Is legislative health-care reform really dead?

Most of Congress seems to think so, and President Trump agrees, if his irate tweets about taking executive action to fix health care on his own are any indication. But the fact remains that Obamacare exchanges are still struggling all across the country. While a GOP-led repeal bill might not be on the table again anytime in the near future, some lawmakers continue to float possible solutions.

In the House, a group of about 40 centrist lawmakers hopes to lead the effort to stabilize the Obamacare exchanges. Called the Problem Solvers caucus, the group includes some moderate congressmen from the New Democrat Coalition and the GOPs Tuesday Group.

Led by Democratic congressmen Tom Reed (N.Y.) and Josh Gottheimer (N.J.), the caucus is primarily focused on continuing to fund the Affordable Care Acts cost-sharing-reduction subsidies (CSR payments), which reduce the significant costs to insurers of covering low-income Americans under Obamacare.

The bipartisan group also wants to establish a federal stability fund that states could access to reduce premiums for citizens with high-cost medical needs. The moderate lawmakers hope to alter the employer mandate so that it applies only to companies with over 500 workers, which would relieve the tax burden on small businesses that choose not to provide insurance plans.

The Problem Solvers caucus has also rallied behind a few ideas that have gained bipartisan support in the past, including abolishing the ACAs medical-device tax and expanding states ability to seek waivers from some of the bills coverage rules.

On Wednesday, Republican congressman Mark Meadows, chair of the House Freedom Caucus, said health-care reform isnt over. He also said that he has met with the Trump administration to discuss the path forward, and hes confident they can develop a new plan. Meadows was one of the key GOP members to broker the deal for an amendment that enabled the American Health Care Act to pass the House in April.

Over in the Senate, a handful of moderate GOP senators have suggested providing block-grant health-care funding to the states. This proposal was put forth in an amendment last week by GOP senators Lindsey Graham and Bill Cassidy, but it has yet to receive a vote. It would need to be scored by the CBO before a floor vote could take place.

Graham and Cassidy, along with moderate GOP senator Dean Heller (Nev.), met with Trump on Friday to discuss their plan. The White House, eager to capitalize on any idea to advance reform after last weeks debacle, seems intent upon using this plan as a means of gathering momentum for further health-care negotiation.

Meanwhile, Republican senator Lamar Alexander (Tenn.) and Democrat Patty Murray (Wash.) announced Tuesday afternoon that the Senate Health, Education, Labor, and Pensions committee will hold bipartisan hearings throughout September to discuss possible ways to stabilize the ACA marketplaces.

For his part, Trump has threatened to stop doling out CSR payments, apparently with the goal of further exacerbating the problems that already exist on the Obamacare exchanges. Trump seems to believe that further devolution of the exchanges would force lawmakers to implement an immediate health-care solution, but ending CSR payments would almost certainly lead to utter chaos in the insurance markets, making a fix even more difficult.

These efforts, while uncertain and rather uncoordinated, reveal a basic fact: We simply cant afford to give up on health-care reform. The fact that bipartisan cooperation is emerging only now is shameful; Democrats should have cooperated to begin with. Obamacare reform was always going to be necessary, in one form or another. With earlier Democratic support, it mightve been feasible to develop legislation that could fix at least some of the problems with the exchanges and garner enough support to be passed into law.

Legislative efforts may be effectively dead for the near future, but as health-care policy expert Avik Roy wrote on the Corner just after the Senate vote failed early Friday:

The GOP cannot simply move on and give up on health care. Health care is the biggest driver of our debt and deficit, the biggest driver of growth in government, and one of the biggest drivers of economic insecurity for those in the middle class and below. Take some time to reflect, yes. Come up with a better strategy, yes. But to give up on health-care reform is to give up on everything conservatives stand for.

If nothing else, the evident failures of Obamacare premium costs constantly on the rise, more insurers fleeing the ACA exchanges across the country, leaving many states with just one or two insurance options on the exchanges preclude anyone in Washington from giving up on reform for good.

READ MORE: Editorial: The Republican Health-Care Fiasco Republicans Should Revisit Health Care after a Tax Reform Success Maybe Health Care Wasnt Possible

Alexandra DeSanctis is a National Review Institute William F. Buckley Fellow in Political Journalism.

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Health-Care Reform Can't Die - National Review

By Laurie Meisler

August 2, 2017

Typically, the more a developed country spends on health care, the longer its people live. The U.S., which spends the most on health care, bucks that trend. Compared to the 35 countries in the Organization for Economic Cooperation and Development, which promotes policies to improve social and economic well-being, the U.S. life expectancy of 78.8 years ranks 27th. It has the fourth highest infant mortality rate in the OECD, the sixth highest maternal mortality rate and the ninth highest likelihood of dying at a younger age from a host of ailments, including cardiovascular disease and cancer.

The U.S. is the most obese country in the OECD, leads in drug-related deaths and ranks 33rd in prevalence of diabetes. Yet 88 percent of Americans say they are in good or very good health, according to OECD statistics. Only 35 percent of Japanese, who have the highest life expectancy in the OECD, regard themselves as healthy or very healthy.

Unlike other countries in the OECD, the U.S. mostly relies on voluntary health insurance to fund health-care costs. Public health insurance, such as Medicare and Medicaid, accounts for 27 percent of coverage. By contrast, the 10 countries with the highest life expectancy depend on voluntary insurance for an average of less than 6 percent of their costs, and government spending for nearly half.

One big reason U.S. health care costs are so high: pharmaceutical spending. The U.S. spends more per capita on prescription medicines and over-the-counter products than any other country in the OECD.

Notes: *Included in per capita spending on health care

**Includes cardiovascular disease, cancer, diabetes and chronic respiratory disease

Methodology: Bloomberg ranked the OECD countries by total expenditure on health, which is the amount each country spends for both individual and collective services. Dollar figures for per capita spending use current prices and current purchasing power parities. (PPPs are the rates of currency conversion that eliminate the differences in price levels between countries.) Expenditure data include personal health care services and expenses, medical goods dispensed to outpatients; prevention and public health services; health administration and health insurance. Spending figures for 2016 are estimated or provisional. Data for related factors are for 2015 or the latest data available.

Infant mortality refers to the number of deaths of infants under one year old. Compulsory/contributory health plans include social health insurance, compulsory private insurance and compulsory medical savings accounts.

Source: OECD, The World Bank, World Health Organization, International Diabetes Federation and Diabetes Atlas

With assistance from Yvette Romero

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Americans Die Younger Despite Spending the Most on Health Care - Bloomberg

Omega Healthcare Investors (OHI) shares are already a bargain, but they could get even cheaper as part of a wider market drop. With stocks sitting near record highs, a price drop of five to ten percent is fully within the realm of possibility, and investors need to plan accordingly. I am increasing my cash levels now in order to be able to take advantage of an inevitable market drop that would make quality income vehicles like Omega Healthcare Investors even cheaper.

Can you even remember the last time stock prices dropped 5 percent, 10 percent, or even 20 percent? And can you recall how painful the last bear market was for most investors? Chances are you cant because stock prices have been steadily climbing in the last couple of years, and the 2007 market crash happened almost a decade ago. In short, investors have short memories, and they have become way too complacent.

Earnings season has been pretty good so far for companies and investors, and, by extension, stocks. That said, though, todays complacency paired with investors willingness to buy into stocks at record levels is a convincing reason to be fearful. Valuations, on average, are pretty high, and they coincide with something else: Overbought sentiment.

As a matter of fact, I think there are three overriding reasons why investors should be prepared to buy into Omega Healthcare Investors as pressure on valuations begins to mount:

Omega Healthcare Investors has invested $5.8 billion in the growth of its real estate portfolio in the last thirteen and a half years - $1.3 billion in 2016 alone - in order to morph into a health care REIT with a national presence.

Source: Omega Healthcare Investors

Omega Healthcare Investors now has operating facilities in 42 states and in the United Kingdom.

Source: Omega Healthcare Investors

Omega Healthcare Investors works closely with health care facility operators. While the health care REITs relationships with its operator base have evolved over time, no operator poses an outsized risk to Omega in terms of revenues.

Source: Omega Healthcare Investors

In addition to a widely diversified real estate portfolio, Omega Healthcare Investors has had industry-beating occupancy rates.

Source: Omega Healthcare Investors

Omega Healthcare Investors just reported robust Q2-17 results, and continues to display top-shelf dividend coverage for a health care REIT. I recently doubled down on Omega Healthcare Investors as the REIT combines excess dividend coverage with an above-average commitment to raising its dividend payout every single quarter (Omega Healthcare Investors just raised its dividend for the 20th consecutive quarter and the new dividend rate is $0.64/share).

Omega Healthcare Investors is in a stable financial position and can continue to grow its dividend. I updated Omega Healthcare Investors dividend coverage chart for its second quarter results, and the real estate investment trust should have no problems growing its dividend payout by $0.01/share moving forward.

Source: Achilles Research

Omega Healthcare Investors guided for adjusted funds from operations of $3.42-$3.44/share for the current year. Based on this guidance, income investors seeking to access Omega Healthcare Investors 8.2 percent dividend, pay 9.1x 2017e AFFO. A market slide would translate into an even lower AFFO multiple (and higher cash flow yield), increasing investors margin of safety.

Income investors pay a premium to the REIT's book value. The premium valuation is justified in my opinion based on Omega's above-average dividend visibility, high cash flow yield, and potential for AFFO growth.

Investors have been piling into stocks for more than eight years (where do you think all that central bank money went?), pushing investors into risky assets and inflating their prices. Against this backdrop, I think the time has come to be a little more cautious, and raise cash in order to gobble up high-quality income vehicles when they are on sale.

If you have read my articles before you know that I have almost entirely liquidated my high-yield income portfolio earlier this year - primarily BDCs and mortgage REITs - due to concerns about stretched valuations and overbought sentiment, and because good investment opportunities have become increasingly hard to find.

Considering that a 5-10 percent market drop is entirely within the realms of possibility, having cash at hand to deploy during a market drop is the smart thing to do.

Omega Healthcare Investors has assembled a high-quality, geographically-diversified skilled nursing facility portfolio that throws off a growing stream of FFO. I have doubled down on the health care REIT because of its low valuation, and because it has a high degree of dividend coverage/visibility. Omegas second quarter results continued to show AFFO resilience and very good dividend coverage.

That said, I think income investors need to raise their cash levels in order to be able to scoop up high-quality income vehicles like Omega Healthcare Investors once the market falls back from its recent highs. Though Omega Healthcare Investors already makes a solid value proposition, I think the reward-to-risk ratio looks particularly attractive below $30.

If you like to read more of my articles, and like to be kept up to date with the companies I cover, I kindly ask you that you scroll to the top of this page and click 'follow'. I am largely investing in dividend paying stocks, but also venture out occasionally and cover special situations that offer appealing reward-to-risk ratios and have potential for significant capital appreciation. Above all, my immediate investment goal is to achieve financial independence.

Disclosure: I am/we are long OHI.

I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

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Omega Healthcare Investors: Strong Buy Below $30 - Seeking Alpha

Photo Credit Linda Huang

Something unusual and important is happening in Congress: Republicans and Democrats are working together to improve the health care system. And theyre doing so in defiance of President Trump, who appears determined to sabotage the Affordable Care Act and the health insurance of millions of people.

This surprising if modest burst of bipartisanship comes just days after the Senate failed to pass a Republican bill to repeal important provisions of the A.C.A., or Obamacare. On Monday 43 members of the House outlined a proposal to strengthen the insurance marketplaces created by the 2010 law. On Tuesday Lamar Alexander and Patty Murray, the Republican and Democratic leaders of the Senate Health, Education, Labor and Pensions Committee, said they would hold hearings and introduce a bill to cut premiums and encourage insurers to sell policies on the marketplaces for 2018.

It is, of course, impossible to know if such efforts will succeed. Even if they result in legislation, Republican leaders could refuse to bring it to the floor for a vote. Having treated Obamacare as a political piata for seven years, Republicans might find it hard to actually help the program. Another danger is that Mr. Trump and his health and human services secretary, Tom Price, could try to pre-emptively weaken the marketplaces through administrative measures. Still, its good to see politicians actually doing their jobs. The sight of members of both parties working together in the public interest is uplifting, especially after the long partisan campaign to take insurance away from so many Americans.

Contrary to Mr. Trumps tweets, Obamacare is not collapsing. But it needs work, and some insurance markets are in trouble. Insurers have said they will no longer sell policies in 20 counties in Indiana, Nevada and Ohio, and many are proposing to raise premiums because of the uncertainty created by Mr. Trumps threats. Experts say insurers could withdraw from even more counties, especially in rural and suburban areas, if the president sabotages the law.

The biggest fear, one shared by Mr. Alexander and Ms. Murray, is that Mr. Trump will stop subsidies authorized by the A.C.A. to make health care affordable to low-income people. The government pays these subsidies, about $7 billion this year, to insurance companies every month. In exchange, the companies reduce the deductibles and co-pays for people who earn between 100 percent and 250 percent of the federal poverty line, or $12,060 to $30,150 a year for a single person.

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Capitol Shocker: Democrats and Republicans Start Working Together on Health Care - New York Times

Sen. Lamar Alexander, R-Tennessee, said the Senate health committee will hold bipartisan health care hearings on how to repair the individual market. In the House, a group of 40 lawmakers from both parties endorsed an outline of ideas aimed at making urgent fixes to Obamacare.

The step toward bipartisanship on health care comes as some Republicans consider an approach that diverges from the president's stance.

In tweets this weekend, he threatened to stop paying insurance companies cost-sharing subsidies that help lower out-of-pocket expenses for low-income policyholders, calling them "bailouts."

Here are some of the bipartisan efforts underway in Congress over Obamacare.

"If your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market," he said in a statement. "Both Republicans and Democrats agree on this."

Alexander said in the statement that he was working with Sen. Patty Murray, D-Washington, to make the hearings bipartisan.

Congress has to come up with a solution before September 27, when insurers sign contracts with the federal government over what insurance plans to sell on the exchange for 2018. About 18 million Americans who get their insurance in the individual market stand to be affected, he said.

"Unless we act, many of them may not have policies available to buy in 2018 because insurance companies will pull out of collapsing markets," Alexander said.

The senator also urged Trump to temporarily keep making the cost-sharing payments so Congress could work on stabilizing the individual market for 2018.

Last week, Alexander voted for two out of the three repeal Obamacare bills that went up for a vote in the Senate.

In the House, a group of around 40 Republicans and Democrats known as the Problem Solvers Caucus endorsed an outline of ideas aimed at making urgent fixes to Obamacare.

While there is no legislative text yet, members in the caucus are moving quickly to seize the defeat of a Senate bill last Friday to garner broader support for their proposals -- and to force the GOP to ditch its quest to gut the current health care law once and for all.

The group's proposal includes mandatory funding for cost-sharing reduction payments; the creation of a stability fund; a repeal of the medical device tax; and to raise the threshold of the employer mandate so that companies with 500 employees or more, rather than 50, are required to provide workers with health insurance.

New Jersey Rep. Josh Gottheimer, the Democratic leader of the Problem Solvers Caucus, acknowledged that its initial proposal "does not attempt to do everything" -- but that it's a start.

"Instead of just focusing on killing the ACA, we're focused on how to fix it in a smart way," Gottheimer said on Monday. "When (Sen. John) McCain said on the floor it's time to work together like the country wants -- that had a big influence on our group. It was a shot in the arm."

The effort comes from Republican and Democratic lawmakers representing the most competitive districts across the country.

Rep. Martha McSally, R-Arizona, stressed the importance of the group's bipartisan approach as well as its goal to stabilize the individual market.

"The big headline here is: Democrats, Republicans trying to find a way forward. We're not going to solve everything, but we're trying to deal with the problem at hand, and that's exactly what we did," McSally, who voted in favor of the House health care bill, told CNN's Wolf Blitzer on Tuesday.

"So these are singles and doubles. It's not a home run for everybody, but we're here to govern," she added.

There are barriers ahead.

House Speaker Paul Ryan's spokeswoman made it clear that the bipartisan health care proposals were not moving anytime soon in the House.

"While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare," AshLee Strong said.

At the same time, others in their party are just as insistent that it's time for the party to leave a comprehensive health care overhaul behind and focus on smaller fixes that Democrats can get behind.

CNN's MJ Lee, Deidre Walsh and Noa Yadidi contributed to this report.

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Senator announces bipartisan health care hearing on Obamacare - CNN

Senator Chuck Schumer, the minority leader, and Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, organized the drafting of the letter, which lays out their priorities. Three Democratic senators who are up for re-election next year Joe Donnelly of Indiana, Joe Manchin III of West Virginia and Heidi Heitkamp of North Dakota did not sign the letter. They could be ripe targets for Republicans looking for Democrats to get on board with their tax plan.

Despite the outreach, bipartisanship will not come easy.

On taxes, Democrats tend to favor raising taxes on the rich to pay for cuts that would reduce tax rates for middle-income families. The parties are in closer agreement on changes to the corporate tax system, but Democrats argue that the cuts Republicans are proposing are far too deep.

In the conditions laid out in their letter, the Democrats insisted that changes to tax laws not increase the tax burden on the middle class and that the wealthiest 1 percent of taxpayers not see their tax bills shrink.

They also insisted that Republicans return to regular order and not try to push a tax bill through Congress using budget reconciliation rules that require only a simple majority in the Senate.

Finally, they want a rewrite of the tax code that does not add to the deficit and is not paid for with cuts to programs such as Medicare, Medicaid and Social Security.

For much of this year, Democrats have criticized the proposed tax policies of Republicans as giveaways to the rich. It was clear on Tuesday that Republicans are not eager to let Democrats meddle with their plans for a tax overhaul, even if they would welcome a few of their votes.

We will need to use reconciliation because we have been informed by the majority of the Democrats in a letter I just received today that most of the principles that would get the country growing again, theyre not interested in addressing, Mr. McConnell said, leaving the option for Democrats to support a Republican-led tax plan. So I dont think this is going to be 1986 when you had a bipartisan effort to scrub the code.

For its part, the Trump administration has been more vocal this week about the importance of attracting some Democrats to its tax plan. At a gathering on Monday of conservative activists sponsored by Americans for Prosperity, the political network of the Koch brothers, Marc Short, the White House legislative affairs director, made the case that Democrats need to be brought into the fold. The Republican majority in the Senate, he said, was too slim for party members to count only on one another.

We ask your help, actually, reaching out to Democrats as well, Mr. Short said, noting the ones who are coming up for re-election. If they hear from their constituents that they need tax reform, thats going to be a very strong selling point.

It remains unclear how enthusiastic Democrats really would be to make compromises with Republicans that would allow Mr. Trump to score a major legislative victory. In the battle over the Affordable Care Act, even potentially vulnerable Democratic senators from states that the president won last year held firm in their opposition to the repeal of the health care law.

Relegated to the minority, however, Democrats are trying to stake out the moral high ground. Mr. Schumer warned on Tuesday that Republicans could suffer the same fate on taxes that they did on health care if they continue to operate alone.

Theres real potential for bipartisan support on tax reform, but I think our Republican colleagues, dictated by the Koch brothers hard right wing of their party, is running away from it, Mr. Schumer said. They say tax reform is hard, and it is. But its a lot harder if Republicans try to do it all by themselves.

Cooperation between the parties will be necessary for Congress to deal with more immediately pressing legislative priorities. The debt ceiling must be lifted by the end of September, and Mr. Schumer, Mr. McConnell and Treasury Secretary Steven Mnuchin huddled on Tuesday morning to discuss the way forward.

Although Mr. Mnuchin and Democrats want a clean lift of the statutory borrowing limit, many Republicans are pushing for spending cuts or changes to budget process to be linked to any legislation.

No breakthrough was made on that issue.

A version of this article appears in print on August 2, 2017, on Page A11 of the New York edition with the headline: Democrats Make Overture To G.O.P. on Tax Overhaul.

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After Health Care Victory, Senate Democrats Seek Compromise on Tax Plan - New York Times

(Jeff Greenberg/UIG via Getty Images)

While many physicians in the United States report frustrations with their work, the public continues to hold health care providers in high regard.

Nearly nine-in-ten Americans (87%) who have seen a health care provider in the past year say their concerns or descriptions of symptoms were carefully listened to, and 84% say they felt their provider really cared about (their) health and well-being, according to a Pew Research Center survey conducted in spring 2016. Just 23% of patients said they felt rushed by their health care provider, and even fewer (15%) felt confused about instructions they got for treatment or at-home care.

These findings come despite a range of negative experiences reported by health care providers themselves. Professional burnout, for example, is reportedly on the rise among physicians due to long work hours and excessive administrative burdens. Pediatricians find it harder to do their jobs as they confront a growing number ofparents who are hesitant to vaccinate their children.

Adding to this pressure, the medical personnel at the Centers for Disease Control and Prevention have had to cope with some 750 potentially serious health threats in the past two years, even as the agency faces budget uncertainties in the year ahead.Medical professionals and other stakeholders also have beenshut outof congressional deliberations about repealing and replacing the Affordable Care Act. Meanwhile, their own patients have grown more critical about the countrys health care system: A2014 Pew Research Center surveyfound that just 26% of adults say U.S. health care is above average or the best in the world, down from 39% in 2009.

Health care providers are not the only medical professionals who receive favorable ratings from the public. Medical scientists are likewise held in high esteem.

For example, in a 2016 Pew Research Center survey, 84% of Americans expressed at least a fair amount of confidence in medical scientists to act in the best interests of the public. And a 2013 survey revealed that 66% of Americans believe doctors contribute a lot to the well-being of society a higher rating than for the clergy, journalists and business executives.

Moreover, although pediatricians are confronting an increasing number of vaccine-hesitant parents, the majority of the U.S. public still wants them engaged in the issue. Nearly three-quarters of U.S. adults (73%) believe that medical scientists should have a major role in policy decisions related to childhood vaccines.

Topics: Work and Employment, Health Care, Health, Science and Innovation

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Most patients in US have high praise for their health care providers - Pew Research Center

The Latest on the Republican effort to repeal and replace the Obama health law (all times EDT):

8:30 p.m.

A federal appeals court in Washington has agreed to let a group of states get involved in a lawsuit over government payments to insurers as part of the Obama administration's health care law. It's an intervention House Republicans had opposed.

House Republicans trying to thwart the Affordable Care Act sued the administration in federal court in 2014, arguing the law lacked specific language appropriating the "cost-sharing" subsidies. A district court judge agreed with House Republicans but the case was appealed to the U.S. Court of Appeals for the District of Columbia Circuit.

On Tuesday, the court allowed a group of state attorneys general to join in the case, in defense of the subsidies. In an order, the court says the states have "demonstrated the appropriateness of their intervention."

7 p.m.

There are signs of a modest bipartisan effort to buttress health insurance markets, four days after the GOP effort to uproot and reshape the Obama health care law crumpled in the Senate.

The Republican chairman of the Senate health committee, Tennessee's Lamar Alexander, says he'll seek bipartisan legislation extending for one year federal payments to insurers that help millions of low- and moderate-income Americans afford coverage.

President Donald Trump has threatened to halt those subsidies in hopes of forcing Democrats to make concessions. Top Senate Democrat Chuck Schumer of New York says that's "not what an adult does."

3:05 p.m.

Senate Majority Leader Mitch McConnell is answering President Donald Trump's call for a change in Senate rules with a dose of political reality.

The Republican leader told reporters on Tuesday that the reason for the collapse of health care legislation was not Democrats in opposition, but rather, "we didn't have 50 Republicans."

Over the weekend, Trump tweeted that Republicans should change the rules on legislation and reduce the 60-vote threshold to eliminate possible filibusters. His tweets came after the failure of health care legislation on a razor-thin margin of 51-49 on Friday.

McConnell said there are not enough votes to change the rules in the Senate. He said, "The votes are simply not there."

2:55 p.m.

The chairman of the Senate health committee says he wants his panel to approve a one-year extension of federal payments to insurers so they can curb out-of-pocket health care costs for millions of Americans.

Tennessee Republican Sen. Lamar Alexander says he wants his committee to pass a bipartisan bill doing that by mid-September. He says he's asked President Donald Trump to continue the payments in August and September to give his panel time to do its work.

Trump has called those payments bailouts for insurers. He's threatened to halt them to force Democrats to negotiate with him over repealing and replacing the Obama health care law.

Democrats, the insurance industry and some Republicans say halting those subsidies would roil insurance markets and boost premiums for many consumers.

12:40 p.m.

The No. 2 Senate Republican leader seemed to suggest that the two parties should try working together on health care.

Sen. John Cornyn of Texas did not specify what issues the two sides could address together. But his comments followed last week's crumpling of the Senate Republican effort to repeal and replace President Barack Obama's health care law.

In remarks on the Senate floor Tuesday, Cornyn cited "fragile majorities" in the Senate and said "we are forced to work together to try to solve these problems." He added that he believes bipartisan solutions "tend to be more durable."

Along those lines, Senate GOP health committee chairman Lamar Alexander of Tennessee discussed health care Tuesday at a private meeting with the panel's top Democrat, Patty Murray of Washington.

12 p.m.

The Senate's top Democrat says President Donald Trump's threats to block federal payments to insurers are "not frankly what an adult does" and would boost consumers' premiums.

Senate Minority Leader Chuck Schumer made the comments as Washington waits to see if Trump will halt the expenditures.

President Barack Obama's law requires insurers to lower out-of-pocket costs for millions of lower- and middle-income consumers. A court has ruled that Congress hasn't properly authorized the money. Trump has continued the payments until now.

Trump and Republicans call the expenditures bailouts for insurers.

The insurance industry notes they're legally required to reduce many customers' costs. It says blocking the federal payments would cause them to boost premiums by around 20 percent.

Schumer says Trump would be to blame if that happens.

3:30 a.m.

Top Senate Republicans think it's time to leave their derailed drive to scrap the Obama health care law behind them.

And they're tired of the White House prodding them to keep voting on it until they succeed.

Several GOP leaders say that at least for now, they see no clear route to the 50 votes they'd need to get something anything recasting President Barack Obama's health care statute through the Senate.

Their drive crashed last week. And their mood didn't improve after a weekend of tweets by President Donald Trump saying they "look like fools" and White House budget chief Mick Mulvaney using TV appearances to say they should continue voting.

No. 2 Senate Republican John Cornyn of Texas says Mulvaney should "let us do our jobs."

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The Latest: States get involved in health care court case - ABC News

Presidential candidate Mirhossein Mousavi (R) and his his wife Zahra Rahnavard cast their ballots during the Iranian presidential election in southern Tehran June 12, 2009.

The former candidates, Mehdi Karroubi and Mir Hossein Mousavi, and Zahra Rahnavard, an author and activist who is Mousavis wife, have been under house arrest in Tehran since February 2011. Iranian authorities should immediately provide them with unrestricted access to adequate health care.

Iranian officials have deprived Mousavi, Karroubi, and Rahnavard of their most basic rights for more than six years, all without a judicial order or even the pretense of due process, said Sarah Leah Whitson, Middle East director at Human Rights Watch. Irans authorities should stop denying Mousavi and Karroubi the care they need, grant immediate access to a specialist medical facility, and end their house arrest.

On July 24, 2017, Mohammad Taghi Karroubi, Karroubis son, posted on Twitter that his father had been transferred to a hospital in Tehran after suffering an abnormally low heart rate. On July 28, Mohammad Taghi Karroubi confirmed in correspondence with Human Rights Watch that Intelligence Ministry officials had ordered Karroubis transfer back to his house the day before, against Karroubis doctors advice.

On July 28, Karroubis family wrote an open letter published in several Persian-language media outlets stating that Karroubi had suffered from a serious heart issue the day after he was moved back to his house. On July 30, Hossein Karroubi, another of Karroubis four sons, reported that authorities transferred his father back to a hospital in Tehran, where he is being treated.

Mohammad Taghi Karroubi told BBC Persian that the authorities treatment over the last several years has instilled fear among his family that the Ministry of Intelligence has appointed someone to the case who sees ending these detainees lives as his duty. The family has said they hold President Hassan Rouhani responsible for Karroubis wellbeing.

On July 26, the Kalameh, a pro-reform news website, reported that according to Mousavis daughters, Zahra and Narges, the former presidential candidate and prime minister is suffering from high blood pressure, dizziness, and chronic kidney problems. On July 27 and 28, Zahra and Narges Mousavi posted on their Twitter accounts that they have not been able to get any information on their fathers medical condition since their visit with him on July 25.

Several members of parliament, including Mahdmoudi Sadegh and Elias Hazari from Tehran, reported that they have tried to visit Karroubi in the hospital but that authorities have denied them permission.

Officials placed the two former presidential candidates and their wives, Zahra Rahnavard and Fatemeh Karroubi, under house arrest on February 14, 2011, in response to the opposition figures call for demonstrations in support of popular uprisings across the Middle East. While the authorities have released Fatemeh Karroubi, the other three remain detained. During six-and-a-half years of detention, officials have regularly deprived Mousavi and Karroubi from receiving the regular check-ups doctors had recommended for serious medical conditions.

Iranian officials, including Irans judiciary, have failed to provide any legal justification for the opposition figures continuing arbitrary detention. President Rouhani promised during his 2013 presidential campaign to lift the former candidates house arrest, but has not, and there is little available information about his efforts, if any, to free them.

Ali Motahari, a parliament member from Tehran who has repeatedly protested the house arrest in his speeches, said several times that the Supreme Leader, Ayatollah Ali Khamenei, is in favor of continuing the house arrest.

In August 2012, the United Nations Working Group on Arbitrary Detention, a body of five independent experts acting under the UN Human Rights Council, issued an opinion that the detentions are arbitrary (and thus prohibited), and recommended that the Iranian government release the detainees immediately and compensate them for their wrongful imprisonment.

Human Rights Watch has repeatedly called on Irans authorities, including Rouhani, to push for the release of the opposition figures and give them adequate access to medical care.

As President Rouhani begins his second term on August 5, he should demonstrate that he takes his promises to his fellow citizens for more rights and legal protections seriously, Whitson said. A good place to start would be to free Mehdi Karroubi, Mir Hossein, and Zahra Rahnavard from house arrest and to see that they get the health care they need.

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Iran: Opposition Figures Denied Health Care - Human Rights Watch

Senate Homeland Security and Governmental Affairs Committee Chairman Ron Johnson speaks on Capitol Hill in 2016. Shawn Thew / EPA file

"Its something the president should do," Robert Moffit, a senior fellow at the Heritage Foundation who has tracked the issue, told NBC News. "Beyond the separation of powers question...they shouldnt be getting special advantages at the expense of the taxpayer."

Since members make too much money to qualify for Obamacare subsidies, theyd have to pay the full cost of the premiums, which would be a major increase.

Congress could pass legislation to grant themselves their current benefits, but theyd face taunts from Trump and other critics accusing them of voting to enrich themselves. Theres a reason they havent resolved the issue up to this point.

But its possible the move could come off as unnecessarily cruel. After all, it wouldnt just be elected officials with six-figure incomes who would be affected.

"While people are maybe not sympathetic to members of Congress, more would be sympathetic to the staff and it would be a far, far bigger deal for the staff," Len Nichols, Director of the Center for Health Policy Research and Ethics at George Mason University, told NBC news.

It could also backfire if Congressional Republicans resent the move and become less cooperative. Senators, in particular, have proven increasingly willing to buck the president and he cant afford to lose more support and follow through on his agenda.

Trump has said Congress should not vote on any other legislation until lawmakers pass health care.

This one is harder to pull off. The legislative branch sets its own rules, follows its own schedule, and its members can get prickly if they believe the executive branch is muscling in on its territory.

"He and his team have to understand that Congress is a co-equal branch of government," said Jim Manley, a former top aide to Senator Harry Reid. "They dont respond well to threats from any president of either party."

Trump couldn't stop Congress from voting on legislation. If he really wanted to, though, he could veto all bills until members caved.

He would be picking an especially dangerous time to issue a blanket veto threat. Over the next few weeks, Congress needs to pass legislation to fund the government or there will be a shutdown. It also needs to raise the debt limit or it risks setting off a financial crisis. Neither scenario would be a good look for the party with unified control of government.

Trump also cant keep up a blockade indefinitely without threatening the next item on his agenda: Taxes. The House and Senate are using this years budget reconciliation process to try and pass health care. But the fiscal year ends September 30, and once Congress passes a new budget, the legislation will expire. The new reconciliation bill is supposed to be the vehicle for tax reform, which promises to be a difficult fight as well.

For their part, members of Congress dont sound too intimidated so far.

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Health Care: President Trump's Triple Threat - NBCNews.com

Schumer said he was all for the concept of a bill advanced by Rep. Thomas Reed that would mandate roughly $7 billion in federal cost-sharing subsidies. | Getty

ALBANY, N.Y. Sen. Chuck Schumer said Monday he has heard from 10 of his Republican colleagues in response to his call for a bipartisan approach to health care legislation.

No one thought Obamacare was perfect it needs a lot of improvements, Schumer (D-N.Y.) said after an unrelated news conference at Albany Medical Center. Were willing to work in a bipartisan way to do it. What we objected to was just pulling the rug out from it and taking away the good things that it did: Medicaid coverage for people with parents in nursing homes, for opioid treatment, for kids with disabilities, pre-existing conditions.

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The so-called skinny repeal bill, which would have removed some of Obamacares least popular provisions, failed early Friday in a 51-49 vote. According to The New York Times, Schumer told Sen. John McCain, a Republican from Arizona, that he was committed to a legislative effort in regular order to improve the health care system. McCain cast an unexpected and decisive "no" vote.

Schumer said he was all for the concept of a bill advanced by Rep. Thomas Reed (R-N.Y.) that would mandate roughly $7 billion in federal cost-sharing subsidies that reduce out-of-pocket costs for poor consumers. Schumer, the Senate's minority leader, said he wasnt sure whether legislation would emerge in a big bill or take several steps.

Well, well have to wait and see. The first step is to try and stabilize the system that means the cost-sharing which would reduce premiums and increase coverage. Both Democrats and Republicans Sens. [Tim] Kaine and [Tom] Carper and [Susan] Collins have talked about re-insurance plans, so the most severe cases go into a separate insurance fund, and that reduces costs, Schumer said. Those are immediate things, but in the longer term, Republicans have some ideas, we have some ideas, and well sit down and try to hash them out as Congress should do.

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Schumer: Republicans have been in touch about health care - Politico - Politico

Top Senate Republicans think it's time to leave their derailed drive to scrap the Obama health care law behind them. And they're tired of the White House prodding them to keep voting until they succeed.

Several GOP leaders said Monday that at least for now, they saw no clear route to the 50 votes they'd need to get something anything recasting President Barack Obama's health care statute through the Senate. Their drive crashed with three disastrous Senate votes last week, and their mood didn't improve after a weekend of tweets by President Donald Trump saying they "look like fools" and White House budget chief Mick Mulvaney using TV appearances to say they should continue voting.

Mulvaney has "got a big job, he ought to do that job and let us do our jobs," No. 2 Senate GOP John Cornyn of Texas said. He also said of the former House member, "I don't think he's got much experience in the Senate, as I recall."

"It's time to move onto something else, come back to health care when we've had more time to get beyond the moment we're in," said Sen. Roy Blunt of Missouri, another member of the GOP leadership. Asked about threats by conservative groups to attack GOP lawmakers who abandon the fight, Blunt said, "Lots of threats."

While the leaders stopped short of saying they were surrendering on an issue that's guided the party for seven years, their remarks underscored that Republicans have hit a wall when it comes to resolving internal battles over what their stance should be.

Yet even the White House's focus turned Monday to a new horizon: revamping the tax code.

White House legislative director Marc Short set an October goal for House passage of a tax overhaul that the Senate could approve the following month. Plans envision Trump barnstorming the country to rally support for the tax drive, buttressed by conservative activists and business groups heaping pressure on Congress to act.

On health care last week, Republican defections led to the Senate decisively rejecting one proposal to simply erase much of Obama's statute. A second amendment was defeated that would have scrapped it and substituted relaxed coverage rules for insurers, less generous tax subsidies for consumers and Medicaid cuts.

Finally, a bare-bones plan by Senate Majority Leader Mitch McConnell, R-Ky., rolling back a few pieces of Obama's law failed in a nail-biting 51-49 roll call. Three GOP senators joined all Democrats in rejecting McConnell's proposal, capped by a thumbs down by Sen. John McCain, R-Ariz.

Republican, Democratic and even bipartisan plans for reshaping parts of the Obama health care law are proliferating in Congress. They have iffy prospects at best.

Republicans can push something through the Senate with 50 votes because Vice President Mike Pence can cast a tie-breaking vote. But rather than resuming its health care debate, the Senate on Monday began considering a judicial nomination.

In the House, 43 Democratic and Republican moderates proposed a plan that includes continuing federal payments that help insurers contain expenses for lower-earning customers. It would also limit Obama's requirement that employers offer coverage to workers to companies with at least 500 workers, not just 50.

But movements by House centrists seldom bear fruit in the House, where the rules give the majority party ironclad control, and Speaker Paul Ryan, R-Wis., offered little encouragement.

"While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare," said Ryan spokeswoman AshLee Strong.

Trump has threatened anew in recent days to cut off the payments to insurers, which total $7 billion this year and are helping trim out-of-pocket costs for 7 million people.

Those payments to insurers have some bipartisan support because many experts say failing to continue them or even the threat of doing so is prompting insurers to raise prices and abandon some markets.

Obama's statute requires that insurers reduce those costs for low-earning customers. Kristine Grow, spokeswoman for the insurance industry group America's Health Insurance Plans, said Monday that halting the federal payments would boost premiums for people buying individual policies by 20 percent.

"I'm hopeful the administration, president will keep making them," said No. 3 Senate Republican leader John Thune of South Dakota. "And if he doesn't, then I guess we'll have to figure out from a congressional standpoint what we do."

Senate health committee chairman Lamar Alexander, R-Tenn., said his panel will hold hearings in coming weeks about how to steady roiled health insurance markets.

Hoping to find some way forward, health secretary Tom Price met with governors and Louisiana Republican Sen. Bill Cassidy. Among those attending was Republican Arizona Gov. Doug Ducey, who's been trying to defend his state's expansion of Medicaid, the health insurance program for poor people, against proposed GOP cuts.

Cassidy and Sens. Lindsey Graham, R-S.C., and Dean Heller, R-Nev., have proposed converting the $110 billion they estimate Obama's law spends yearly for health insurance into broad grants to states.

Associated Press writer Bob Christie in Phoenix, Arizona, contributed to this report.

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Senate GOP sees no path on health care, despite Trump prods - ABC News

Billionaire Mark Cuban has proposed scrapping insurance companies from the U.S. health-care system and instead using federal funds to boost medical staff numbers and make care more widely accessible.

In a series of tweets late Sunday, which appeared to advocate parts of the U.K.'s National Health Service (NHS), the tech titan and philanthropist weighed in on President Donald Trump's beleaguered health-care reform agenda, saying that insurance companies were draining U.S. funds with "artificial" and inflated costs.

"Dear politicians. Let me ask a question. If every person in our country had health insurance, would we be any healthier?" Cuban posited in the first in a series of tweets.

He then went on to criticize the U.S. system, which relies on individual health insurance policies, and claimed that eradicating the role of private insurers could reduce costs by 50 percent or more. This would bring the U.S. system closer in line with the U.K.'s NHS or Australia's Medicare, which are largely state-funded.

"No chance a system where you give an ins (insurance) comp $, then beg them to spend it among limited options is the way to optimize our healthcare," Cuban insisted.

Cuban proposed that if he were in the president's shoes he would repeal Barack Obama-era insurance subsidies and instead use the funds to double medical school capacity and offer needs-based grants to increase staff numbers.

"Single Payer is not the solution," Cuban stated in his final tweet, saying that the current system feeds directly into the hands of inadequate insurance companies. Single-payer health insurance refers to a system in which a single public body organizes health-care financing, but the delivery of care remains mostly in private hands.

The U.K.'s NHS system, though widely commended, is not without its troubles, however, as it struggles to manage growing patient numbers with increasingly tight funding and falling staff numbers.

Follow CNBC International on Twitter and Facebook.

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Mark Cuban sees a model for fixing health care and he didn't find it in the United States - CNBC

1. President Trump President Donald Trump dictated a misleading statement for his son in response to a news report that Donald Trump Jr. hadmet with a Russian lawyer during the campaign,the Washington Post reported. Team Trump's original plan was to issue a truthful statement, but then Trump personally decided to have the statement say Trump Jr. had met with the lawyer, Natalia Veselnitskaya, to discuss the adoption of Russian children by Americans. White House press secretary Sarah Huckabee Sanders referred CNN to Trump's outside counsel for a response to the story. Attorney Jay Sekulow issued a statement, saying, "Apart from being of no consequence, the characterizations are misinformed, inaccurate and not pertinent." 2. White House The general is in -- and the Mooch is out. And so goes another zany day at the White House. Trump's new chief of staff, John Kelly, was sworn inMonday, and the retired US Marine Corps general made it clear bytossing out Communications Director Anthony Scaramuccithat he wants to run a tighter ship. Scaramucci blazed quite a trail during his 10 days on the job, engineering the ouster of former Chief of Staff Reince Priebus (whom he accused of leaking) and crudely taking on presidential advisor Steve Bannon in one of the most colorful interviews in White House history. Scaramucci leaves behind a small treasure trove of memorable lines (late night talk show hosts are devastated), but in the end, sources say, his profile was just getting too big for the Trump White House. CNN's Chris Cillizza says the way Kelly, who'd been Trump's secretary of homeland security,handled Scaramucci may mean he's more of a boss than we thought. The way the White House is now being restructured, everyone on staff will report to him, including Ivanka and Jared. 3. Venezuela A pair of leading opposition leaders have been rounded up in Venezuela. Leopoldo Lopez and Antonio Ledezma were taken from their homes, their families said on Twitter. Their removal follows Sunday's controversial election establishing a new legislative body made up entirely of President Nicolas Maduro's supporters. This new national assembly will have the power to rewrite the country's constitution. The election has been denounced worldwide, and the US Treasury Department hit Maduro with sanctions after the vote. 4. Climate change Two studies say the Earth is going to warm 2 degrees Celsius by the end of the century. If the studies' grim predictions are correct, we might not even recognize this planet by 2100. Rising sea levels, super droughts, mass extinctions, extreme weather and the melting of the Arctic would mean life as we know it would change dramatically. Researchers say the best way to avoid all of that is for governments to enact changes in public policy that lead to a serious reduction in greenhouse gas emissions. 5. Health care The GOP effort to kill Obamacare may be over, but there's still a desire to make improvements to our health care system. So lawmakers are looking at possible fixes to the health care law, and this time it's a bipartisan effort. About 40 House Republicans and Democrats -- who go by the very catchy name of the Problem Solvers Caucus -- have endorsed an outline of ideas aimed at making urgent fixes to Obamacare. Their ideas include mandatory funding for cost-sharing reduction payments, creating a stability fund, repealing the medical device tax and tweaking the employer mandate. None of this has been put into any bills yet, but it's a start. BREAKFAST BROWSE

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5 things for Tuesday, August 1: Trump, Scaramucci, Venezuela, climate, health care - CNN International

President Harry Truman, who tried to enact a national health care system, gives his 1949 inaugural address. Corbis via Getty Images

For years afterwards, the Democratic partys platform called for a "federally-financed and federally-administered...system of universal National Health Insurance," as the

But Democrats were thwarted by the large price tags, the policy complications, and the pernicious association with socialism, leading them to eventually conclude that only more modest reforms like Obamacare were possible. And support for the approach in the Senate among Democrats lags behind the House.

"There's a bit of a false dawn with single-payer that this is going to be popular even once details are known," said Jim Kessler, the senior vice president for policy at the centrist Democratic think tank Third Way.

"There's going to be tons of disruption," Kessler continued. "Maybe it's worth it, maybe it isn't. But before people sign on in a rush to it, we have to have a serious analysis of what it's going to mean for people and all the institutions involved."

"The ACAs changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system," the Urban Institute noted in its

Indeed, the same polls that supporters cite to demonstrate the appeal of single payer also show that voters are responsive to negative arguments about costs and government control.

"While a slim majority favors the idea of a national health plan at the outset," wrote Liz Hamel and her colleagues at the nonpartisan Kaiser Family Foundation of their

Many Democrats worry their party is hurtling toward a policy commitment they dont fully understand when they should be focused on defending existing gains.

"We're one bad election away from the Affordable Care Act being repealed," said Kessler, referring to possible GOP gains in next year's midterm elections.

Its possible single-payer could give way to less sweeping changes if Democrats retake power.

Democrats have revived their push to create a public option a government-run alternative that would be sold alongside private insurance on the ACA exchanges. The idea, which liberals unsuccessfully fought to include in the ACA, would be far less expensive than full single-payer since most Americans would still get coverage from traditional insurance. Another proposal is to allow older people to voluntarily buy into Medicare.

"Every major breakthrough from Civil Rights to Social Security to what happened on the right under Ronald Reagan were driven by significant mobilization behind an idea that was much more extreme than what actually happened," Yale political scientist Jacob Hacker, who popularized the public option, told NBC News.

A few short years ago, Hacker's idea for a public option was killed by conservative Democrats involved in crafting Obamacare who saw it as too radical. Now, Hacker gets attacked by single-payer activists as a sellout for still favoring the idea.

Some politicians are trying to temper expectations. Sen. Ron Wyden, D-Ore., championed the Obamacare provision that allows states to enact their own single-payer plans, but noted that places like California and Vermont have had trouble finding a way to "get from here to there."

Instead, he hinted at a more gradual path to single-payer by passing legislation that would encourage more workers to buy insurance on an individual basis rather than through their employer. If you gave them access to a public option, he argues, it could grow to eventually become the dominant plan.

"You really strengthen the exchanges and probably provide another path for people actually advocating single-payer...to make the transition work," he said.

As for Conyers, who turned 88 a few months ago, hes willing to wait.

"I've said before, this is a civil rights issue and it'll take a movement on the scale of the one Dr. King led," he said. I'm glad we're here it shows we're making progress but my goal isn't a certain number of co-sponsors, it's passing a bill that makes every American Medicare-eligible."

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Government-Run Health Care: Democrats' New Litmus Test - NBCNews.com

With Republican efforts to dismantle Obamacare in disarray, hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets.

In response, Trump on Friday again suggested his administration would let the Obamacare program "implode." He has weakened enforcement of the law's requirement for individuals to buy insurance, threatened to cut off funding and sought to change plan benefits through regulations.

Meanwhile, some congressional Republicans were still trying to find a way forward on health care.

Senator Lindsey Graham said in a statement issued late on Friday that he and two other Republican senators, Dean Heller and Bill Cassidy, had met with Trump after the defeat to discuss Graham's proposal to take tax money raised by Obamacare and send it back to the states in the form of health-care block grants.

Graham said the move would end Democrats' drive for a national single-payer health-care system by putting states in charge.

"President Trump was optimistic about the Graham-Cassidy-Heller proposal," Graham added. "I will continue to work with President Trump and his team to move the idea forward."

However, a majority of Americans are ready to move on from health care at this point. According to a Reuters/Ipsos poll released on Saturday, 64 percent of 1,136 people surveyed on Friday and Saturday said they wanted to keep Obamacare, either "entirely as is" or after fixing "problem areas."

When asked what they think Congress should do next, most picked other priorities such as tax reform, foreign relations and infrastructure. Only 29 percent said they wanted Republicans in Congress to "continue working on a new health-care bill."

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Trump threatens to end insurance payments if no health-care bill - CNBC

"The ball is really in our court right now," Collins said. "Our job is not done."

The Maine Republican called for a return to the normal legislative process by addressing problems and crafting bills on the committee level before bringing them to a vote before the full chamber.

"We need to go back to committee," she said.

Collins also emphasized her opposition to more comprehensive legislation and instead advocated the Senate "produce a series of bills" aimed at addressing pressing issues in health care. She said the first issue the Senate should focus on would be to stabilize the insurance markets.

"I certainly hope the administration does not do anything in the meantime to hasten that collapse," Collins said.

Sen. Jeff Flake, a Republican senator from Arizona, said he was disappointed the proposal had failed, but echoed Collins' call for a return to the committee process in an interview on CBS's "Face the Nation."

"That'll be certainly good for us and good for the country," Flake said.

In a series of tweets over the weekend, President Donald Trump has called on the Senate to change its rules and move health care legislation through without the threat of a filibuster, meaning if a simple majority of Republicans could agree on a proposal, it could pass.

Flake expressed his opposition to Trump's call for the Senate to change its rules and said a degree of bipartisanship was needed in the chamber.

"Even if you change the rules of the Senate, which we should not do, there are limits to what one party can do," Flake said.

When Senate Majority Leader Mitch McConnell moved to eliminate the filibuster for Supreme Court candidates in April, he reiterated his opposition to eliminating the filibuster for legislation, and despite Trump's repeated tweets pushing for an altering of the rules, there appears to be little appetite in the Senate for the change.

Collins contended that the cost-sharing reduction payments to insurance companies to cut deductibles and co-pays for lower-income people were not "bailouts," and that although the payments went to insurance companies, they have helped many who need it most to gain access to health care.

"It really would be detrimental to some of the most vulnerable citizens if those payments were cut off," Collins said.

On the second half of Trump's tweet, targeting members of Congress, White House budget director Mick Mulvaney said in a separate interview on the Sunday program that Trump was eying ending employer contributions for health insurance for members of Congress.

Lawmakers get insurance under the exchange system established under Obamacare, but as Mulvaney explained, the Office of Personnel Management during the Obama administration decided members would receive the employer contribution from the federal government.

"That's the rule that the President was talking about in his tweet yesterday," Mulvaney said.

Mulvaney further clarified that Trump's tweet demanding a vote on health care before any other legislation was the White House's official position.

"In the White House's view, they can't move on in the Senate," Mulvaney said.

He argued Republicans in Congress need to pass a bill targeting Obamacare as a matter of practicality and politics.

"You promised folks you'd do this for seven years," Mulvaney said. "You cannot go back on that."

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Susan Collins: 'Go back to committee' on health care - CNN

The Problem Solvers caucus, led by Tom Reed (above) and Josh Gottheimer, is fronting the effort to stabilize the ACA markets. | AP Photo

A coalition of roughly 40 House Republicans and Democrats plan to unveil a slate of Obamacare fixes Monday they hope will gain traction after the Senates effort to repeal the law imploded.

The Problem Solvers caucus, led by Tom Reed (R-N.Y.) and Josh Gottheimer (D-N.J.), is fronting the effort to stabilize the ACA markets, according to multiple sources. But other centrist members, including Rep. Kurt Schrader (D-Ore.), and several other lawmakers from the New Democrat Coalition and the GOPs moderate Tuesday Group are also involved.

Story Continued Below

Their plan focuses on immediately stabilizing the insurance market and then pushing for Obamacare changes that have received bipartisan backing in the past.

The most significant proposal is funding for Obamacares cost-sharing subsidies. Insurers rely on these payments estimated to be $7 billion this year to reduce out-of-pocket costs for their poorest Obamacare customers.

President Donald Trump has repeatedly threatened to cut off the payments, deriding them as a bailout for insurance companies. White House counselor Kelly Conway said on Sunday that Trump will decide this week whether to scrap the subsidies which could make the markets implode.

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The bipartisan working group also wants to change Obamacare's employer mandate so that it applies only to companies with more than 500 workers. Currently companies with at least 50 workers can be hit with a tax penalty if they don't provide coverage to their workers.

The group also wants to create a federal stability fund dollar amount unspecified -- that states can tap to reduce premiums and other costs for people with extremely expensive medical needs. Both the Senate and House repeal packages contained similar pots of money.

The bipartisan proposal also calls for scrapping Obamacares medical-device tax, an idea that has received bipartisan support in the past.

Finally, the working group is seeking greater flexibility for state innovation. Obamacare already allows state to seek waivers from coverage rules, but the lawmakers want additional guidance on how states can take advantage of them.

The roll out of their stabilization agenda follows months of private meetings between various members involved in the Houses centrist caucuses about ways to stabilize Obamacare if the GOPs repeal effort sputtered.

The push was intensified after the Senates repeal collapsed in the wee hours of Friday morning when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and John McCain (R-Ariz.) joined with all Senate Democrats to reject the GOPs skinny repeal."

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Centrist lawmakers plot bipartisan health care stabilization bill - Politico

WASHINGTON President Donald Trump is looking for a fresh start with a new White House chief of staff. But he's still clinging to an old battle, refusing to give up on health care.

Weighed down by a stalled legislative agenda, a cabal of infighting West Wing aides and a stack of investigations, Trump is hoping that retired Gen. John Kelly can bring some order as his next chief of staff. Trump tapped Kelly, his Homeland Security secretary, last week to take over for Reince Priebus, who he ultimately viewed as ineffective.

Starting Monday, Kelly must try to exert control over a chaotic White House, but his ability to do so will depend on how much authority he is granted and whether Trump's dueling aides will put aside their rivalries to work together. Also unclear is whether a new chief of staff will influence the president's social media histrionics or his struggle to keep his focus on policy.

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Trump has new chief of staff, old health care fight - Minneapolis Star Tribune

As Republican members of Congress have tried and failed to follow through with their campaign promise of repealing Obamacare, President Donald Trump has threatened to eliminate some health benefits for members of Congress and their staffs.

If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon! Trump tweeted Saturday.

Congress members and their staffs were moved from the the typical federal employee health care benefits program to the Obamacare exchanges as part of the law. The Office of Personnel Management determined in 2013 that the federal government could help pay premiums on the exchanges for congressional employees, as Roll Call reported at the time.

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U.S. President Donald Trump concludes his remarks about his proposed U.S. government effort against the street gang Mara Salvatrucha, or MS-13, to a gathering of federal, state and local law enforcement officials in Brentwood, New York, U.S. July 28, 2017. Trump threatened health care benefits for congress on Saturday. REUTERS/Jonathan Ernst

Mick Mulvaney, the director of the Office of Management and Budget, told CNNs Jake Tapper Sundayon State of the Unionthat he had spoken at length about that exact issue with President Trump Saturday.

What hes saying is, 'Look, if Obamacare is hurting people, and it is, then why shouldnt it hurt insurance companies, and, more importantly, perhaps, for this discussion, members of Congress? Mulvaney said. There is a certain benefit that members of Congress getas part of an OPM decision from a couple of years ago, and I think the president is simply looking at this and going, Is this fair?

Health benefits for congressional staffers had been subsidized by the federal government before passage of the Affordable Care Act, and continued to be so as the OPMs decision came before health plans forcongressional staffers moved over to the Obamacare exchanges.

Although the original amendment putting members of Congress and their staffs onto the exchanges explicitly said employer reimbursements would continue, that language did not make it into the final Obamacare bill. The OPMs ruling came as partisan divides over the law made passage of a legislative fixa daunting proposition.

Since the regulation came from the OPM, and not an act of Congress, the administration technically could revoke these benefits. But the memo would have toofficially be rescinded by the director of the OPM.

The office currently has an acting director, Kathleen McGettigan, who is a holdover from the Obama administration. McGettigan is a career OPM employeewho has worked for the OPM for 25 years.

Trump has nominated George Nesterczuk, who worked in the OPM during the Ronald Reagan and George W. Bush presidencies, to lead the office. Nesterczuk, also a member of the Trump transition team, has not yet been confirmed by the Senate.

Currently OPM is headed by Obama appointee. She will have to revoke the memo. Or get fired. Josh Blackman, an adjunct scholar at the libertarian Cato Institute, said on Twitter. POTUS may need to install someone as head of OPM for purpose of rescinding memo.

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Trump Threatened to Take Away Health Care From Members of Congress. Can He Do That? - Newsweek