We have watched one Republican health-care plan after another the original House plan, the Meadows-MacArthur amended plan, the original Senate plan and now the Cruz-amended plan. There are some constants:

As to the last:

The July Kaiser Health Tracking Poll finds that most Americans (61 percent) continue to hold unfavorable views of the plan to repeal and replace the Affordable Care Act (ACA), including over four in ten (44 percent) who say they have very unfavorable view. The share of the public with negative views of the law has increased slightly in the past month, from 55 percent to 61 percent. Views of the Republican plan to repeal and replace the ACA continue to vary widely by party and a large intensity gap remains, with Democrats being nearly three times as likely to hold a very unfavorable view as Republicans are to hold a very favorable view (71 percent versus 25 percent, respectively).

Nearly two-thirds of the public opposes (65 percent) major reductions in federal funding for Medicaid as part of a plan to repeal and replace the ACA, and most continue to oppose these reductions even after hearing arguments in support of them. About half of Republicans and those who approve of President Trump support major reductions in federal funding for Medicaid. . . .As seen in previous months, more of the public views the ACA favorably than the plan to replace the 2010 health care law (50 percent compared to 28 percent).

Voters are telling Congress and the White House what they want. The majority of the public (71 percent) would rather see Republicans in Congress work with Democrats to make improvements to the ACA but not repeal the law, compared to one-fourth (23 percent) who say they would rather Republicans continue working on their own plan to repeal and replace the ACA. Although a majority of self-identified Republicans do not want bipartisan health care, Trump supporters are divided with similar shares saying Republicans in Congress should continue working on their own plan (47 percent) as saying they want them to work with Democrats on improving the ACA (46 percent).

In short, the longer the GOP debates health care, the less appealing its plan becomes. In this regard, Senate Majority Leader Mitch McConnell (R-Ky.) had it initially right set a quick deadline and take a vote so the GOP can move on to other things. Leaving the plan out there does not help its chances. Alas, McConnell caved to right-wing and White House pressure and now will keep working on health care through mid-August. The danger here is threefold: More debate will intensify opposition; the GOP will be less prepared to shift gears to deal with issues like the budget and debt limit in September; and the rest of the GOPs legislative agenda will become less and less viable. On this one, McConnell should have stuck to his original game plan.

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Some consistency in all the GOP health-care plans - Washington Post

Senate Majority Leader Sen. Mitch McConnell, R-Ky., on his to his office on Thursday at the Capitol in Washington, D.C. Alex Wong/Getty Images hide caption

Senate Majority Leader Sen. Mitch McConnell, R-Ky., on his to his office on Thursday at the Capitol in Washington, D.C.

Updated 6:56 p.m. ET

Senate Republicans on Thursday released a revised version of the Better Care Reconciliation Act, their plan to replace the Affordable Care Act.

The new version comes after the Congressional Budget Office found that the original BCRA would in the next decade increase the uninsured population by 22 million over what it would otherwise be. Senate Majority Leader Mitch McConnell had hoped for a vote before July 4, but was forced to delay that because he couldn't garner the 50 votes he needed among the 52 GOP senators.

The question now is whether this version of the bill could pass the Senate. Shortly after its release, Maine Sen. Susan Collins and Kentucky Sen. Rand Paul both said they intend to vote against letting the bill go forward. With two no votes, Vice President Pence could provide the 51st vote needed for passage. But if three Republican senators defect, the bill cannot pass.

The new bill makes some big changes from the last BCRA draft, but it also leaves some major parts of the original Senate proposal intact it would still repeal the individual and employer mandates, it would still mean cuts to Medicaid spending, and it would still allow states to opt out of key parts of Obamacare.

In their summary of the bill, Senate Republicans laid out the major provisions. Here are some of those big changes that this new version of the bill would make to the original BCRA, and what they would mean:

Health savings accounts will be able to pay for premiums. Under IRS rules, people with high-deductible plans are eligible for health savings accounts (HSAs), accounts into which people can put money for health care expenses tax-free. Under this bill, people would for the first time be able to use that money for premiums. Americans' deposits in HSAs have ballooned over the last decade, according to HSA consulting firm Devenir. However, those accounts also tend to benefit higher-income people more than others, as Kaiser Health News' Michelle Andrews wrote in December for example, richer people are more likely to have the extra money to sock away for health expenses.

More money for the opioid epidemic. The Senate's initial bill offered $2 billion to address the opioid crisis for 2018. This version would offer about $45 billion over 10 years, which is what Republicans Ohio GOP Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito had requested at one point. However, some experts say that around $4.5 billion a year is nowhere near enough for combating America's massive opioid epidemic, as the New York Times reported in June.

Keeping some Obamacare taxes. The first BCRA version would have repealed an array of Affordable Care Act taxes, which would have overwhelmingly benefited higher-income Americans. This newer version of the bill keeps some in place, including the net investment income tax and a payroll tax that hit higher-income Americans.

Allowing insurers to offer non-Obamacare-qualified plans. This mirrors an idea that Texas Sen. Ted Cruz and Utah Sen. Mike Lee had proposed in recent weeks: The Senate's bill would allow an insurer to offer skimpier plans. As long as an insurer does offer a plan on the individual insurance exchanges that meets the demands of Obamacare's Title I (for example, covering certain areas like preventive care and protecting people with pre-existing conditions), that insurer will be allowed to offer additional plans off of the individual insurance exchanges that don't meet those criteria.

That idea had created worries of a two-tiered insurance system one in which older and sicker people would opt into the more comprehensive plans, while younger and healthier people would choose the cheaper plans that covered less, potentially causing a "death spiral" on the exchanges for those older and sicker people.

Extra stabilization money, in part for high-risk customers. The original version of the BCRA provided $112 billion that would have allowed states to stabilize their markets or help high-risk customers in a wide variety of ways. In this version, that is bumped up to $182 billion. One function of this money is to mitigate some of the two-tier issues created by new, nonqualified plans. If an insurer offers a plan that meets the Obamacare criteria, that insurer would be eligible for money to help high-risk customers.

This all means that the new version doesn't make major changes to one big part of the BCRA: Medicaid. Under the original Senate bill, the Obamacare Medicaid expansion would be rolled back, and Medicaid spending would be capped states would either be allotted a certain amount per capita, or they could get a block grant instead. It also caps Medicaid spending growth in the medium-to-long-term. This bill doesn't change any of that.

According to the CBO, the original BCRA would have cut Medicaid spending by $772 billion over 10 years, and would have resulted in 15 million fewer Medicaid enrollees by 2026 than under current law.

A new CBO score on the bill is expected Monday or Tuesday. By the end of next week, there is likely to be a key procedural vote. That would put things on track for a final vote the following week.

Were this bill to pass the Senate, it would then have to be reconciled with the House's attempt to repeal and replace Obamacare, known as the American Health Care Act.

Meanwhile, Republicans Bill Cassidy of Louisiana and Lindsey Graham of South Carolina released an alternative plan Thursday morning.

A summary of the bill is embedded below. You can read the full draft here, and see the previous Senate version here.

Washington Desk editor Arnie Seipel contributed to this report.

This report has been updated to reflect that the extra $70 billion for stabilization funding will be in part used for helping insurers defray the costs of high-risk individuals.

Continued here:

Senate Health Care Bill Revisions Released In Attempt To ...

Money doesn't always buy healthiness.

The U.S. spends more on health care than 10 other countries in a study by The Commonwealth Fund, but was found to have the worst health-care system.

Health-care spending accounts for 16.6 percent of the U.S. gross domestic product, 5 percentage points more than Switzerland, the next closest country. Yet in a measure of health-care system performance among 11 high-income nations, the U.S. ranked dead last.

The United Kingdom's health-care system was ranked the best, followed by Australia and the Netherlands. France placed second to last, and Canada placed third to last.

Of the countries studied, the U.S. is the only one that does not offer universal health insurance coverage. Each of the other 10 countries, though, uses a slightly different model.

The study's publication comes one day after the Senate Republicans released details of a new bill to repeal and replace the Affordable Care Act.

"We have not had time to digest the (Senate) bill, but in general, the proposals we've seen would actually reverse progress, especially on insurance coverage," said Eric Schneider, senior vice president of policy and research at The Commonwealth Fund.

The study identified four main problems plaguing the U.S. health-care system: a large number of uninsured patients, limited primary care, administrative burdens, and disparities in care between higher- and lower-income patients.

The House and Senate proposals do not address problems the Affordable Care Act, also known as Obamacare, does, specifically the availability of primary care, nor do they simplify the insurance system, said David Blumenthal, president of The Commonwealth Fund. The disparity of access would "likely not get better" because the proposals include cuts to Medicaid.

One part of the health-care debate has been whether to create high-risk insurance pools. The Netherlands, the second-highest ranked country in the study, does the opposite and makes sure the risk is balanced, Schneider said.

Countries that rely on minimal or no cost sharing health systems scored better than the U.S., said Blumenthal. Evidence suggests that cost sharing does not improve a country's health-care performance, he said.

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US spends big on health care but doesn't get much back, study says - CNBC

Arrests were made nationwide over the course of the last week, the Justice Department said, as part of a Medicare fraud task force established in 2007. The more than 400 prosecutions, a record for the task force, covered years of activity and were spread across more than 20 states.

In one case, prosecutors said, the owner and operator of a drug-treatment center in Delray Beach, Fla., recruited addicts to aid him in his schemes, attending Alcoholics Anonymous meetings and visiting crack motels to persuade people to move to South Florida to help him. He offered kickbacks in the form of gift cards, plane tickets, trips to casinos and strip clubs as well as drugs.

The owner, Eric Snyder, and an associate were charged with fraudulently billing insurance companies for more than $50 million for false treatment and urine tests over nearly five years, the authorities said.

Bruce Alan Zimet, a lawyer for Mr. Snyder, said that his client had been cooperating with investigators since 2014. We anticipate having additional communications with the government, Mr. Zimet said, and were hopeful theyll be listening carefully and evaluating whether this is a case that should go forward or not.

In New York, a Queens cardiologist was arrested at Kennedy Airport on Thursday and accused of engaging in kickback schemes with medical diagnostic facilities to whom he referred business. In Maine, an office manager was charged with embezzling funds from a medical office. In Connecticut, Indiana, Iowa, Texas and other states, people were charged in schemes involving the distribution of medically unnecessary drugs, including opioids.

Opioid addiction is an escalating public health crisis in America, with drug deaths rising faster than ever. Hydrocodone and oxycodone, two powerful opioids, are among the most commonly abused prescription drugs, and the Centers for Disease Control and Prevention estimates that 91 Americans die each day of an opioid-related overdose.

Mr. Sessions has emphasized cracking down on drug crime as a priority, directing the nations prosecutors in May to pursue the toughest charges for such crimes, even when they may carry mandatory minimum prison sentences.

Last year, the fraud task force charged 301 people for some $900 million in false billings. Since its creation a decade ago, it has charged more than 3,500 people for what prosecutors said were over $12.5 billion in false billings.

Thanks to these efforts, fewer criminals will be able to exploit our nations opioid crisis for their own gain, said Tom Price, the secretary of health and human services. He cited the Trump administrations budget request for a $70 million investment in the health care fraud control program as a sign of its commitment to rooting out such crimes.

I know we overuse certain words in the lexicon like unprecedented and historic and unique, said Chuck Rosenberg, acting administrator of the Drug Enforcement Administration, who cited an estimated 59,000 deaths from drug overdoses in the United States last year. But this is an epidemic.

Get politics and Washington news updates via Facebook, Twitter and in the Morning Briefing newsletter.

A version of this article appears in print on July 14, 2017, on Page A11 of the New York edition with the headline: U.S. Arrests 412, Saying They Bilked Health Aid.

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US Charges 412, Including Doctors, in $1.3 Billion Health Fraud - New York Times

Sen. Ted Cruz, R-Texas, speaks to members of the media on Capitol Hill on July 13. Pablo Martinez Monsivais / AP

The Senate bill would change that. It includes a modified version of a proposal by conservative Senators Ted Cruz, R-Texas, and Mike Lee, R-Utah, that would allow insurers to sell plans that do not meet Obamacares regulations.

That means they dont have to not cover essential health benefits, which include everything from hospitalization to maternity care. They could also deny plans to people with pre-existing conditions or charge them more based on their health.

Customers would not be able to use federal subsidies to buy these plans, which would likely have much lower premiums than other coverage, along with high deductibles. That could interest people who dont qualify for tax credits and dont have any immediate medical needs, but still want some limited insurance.

If you have expensive medical needs, though, youd have to turn elsewhere.

The Senate GOP bill creates a temporary $70 billion fund to help insurers pay for more expensive patients, but only if they sell comprehensive plan that contain essential health benefits and meet other Obamacare regulations. Since these plans would be far more attractive to sicker patients and the skimpier plans far more attractive to healthy people, the premiums would likely become more expensive.

AHIP, the main lobby for insurance companies, has

For plans that are eligible for subsidies on Obamacare's exchanges, there could be changes to "essential health benefits" as well. The Senate bill would allow states to waive the benefit rules in favor of their own version. In states that reduced or eliminated these benefits, healthy people could gravitate toward cheaper and less generous plans, further driving up costs for more comprehensive coverage.

Treatments left out of essential health benefits could also become subject to annual or lifetime limits by insurance companies, a practice that was banned under Obamacare.

This change could potentially affect benefits for employer plans as well, according to some health experts who have examined the bill. Current regulations require employers to provide coverage that's consistent with essential benefit rules in a state of their choosing. That means if one state deregulates their plans, it could give employers around the country the ability to adopt their rules and provide plans with fewer benefits and with annual and lifetime limits.

The Senate bill would reduce Medicaid spending dramatically compared to current law.

It would gradually eliminate Obamacares Medicaid expansion, which covers people making up to 138 percent of the federal poverty line (about $16,500 for individuals) in participating states. About 11 million people have gained coverage under this provision.

Going further than rolling back Obamacare's Medicaid provisions, it would also reorganize Medicaid and cap federal spending on a per-person basis, which is a major change from the current system that matches states based on their own contribution to the program.

The bill would also grow future Medicaid spending at whats expected to be a slower rate than current law, leading to deeper reductions in spending over time.

The CBO found these changes, which were in the previous version of the bill, would reduce Medicaid spending by $772 billion over the next decade in comparison to current law and cover 15 million fewer people. States would have to either raise taxes or cut spending elsewhere to make up the difference or reduce benefits for Medicaid recipients like nursing home residents and people with disabilities.

There are some tweaks in the new version. It includes a mechanism that would let states increase Medicaid spending if theres a health emergency that drives up per-person costs. The bill also changes a formula to help hospitals pay for low-income patients in a way that benefits states with more uninsured people, which would likely help states that chose not to expand Medicaid.

The CBO and outside experts will have to weigh in on the new provisions, but theyre unlikely to offset the old version's spending reductions by large amounts.

The Senate bill will eliminate Obamacares taxes on medical companies and remove its penalties on individuals who dont buy insurance and employers who dont provide it.

Notably, though, it will keep taxes on high-income households that were created to finance Obamacare: A 3.8 percent tax on investment income for families making over $250,000 a year and a 0.9 percent Medicare payroll tax. The bill also keeps a tax on health insurance CEOs personal earnings.

This frees up the bill to spend more elsewhere and addresses complaints by moderate Republicans over criticism that the previous version cut spending for low-income households and used the savings to lavish tax cuts on the rich.

The new bill does add a tax break favored by conservatives that primarily helps higher-income families. It allows people to pay for premiums on individual insurance plans using their tax-exempt contributions to a Health Savings Account. Since lower income households usually dont have extra cash to contribute to an HSA, the change is unlikely to benefit them much. The tax benefits are also proportionally bigger for people in higher income tax brackets.

A health care activist lifts signage promoting Planned Parenthood during a rally as part of the national "March for Health" movement in front of Trump Tower on April 1, 2017 in New York City. Kevin Hagen / Getty Images

The bill would cut off Planned Parenthood from receiving Medicaid payments. The organization is already barred from accepting federal contributions for abortion, but is reimbursed by the government for other treatments.

Insurers would also not be allowed to offer individual plans eligible for subsidies that cover abortion. Under Obamacare, insurers can include abortion coverage, but the provision is paid for separately using premiums and not federal subsidies.

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Major Health Care Changes in the Senate GOP Bill - NBCNews.com

Trump noted the fact that revisions to health-care bills in both the Senate and the House have been made to draw support from wavering legislators. But in the process, those revisions lose support from other lawmakers who might have supported earlier versions of a bill to significantly reform the Affordable Care Act.

"You get a couple here and you say, great, and then you find out you just lost four over here," Trump said.

"Health care is tough," said Trump.

"But," the president added, "I think we're going to have something that's really good and that people are going to like."

"We're going to find out over the next you know, we just extended for two weeks," Trump said, referring to Senate Majority Leader Mitch McConnell's decision to delay the Senate recess to get a health bill passed, along with other legislation.

Two GOP senators, Susan Collins of Maine and Rand Paul of Kentucky, said they were opposed to the revised bill as currently written. At least five other Republican senators indicated they were undecided. If GOP leaders have three defections on the bill from their own caucus, they will be unable to get the 50 votes they need to pass the bill.

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President Trump says health-care reform is 'more difficult' than getting peace between Israel and Palestinians - CNBC

Editors, USA TODAY Published 5:37 p.m. ET July 13, 2017 | Updated 7:16 p.m. ET July 13, 2017

Sen. Ted Cruz, R-Texas,, second from left, waits for President Donald Trump to join a meeting of Republican senators on health care in the East Room of the White House in Washington, Tuesday, June 27, 2017.(Photo: Susan Walsh, AP)

If at first you don't succeed, try, try again. Senate Republicans unveiled a new version of their health care bill Thursdaythat would allow the sale of cheap, bare-bones insurance plans as a way towoo conservatives to support the measure. Moderates also got a win in the new version, with $43 billion more funding to fight opioid addiction. The new bill still isn't a shoo-in to pass. Insurers warn the changes could cause premiums to skyrocketfor older Americans and those with pre-existing conditions. Two Republicans enough to derail the plansaid they wouldn't even vote for a procedural motion to allow a vote on the bill next week. If the measure does pass,here's a run down of what it means for Medicaid funding (deep cuts) and private insurance subsidies (could still lose all or some of them) and other aspects.

In a high-stakes bid for conservative support, Senate Majority Leader Mitch McConnell has agreed to demands from Republican Sen. Ted Cruz of Texas to allow insurers to sell low-cost, skimpier plans as part of a new health care bill. Time

Don't freak out, but Game of Thrones won't win an Emmy this year. The HBO hitdidn't premiere early enoughto make the cut for the 2017 awards and defendits two-year-long winning streak in the Best Drama category. Who's filling the Thronesvoid? HBO'sWestworldtopped the list with 22 nominations, andSaturday Night Livealso snagged 22 nods, filling out the comedy side of the list. Stranger Things(#JusticeForBarb) and Feud: Bette and Joanwere also among the top contenders. And, as always, there werenotable snubs, likeLena Dunham and Jimmy Fallon.Find out here if your favorite show madethe cut.

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President Trump not only won the election last year, but a new study shows he also was the winner of the 2016 Presidential Twitter War over theHillary Clinton faithful.A University of Edinburghstudy found pro-Trump tweets nearly doubled that of Clinton in the final two months of the campaign. In fact, Clinton was criticized nearly three times more than she was praised. Thats despite her sending more negative tweets aboutTrump than he posted of her. Some silver lining for the #Imwithher crowd, she did get the help of the Sultan of Salaciousness himself, Jerry Springer. More on Trump today, beyond the tweets:

A jailed man confessed to killing four missing Pennsylvania men after authorities had identified him as a person of interest earlier Thursday, his attorney said. Cosmo DiNardo, who was initially charged with trying to sell illegally one of the dead friends' car, now plans to plead guilty to four counts of first-degree murder. The body of Dean Finocchiaro was found along with other human remains in a 12 foot common grave Wednesday on a 70-acre farm owned by DiNardo's parents. Along with Finocchiaro, Mark Sturgis, Tom Meo, and Jimi Tar Patrick were also missing. Patrick was last seen Wednesday, while the other three vanished Friday.

The body of Dean Finnocchiaro, one of four missing men, and other human remains were found buried 12 feet underground on a Pennsylvania farm. USA TODAY

This sounds encouraging: Americans are saving more money. The labor market remains strong, and steady paychecks have helped boost overall deposits in the countrys banks. The average U.S. checking account deposit has risen from $1,000 in 2007 to about $3,600 great, right? Well, while saving is a personal finance virtue, most consumers are making very little return off of the money stashed in their checking account, since interest rates are still historically low. Got extra cash and need advice on what to do with it? Heres are some smart ways to invest $1,000.

What else is happening this week?Bookmark our calendar.

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Senate health care bill, take two - USA TODAY

Health care discussions were overtaken by the latest Russia bombshell, and members coming out of the Tuesday luncheon made clear that the votes still aren't there, and more importantly, that it's not yet clear how this bill will pass.

But despite the continued confusion and skepticism, Senate Majority Leader Mitch McConnell is moving full steam ahead. In fact, he is raising the stakes: he's delayed the start of August recess precisely for the stated purpose of tackling important legislative priorities "once the Senate concludes its work on health care reform."

Thursday: Draft bill(s) released.

Early next week: CBO score(s) released.

Mid-next week: Vote on motion to proceed.*

*This is not to be confused on a vote on the bill itself. This is just the first procedural step that would start debate on the bill.

And an important reminder on this: If this bill looks like it's going to fail, the "no" Republicans will want to kill it on the motion to proceed. This will save them from going through the vote-a-rama, when Democrats offer many politically tough amendments for Republicans to vote on.

Senators walked out of their Tuesday lunches believing that they could be seeing double.

On Thursday, it's possible that there will be two draft bills released -- one with Ted Cruz's amendment (which conservatives like), and one without, according Sen. Bob Corker of Tennessee. The Cruz amendment would allow insurers that offer Obamacare policies to also offer cheaper, stripped-down policies unregulated by the law.

Similarly, early next week, we could get two Congressional Budget Office scores: one with the Cruz amendment, and one without, according to Sen. Bill Cassidy of Louisiana.

Prior to July 4 recess, various bills were submitted to CBO for scoring (so that the office would be ready to release an updated score as quickly as possible). What was less expected, however, was the possibility that leadership could be undecided between two bills so close to a vote, and present the conference with multiple versions.

Cruz amendment aside, here's what else we know about what's expected to be in the new bill:

Apparently, Sen. Lindsey Graham of South Carolina is working on an "alternative" health care plan of his own. He told reporters Tuesday that he is developing a proposal with several of his colleagues -- and even trying to woo Democrats -- though he wouldn't share what exactly that proposal looks like.

"I want to do the best I can and I think the best we can is not on the table right now," he said.

He noted it would likely be an amendment to the current bill, rather than a new bill. A Democratic aide says he's also reached out to senators across the aisle to discuss this.

What are the Democrats conveying to Graham? "Abandon the repeal bill that cuts taxes for the wealthy and Medicaid, and we're eager to work with you," a senior Democratic aide said.

If Graham is working on an amendment, that means we're still talking about the reconciliation process, which requires just a simple majority (50) for passage. Congressional observers should still be skeptical about the bipartisan talk around this Graham bill. Democrats have been very, very clear: they will not work with Republicans on anything resembling an Obamacare repeal bill. Anything that's a bipartisan health care effort will have to go through regular process (committee hearings, debate, requiring 60 votes) -- and if Graham is working on an amendment to the current bill, this is not that.

Here's where it looks like we are headed as of now. There still are not 50 votes in sight. Conservatives have demands, moderates like Susan Collins and Lisa Murkowski have demands, and Sen. Rob Portman is fighting back against the decision to make major cuts to Medicaid in the long term. None of those problems have been solved yet and assuaging the concerns of one faction only alienates another.

Here are the ways this could end:

It's Byrd Bath time. This process has been ongoing, but Republicans and Democrats are debating behind closed doors what actually can be included in the health care bill under those special set of reconciliation rules.

Remember, reconciliation is the process that lets Republicans pass the health care bill with just a simple majority. But, there are rules attached. Basically, staff is debating the merits of each provision before this bill goes to the floor.

Things that could come out of the GOP health care bill during this process? Two things everyone is talking about are the Planned Parenthood defund and any regulatory changes. Also a hot topic is whether Cruz's amendment is allowed under Byrd.

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Health care state of play: The votes aren't there yet. But there will (probably) be a vote - CNN

The Senates ObamaCare repeal bill has turned the U.S. healthcare industry against itself.

Hospitals and doctors have mobilized aggressively against the bill, sending letters to Republican Senate leaders and flooding Capitol Hill with lobbyists. Providers are primarily concerned about the $772 billion the bill would cut from Medicaid.

On the other side of the debate are large insurers and their lobbying group, Americas Health Insurance Plans. The Senate bill has some policies the insurers like: $140 billion in tax cuts and $50 billion over the first four years to stabilize ObamaCares insurance markets. The bill also contains more than $60 billion to help insurers cover high-cost patients.

Anthem was one of the first insurers to endorse the Senate bill.

We believe the Senate discussion draft will markedly improve the stability of the individual market and moderate premium increases because it appropriates billions of dollars in short-term funding to shore up the exchanges, provides cost-sharing reduction funds and eliminates a tax on health insurance plans, Anthem said in a statement.

The BlueCross BlueShield Association also endorsed the stabilization funds in the bill.

We are encouraged that the draft Senate legislation funds cost-sharing reductions, which help those who need it most with out-of-pocket costs, so they can access care, the group said. The state stability and innovation program will also go a long way in helping to cover the costs of caring for those with significant medical needs.

Some Senate Republicans were quick to seize on the industrys support. But others, like Sen. Rand PaulRand PaulRand Paul: Senate bill 'does not repeal Obamacare' Healthcare industry at odds over Senate proposal Senate GOP to offer new healthcare bill on Thursday MORE (R-Ky.), decried the bills bailouts to the insurance industry and demanded the legislation be changed.

The divide within the medical community over the healthcare bill is a striking departure from the debate over the Affordable Care Act (ACA).

Seeking to neutralize industry opposition, the Obama administration sought to bring payers and providers together in support of the Democratic legislation and largely succeeded.

All the major players made sacrifices, but they all got something in return. Hospitals and doctors were able to decrease their uncompensated care, while insurers gained access to a larger population of customers who could buy coverage with a government subsidy.

But the debate over the Senates Better Care Reconciliation Act has shattered that detente within the industry.

Although they are at loggerheads now, payers and providers had made progress under the ACA, said Andrew Selesnick, an attorney at the law firm Buchalter in Los Angeles. There are always going to be divergent views and always tensions that exist [between payers and providers], but this new bill just exacerbates it.

Selesnick said the divisions between payers and providers significantly decreases the changes of success for the bill. People in the industry have a much different view of healthcare than Republicans, he said.

Jeff Myers, president and CEO of Medicaid Health Plans of America, said hes not surprised there are such divisions among the healthcare sector. He said the limitations of the reconciliation process, which Republicans are using to pass the bill, makes it almost impossible to make sure the needs of every industry are addressed.

Reconciliation makes that kumbaya moment very hard, Myers said, because under reconciliation, changes have to be budget neutral.

While everyone was giving up something [during the ObamaCare debate], there was some value in the creation of new opportunities. But theyre not passing out candy here, Myers said.

The insurers dont necessarily like the Medicaid cuts in the Republican bill, but on balance, their plans would benefit more from the tax cuts and the market stabilization money the legislation would provide.

Hospitals and doctors, on the other hand, have been campaigning vocally against the legislation.

The opposition from hospitals has been particularly strong. ObamaCare resulted in millions of people gaining insurance coverage, and the Senate bill would undo a lot of those gains. Hospitals still have to treat people, even if they dont have coverage, so those reductions in uncompensated care would likely disappear.

When the bill was introduced, the American Hospital Association (AHA) urged senators to go back to the drawing board.

From the onset of this debate, Americas hospitals and health systems have been guided by a set of key principles that would protect coverage for Americans, AHA President and CEO Rick Pollack said in a statement.

In an interview on C-SPAN last week, Pollack took a veiled swipe at the insurance industry.

Some sectors of the healthcare field have different types of concerns, because a lot of their concerns have to do on the tax side, and [they] want to see different types of taxes repealed, Pollack said.

The American Medical Association (AMA) said the bill would violate medicines do no harm principle.

Medicine has long operated under the precept of Primum non nocere, or first, do no harm. The draft legislation violates that standard on many levels, AMA Executive Vice President and CEO James Madara said.

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Healthcare industry at odds over Senate proposal - The Hill

WASHINGTON (Reuters) - U.S. Senate Republicans said Tuesday they will seek to bring their healthcare overhaul to the Senate floor next week after a lengthy intraparty struggle, but it remained unclear whether they had the votes to pass the measure or even what form it would finally take.

With his reputation as a master strategist on the line, Senate Majority Leader Mitch McConnell laid out a timetable for Senate consideration of legislation to fulfill President Donald Trump's campaign promise to dismantle the 2010 Affordable Care Act, also known as Obamacare.

In a departure from Republican orthodoxy on tax-cutting, the legislation likely will retain some of the taxes that were imposed on the wealthy under Obamacare, Senate sources said.

But it was unknown whether a revised version of the bill to be announced on Thursday morning can satisfy both moderates and hard-line conservatives in the Republican majority who voiced opposition to a draft unveiled last month on very different grounds.

With Trump urging the Senate to act before taking the August break, McConnell pushed back the Senate's planned August recess by two weeks to allow senators more time to tackle the measure that would repeal key parts of Obamacare, as well as pursue other legislative priorities.

McConnells announcement drove a turn-around in stock prices in afternoon trading on Wall Street after an earlier sell-off, on hopes that a shortened recess could mean progress on the stalled Republican legislative agenda.

A dark mood lingered among some Republicans over the healthcare subject, with party leaders appearing to act because of the need to dispense with healthcare and turn to other issues, among them increasing the U.S. debt ceiling.

"I think we've narrowed down now to where we know where the decision points are, and we just have to make those decisions," Senator John Thune, a junior member of the Republican leadership, told reporters. Leaders were still trying to "figure out how we get to 50" votes, he said.

Republicans, who hold 52 seats in the 100-seat Senate, would need 50 votes to pass the bill, with Vice President Mike Pence providing the tie-breaking vote.

"I am very pessimistic" about the prospects for Republican healthcare legislation, Chuck Grassley, a senior senator, told Fox News on Tuesday. Another Republican senator, Lindsey Graham, was working on his own healthcare proposal and will unveil it this week, a Graham aide said.

McConnell said the plan was to vote on the healthcare bill next week, and said he hoped to have a fresh analysis of the bill from the nonpartisan Congressional Budget Office at the start of the week. He did not reveal any of the planned changes to the draft, on which he postponed action last month after it failed to gather enough support.

But Senate sources said it is likely that two Obamacare taxes on the wealthy will be kept in place - a 3.8 percent net investment tax and a 0.9 percent payroll tax that helps finance Medicare - which would appeal to moderates who have balked at the prospect of cutting taxes for the wealthy while reducing benefits for the poor.

"Obviously that's the direction I think that a lot of our members want to move, is to keep some of those (taxes) in place and be able to use those revenues to put it into other places in the bill," Thune said, while stressing that no decisions were final.

Republicans could also retain Obamacare's limit on corporate tax deductions for executive pay in the health insurance industry, one Senate source said.

It was unclear whether the bill would include a proposal by conservative Republican Ted Cruz that would allow insurers to offer basic low-cost healthcare plans that do not comply with Obamacare regulations.

Cruz argues it would help to lower premiums, but critics say it would allow insurers to offer skimpier plans that may not cover essential health benefits while also charging more for more comprehensive, Obamacare-compliant plans.

The Senate Republican healthcare bill unveiled last month would phase out the Obamacare expansion of Medicaid health insurance for the poor and disabled, sharply cut federal Medicaid spending beginning in 2025, repeal many of Obamacare's taxes, end a penalty on individuals who do not obtain insurance and overhaul Obamacare's subsidies to help people buy insurance with tax credits.

Democrats are united in opposition to the bill and at least 10 Republicans have said they oppose the existing draft. The House of Representatives passed its own version in May.

Moderate Republicans are uneasy about the millions of people forecast to lose their medical insurance under the draft legislation, and hard-line conservatives say it leaves too much of Obamacare intact.

Democrats call the Republican legislation a giveaway to the rich that would hurt the most vulnerable Americans.

Additional reporting by David Morgan and Amanda Becker; Writing by Susan Cornwell and Tom Brown; Editing by Mary Milliken and Leslie Adler

More:

Senate may vote on revised healthcare bill next week - Reuters

Last August, then-candidate Donald Trump tried to court voters of color by asking, What the hell do you have to lose? When it comes to health care, the answer is clear: everything. Senate Republicans are poised to vote for the Better Care Reconciliation Act (BCRA), which would strip coverage, reduce access to care, and cause a spike in premiums for millions of people of color. Trump pledged to be president for all Americans, but the plan he endorses will disproportionately hurt people of color while giving a massive tax break to the wealthiest Americans. If he succeeds, thousands of people will die and millions more will suffer. Here are three things you need to know about the Senate health care bill and communities of color.

Planned Parenthood provides health servicessuch as physicals, cancer screenings, and contraceptive careto nearly 1 million people of color, and this number is increasing. For example, in the past decade, the number of African American patients increased by 12 percent. Furthermore, according to a recent survey, 1 in 4 Planned Parenthood clients reported that it was the only place they could get the services they need. Without Planned Parenthood health centers, many women of color will be unable to find and receive high-quality, affordable health care.

The age tax is an attack on one of societys most vulnerable populations and will disproportionately hurt people of color. Today, the poverty rate for Asian American seniors is nearly double that of white seniors7 percent versus 13 percent. For certain Asian American subgroups, such as Cambodian American seniors, poverty rates are as high as 23 percent. African American and Hispanic seniors experience poverty rates of 18 percent and 20 percent, respectively, and according to Demos, Ninety percent of Latino and 83 percent of African-American seniors have insufficient retirement assets to last through their expected lifespans. Elderly American Indians and Alaska Natives are already five times more likely to forego medical care due to cost than the average American senior. Forcing the near-elderly to pay significantly more for health insurance would undermine retirement planning and diminish outcomes for people of color.

People of color experienced historic increases in coverage under the Affordable Care Act. Between 2013 and 2015 alone, the uninsured rate for Asian, Hispanic, and black populations declined by 7, 9, and 5 percentage points, respectively. However, the Senate health care bill seeks to undo this progress by stripping coverage from 10.6 million people of color in 2022. The effect on coverage would get even worse in 2025, when deeper cuts to Medicaid funding would kick in. People of color make up 58 percent of Medicaid enrollees and suffer disproportionately from a range of health disorders, including asthma, diabetes, and heart disease. Without health coverage, these families will face impossible decisions and tragic consequences.

If passed, the Senate health care bill would devastate communities of color. Instead of advancing legislation that will undermine the health of our countrys most vulnerable populations, the Trump administration should work across the aisle to find ways to improve the Affordable Care Act.

Michele Jawando is the vice president for Legal Progress at the Center for American Progress.Connor Maxwell is the research associate for Progress 2050 at the Center.

More here:

3 Ways the Senate Health Care Bill Would Devastate Communities of Color - Center For American Progress

Some investors are growing concerned over the seemingly endless bull market in stocks, which is being powered by technology companies. They may want to explore health-care shares, whose price-to-earnings valuations have declined over the past two years even as their prices have risen 16% this year, right behind tech stocks ascent.

Well list analysts favorite health-care stocks below. First, heres how the sectors of the S&P 500 Index SPX, +0.66% have performed over the past 10 years, leaving out the real estate sector, which was carved out of the financial services sector in September:

Health care has run a very close second to tech in the past 10 years. Over two years, the tech sector has returned 43%, while health care has risen only 9%.

This chart shows the changes in forward price-to-earnings ratios (based on consensus earnings estimates among analysts polled by FactSet for the next 12 months) for the two sectors and the index over the past two years:

So far this year, the tech sector has returned 19%, while health care has risen 16%. Long-term prospects for both sectors are excellent, with continued innovation for tech and demographic trends, innovation and government subsidies for health insurance all favoring the health-care sector.

But health care has been overlooked by some investors, who understandably focus on tech-related companies with the largest market values among the S&P 500: Apple Inc. AAPL, -0.13% Alphabet Inc. GOOG, +1.06% Microsoft Corp. MSFT, +1.34% Amazon.com Inc. AMZN, +0.97% and Facebook Inc. FB, +1.87%

Heres a list of the 10 S&P 500 health care stocks with majority buy ratings from analysts and the most upside implied by analysts price targets:

None of the stocks are rated sell by any sell-side analyst polled by FactSet.

You can click the tickers for additional information on each company, including news, valuation ratios, financial statements and filings.

Dont miss: Hedge fund manager who scored a 78% annual return with Apple and Amazon is short-selling Netflix

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Scared of tech stocks? Health-care shares are cheaper and rallying - MarketWatch

HOUSTON (AP) After Michael Covert submitted his resignation as CEO of the St. Luke's Health System in June, the initial announcement came not from his Houston bosses, but from the Colorado headquarters of its owner, Catholic Health Initiatives.

The Houston Chronicle reports the internal email, sent to Catholic Health CEOs around the nation and absent customary expressions of thanks, widely was interpreted as evidence the move was driven by the national office, unhappy about St. Luke's multimillion dollar losses.

Around the country, health care system governing boards increasingly are losing patience as their hospitals struggle to adjust to a rapidly shifting health care landscape one characterized by declining insurance reimbursements, a push to get patients into outpatient clinics, policy uncertainty in Washington and the replacement of the old fee-for-service model with value-based care. The combined forces have resulted in a sharp downturn in the operating margins of hospitals.

The logical fall guy: the CEO.

In just the last six months, the CEOs of 30 medium- to large-sized hospitals around the nation have departed, according to Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges. Some were due to retirements and career advancements, but many were involuntary.

"That's an increase in turnover, probably a reflection of the current volatility of the health care market," said Orlowski. "Many hospitals are losing money now and the future only looks rockier, with more uninsured and less Medicaid support. Boards want the right person to lead them into such turbulent times."

Nowhere has there been more change at the top than Houston home to the world's largest medical complex where not just Covert, but MD Anderson Cancer Center's Dr. Ron DePinho and Memorial Hermann Health System's Dr. Benjamin Chu also recently left unceremoniously. A fourth CEO, the Texas Medical Center's Dr. Robert Robbins, also stepped down in April but it was to become the president of the University of Arizona.

The shake-ups demonstrate the challenges and pressures CEOs face from board members who, in addition to watching the bottom line, now feel more pressure to stay engaged and ahead of change. Harvard University health-policy professor Ashish Jha said CEOs are "likely to struggle if they're still operating under the assumptions of the hospital industry of 10 years ago."

The Houston departures also show the difficulties outsiders Chu, Covert and DePinho all came from outside the state face navigating the Texas Medical Center, known for its tricky geopolitics. Baylor College of Medicine President Dr. Paul Klotman, one of the few to succeed, calls it the "most complex political environment I've ever been in, including New York City a product of 57 institutions next to each other, competing and collaborating."

Houston's turnover was big news not just locally but nationally, where more than one observer invoked the phrase "dropping like flies" to describe the city's recent spate of departures. The moves drew attention because DePinho and Chu, in particular, are nationally known figures.

The Houston CEOs and representatives of their boards all declined interview requests or were not available, spokespeople said.

"It's kind of unusual to have so many prominent people disappear that quickly in one city," said Jeff Goldsmith, professor of public health sciences at the University of Virginia. "Lots of health care institutions are hitting the concrete right now, but most are scattered around the country."

Goldsmith and others said they were most surprised by the June 19 exit of Chu, considered a big-time hire by Memorial Hermann in 2016. Modern Healthcare magazine ranked him No. 8 on its 2017 list of the nation's Most Influential Physician Executives and Leaders, a testament to his reputation as a leading thinker about the changes in the industry.

Memorial Hermann layoffs were part of Chu's short tenure, about 110 in the spring, 350 the week after his departure. System officials insist there was no connection between the two, noting its financial challenges and initiative to become more efficient predated Chu's hiring.

Instead, Chu and Memorial Hermann turned out to be a poor fit, said people familiar with the situation a first-time CEO whose experience at a long-established managed-care consortium in California did not prepare him for a sprawling health system relatively new to such reform. Chu struggled, they said, to adjust to the new role and the culture change.

So did DePinho, whose 5-year tenure was full of tumult, including financial difficulties that led to the layoffs of 778 employees in January. Financial experts said MD Anderson's problems it lost more than $460 million over 16 months came as a surprise because cancer care is considered so lucrative in the health care industry.

In his resignation speech, DePinho, whose background primarily is as a laboratory scientist, made reference to the challenges faced by today's hospital leaders when he noted that it had become clear to him that MD Anderson needs "a new president who will inspire greater unity and a sharp operational focus on navigating the tectonic changes in health care delivery and economics."

Covert's resignation came as much a surprise locally as Chu's the week before. The St. Luke's board of directors did not request it nor see it coming, said Klotman, a board member.

In retrospect, the departure may have been inevitable.

St. Luke's and two sister systems of CHI hospitals in Texas reported a $51 million decline in a key measure of operating income between July 2016 and March 2017, compared to the same period the year before, according to CHI financial reports. During that period the Texas division laid off 810 employees and cut its payroll by 1,295 jobs, most of them at St. Luke's.

CHI made no secret of its disappointment, including at an investor presentation in February.

"The Texas division financial results for the fiscal year to date (are) behind expectations," according to the slide presentation made to investors by CHI officials. "Volumes and service line mix have deteriorated and labor costs have increased."

In that respect, Orlowski suggested, Covert's departure was not surprising.

"Covert got three years, a typical time frame at which CEOs lose their jobs if boards don't see a bounce back from significant financial struggles," she said, "Boards commonly make a change at that point if there's not a quick turnabout."

Orlowski added that boards are moving even quicker these days to remove CEOs if the finances are bad.

Orlowski said Covert was "very well respected, which only shows what a tough job the CEO position will be for whoever comes in next."

Rating agency S&P Global's report gave St. Luke's credit for reining in expenses after the layoffs, but the system remains well behind Houston Methodist and Memorial Hermann in the race for area patients. Orlowski wondered if it will "need to make fundamental changes in what they're doing, become smaller or find new niches."

The financial struggles of MD Anderson and St. Luke's have attracted significant attention, but they hardly are unique. Goldsmith noted that Partners Healthcare in Boston reported a $214 million drop in operating income in its last two fiscal years; the Cleveland Clinic had a 68 percent decline in earnings in 2016; and western U.S.-focused Providence Health & Services, one of the strongest Catholic systems, lost $562 million over 15 months.

The struggles somewhat puzzle Goldsmith, who noted they have come absent cuts in Medicare or Medicaid funding and added that the increase in Medicare beneficiaries should not have surprised anyone. He blamed hospital boards for not demanding more operational discipline, for allowing management to grow their expenses faster than their revenue.

Jha, however, said it would be a mistake to underestimate "these tumultuous times for the industry."

"A lot's changed," Jha said. "You've got the implementation of the Affordable Care Act and uncertain policy ahead, you've got changes in how hospitals are getting paid and what's rewarded and you've got changes in what we expect from hospitals, the pressure to improve health for entire populations and the need to provide care beyond what happen between the four walls of the hospital.

"It requires a different set of skills than those previously held by hospital CEOs and a different set of resources than those to which hospitals are previously accustomed. It's probably why you're seeing so much turnover these days."

Information from: Houston Chronicle, http://www.houstonchronicle.com

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Houston hospitals deal with shifting health care landscape - STLtoday.com

T

he phrase less is more has become omnipresent in health care. Whether its inserting too many artery-opening stents into people with angina, performing too many surgeries for back pain, ordering too many CT scans for headaches, or prescribing too many narcotics for people with chronic pain, overuse is rampant in our medical system. As the Senate tries to fashion a bill that will likely end up taking away access to health care from millions of Americans, it is important to remember that underuse of evidence-based services is an equally pressing issue. When it comes to health, less is sometimes lesser.

While the United States outspends every other developed nation on health care nearly 18 percent of our gross domestic product Americans lag behind many other countries in the quality of care they receive at the beginning, middle, and end of their lives. This discordance has increased pressure to reduce costs, and so-called medical waste has become a prominent target. While several measures have been developed to curb wastefulness, some of these have had the unintended consequence of reducing access to potentially lifesaving treatments or therapies.

In cardiology, my specialty, the overuse of artery-opening stents has gained substantial attention. While absolutely lifesaving when used for someone in the throes of a heart attack, stents are no better than medication for improving outcomes for patients who have the stable chest pain known as angina. To set standards for stent placement, professional cardiology societies have introduced appropriateness criteria that offer guidelines as to when, and when not, to place a stent.

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Many states now also require public reporting of patient outcomes after stent placement. While this reporting has helped reduce unnecessary use of stents, it has also led to their underuse in the sickest patients, presumably because physicians did not want to have poorer outcomes and death which would be expected in this population count against them.

A similar story has evolved in the world of health insurance. In an effort to make consumers more cost-sensitive, insurers have increased copays associated with medical charges. This strategy has had some benefits. A significant part in the slowdown of heath care costs is related to patients having more skin in the game, Dr. Mark McClellan, a former head of the Food and Drug Administration and the Centers for Medicare and Medicaid Services, and now the director of the Margolis Center for Health Policy at Duke University, told me.

However, a clinical trial involving about 6,000 individuals who had just suffered heart attacks showed that those who had no copays associated with their medications had lower rates of future strokes, heart attacks, and other cardiovascular complications, and incurred no increased cost to insurers, compared to those with standard copays. A significant increase in complications among those with copays was driven primarily by fewer patients taking their prescribed medications. African-Americans are especially prone to underusing medications due to cost. In other words, well-meaning policies meant to curb excess can limit access.

Medical interventions aimed at preventing disease or keeping it from escalating are universally underused compared to those with shorter-term effects. Consider people with asthma. Its recommended that they use a daily controller inhaler to ease the airway inflammation at the root of the disease, as well as a rescue inhaler that provides only short-term relief when symptoms appear. Yet controller inhalers are widely underused while many individuals with asthma overdose on rescue inhalers.

This is true with regard to heart disease as well: Even as the use of cardiac imaging and cardiac procedures are skyrocketing, inexpensive medications proven to prevent future heart attacks and strokes are inconsistently prescribed or taken. A similar trend is observed in immunization and screening tests.

The low uptake of appropriate medical services can actually lead to downstream overuse. African-Americans, Hispanics, and other minorities are more likely to undergo procedures and surgeries at the end of life and incur significantly more costs in the last six months of life than whites. Much of this is driven by an underuse of preventive measures in the years preceding the end.

According to the Dartmouth Atlas of Health Care, which has been exploring variations in the use and distribution of medical resources in the United States for the past 20 years, spending decreases when recommended care is practiced.

Too much medicine has been the source of unbridled indignation over the past few years. Curiously, theres been little outcry about the underuse of evidence-based care. Perhaps this differential reaction stems from the incorrect notion that overuse is associated with rising medical costs while underuse of evidence-based care isnt. Thats simply not true.

Many studies that have evaluated the number of patients who rightly received specific services did not analyze how many did not get them. So rather than looking at overuse and underuse, perhaps we need to focus on appropriate care, or what the Lown Institute, a Boston-based nonprofit think tank, refers to as RightCare, which melds these two seemingly opposite trends.

A movement toward performance-based payments may increase the use of appropriate care by physicians and health systems. All services are vulnerable to over- and under-utilization, Dr. Harlan Krumholz, a cardiologist and professor at Yale University, wrote to me in an email, and the challenge for the future is to provide the information that helps patients make the best choices. A stent, for example, can be the most and least appropriate intervention for a patient, given the clinical context. Patients need to be more engaged in their health care and their physicians need to balance medical treatments that are less likely to provide instant relief with those that reduce the risk of serious events over the long term.

Over the past decade, some health care experts have skeptically asked the question, Is more care better? Policymakers mulling the Senate health care bill must keep in mind that, when the care is truly appropriate, more is indeed better.

Haider Warraich, M.D., is a fellow in cardiology at Duke University Medical Center and the Duke Clinical Research Institute, and author of Modern Death: How Medicine Changed the End of Life (St. Martins Press).

Haider Warraich can be reached at haider.warraich@duke.edu Follow Haider on Twitter @haiderwarraich

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Underuse of appropriate health care is harmful and costly - STAT

Tilting their heads down under the beaming sun, they started to shout: "Hey, hey! Ho, ho! Medicaid cuts have got to go!"

The two women led a crowd of dozens of protesters in a chant.

It was a typical 89-degree afternoon. DC staffers walked past on their lunch breaks, watching the action from behind their Ray-Ban sunglasses.

As the crowd of children and adults continued to chant in unison, Lorio and Michot glanced at each other. It was a moment that came on the heels of a long and harrowing journey.

Lorio is a politically conservative Catholic from New Orleans who voted for Donald Trump in November. Michot is a politically liberal Lutheran from Laplace, Louisiana, who voted for Hillary Clinton.

Despite their differences, the women joined forces over the weekend to take a stand against Senate Republicans' health care bill, which proposes deep cuts in federal spending on Medicaid.

The dynamic duo organized an eventful road trip from Baton Rouge to Washington to protest health care reform -- and along the way, they managed medical scares and rode a wave of emotions.

For the roughly 24-hour bus ride, Lorio and Michot brought something else they have in common: 4-year-old sons.

Lorio's son, John Paul, and Michot's son, Gabriel, were both born early at 27 weeks, which caused complex health conditions.

The children's caretaking needs will be affected if Medicaid gets drastically cut, Lorio said. "It's not what they're cutting; it's who they're cutting."

Michot said that for Gabriel, such cuts could mean life or death. She knows this firsthand because Gabriel was born with a twin, Michael, who died when he was about a year old, and she doesn't want to experience that pain again.

"Without Medicaid, he won't have a ventilator," Michot explained her fear.

As a storm brewed in a moody sky above Baton Rouge on Saturday morning, Lorio frantically packed supplies for the bus ride. Her husband, Neal Lorio, helped carry bags while John Paul played in the living room on a soft blue mat.

John Paul found two small American flags perched by the couch. He wrapped his tiny fingers around the flags and waved them in the air. His big bright eyes, framed by blue glasses, twinkled with glee.

"He's got a really sunny disposition," said Hope Scott, a direct service worker who has helped the Lorio family care for John Paul since he was 6 months old and who was at their home as they packed for the trip.

"It's amazing to see him, under his circumstances, enjoying life the way he does," she said, looking lovingly at John Paul.

Without Medicaid, however, the family could no longer afford Scott's assistance, Lorio said.

The Lorio family car was packed with feeding tubes, feeding formula, a heart rate monitor and other medical equipment for John Paul.

"Everything with a child that has special needs is extra," Scott said. "You have to be prepared. You never know when something's going to happen. He's been perfectly fine one minute ... and then all of a sudden he's got a mucus plug in his trach, and you can't tell what's going on."

Scott stood on the family's front porch and waved goodbye as the Lorio trio -- mother, father and son -- drove off to board the charter bus to DC.

A couple of physicians who helped raise funds for the road trip visited the bus departure site to see off the 35 passengers.

Dr. Kiersta Kurtz-Burke, an instructor of clinical medicine at Louisiana State University School of Medicine in New Orleans, helped raise money for the road trip but couldn't participate in the journey due to her schedule.

"But we're seeing with this legislation, the overall picture is that there are health care needs being threatened on a bigger level, on a national level, and that's also our responsibility, too," she said.

Lorio brought on the bus a sign that said "1st do no harm."

Wearing a SLIC T-shirt, Fuselier used his wheelchair to board the bus with his colleagues. About 34 years ago, when Fuselier was 19, he was paralyzed from the shoulders down after a diving accident at Ouiska Chitto Creek in Louisiana.

"I think it's important that the government, here in Washington, works together," Fuselier said of health care. "This is directly about the people."

Diez and her husband, Ronald's, 13-month-old daughter, Chasely, was born with what doctors suspect to be an undiagnosed genetic syndrome. Among Chasely's health issues are abnormalities with her brain, digestive system, and hands and feet.

"Her future is so dependent upon Medicaid, and I wouldn't even attempt to take the chance, or take (lawmakers') word for it, because many times before, people have not stuck to their word," the Napoleonville, Louisiana-based mother said of some lawmakers' comments on pre-existing conditions.

"Any cuts to Medicaid would be detrimental to my baby's future and her life, and we just need to keep Medicaid the way it is," Diez said.

"It pays for her ventilator supplies. She could not breathe without it," she said. "It pays for her feeding tube and feeding pump supplies. It helps with nursing, and I could not care for her 24 hours a day, seven days a week alone."

Diez's love for Chasely was evident Saturday night, when Diez noticed that her fragile daughter had a 102-degree fever. The cause of the fever could have been any one of myriad factors, Diez said. Chasely has multiple tubes and shunts, including one in her brain that stops fluid from building up, and they can get easily infected.

Diez suspected that the fever could be an unrelated viral illness that would go away on its own, but Lorio, who organized the bus ride, still searched for nearby children's hospitals just in case Chasely's condition turned serious.

Chasely's fever went down after she was given an anti-inflammatory, and Diez, with tears in her eyes, said she didn't regret bringing her daughter on the road trip.

"We want (lawmakers) to actually see her face and see that, yes, she does depend on the ventilator, but she is not in a bed and has no neurological function. She has neurological function. We want them to see that she is a life, and this life is at stake," Diez said.

Lorio also had no regrets about bringing her son, John Paul, on the journey, despite facing a medical scare of her own.

On Saturday afternoon, John Paul suddenly became fatigued and started coughing aggressively.

"He never coughs like this," Lorio said while holding her son. "I don't know why he's coughing this much. ... Who's got oxygen close by?"

John Paul's eyes fluttered open and closed. He vomited, and a stream of his bodily fluids flowed down Lorio's leg as she cradled her son in her lap.

Diez and Michot rushed to the pair's aid, wiping the fluids off the floor and helping Lorio change John Paul's trach tube, which was oozing with secretions.

The incident occurred shortly after John Paul was fed, and "basically, he didn't tolerate it," Lorio said. He quickly recovered his cheerful demeanor after the trach change and some rest.

Despite the various medical incidents, the bus continued to carry the Medicaid activists to the nation's capital.

Medicaid is keeping Lillian DeJean's family from going bankrupt, she said. "I really shouldn't have to deal with this. I'm 15 years old. It's not exactly a common thing for a 15-year-old to be doing on a weekend," she said of the road trip.

"You're not just cutting Medicaid, but you're cutting a lot of people's access to independent living," Lillian said on the bus.

"In the future, if I have Medicaid, I'll be able to live independently because of my waiver and because of the insurance coverage," she said. "Also, Medicaid helps my family stay afloat right now. It's not just the future we're talking about but the present."

The lyrics swept across the bus, and so did a wave of emotion, leaving passengers such as Elaine Harmon with tears streaming down their faces.

Harmon stood next to her 18-year-old son, Marcus Johnson, who sat in a wheelchair, with her hand on his shoulder. He smiled at her as she sang, "Deep in my heart, I do believe, we shall overcome someday."

A mishap during a hernia surgery at 2 years old left Marcus with developmental disabilities. Harmon now relies on Medicaid for an in-home nurse to help care for him.

"We represent thousands of people who are on waiting lists to get services, any type of service, in their house. We're here to bring awareness that this needs to be fixed, not cut out," Harmon said.

Marcus, who follows the news closely, wanted to visit DC last year to speak out against proposals to cut Medicaid, Harmon said.

"He said, 'Momma, I need to go to that White House, and I need to go talk to people so they can help us.' And I said, 'Marcus, just keep giving it to God,' " Harmon said. Now, about a year later, they finally made their appearance in DC.

Harmon said she believes that it is "inhumane" that activists such as her son have to travel to show politicians they are disabled and impacted by changes in policies, even though a physician's letter can document a disability. That's something Marcus questioned at a young age, she said.

"He always did say, even (when he was) small, 'Why do we have to show them we're disabled to get help?' " Harmon said. "That is an inhumane act that someone has to go and show you what a document is already telling you."

The moment "We Shall Overcome" came to an end, the bus approached Birmingham, Alabama, city limits, on its way to Washington.

The bus ride continued overnight Saturday with little additional drama. The families arrived in DC on Sunday and spent the night at a motel.

Monday morning, as sunshine beamed through the windows of the Holiday Inn where the activists had slept, excitement -- and anxiety -- filled the air.

The group gathered to depart for the RNC building, but Diez and her daughter, Chasely, stayed behind.

Chasely's body temperature went back up to just over 102 degrees, and Diez tearfully took her to Children's National Medical Center in DC, where doctors diagnosed her with an ear infection.

After wishing Chasely well, the other activists embarked on their mission.

As the bus stopped about a block from the RNC building, Michot started to put sunscreen on Gabriel. John Paul found one of his American flags and waved it in the air. They were ready for showtime.

"Hey, hey! Ho, ho! Medicaid cuts have got to go," Lorio and others yelled at the front doors of the RNC building.

She said she saw a security guard lock the doors as the group approached. No one could get in, and no one could get out, but silhouettes of passersby within the building could be seen through the front door windows.

"I'm a Republican! I'm a Republican!" Lorio mouthed through the door, with frustration, at the passing shadows. "I'm a Republican!"

A spokeswoman for the RNC said in a statement Monday that "Republicans continue to work to provide greater choice and control for individuals with disabilities, including reforming our health care system to ensure every American has affordable and accessible health care."

Monday wasn't the first time Lorio and many of the others have spoken out about health care reform proposals.

Lorio said he did not call on their group to speak at the meeting. However, while in DC on Monday, a staffer from Cassidy's office met with Lorio, Michot and other activists as they shared their concerns.

In a statement Monday, Cassidy spokesman Ty Bofferding said that "It is important to Senator Cassidy to make himself available to constituents -- holding numerous town halls across Louisiana. He does his best to answer as many questions as possible during those meetings, but cannot always get to everyone in the limited time available. A member of our staff spoke with the Louisiana constituents in DC and is passing their concerns along to the senator."

As the DC protest came to an end, Lorio rallied the group back on to the charter bus. Though the protests are finished, their risky road trip continues.

"Until we're back safely and everybody is safely back home in Louisiana, I have to remain vigilant," she said. "Until everybody's safe back in their homes, I will be on edge."

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Families take a risky road trip to save their health care - CNN International

Jul. 11, 2017 at 6:01 AM

Maine Sen. Susan Collins has opposed her colleagues health insurance bill from the start.

Republicans appear to be at least seven votes short of the 50 they need to get a health care bill through the Senate, which is basically where they were when Senate Majority Leader Mitch McConnell unveiled a draft bill more than two weeks ago.

Soon after the draft bills release, one bloc of GOP senators (Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Rand Paul of Kentucky) argued that the bill was insufficiently conservative and did not repeal enough of the Affordable Care Act, aka Obamacare.

A separate bloc of more moderate Republican senators (Shelley Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada and Rob Portman of Ohio) said the bill was too conservative. Lisa Murkowski of Alaska, another more moderate Republican, has been noncommittal about backing the bill.

There are 52 Republicans in the Senate the bill has no support from non-GOP senators so leadership can afford to lose only two in a vote (with Vice President Mike Pence as the tiebreaker to push the tally to 51). If this process were going well for Republicans, by now some of the hesitant members would have proposed changes to the bill, McConnell would have said he is adopting those changes, and these members would say they were voting for the bill, pending those changes. That full cycle has not happened yet with any of these nine members. Some have publicly proposed ideas that McConnell has not yet said he will adopt, presumably because he knows those ideas wont fly with other members. Others have not, at least publicly, given any kind of wish list, suggesting that they would like the bill to die.

I would say Republicans are stuck in neutral, except that they might be moving backward, adding opponents to the legislation. Two stalwart Republican senators (North Dakotas John Hoeven and Kansass Jerry Moran) criticized the McConnell bill last week, although Im skeptical that either would be a no if the legislation moved to a vote.

McConnell and other Republicans seem to be increasingly pessimistic that Republicans can come together. And a close look at these nine senators and their public comments suggests that this pessimism is grounded in reality. (We grouped some of the senators below to illustrate how interconnected some of their concerns are.)

The Nevada senator sharply criticized McConnells bill the day after it was released, arguing that its cuts to Medicaid were much too deep and that it was a lie to claim that the bill would lower health care premiums for Americans. Heller has said little publicly about the legislation since then. Thats not good for Republicans, because his initial opposition was strong and there is little indication that Heller is working with Republican leaders to push for changes to the bill that would bring him closer to voting for it.

Like Heller, Collins was strongly against the bill from the start; she shared the Nevada senators concerns about Medicaid and affordability. She has continued to make public comments on the legislation but they suggest that she is moving further away from it. She told The Washington Post that at a Fourth of July parade in Eastport, Maine, some of her constituents had praised her for opposing the legislation. Collins also told the Post that she has been talking to Democrats about pursuing bipartisan legislation if McConnell drops his push to pass a health care bill with only Republican votes.

One other thing about Collins and Heller: They are both from states that Hillary Clinton won in 2016. And Heller is up for re-election next year. They have political and policy reasons to object to this legislation.

So lets consider them two no votes. That means for the Senate bill to pass, McConnell needs all seven of the remaining critics of the legislation to back it. Right now, that looks very unlikely to happen.

While in Alaska last week, Murkowski suggested that she was being left in the dark about the legislative process by Senate Republican leaders. The Alaska senator also said that she, like Collins, is interested in working with Democrats on a bipartisan bill. Those are not great signs that she wants to work with McConnell on a revised version of a GOP-backed bill.

We described last week a three-part plan for Republicans to pass the bill through the Senate: loosen some of the insurance requirements, as conservatives want; reduce the cuts to Medicaid and add money to fight the opioid crisis, as some moderates have urged; and appeal to party loyalty to get other reluctant Republicans behind the legislation.

Cruz is touting a proposal that would let insurers sell plans that do not include all the essential benefits mandated under Obamacare, as long as those insurers sell some plans that do include these benefits. (Health care experts say this approach is likely to result in cheaper plans for healthier people and much more expensive coverage for people who already have health problems.) Lees spokesman has said that the Utah senator will back McConnells bill if this provision is included. Johnson has said little publicly since his initial opposition, but he has allied himself with Cruz and Lee in this process and seems likely to back the bill with this change as well. (An op-ed that Johnson wrote in The New York Times echoes some of the general ideas of the Cruz proposal.)

Its safe to assume that Cruz also would support the bill if this provision were included.

So thats good news for McConnell: The conservative bloc could be placated.

Heres the bad news: The conservative bloc may be becoming insistent on this particular provision. Lees spokesman told Axios that the senator would back the Senate bill only if this provision were added. Cruz has hinted that he has a similar view. Such absolutism is problematic for McConnell, who probably needs senators to stay flexible on the exact language of the bill.

But the bigger problem with the Cruz proposal is

Capito told the Charleston Gazette-Mails Jake Zuckerman that she opposes the Cruz proposal. She said it undermines protections for people with pre-existing conditions, who might be unable to afford premiums under the system that Cruz proposes.

This is significant. Typically, a change in a bill that would bring in three votes would be worth turning off one senator. But remember if Collins and Heller are already against this legislation, McConnell cant afford any more no votes. So if the Cruz proposal takes away Capitos vote, McConnell probably cant add it to the bill. This may explain why McConnell has not publicly committed to including the Cruz provision in the legislation.

Capito also suggested that she thinks the legislation cuts Medicaid too deeply.

And theres another problem with getting Capitos vote: her public vagueness. Cruz and Lee are being specific. They have discussed policy changes that they want to see in the bill and have laid those out in public. If the Cruz provision is in the bill, Lee has essentially committed publicly to voting for it.

In contrast, Capitos concerns are more vaguely defined (at least publicly she might have handed McConnell a detailed, specific list in private). Its difficult to know whether she opposes the $772 billion in Medicaid cuts, compared to funding under existing law, that the Congressional Budget Office says is one outcome of the McConnell draft bill, but would be fine with $400 billion or $200 billion.

Portman has allied himself with Capito in pushing for more funding to fight the opioid crisis and fewer cuts to Medicaid. He has been quieter about his views about the bill recently, but there is no indication yet that he will back it or that he has a list of specific changes that he wants.

Paul has been as critical of the McConnell draft as Collins and Heller, but his criticism comes from the right. There is no indication that he thinks the Cruz provision will address his core argument, that the outlines of Obamacare will remain law if any version of the McConnell draft passes. He blasted the legislation on the Fox Business network last week.

I didnt include him in the no group with Collins and Heller only because Paul has political incentives to back this legislation: Trump won by 30 percentage points in Kentucky.

A lot of news coverage over the last week has focused on comments from Republican senators like Chuck Grassley of Iowa and John McCain of Arizona that downplayed the likelihood of the bills passage. I dont put much stock in these senators essentially playing pundit. Neither has laid out a deep, substantive critique of the bills contents, and I assume both would back it in a formal vote. I take their comments as lagging indicators of what I laid out above: Grassley and McCain can count votes the same way you and I can, and they see that the bill is well short of the support it needs.

There is likely to be a lot of news coverage the next few weeks that focuses on McConnells legislative skills or Trumps strategy on health care. I would discount much of that. The fundamental question is whether at least seven of these nine Republican senators will accept a bill that is either more conservative or less conservative than they would like.

So far, these nine arent sounding like they will accept many compromises.

The rest is here:

Republicans Are Still Seven Votes Shy On Health Care - FiveThirtyEight

Republicans have come up with a new twist on their health-care plan that would make premiums cheaper for healthy people but prohibitively expensive for upper-middle-class people with preexisting conditions.

I guess that counts as progress?

The proposal, the brainchild of Sen. Ted Cruz (R-Tex.), would let health insurers offer plans that don't follow Obamacare's rules as long as they offer one that does. Which is to say that they'd once again be free to not only sell skimpy plans that didn't cover things like mental health or maternity care or prescription drugs, but also charge people with preexisting conditions more for them if they didn't just deny them outright.

This is a small idea that would have big consequences. That's because letting insurance companies sell plans that only healthy people could buy would mean it wouldn't be long until those were the only ones healthy people did buy at which point sick people would be left having to pay more than they could afford. Think about it like this. The simple fact that, given the choice, many healthy people would pick bare-bones plans over more comprehensive (and costlier) options would set off a chain reaction in the rest of the insurance market. The prices of those more extensive plans would go up a lot since not enough healthy people had signed up for them, and the healthy people who had done so would drop their coverage since it had gotten so much more expensive which, you guessed it, would make prices shoot up even more, until eventually there were only sick people left.

The health insurance market, in other words, would split into two. Healthy people would buy plans that wouldn't actually cover much, and sick people would try to buy plans that would actually cover them.

And as long as they weren't getting paidtoo much, they could do that. The Senate bill, you see, gives people making350 percent of the poverty line or less $42,210 for individuals, or $86,100 for a family of four the same kind of subsidies Obamacare does that automatically go up as premiums do. So the people who got them would be insulated from what would otherwise be the unaffordable increases the Cruz planwould cause.

Despite that, though, people with preexisting conditions would still be considerablyworse off under the Republican plan than they are under Obamacare. Why is that? Well, the people who did get subsidies would only be able to buy plans theycouldn't really afford to use, and the ones who didn't wouldn't be able to buy any kind of plans, period. There are two stories here. The first is that the Senate bill would peg the value of its subsidies to much cheaper plans than Obamacare does, so a lot of people would be pushed into higher-deductible ones that, as far they're concerned,might as well be none at all. Indeed, in the case of someone making $18,090 or less, the nonpartisan Kaiser Family Foundation estimates that their deductible would go from an average of $255 under Obamacare to $6,105 under the Senate bill.

The second is that it would make the cost of comprehensive plans skyrocket so much that nobody would be able to afford them without government help. This would be a big difference from the way things are now. Forall of President Trump's talk about Obamacare alternatively imploding or exploding or entering a death spiral, his own administration has concluded that this is not the case. Insurance markets are mostly stable. And since people with preexisting conditions aren't shunted off ontheir own, their premiums haven't gone up more than everybody else's. It might not be easy, but for individuals making more than $48,240, or families of four making more than$98,400 that's how high Obamacare's subsidies go it is possible, for the most part, to get covered regardless of their health status.

But the Cruz plan, as we've said before, would change that. Sick people would be segregated into what would be de facto high-risk pools, and, as a result, their premiums would soar into the financial stratosphere. Compounding that is the fact that the Senate bill would only offer subsidies up to 350 percent of the poverty level instead of the 400 percent that Obamacare does. Anyone making more than this new lower level would be out of luck, and out of the health insurance market. That means if you had acne or diabetes or were pregnant all preexisting conditionsthat insurers could use to discriminate against youunder the Cruz plan you'd be better off making $42,210 than $42,211, since that extra dollar would cost you thousands in subsidies.

The Republican plan, then, would make it so sick people couldn't buy insurance without subsidies at the same time that it cut the value of those subsidies and took them away from some middle-class people.

This is really only about one thing: redistributing money from the poor and sick to the rich and healthy. And that's not just what liberals are saying. Conservatives are too. James Capretta, a former Bush administration official who is now a resident fellow at the American Enterprise Institute, says that the main effect of Cruz's plan would be to shift costs from healthy consumers to less-healthy consumers and household with lower incomes.

Freedom, ain't it grand!

Link:

Ted Cruz's health-care plan works great unless you need health care - Washington Post

Story highlights

Protesters demonstrated in 13 different locations in House and Senate office buildings, according to Capitol Police spokeswoman Eva Malecki. As of Monday afternoon, Capitol Police had arrested 80 protesters 21 in House office buildings and 59 in Senate buildings and charged them with the misdemeanor of "Crowding, Obstructing, or Incommoding," Malecki said.

Sens. Ted Cruz, Jeff Flake, Rob Portman and Lamar Alexander, all Republicans, had protesters either inside or in the vicinity of their offices, holding signs and chanting their opposition, including "Save our lives, kill the bill" and "Come out and talk to us."

Some of the protesters outside of Cruz's office lay down on the ground, blocking foot traffic, forcing Capitol Police officers to carry them down the hall.

Cruz and Portman both expressed opposition to the Senate's health care bill before leaving for the July 4 recess, though Cruz had recommended and GOP leadership was considering an amendment to the current legislation.

"One of the great things about freedom in America is even people who disagree can speak out, and there is a small group of people on the left who, right now, are very angry," the Texas senator said last week. "We can engage in cordial and civil debate -- that's how democracy works and that's how it's meant to work."

CNN's Deirdre Walsh contributed to this report.

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80 arrested on Capitol Hill after health care protests - CNN

Sen. Mike LeeMike LeeGOP senator impressed by Trumps knowledge of healthcare details Six GOP senators: Shorten or cancel August recess Senate GOP tries healthcare do-over MORE (R-Utah) said in an interview released Tuesday that he felt "fairly impressed" by President Trump's knowledge of healthcare.

I was actually fairly impressed with how many details he did know, Lee toldPolitico's "Off Message" podcast.

Lee's comments come asRepublicanleadership looks to push their bill torepeal and replace ObamaCare to a voteas lawmakers return from theFourth of July recess.

"The bill as it was released a few days ago is not sufficiently conservative for me to vote for it because it doesn't undo what I see as one of the most fatal flaws in the Affordable Care Act," he said, pointing to ObamaCare's regulations.

The Utah senator saidhe will not vote for the billunless it includes an amendment, which he has sponsored with his conservative colleague, Sen. Ted CruzTed CruzGOP senator impressed by Trumps knowledge of healthcare details Demystifying the foggy haze of Federal Reserve policymaking Cruz: 'Crazy' to go into August recess having healthcare plan MORE (R-Texas), that allows insurance companies offer plans that do not meet ObamaCare regulations, as long as they also offer oneplan that does.

In a discussion abouthis new book, "Written Out of History," theRepublican lawmaker also said the Founding Fathers would "loathe" the closed-door process through which Senate GOP leadership crafted the new healthcare legislation, as he did.

"It is not a good thingfroma policy standpoint to negotiate something that is supposed to be enacted by a legislative assembly consisted of elected officials. It is not a good thing to draft, negotiate, change it all behind closed-doorsand thenbring out, telling people, 'You got to pass it to find out what is in it.' It is not a good thing."

Republican lawmakers in the upper chamber are scheduled to receive an updateon the healthcare billduring a closed-door caucus later Tuesday.

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GOP senator 'impressed' by Trump's knowledge of healthcare details - The Hill

The political points he might have earned were quickly knocked off the board as he and a string of top aides acquiesced to the Kremlin's claims that Trump accepted Putin's denial of election interference. (Only the president's chief of staff Reince Priebus, who was not present for the Putin meeting, refuted the Kremlin account.) By Monday night, the White House once again found itself firmly under the storm of Russia controversies after a series of New York Times reports tied Trump's eldest son to alleged Russian government attempts to influence the election.

By the time the White House's No. 2 spokesperson Sarah Huckabee Sanders stepped up to the podium Monday, concerns over the Trump-Putin meeting were amplified by the revelation that the president's eldest son had met during the campaign with a Russian lawyer whom the younger Trump was told had dirt on Trump's Democratic rival, according to the Times.

The White House tried to veer away from those controversies, drawing attention to administration nominees they say Senate Democrats are blocking and presenting a rosy picture of efforts to rally Senate Republicans around health care reform legislation.

But the Russia controversies once again commanded the spotlight.

Sanders -- speaking once again off-camera -- was deluged with questions that underscored the rollicking 72 hours of fallout from Trump's encounter with the Russian leader, a period marked by clashing accounts of that meeting, eyebrow-raising Trump tweets and criticism from fellow Republicans aimed squarely at Trump.

Following the treasury secretary and national security adviser's lead, Sanders declined to contradict the Kremlin's account that Trump "accepted" Putin's denial of election-meddling.

"The President heard Putin's denial," Sanders said. "He heard his answer and he moved forward with places that they thought they could work together."

The lack of pushback on the Kremlin's account sent a stark message from the White House: That Putin's denials are at least on par with the US intelligence community's conclusions that Putin directed a campaign to interfere with the 2016 presidential election.

And Sanders again opened the door to the "impenetrable Cyber Security Unit" that Trump raised and killed in the space of a day on Twitter amid widespread criticism from Republicans like Sens. John McCain and Lindsey Graham, who mocked the irony of collaborating with Russia on cybersecurity.

"Discussions may still take place," Sanders said, after noting the "need to have conversations with our adversaries."

And after a brief attempt to swat away criticism surrounding the revelation that Donald Trump, Jr. had met -- alongside Trump son-in-law Jared Kushner and former Trump campaign chairman Paul Manafort -- with a Russian lawyer, Sanders said she'd have nothing further to add on the matter.

That story is not likely to be short-lived. It has already prompted calls from members of Congress for further scrutiny and is likely to add to the pile of Russia-related questions that Trump's nominee for FBI Director Christopher Wray will face Wednesday when he heads to Capitol Hill for his first confirmation hearing.

The barrage of questions on Russia-related matters was nothing new to a White House that has been buried week-after-week by developments in the investigation into ties between Trump campaign associates and Russia, and scrutiny over Trump's relatively amiable posture toward Russia.

And once again, the barrage was also a sign of a missed opportunity.

"If Trump had said to Putin -- and afterwards to the public -- that interference is absolutely unacceptable, that we won't allow it and will take steps to prevent it in the future, he might have begun to get ahead of this issue. But he bungled it badly," said Stephen Sestanovich, a Columbia University professor who served as ambassador-at-large for the former Soviet Union in the Clinton administration.

"By showing he can't handle Putin, he may even have made his problem worse," said Sestanovich, also a senior fellow at the Council on Foreign Relations.

Trump, meanwhile, remained behind closed doors on Monday -- continuing to avoid the press after he bucked the precedent set by the last two presidents and declined to hold a news conference at the G20 summit.

He did take to Twitter -- not to reaffirm his support for the US intelligence community's assessment of Russian meddling -- but to say he and Putin discussed the Democratic National Committee's refusal to turn over its hacked server to the FBI for inspection.

The latest drop in what's become a squall of Russia-related controversies once again clouded the White House's efforts to make progress on policy fronts.

As the Senate returned from recess facing daunting odds of passing health care reform, the White House was once again mired in controversy rather than working to publicly sell the health care bill.

But even as the number of Senate Republicans opposed to the health care bill backed by the White House rose to 10 after senators returned home to face their constituents, Trump had no public events on his schedule Monday and is not expected to make a public push on health care before leaving for France later this week.

The lack of any public advocacy from the president came even as the White House's director of legislative affairs Marc Short said Monday that "there's more we could do to educate the public."

"It's a fair point that the Democrats were more organized in their messaging on the bill than collectively Republicans have been," Short said, acknowledging the current bill's abysmal approval rating.

The lackluster public engagement from the President -- who has continued to speak directly with Senate Republicans, according to White House officials -- has left many Republicans scratching their heads or questioning Trump's commitment to the legislation's passage.

Doug Heye, the former communications chief to former House Majority Leader Eric Cantor, noted that Trump could "be very influential" in pressuring several GOP opponents of the current bill who represent states he won handily in 2016 if he headed to those states to boost the health care bill, similarly to how President Barack Obama rallied support for the Affordable Care Act before it passed.

"The only dynamic between where we are now and the past Republican struggles to pass any healthcare legislation is that we've got a Republican in the White House," said Heye, a CNN political commentator. "Whether that's Donald Trump or Jeb Bush or Marco Rubio -- that should be enough. If there's a fully engaged effort, that should be enough to get it over the finish line."

Trump has held some public events at the White House to push the health care bill, he has held no public events outside the White House aimed solely on selling the legislation and raising pressure on fellow Republicans.

While White House officials considered such rallies to push the health care bill, a White House official told CNN aides to the president moved away from that idea -- seeking to put some distance between the president and the increasingly unpopular bill.

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Amid health care push, White House can't shake Russia - CNN