads to make sure they strike a “fair balance” between the benefits of the drug and the side effects. (Thielking, 6/28)

Nolan and Jack Willis, twins from upstate New York, and just 10 other boys took part in a clinical trial that led to the approval last fall of the very first drug to treat their rare, deadly muscle disease. Now the Willis boys are again test cases as a different type of medical question comes to the fore: whether insurers will cover the controversial drug, Exondys 51, which can cost more than $1 million a year even though it’s still unclear if it works. (Thomas, 6/22)

President Trump spent the last several weeks blasting Democrats for refusing to work with Republicans on health care. Now, two of the Democrats who have shown the most willingness to work with him on one specific health issue ― drug pricing ― are blasting him back. Reps. Peter Welch of Vermont and Elijah Cummings of Maryland made headlines when they agreed to meet Trump at the White House in March to discuss efforts to bring down drug prices, even as many of their colleagues worked to distance themselves from the president. The pair came away from that meeting optimistic about Trump’s willingness to press for relatively liberal changes, like allowing the importation of drugs from Canada or letting Medicare negotiate drug prices. (Mershon, 6/23)

Several items in a draft version of a White House executive order on drug pricing are causing consternation, but some Democratic lawmakers are especially upset the Trump administration seeks to weaken a program that offers discounts on medicines to hospitals. The 340B Drug Discount Program, as it is known, requires drug makers to offer discounts of up to 50 percent on all outpatient drugs — for everything from AIDS to diabetes — to hospitals and clinics that serve indigent populations. (Silverman, 6/23)

High drug prices are a constant consumer complaint about health care. Judy Woodruff sits down with Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, at the Spotlight Health Conference at the Aspen Institute to discuss the Senate Republican health care bill, the prospects for lowering drug prices and the connection between the opioid crisis and the industry. (6/23)

The FDA just took a step that could increase competition and prevent price gouging on drugs that seemingly jump in price overnight. In May, Food and Drug Administration commissioner Dr. Scott Gottlieb said he wanted to make it more difficult for drugs that are off patent to jack up the price of the medication because they don't face any competition. The biggest example of this was Daraprim, a decades-old drug that then-Turing CEO Martin Shkreli increased in price from $13.50 to $750 a pill. To keep that from happening in the future, the FDA on Tuesday published a list of more than 200 drugs that have fallen off patent where the FDA hasn't received any applications for a generic drug version of that drug. (Ramsey, 6/27)

Ayear ago, a widower caused a stir by writing in an opinion piece that advertising for a Bristol-Myers Squibb cancer drug was “misleading and exploitive.” His wife had recently passed away from lung cancer after being treated with the company’s Opdivo medicine, and he argued that Opdivo ads overstated the chances of living longer. Concerns about drug advertising are hardly new, but his op-ed, which appeared in The New York Times, triggered a fresh round of debate. Why? Opdivo is one of the new so-called immunotherapies, which harness the body’s own immune system to attack tumors. And they are transforming cancer care, raising expectations among investors, doctors and, especially, patients. (Silverman, 6/23)

Among many things the Senate bill would do is roll back a tax increase agreed to by the pharmaceutical industry at the time Obamacare was approved with the understanding that health-care coverage, and thus expenditures for drugs, would increase. The Congressional Budget Office, in estimating the financial impact of the latest bill, said the resulting tax break for pharmaceuticals over a decade would be $25.7 billion. (Johnson, 6/27)

From 2010 to mid-2015, drug stocks soared to record heights on the back of massive mergers and seemingly boundless optimism. Then, throughout the 2016 election campaign, worries about political pressure to lower drug prices put biotech stocks in a prolonged slump. (Nisen, 6/22)

If you’ve been following all things biotech, you know this has been a very good week for the industry. Stocks are up sharply across the board. Indeed, the sector is enjoying its best run of the year. In the past week, six of the 10 top performers in the S&P Healthcare Index were large-cap biotech stocks. Shares of Celgene (up 10 percent), Regeneron Pharmaceuticals (up 11 percent) and Vertex (up 8 percent) have all reached new highs. Biogen is up 9 percent, too. (Feurstein, 6/22)

Martin Shkreli is infamous. That’s making it tough to find a jury of 12 for his criminal fraud trial in Brooklyn, where he’s even being blamed for other pharma executives’ bad behavior, such as raising the price of the life-saving EpiPen. The first potential juror interviewed Monday, a young woman in her 30s, called Shkreli “an evil man.” Another woman said she knew he’d been labeled “the most hated man in America,” while a third woman declared, “I looked right at him and, in my head, I said ‘that’s a snake.”’ They were among at least a dozen people dismissed from jury service because of their strong opinions about Shkreli and at least three potential jurors blamed him for a spike in the price of the EpiPen. (Hurtado and Egkolfopoulou, 6/26)

Martin Shkreli got his first taste of Wall Street as an intern for a hedge fund firm started by CNBC personality Jim Cramer. After striking out on his own, he developed a reputation for aggressive tactics, including betting a company’s stock price would fall and then berating its executives on social media. His battles earned him a spot on Forbes list of “30 under 30” after, the magazine said, Shkreli torpedoed a health care industry merger and “antagonized” pharmaceutical giant Pfizer into removing its former chief executive from the company’s board of directors. Shkreli, now 34, is a “boy genius,” his attorney has said. (Merle, 6/27)

Danish pharmaceutical company Novo Nordisk A/S is betting that wider uptake of its products in China will offset price reductions required by the Chinese government. Chinese regulators will soon decide whether to include two of Novo Nordisk’s newer medications — Victoza, used to treat Type 2 diabetes, and NovoSeven, a hemophilia treatment — on the country’s reimbursement drug list. The state-funded program reimburses Chinese patients part or all of the drug’s price, depending on its classification. (Trentmann, 6/27)

Ahalf dozen U.S. senators want the U.S. Army to hold a public hearing to explore the controversy over the pricing of a Zika virus vaccine that Sanofi is developing with taxpayer dollars. In a letter sent on Monday to Acting U.S. Secretary of the Army Robert Speer, the lawmakers expressed concerns that a vaccine would not be “accessible and affordable” for many Americans, since the company may win an exclusive license to develop the technology and have “monopolistic” rights through 2036. (Silverman, 6/26)

The first ever EU antitrust probe into excessive drug pricing is taking the European pharmaceuticals industry into uncharted territory, unnerving some companies and lawyers worried about the reach of market intervention. It comes as drugmakers face global pressure over the high cost of prescription medicines, with particular anger focused on makers of older generic products who exploit limited competition to force through big price rises. (Chee and Hirschler, 6/26)

The festivities are over here at BIO 2017, but it’s been a busy week at the the drug industry’s big annual networking conference. It’s been telling, too, of what biotech leaders see as their industry’s biggest opportunities, priorities, and problems. Here are our takeaways from four days of talking and listening to executives here. (Robbins and Garde, 6/23)

Our understanding of cancer has been morphing from a tissue-specific disease — think lung cancer or breast cancer — to a disease characterized more by specific genes or biomarkers than by location. A recent FDA decision underscores that transition and further opens the door to personalized medicine. (Edward Abrahams, 6/21)

According to the most recent report by the Robert Wood Johnson Foundation, Latinos and African-Americans have health outcomes that are 30 to 40 percent poorer than white Americans. ... That’s why policymaking in the health care sphere has to move in a direction that closes this health outcomes gap, and takes great care not to make these disparities even worse. ... We could take giant steps backward, however, if Congress moves ahead with the idea of permitting the importation of prescription medicines from other countries. If this happens, the United States government will actually be promoting the use of counterfeit and unsafe medications from China, Mexico, Pakistan and other parts of the world in which our Food and Drug Administration has zero oversight. (Garfield Clunie and Richard Williams, 6/23)

When Jeffrey Kivi's rheumatologist changed affiliations from one hospital in New York City to another, less than 20 blocks uptown, the price his insurer paid for the outpatient infusion he got about every 6 weeks to control his arthritis jumped from $19,000 to over $100,000. Same drug; same dose -- though, Kivi noted, the pricier infusion room had free cookies, Wi-Fi and bottled water. (Elisabeth Rosenthal, 6/26)

We are all focused on Republican efforts to repeal the Affordable Care Act and replace it with new policies that will result in millions of Americans paying more and getting less. But there is another health care issue that also needs attention: the future of prescription drug prices. (Jan Schakowsky, 6/26)

A proposal to cap the out-of-pocket cost of drugs, which just passed the state Senate unanimously, sounds like a Godsend for patients. If you've got a rare form of leukemia or HIV/AIDS and need a specialty drug that costs tens of thousands of dollars, it can be. (6/27)

The Senate health-care bill, which was scuttled Tuesday until after July 4, was doomed by two narratives: Republicans are mean, and poor people would be dropping like flies. Assisting the opposition was none other than President Trump, who called the earlier version passed by the House “mean.” Trump met with Senate Republicans on Tuesday afternoon to plot their move to repeal and replace Obamacare, which remains the GOP’s objective. (Kathleen Parker, 6/27)

For a good laugh, or rather cry, zip backward to the beginning of 2014, when Democrats still had control of the Senate, and listen to Mitch McConnell’s lamentations about the way they were doing business. “Major legislation is now routinely drafted not in committee but in the majority leader’s conference room,” he declaimed on the Senate floor. “Bills should go through committee.” He pledged that if Republicans were “fortunate enough to gain the majority next year, they would.” (Frank Bruni, 6/28)

Senator Mitch McConnell hoped that keeping his wretched bill to destroy the Affordable Care Act secret until the last minute would make it easier for him to railroad fellow Republicans. The facts the majority leader had hoped to suppress came back to bite him on Monday when the Congressional Budget Office released a detailed review of the bill that confirmed what governors, doctors and indeed the American public had been saying for days: The bill is a cruel hoax that would help the wealthiest Americans at the expense of the poorest. (6/27)

The fate of the Affordable Care Act may be determined this week, and no one can claim ignorance of the stakes. Republican leaders in the Senate drafted their proposed replacement, the Better Care Reconciliation Act, behind closed doors without hearings or committee consideration. But the Congressional has pierced the Orwellian packaging to make clear the consequences of the coming vote. Senators cannot say they weren’t warned, and neither can the American people. (William A. Galston, 6/27)

Two Junes ago, when the Supreme Court upheld, 6 to 3, a challenged provision of the Affordable Care Act, Chief Justice John G. Roberts Jr., writing for the majority, vented: “Congress wrote key parts of the Act behind closed doors. . . . Congress passed much of the Act using a complicated budgetary procedure known as ‘reconciliation,’ which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. . . . As a result, the Act does not reflect the type of care and deliberation that one might expect of such significant legislation.” Now, however, Republicans run things, so . . . (George F. Will, 6/27)

Monday’s report on the Senate health-care bill from the Congressional Budget Office said that 22 million people would lose coverage under the plan and that coverage in the non-group market would become far stingier than it is today. By Tuesday the bill had been pulled back for revision. The quick sequence was revealing: Senators clearly could use some extra time to figure out how to bridge a giant gap between policy theory and reality. (Drew Altman, 6/27)

That sounds unlikely, I know. McConnell prides himself on his prowess as a legislative strategist; he likes nothing better than crushing his opponents. Repealing Obamacare was one of the GOP’s core promises in 2016, and most conservatives (including McConnell, presumably) still believe in the cause. Equally important, McConnell and House Speaker Paul Ryan desperately wanted to pass a healthcare bill with a big tax cut at its center. That’s the core of the Republican economic agenda. (Doyle McManus, 6/28)

Deemocrats these days must feel like Michael Dukakis, as famously played by Jon Lovitz in a debate with then-Vice President George H.W. Bush on "Saturday Night Live," when he said, "I can't believe I'm losing to this guy." Less than a week after losing four special elections they thought they could win, based on President Donald Trump's plunging approvals with swing voters, Democrats face a new Senate Republican bill to replace the Affordable Care Act, also known as Obamacare. (Clarence Page, 6/27)

Senate Republicans on Tuesday delayed a vote on their health-care bill until after the July 4 recess, and the timidity and opportunism of too many Senators suggest they may never get 50 GOP votes. We hope they understand that if they fail, Republicans will be entrusting their political health-care future to the brutal generosity of Democratic Leader Chuck Schumer. (6/27)

The massive redistribution of wealth from poor to rich that’s masquerading as a health-care bill in the U.S. Senate is even more cruel in some ways than the bill that cleared the House and that President Donald Trump later called “mean.” Under the bill that Majority Leader Mitch McConnell wants to whisk into law, 22 million Americans would lose their health insurance by 2026 while out-of- pocket costs would rise for the insured, according to an analysis by the nonpartisan Congressional Budget Office. Recall that Trump promised no one would lose insurance and that coverage would be better if he became president. (6/28)

Donald Trump asked Senate Republicans to introduce a healthcare bill with “more heart.” They didn’t. The senators’ draft legislation, introduced last Thursday, will strip tens of millions of low-income and middle-class Americans of their health insurance. Millions more will face higher costs for lower coverage. The Congressional Budget office estimates 22 million more people will likely be uninsured by 2026 than would be if the Affordable Care Act remained law. (Judy Lubin, 6/28)

For example, Vice President Mike Pence touted this as a new system based on “personal responsibility.” He did not specify what failure of “personal responsibility” he finds in people with disabilities who won’t be able to get treatment under the Republican plan. Kellyanne Conway opined that those who lose their Medicaid “can always get jobs.” Which will doubtless surprise many low-income workers who depend on it. They thought they already had jobs, albeit jobs that don’t offer health insurance. A woman on Twitter asked what will happen to her son “born at 26 weeks with a serious heart condition.” Another woman replied: “Sorry about your son, but what would he have done 200 years ago things are much better but nothing is promised to anyone.” (Leonard Pitts Jr., 6/27)

News outlets around the country led with a big number from the Congressional Budget Office’s review of the Senate health care bill: Were it to pass, 22 million people could “lose” insurance, as many put it. (6/27)

It stands to reason that in an era of alternative facts and alt-right websites generating fake news, we're not getting the whole story on the U.S. Senate Republicans' bill to overhaul the Obama-era health care law. On Monday, Tom Ashbrook, the normally measured host of National Public Radio’s “On Point,” about lost it after failing to get his guests to simply agree what the bill would do. "It just stinks when Americans can’t hear what is actually in this bill!” Ashbrook exclaimed. (Rekha Basu, 6/27)

Yet another influential group heard from on the Senate’s plan to cut health-insurance for the poor in order to offer tax cuts to the wealthy. This time, it’s the nation’s Catholic bishops, responding to the non-partisan Congressional Budget Office report that 22 million Americans would no longer have insurance by 2026 -- either because they don't want it or their employer no longer offers it or they can't afford it. (Laurie Roberts, 6/27)

For millions of Americans across the country, the possible repeal of the Affordable Care Act is a terrifying prospect. People are facing dire consequences if President Donald Trump succeeds in his quest to destroy health care to serve a political talking point, and the impact on LGBTQ people, communities of color, women, children, seniors and others disproportionately reliant on the ACA will be devastating. (Chad Griffin and William Hardy, 6/28)

If you were Thom Tillis, but without his paycheck, would you think the Senate Republican health plan is a good idea? Let’s say you were 60 years old, just four years older than Tillis, and from Mecklenburg County, as he is. If you made $40,000 and purchased a Bronze plan on the Affordable Care Act exchange, you’d pay about $1,100 in premiums after tax credits. Under the Republican health plan – the Better Care Reconciliation Act – you would pay $5,420, according to a Kaiser Family Foundation analysis. That’s an increase of 393 percent. (6/27)

Too many families in Kentucky who liked their insurance plans or their doctors soon found they weren’t able to keep them. When families are kicked off their plan, they must find a new insurer, often at a higher price. When families must change doctors, they often lose a bond of trust they developed with a physician who’s familiar with their medical history. And when insurers flee the exchanges, it leaves families with fewer options for their health care. In fact, Kentuckians in nearly half of our counties now have only one option on the Obamacare exchanges — and, as we all know, one option isn’t really an option at all. (Sen. Mitch MCConnell, 6/27)

America faces an urgent crisis in its health-care system. Costs are skyrocketing and choices are disappearing on the individual and small-group markets. Many people now confront the real challenge of having no choice in their health coverage. (HHS Secretary Thomas E. Price, 6/27)

The much-ballyhooed Senate Republicans’ health-care reform — officially the Better Care Reconciliation Act of 2017 and better known as Obamacare repeal-and-replace — is now the center of public debate. Much of the discussion has focused on issues of timing — the “secretive” process by which the bill was developed, the putative “jamming” of the bill forward for a floor vote and now a delay of the vote until after the July 4 recess. But to begin: What’s actually in the BCRA? (Douglas Holtz-Eakin, 6/27)

President Trump called on Congress earlier this year to give governors around the country “the resources and flexibility they need with Medicaid to make sure no one is left out.” As administrator for the Centers for Medicare and Medicaid Services, I share the president’s vision: to ensure that Medicaid works for those it was designed to serve. (Seema Verma, 6/27)

In my view, the keening about how the GOP bills will strike people dead is sheer hysteria. Liberals always claim that if conservative policies prevail — on health care, on fossil fuels, on welfare reform, on abortion rights, on the Second Amendment, even on rent control — more people will die. (Jeff Jacoby, 6/27)

The parents of a 3-year-old are silent as they sit in their pediatrician’s office in Potosi. They have just learned their son has leukemia. The treatment will be long and hard, but at least it is a type of leukemia that usually has a good outcome. Yet they are also frightened because, between the two of them, they are working five part-time jobs just to keep their family’s heads above water. So they are relieved to hear that Medicaid will cover the bulk of the enormous cost of their child’s treatments. (Robert W. Wilmott and Gary A. Silverman, 6/27)

The AHCA has less-generous tax credits tied only to age. The BCRA, meanwhile, keeps the basic ACA structure, which makes it seem friendlier to patients and to health-care providers. But a closer look reveals warts. In 2020, the income range for tax credits shifts down to 0 to 350 percent of the poverty level. That may help low-income people in states that didn't take the ACA's Medicaid expansion. That's arguably a positive for hospitals and insurers. But other aspects of BCRA erase that benefit. Cost-sharing subsidies will end in 2019. And tax credits will be far less generous. (Max Nisen, 6/27)

In many ways, calling the U.S. House of Representatives’ passed American Health Care Act (AHCA) or the Senate-proposed Better Care Reconciliation Act (BCRA) a “repeal and replacement” of the Affordable Care Act (ACA) is a misnomer. Neither bill fully repeals the ACA nor do their changes focus solely on replacing the ACA’s key provisions. At the most fundamental level, both bills have different goals than the Affordable Care Act. (Marianne Udow-Phillips, 6/27)

Congressional Republican proposals to “repeal and replace” Obamacare would slash Medicaid, the nation’s health insurance program for the poor. In so doing, they would devastate Los Angeles in ways that may not yet be fully appreciated. One in 20 of the nation’s Medicaid recipients lives in L.A. County and relies on the program for their healthcare. About 4 million strong, they make up about 40% of the county’s population. Many would be at grave risk of losing their health coverage, and consequently all but emergency medical treatment, under the Republicans’ program. Current programs to provide housing and treatment to thousands of people living on the streets, or heading there after their discharge from hospitals or release from jails and prisons, would be seriously curtailed. (6/27)

The health-care overhaul that Senate leaders floated this past week does more than roll back an entitlement Republicans have loathed since the day it was enacted in 2010. It portends a deeper struggle over the safety net that pits the elderly against the poor. The federal government is often called an insurance company with an army. Thanks to aging and health-care inflation, the cost of that insurance is rising relentlessly. Social Security, Medicare and Medicaid now swallow 58% of tax revenue, and are on track to take 80% by 2047. (Greg Ip, 6/28)

You can see the train wreck coming. Iowans who do not receive health insurance through an employer may not be able to buy it next year on a state-based exchange created by Obamacare. Only one insurer has applied to offer individual coverage here in 2018. That company, Medica, is proposing steep rate increases and may still pull out of the market. Iowans cannot purchase insurance if no one will sell it to them. What are they going to do? (6/26)

As Republicans in Washington contemplate the uncertain fate of their health-care bill over the July 4 recess, they might consider recent events in another legislature on the opposite coast of America. Earlier this month, Democrats in the California state senate passed their own big, bold, bad health-care bill. The legislation would have required the state government to supplant insurers, providing health insurance to all residents and negotiating medical costs with hospitals, doctors and other providers. (6/27)

California Assembly Speaker Anthony Rendon did the state a favor late Friday afternoon when he slammed the brakes on a fast-moving Senate bill to create a single-payer healthcare system in California. As should be obvious from the flailing Republican efforts in Washington, it’s easy to talk about drastic changes in the way healthcare is financed, but hard to make those changes work without hurting many of the people you’re trying to help. (6/27)

If expanding access to health care is more important than lining the pockets of special interests and giving tax breaks to billionaires, we can make it a reality. We just need to demand the politicians we elect to represent us, get the message. (Connie Pillich, 6/27)

Thhe central theme of the Republican campaign to repeal the Affordable Care Act has been freedom: freedom from Obamacare’s onerous regulations, freedom from overpriced insurance and most of all, freedom from the tyrannical individual mandate. The Senate has now released its long-awaited alternative to Obama-era health reform. Although the Better Care Reconciliation Act is embattled, there’s still a decent chance that the Senate will pass it. If it does, the bill is likely to become law. (Nicholas Bagley, 6/28)

The Senate Republicans’ stalled effort to repeal the Affordable Care Act is not the only profound threat to our health care system. If Gov. Scott Walker gets his wish, Wisconsin will be the first state that requires adults without children to undergo drug testing if they want to receive Medicaid. Other states could follow his plan. (Jamila Michener and Julilly Kohler-Hausmann, 6/28)

Imagine going to your doctor about one of the most important decisions you’ll ever make. Imagine your doctor’s response is to lie to you. You‘d rightly wonder why you’re not being told the truth and whether this dishonesty violates some law, let alone the ethical and moral duty to provide health care according to a doctor's own best medical judgement. (Nancy Northup, 6/28)

Drug abuse is devastating American society. Opioid overdose alone killed more than 33,000 people in 2015. But rather than address this public-health crisis, Attorney General Jeff Sessions has declared a new war on drugs. He has re-introduced mandatory minimum sentences for drug crimes and has asked Congress to let him spend money to prosecute people and businesses behaving in accordance with their states' medical marijuana laws. Clearly, Sessions is out of step with the scientific consensus regarding the medical effectiveness of cannabis. (Ashley C. Bradford and W. David Bradford, 6/27)

A cancer diagnosis is one of the most disrupting and frightening experiences a person can go through. I know because it happened to me just last year. I live with two forms of blood cancer – myelodysplastic syndrome and myelofibrosis. I am also one of the fortunate ones. Ongoing treatment has so far been successful in keeping the cancer in check, but I live with the reality that my body will stop responding so positively and I will need a new treatment game plan. (Stuart Behune, 6/27)