JUDY WOODRUFF: But first: As Republicans on Capitol Hill try to repeal and replace the Affordable Care Act, were going to spend the next couple of nights hearing what patients and health care providers think should be done.

Our team visited West Virginia and Virginia, which made very different decisions about Medicaid. West Virginia did commit to expanding Medicaid through Obamacare. But Virginia is one of 19 states that didnt. The states Republican-controlled legislature voted against expanding the program to 400,000 more citizens because of concerns over costs.

Tonight, we visit a clinic providing free care in the western corner of Virginia, a region that strongly supported the election of President Trump.

PAULA HILL, Clinical Director, The Health Wagon: My name is Dr. Paula Hill. Im a family nurse practitioner and clinical director here at the Health Wagon. We are at the Smiddy Clinic in Wise, Virginia. We actually say that were the forgotten Virginia, because were down in the corner with Tennessee and Kentucky borders.

And were very rural, very mountainous and very isolated from the rest of Virginia and a lot of ways the rest of the country. We have a high rate of heart disease, diabetes, and its because of the economics here.

JOYCE CAMPBELL, Patient, The Health Wagon: All the mines and stuff have just about closed down. And there really isnt any jobs around here.

My name is Joyce Campbell. Im from Wise, Virginia.

You know, I get $800 a month. And I am fortunate I do have an income coming in, with my Social Security. And the time you pay your rent, your electric, your water, your gas, you either have a choice of whether you want to buy your medicine or whether you want to eat.

PAULA HILL: The Affordable Care Act, when it was enacted, it did help a lot of Virginians. Down here in this part of the state, in far Southwestern Virginia, we didnt benefit as much because there are such dire economic constraints here. Our patients couldnt afford the Affordable Care Act. They couldnt afford $400 a month for a family plan.

And Virginia didnt expand Medicaid. We actually didnt benefit any. It would have helped if we had expanded Medicaid. It would have helped some of our residents anyway, because theres a dire amount of poverty. Theres people dying every day, and dying senseless deaths, because they dont have equal right to health care.

TINA BEAN, Patient, The Health Wagon: My name is Tina Bean. Im 59, and Im from Haysi, Virginia.

I had congestive heart failure twice. I didnt have insurance. And thats when I started coming to Paula, or coming to the Health Wagon. Without the medicines and stuff, I probably wouldnt be here.

When I heard about the Obamacare a few years ago and checked it and stuff, you could tell then that it wasnt going to work. People cant afford it.

JOYCE CAMPBELL: They call it Affordable Care Act. But its not. And they said you could keep your doctors. You couldnt because your doctors wouldnt take the thing. And they said you could go to the same hospital, but a lot of it was built on lies. If you really want to know the truth, I think and I think somebody one of these days is going to give an account for it.

JEFF TILLER, Patient, The Health Wagon: My name is Jeff Tiller. And Im 47 years old. And I have worked in the coal mines for 29 years. They diagnosed me for black lung. They done a chest X-ray. They also have found some nodules in my lung.

PAULA HILL: We are overwhelmed here at the Health Wagon. We have went to over almost 9,000 patients, and we have a staff of less than 20. Every year, we have an outreach clinic event called Remote Area Medical.

You will see them standing in line for dental care, for medical care, for vision. We have found people with dissecting aortic aneurysms thats had to be flown out. We have had patients have stroke right there in front of us at these Remote Area Medical events. We have had brain tumors that have been discovered, lung cancers that have been discovered.

And every year, its like this. We keep thinking, well, is it ever going to get better? Is anybody going to help these forgotten people? Theyre like something you would see in a Third World country.

JOYCE CAMPBELL: The Obamacare could have helped some people. I say it needs to be replaced.

TINA BEAN: I hope that they can replace it. I know its not going to be something they can do overnight, because the mess didnt come overnight.

JEFF TILLER: When I first started hearing that Obama getting ready for health care, Obamacare, I thought that was great. We tried it. We got it. Does it have faults? Yes, it does. Is it working? Yes, it is.

And I know right there in my hometown of people thats got insurance through the Affordable Care Act. And you reverse it, they lose their insurance.

WOMAN: If all of this goes through, I probably wont have anything. I dont know how Im going to get covered.

PAULA HILL: Because of the preexisting conditions?

WOMAN: Yes, right. And I have had it for years.

DR. PAULA HILL: If the Senate plan actually passes, there will be deep cuts to Medicaid. Even though Virginians didnt expand, what they are paying out is going to be even subjected to even more cuts.

Then you have the preventive care thats being discussed that theyre not going to be paying for anymore. Just because it wasnt a perfect plan, it doesnt mean do away with the whole thing. Why cant we build on it and repair it, not take it away and then start over with another plan thats not perfect and not ideal?

JOYCE CAMPBELL: It helped the insurance company, because they made all kind of money off of it. But, as far as helping a lot of poor people, it didnt, and it still isnt.

Now, we cannot afford the high cost like Obama had there. Theres no way that people in Southwest Virginia can handle it. Now, maybe up Washington, or way up where theres money and jobs, you could. But theres neither money nor jobs here.

TINA BEAN: They need to do something to help it. And, hopefully, the administration now, maybe they will do something.

JOYCE CAMPBELL: Washington, come to Southwest Virginia.

DR. PAULA HILL: Come down here and look in their eyes. And dont forget where you came from. Dont forget who put you in the position that youre in.

JOYCE CAMPBELL: Check the people. Look at them. Go sit on the streets. Go bring your car and park it and look at the people that are hurting. And then, if you have got a heart, you will know what it needs.

Continue reading here:

What Virginia's poorest citizens want from health care reform - PBS NewsHour

President Trump tweeted Monday that Senate Republicans wouldnt dare leave Washington before dealing with health care, and GOP leaders later said they could have a new bill drafted as early as this week.

I cannot imagine that Congress would dare leave Washington without a new HealthCare bill fully approved and ready to go! Trump tweeted at 6:47 a.m., as senators were returning to Capitol Hill after a weeklong recess.

Senate Majority Whip John Cornyn (R-Texas) told reporters to expect a tweaked version of the bill this week, with an updated Congressional Budget Office score to follow.

Hopefully next week well be prepared to take the bill up and vote on it, he added.

Republicans have less than two weeks to muster 50 votes before Congress six-week August recess.

At least 10 Republican senators have already declared their opposition to the original draft legislation.

Some holdouts, like Sen. Susan Collins (R-Maine), have suggested collaborating with Democrats to fix flaws in the 2010 ObamaCare law.

Collins told reporters Monday she hopes GOP leaders will introduce more than tweaks in their revised bill, or else I wont be able to support it.

Hours after Trumps Twitter warning, the White House was more optimistic.

Were confident that its going to pass before the August recess, said legislative affairs director Marc Short, who conceded that Democrats have been more organized in their [health care] messaging than I think collectively Republicans have.

More:

White House 'confident' new health care bill will pass - New York Post

The initial GOP bill to repeal and replace the nation's health law is probably "dead" and President Donald Trump's proposal to just repeal it appears to be a "non-starter," two moderate Republican senators indicated Sunday as their party scrambled to salvage faltering legislation.

"We don't know what the plan is," said Sen. Bill Cassidy, R-La. "Clearly, the draft plan is dead. Is the serious rewrite plan dead? I don't know."

Sen. John McCain, R-Ariz., said it may now be time for Republicans to come up with a new proposal with support from Democrats.

"I think my view is it's probably going to be dead," McCain said of the GOP bill. If Democrats are included, he said, it doesn't mean "they control it. It means they can have amendments considered. And even when they lose, then they're part of the process. That's what democracy is supposed to be all about."

Signaling his pessimism as well, Sen. Chuck Grassley wrote on Twitter late Saturday that Republicans will lose their Senate majority if they don't pass health care legislation. The Iowa Republican said the party should be "ashamed" that it hasn't been able to repeal and replace the Affordable Care Act, or Obamacare.

"WE WONT BE ASHAMED WE WILL GO FROM MAJORITY TO MINORITY," he tweeted.

The White House, anxious for a legislative victory on health care, insisted that it fully expects a GOP repeal and replace bill to pass in the coming weeks that will fulfill Trump's pledge to end Obamacare. Democrats have ruled out negotiating with Republicans unless they work to fix the law, not repeal it.

"Whether it'd be before August recess or during August recess, the president expects the Senate to fulfill the promises it made to the American people," said White House chief of staff Reince Priebus.

Trump used Twitter Sunday afternoon to urge Republicans to follow through on their pledge to get rid of the health care law pushed by his predecessor.

"For years, even as a "civilian," I listened as Republicans pushed the Repeal and Replace of ObamaCare. Now they finally have their chance!," Trump said in a tweet.

At least 10 GOP senators have expressed opposition to the initial bill drafted by Senate Majority Leader Mitch McConnell, R-Ky. Republicans hold a 52-48 majority and Democrats stand united against the bill, meaning that just three GOP defections will doom it. The weeklong July 4 recess only raised more doubts among senators as many heard from constituents angry about the GOP bill and the prospect of rising premiums.

McConnell last week said he would introduce a fresh bill in about a week scuttling and replacing much of former President Barack Obama's health care law. But McConnell also acknowledged that if the broader effort fails, he may turn to a smaller bill with quick help for insurers and consumers and negotiate with Democrats.

Cassidy, an uncommitted senator who encountered upset voters this month at a Baton Rouge town hall, rated the chances of Republicans passing broader legislation in the next three weeks at "50-50." He cited questions about the impact on coverage and cost in a revised conservative plan being circulated by Sen. Ted Cruz, R-Texas.

Cruz's plan, which aims to lower premiums for healthy people, has drawn support from the White House and some conservatives in the House, which would have to approve any modified bill passed by the Senate. But his proposal has limited appeal to Republican moderates such as Grassley, who told Iowa Public Radio that it may be "subterfuge to get around pre-existing conditions."

Cruz on Sunday sought to dismiss Grassley's criticism as a "hoax" being pushed by Senate Democratic Leader Chuck Schumer, insisting that people will be able to get the coverage they need at an affordable price. Cruz cast his plan as a compromise to unify the party on a GOP health bill.

"When it comes to repealing Obamacare, what I think is critical is that Republicans, we've got to honor the promise we made to the voters that millions of Americans are hurting under Obamacare," Cruz said.

"In my view failure is not an option," he said.

The growing skepticism among Senate Republicans spurred Trump earlier this month to suggest repealing the Obama-era law right away and then replacing it later, an approach that GOP leaders and the president himself considered but dismissed months ago as impractical and politically unwise.

Cassidy cautioned that if senators are unable to reach agreement by the end of July then a "repeal-only" bill would be a non-starter. Echoing McConnell, Cassidy said Republicans may have to pass legislation instead to stabilize the insurance markets.

"I do think we have to do something for market stabilization, otherwise people who are paying premiums of $20,000, $30,000 and $40,000 will pay even that much more," he said.

Cassidy and Priebus appeared on "Fox News Sunday," Cruz spoke on ABC's "This Week" and CBS' "Face the Nation," and McCain also was on CBS.

Associated Press writer Mark Sherman contributed to this report.

Read more:

2 GOP senators suggest bill to repeal health care law 'dead ...

Scott Wartman, The Cincinnati Enquirer Published 9:45 p.m. ET July 9, 2017 | Updated 9:45 p.m. ET July 9, 2017

Sen. Bernie Sanders delivered a speech on the Senate floor last night regarding Republicans' health care plan, June 20, 2017. Courtesy Office of Sen. Bernie Sanders

Sen. Bernie Sanders, I-Vt., speaks during a "Care Not Cuts" rally in support of the Affordable Care Act, Sunday, July 9, 2017, in Covington, Kentucky.(Photo: AP Photo/John Minchillo)

COVINGTON, Ky. Vermont Sen. Bernie Sanders hoped to draw big crowds in Covington Sunday.

More than 2,000 people showed up at the Northern Kentucky Convention Center, including the Covington Mayor, who introduced Sanders, I-VT.

Sanders and the crowd wanted to send a message to Republicans, particularly Senate Majority Leader Mitch McConnell in his home state.

That message: Don't destroy the Affordable Care Act.

Sanders lambasted the proposed Republican health care bill that would repeal the ACA, also known as Obamacare.

Related:

John McCain: GOP health care bill likely 'dead'

Average premiums could rise 74% by 2020 if Trumpcare passes

"I beg Sen. McConnell to listen to the organizations at the forefront of medicine who oppose this disastrous legislation," Sanders said on Sunday.

Sanders flew to Northern Kentucky after headlining a similar rally earlier on Sunday in Morgantown, W.Va.

The crowd lined up for blocks outside the convention center. Many had earlier in the day linked hands across the Roebling Suspension Bridge in support of the ACA and in opposition to the Republican Health Care Plan.

Megan Meyer and her daughter Maya, 6, traveled five hours from their home in Cadiz, Ky.

Maya proudly held a sign aloft saying, "Even I know this is NOT normal!!"

Sen. Bernie Sanders, I-Vt., arrives to speak during a "Care Not Cuts" rally in support of the Affordable Care Act, Sunday, July 9, 2017, in Covington, Kentucky(Photo: AP Photo/John Minchillo)

Meyer said she didn't have health insurance until the Affordable Care Act. She works for herself refinishing floors and catering.

She believes the demonstration and Sanders' speech on Sunday were worth the five-hour drive.

"I think it's already had an impact the way we've seen people resisting in the streets," Meyer said. "Republicans are nervous."

Was their message heard by Republicans? Before the event, the Republican Party of Kentucky sent a defiant message.

"Senator Sanders' visit is just more proof that the leaders of the Kentucky Democratic Party are continuing to move their party away from Kentucky families and towards coastal liberal elites," RPK spokesman Tres Watson said in a statement.

Covington Mayor Joe Meyer welcomed Sanders to the stage. Interim city manager Loren Wolff prior to that gave an emotional speech about how the Affordable Care Act helped her son, William, get a kidney transplant.

Vermont Sen. Bernie Sanders speaks to 2,000 people in Covington on Sunday(Photo: Scott Wartman/The Enquirer)

The crowd erupted as Sanders took the stage to give a 46-minute speech. He took aim at billionaires frequently and criticized the tax breaks the Republican bill would give them.

We will not allow 22 million to be thrown off health insurance in order to give $500 billion in tax breaks to the top two percent, Sanders said.

The loudest applause came when Sanders repeated his pledge to introduce a bill that would give the U.S. a single-payer health care covering everyone under Medicare.

Republicans have criticized a single-payer "Medicare-for-all" system they have claimedwould cost $32 trillion over a decade.

The average family would save more in health care costs to make up for the rise in taxes to pay for his proposed health care system, Sanders told The Cincinnati Enquirer last week.

"Would taxes go up? The answer is yes," Sanders said. "But for the middle-class family, they would be better off because of their outrageously high health care costs would go down."

Sanders pledged to defeat the Republican health care bill.

The bill currently in the U.S. Senate is a moral outrage and together we will defeat it, Sanders said as he stepped away from the podium to raucous applause.

Follow Scott Wartman on Twitter: @ScottWartman

Why is the Republican health care bill taking so long? Some didn't think Trump had a shot at winning. Buzz60

Read or Share this story: https://usat.ly/2uGIYLU

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Bernie Sanders: 'I beg Senator McConnell to listen' on health care - USA TODAY

Two Republican lawmakers admitted Sunday the initial GOP bill to repeal and replace the nations health law is probably dead and President Trumps proposal to solely repeal it appears to be a non-starter.

Sen. John McCain, R-Ariz., said in a televised interview on CBS it may now be time for Republicans to come up with a new proposal with support from Democrats.

"I think my view is it's probably going to be dead," McCain said of the GOP bill. If Democrats are included, he said, it doesn't mean "they control it. It means they can have amendments considered. And even when they lose, then they're part of the process. That's what democracy is supposed to be all about."

Sen. Bill Cassidy, R-La, speaking on Fox News Sunday, told Chris Wallace We dont know what the plan is. Clearly, the draft plan is dead. Is the serious rewrite plan dead? I don't know."

Sen. Chuck Grassley, R-Iowa, signaled pessimism as well. He wrote on Twitter late Saturday that Republicans will lose their Senate majority if they dont pass health care legislation. Grassley added the party should be "ashamed" that it hasn't been able to repeal and replace the Affordable Care Act, or Obamacare.

Trump used Twitter Sunday afternoon to urge Republicans to follow through on their pledge to get rid of the health care law pushed by his predecessor.

"For years, even as a "civilian," I listened as Republicans pushed the Repeal and Replace of ObamaCare. Now they finally have their chance!," Trump said in a tweet.

At least 10 GOP senators have expressed opposition to the initial bill drafted by Senate Majority Leader Mitch McConnell, R-Ky. Republicans hold a 52-48 majority and Democrats stand united against the bill, meaning that just three GOP defections will doom it. The weeklong July 4 recess only raised more doubts among senators as many heard from constituents angry about the GOP bill and the prospect of rising premiums.

McConnell last week said he would introduce a fresh bill in about a week scuttling and replacing much of former President Barack Obama's health care law. But McConnell also acknowledged that if the broader effort fails, he may turn to a smaller bill with quick help for insurers and consumers and negotiate with Democrats.

Sen. Ted Cruzs plan, which aims to lower premiums for healthy people, has drawn support from the White House and some conservatives in the House, which would have to approve any modified bill passed by the Senate. But his proposal has limited appeal to Republican moderates such as Grassley, who told Iowa Public Radio that it may be "subterfuge to get around pre-existing conditions."

Cruz on Sunday sought to dismiss Grassley's criticism as a "hoax" being pushed by Senate Democratic Leader Chuck Schumer, insisting that people will be able to get the coverage they need at an affordable price. Cruz cast his plan as a compromise to unify the party on a GOP health bill.

"When it comes to repealing Obamacare, what I think is critical is that Republicans, we've got to honor the promise we made to the voters that millions of Americans are hurting under Obamacare," Cruz said.

"In my view failure is not an option," he said.

The Associated Press contributed to this report.

Read this article:

Two Republican senators declare bid to repeal health care law 'dead' - Fox News

Democrats are increasingly committing to support single-payer healthcare, amid Republican attacks on ObamaCare and pressure from their partys left-wing base.

What was once considered only a progressive talking point has gained traction as more Democratic candidates have been willing to embrace government-funded healthcare on the campaign trail and more House members have been signing onto the idea.

Single-payer isnt just being discussed in liberal enclaves of the country like California, where a single-payer measure recently fell short in the state Assembly. Its a hot topic in Speaker Paul RyanPaul RyanSingle-payer healthcare gains traction with Dems GOP chairman proposes new sanctions on Russia for violating arms treaty Ryan says he won't do public town halls citing concerns over possible protests MOREs (R-Wis.) Republican-leaning district, where all the Democratic candidates running in the primary have supported it.

Sen. Bernie SandersBernie SandersSingle-payer healthcare gains traction with Dems The Hill's 12:30 Report In Woodrow Wilson fashion, here are 14 points for ObamaCare repeal MORE (I-Vt.) championed the idea of universal healthcare during his insurgent presidential campaign, and hell introduce his single-payer plan once the debate over ObamaCare ends.

Other senators such asElizabeth WarrenElizabeth WarrenSingle-payer healthcare gains traction with Dems In Woodrow Wilson fashion, here are 14 points for ObamaCare repeal Warren: Ethics director's resignation 'deeply unnerving' MORE (D-Mass.) and Kirsten GillibrandKirsten GillibrandSingle-payer healthcare gains traction with Dems Senate Democrats: ObamaCare repeal fight isn't over yet Bipartisan senators seek to boost expertise in military justice system MORE (D-N.Y.), two potential 2020 contenders are getting on board with a Medicare for All proposal. Sen. Tammy BaldwinTammy BaldwinSingle-payer healthcare gains traction with Dems Major progressive group rolls out first incumbent House endorsement Dems push for more action on power grid cybersecurity MORE (D-Wis.), who faces a tough reelection in a state won by President Trump, said shes a maybe on Sanderss plan but anticipates supporting it, according to The Capital Times.

In the House, Rep. John Conyers Jr.s (D-Mich.) Medicare for All bill has already netted 113 co-sponsors nearly double the number of co-sponsors the legislation garnered last congressional session.

Key names are noticeably absent from the list, including House Minority Leader Nancy Pelosi (D-Calif.) and Minority Whip Steny Hoyer (D-Md.). But other members of leadership, includingDemocratic Caucus Chairman Joseph Crowley (D-N.Y.) and Assistant Democratic Leader James Clyburn (D-S.C.), are co-sponsors of the bill.

Its nice to see many senators and a variety of people in the House publicly stating for the first time on record that a single-payer system is the way of the future that we need to be working toward, Shannon Jackson, the executive director of the Sanders-aligned group Our Revolution, told The Hill.

Warren has publicly encouraged Democratic candidates to campaign on the idea in 2018 and 2020. But even though the Democrats in Ryans likely safe GOP district are supporting it, other Democratic candidates in red states and districts have been more cautious about endorsing single-payer. Rob Quist, the Montana Democrat endorsed by Sanders, was the only candidate in this years House special electionsto run on that platform.

I think that the politicians who choose to run on a campaign that states and embodies that pillar of our platform will be successful and they will be able to connect with the people, Jackson said.

A Kaiser Family Foundation poll shows a modest increase in Americans support for the concept, with 53 percent of the public supporting all Americans getting their coverage through a single government plan.

Thats up from 2008 and 2009, when about 46 percent of the public held this position. A majority of the uptick in support has come from independents, Kaiser noted.

But in practice, Democrats havent been able to muster enough votes to pass a single-payer plan. In Californias state Assembly, moderate and progressive Democrats couldnt agree on the proposal. While it passed the state Senate, California Assembly Speaker Anthony Rendon (D) ultimately tabled the proposal in his chamber.

Itll tend to be an issue that more left-leaning Democrats are willing to embrace, said Dan Mendelson, president of consulting firm Avalere Health.

In order to embrace that concept, youll have to be willing to defend the efficiency and effectiveness of a fully run government system, and there are many Democrats who are not going to do that and there are some who are.

For Democrats, the increased talk about single-payer offers an alternative message to oppose the Senate GOPs bill to repeal and replace ObamaCare, he said.

Under a single-payer system, all Americans would have health coverage, whereas the nonpartisan Congressional Budget Office estimates 22 million people would become uninsured under the Senate GOPs healthcare plan.

I think what you see is the Democrats on the Hill are searching for a single unifying message to unite in opposition to what is happening presently in the Congress, Mendelson said. And thats really what they're looking for.

Republicans have taken note, seizing on Warrens request for Democrats to campaign on single-payer in an attempt to play offense in the healthcare debate as Republicans struggle with their unpopular plan.

But Republicans are seeing an advantage in Democrats embrace of single-payer, too. The National Republican Senatorial Committee (NRSC) is running auto-play Facebook ads that seek to tie the 10 Democratic senators up for reelection in states Trump won to Warren and government-run healthcare.

The Senate GOPs campaign arm and the Republican National Committee have pointed to studies that say Medicare for All could cost as much as $32 trillion over a decade.

I think that the idea that this is becoming ourcentralfocus is mistaken and one that our opponents are trying to put forward so they dont have to talk about their age tax, said a Democratic strategist with ties to Senate races. What unites Senate Democrats is opposition to this disaster of a Republican bill.

Some Republicans dont see single-payer becoming a toxic issue for Democrats, arguing that those kinds of attacks are more of a deflection tool from the GOPs own healthcare bill.

It almost seems like its too wonky and not enough red meat to really make something catch fire, a Republican operative in Washington told The Hill. Its hard to attack Democrats over single-payer healthcare when we cant get our act together on repealing ObamaCare.

Despite increasing talk of single-payer, Democrats havent agreed yet on a healthcare message for the 2018 midterms, in part because that will depend on whether Republicans manage to repeal ObamaCare.

"The [GOP] Senate bill is almost designed to make healthcare top-tier issue in the next elections, said Larry Levitt, a Kaiser Family Foundation senior vice president.

If the repeal and the replace bill is enacted and signed into law, Democrats will face a challenge as to what their healthcare message will be in 2018 and 2020, Levittsaid, adding that its very likely that many Democrats would turn to single-payer as the next step.

Go here to see the original:

Single-payer healthcare gains traction with Dems - The Hill

Most dismaying for me as a physician is that after all of my attempts to apply my compassion and training to save their lives, all three of these patients told me some variant of: Thanks for what youre doing, but I would rather that you hadnt. Even the man with the brain bleed, who certainly would have died without our immediate intervention, expressed dismay. In the neurology intensive care unit, with a bolt through his skull to measure the pressure around his brain, he told me that while he did not have health insurance, he did have life insurance. He said he would rather have died and his family gotten that money than have lived and burdened them with the several-hundred-thousand-dollar bill, and likely bankruptcy, he was now stuck with.

A believer in free-market medicine, Mr. Ryan has said about health care: You get it if you want it. Thats freedom. Yet being given services without your consent, and then getting saddled with the cost, is nothing like freedom.

Imagine Verizon sending you a bill for hundreds of thousands of dollars (roughly the cost of the medical care of the patient with the brain bleed who required an emergency neurosurgery and prolonged I.C.U. stay) and then telling you, We called you to offer you some extra services. You didnt answer the phone because you were in a coma, but we guessed that youd want them, so we went ahead and added them on and charged you for them. Clearly you would be outraged.

So why does this happen with health care? The answer is that we dont truly believe in free-market medicine. We know that in an empathetic and caring society, life is valued above all else, especially when the life in question is in the most helpless condition possible. Deep down inside, we all intuitively know that health care is not a free market, or else society would not allow me to routinely care for people when they are in no position to make decisions for themselves.

Republicans need to be honest with themselves and the public: If they want medicine to be truly free-market, then they have to be willing to let the next man or woman they find lying unconscious in the street remain there and die. In a truly free market, we cannot treat someone and charge someone without their consent and against their will. If we believe, however, that those lying there in their most vulnerable moments deserve a shot, then we need to push forward with the idea that health care, at its core, must be designed around a caring system that serves all people fairly.

Farzon A. Nahvi is an emergency medicine physician and an instructor of emergency medicine in New York City.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

A version of this op-ed appears in print on July 10, 2017, on Page A23 of the New York edition with the headline: Health Care Cant Be a Free Market.

Read more:

Don't Leave Health Care to a Free Market - New York Times

Thousands took part in the third annual Disability Pride Parade in Manhattan on Sunday, where participants expressed concerns about health care funding.

The event traveled from Union Square Park to a festival in Madison Square Park to show solidarity and support for those with disabilities.

"We're here because we're disabled and proud," one participant said.

In 2015, Mayor Bill de Blasio declared July "Disability Pride Month" in honor of the 25th anniversary of the Americans with Disabilities Act.

While participants said rights have come a long way in the nearly three decades since it passed, they said there is still a lot of work to be done.

Many said they were worried that the Republican health care bill being crafted in Washington will cut programs for which people with disabilities depend.

"It's disastrous for the disabled for the cuts, because a lot of the people they only have Medicaid to support them," one parade attendee said.

Some of the top technology to assist those with disabilities was also on display Sunday, including OrCam, an advanced wearable technology that provides artificial vision for those who are blind or visually-impaired.

The Disability Parade also gave participants a platform to talk about issues that are most important to them, such as how to improve the accessibility of the city.

"Every train station with elevators, yes," one woman opined. "Every single station. We travel in the trains."

But they said the most important part of the Disability Pride Parade was coming together.

More:

City's Disability Pride Parade Marches Through Health Care Concerns - NY1

MICHAEL L. MILLENSON HIGHLAND PARK, ILL.

The writer is president of Health Quality Advisors.

To the Editor:

I commend Bret Stephens for pointing out the inconvenient truth that both Obamacare and Trumpcare suffer from an insurmountable problem: For-profit health care is a contradiction in terms. Insurance companies are most concerned about profitability, and profits are derived from high co-payments and premiums, discrimination against those with pre-existing conditions, expensive prescription medications (often with adverse side effects), excessive high-tech screening and surgical solutions. These approaches are not affordable for many people and may not produce good health, which frequently depends more on healthy diet and lifestyle choices, which are not profitable.

As Mr. Stephens points out, both Democrats and Republicans are only tinkering with the same unfixable formula. There is a solution to this problem, however, and it is not the H.S.A.s that Mr. Stephens endorses. The solution is a single-payer health care system. Single-payer health care, by eliminating the pursuit of profit, both reduces health care costs and improves health care outcomes. It is a disgrace that the United States pays at least twice as much per capita for health care and yet has some of the worst health care outcomes in the industrialized world.

Why is the United States the only industrialized country without a single-payer health care system? Perhaps the insurance and pharmaceutical company lobbyists have the answer.

BEVERLY BURRIS ALBUQUERQUE

To the Editor:

Bret Stephens is right to point to the importance of medical cost control, but his suggestion that the Obamacare exchanges are fundamentally unworkable is nonsense. In essence, all Obamacare attempted to do was bring the benefits of group insurance, which covers most working-age Americans, to those without employer-sponsored coverage. Thus the core concept had substantial precedent and was perfectly sound.

And it has succeeded. In an April analysis reported on by The Times (Insurers Stem Losses, and May Soon Profit, From Health Law Plans), Standard & Poors showed that Obamacare enrollee medical costs which shot up rapidly during 2014 and 2015 have since fallen back to comparability with group-policy enrollee costs. We have now weathered the start-up storm. The primary remaining threat to stability in this market is uncertainty around potential disruption by the president and Republican-controlled Congress.

STEVE LEOVY, BOULDER, COLO.

To the Editor:

Re Understanding Republican Cruelty (column, June 30):

Paul Krugman rightly laments the gratuitous cruelty of Republicans in their proposed health bill. It didnt used to be this way.

In 1935 in the House of Representatives, 284 Democrats and 81 Republicans voted to pass the Social Security law; 15 Democrats and 15 Republicans voted against.

In the Senate, 60 Democrats and 16 Republicans voted in favor; one Democrat and five Republicans voted nay.

After the House vote on the bill, The New York Times editorialized that the Republicans, who were its chief critics during the debate, wound up by voting for it overwhelmingly. That was before a morally indefensible agenda, in Mr. Krugmans words, became the name of their game.

SUSAN DUNN WILLIAMSTOWN, MASS.

The writer is a professor of humanities at Williams College.

To the Editor:

Paul Krugman attempts, as so many others have, to explain the brutal and inhuman cruelty of opposition to Obamacare by some fellow Americans. We can reduce the difference between the major parties to bumper-sticker length. For Democrats: Help Others. For Republicans: Help Yourself. The difference of a single word can explain a divided nation.

HOWARD SCHAIN, NEW YORK

To the Editor:

Re Going Small on Health Care, by Ross Douthat (column, July 2): The fundamental problem with going small, as well as the current attempt to repeal and replace, is that both do nothing to bend the curve on the growth of health care costs and spending. A braver approach would be to go even bigger.

Rewrite Medicare, Medicaid and our employer health care plans to mandate capitation (a fixed fee per patient) with health care providers. This gives providers more skin in the game vis--vis overall cost. Give foreign drug companies, vaccine manufacturers and device makers easier access to our markets, and have the government negotiate with them directly accepting only prices that are no higher in the United States than in other G-20 countries. Make high-deductible plans with health savings accounts the standard across the board, even if government has to partially fund these accounts to give all health care recipients a stake in the use of medical resources. Democrats and Republicans should either go big or go home.

RACHEL BRONHEIM, NEW YORK

To the Editor:

Ross Douthat nicely summarizes the difficulties both parties faced in attempting unilaterally to solve our national health care problems. And while I am no fan of our new president, he should recognize that he now has a chance to do something positive by forcing a bipartisan approach.

First, a family member must explain to him that both the House and Senate Republican health care bills fail to meet his own requirement of containing a heart. Second, he should announce that he will sign only a health bill that has strong bipartisan support. President Trump has a chance to demonstrate his alleged skill in the art of the deal by helping to solve a real national problem.

LAWRENCE CHRISTMAS OAK PARK, ILL.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

A version of this letter appears in print on July 9, 2017, on Page SR10 of the New York edition with the headline: How to Improve U.S. Health Care.

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How to Improve US Health Care - New York Times

Sacramento Bee

Feinstein says Senate Democrats 'very close' to defeating Republican health care bill Sacramento Bee Sen. Dianne Feinstein issued a stinging rebuke Friday to the push by congressional Republicans to repeal and replace Obamacare, condemning her GOP colleagues for advancing a health care bill she said was written in private by 13 white men.. Feinstein revs up the opposition to GOP Senate health care planSFGate Senator Feinstein Weighs In On The Future Of US Health CareCBS San Francisco Bay Area all 9 news articles »

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Feinstein says Senate Democrats 'very close' to defeating Republican health care bill - Sacramento Bee

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By the time Elena Hung's daughter turned 5 months, she'd racked up more than $3 million in medical bills. Xiomara was born fighting for her life, with a rare disorder called tracheobronchomalacia, which causes her trachea to collapse when she breathes.

Her name means "ready for battle."

For Hung, any debate about health care is intensely personal. That's why she and an army of parents have flooded Capitol Hill in recent weeks. They're not paid lobbyists or political insiders, but they're desperate for lawmakers to know their children's stories and to put a human face a child's face on abstract debates about insurance lifetime limits, Medicaid funding and pre-existing conditions.

Elena Hung's daughter Xiomara is medically fragile and relies on Medicaid for much of her medical equipment. Hung has shared her daughter's story on Capitol Hill as senators debate the healthcare bill.

We didnt plan to have kids like ours. It happened. It is not like you can plan to have a million dollars in the bank, said Hung, whose daughter also has chronic lung disease, kidney disease, pulmonary hypertension, and developmental delays. Hung's insurance covers most of Xiomara's medical costs, and she relies on Medicaid to cover much of the expensive medical equipment she needs.

Hung, 39, is a private person. She's not entirely comfortable talking about herself and lobbying lawmakers.

But she is part of a group of unlikely lobbyists parents who were far too busy caring for children with extensive medical needs to meddle much with politics, until the push to repeal and replace the Affordable Care Act put their children's needs in the spotlight. The Congressional Budget Office estimates that about 22 million people will lose medical coverage if the health care bill under consideration in the Senate, The U.S. Better Care Reconciliation Act, passes. The bill has stalled in the Senate recently; senators return from their week-long July 4 recess on July 10.

Hung says it feels strange to focus so much outside attention on Xiomara's health when Hung has spent three years fighting to make sure her daughter would not be defined by her medical condition and would get the chance to do "normal kid" things, like go to the zoo and to preschool. Plus, it's exhausting: she stays up until 2 a.m. some nights to work on lobbying plans.

But she thinks it's worth it. If Medicaid cuts affect Xiomara's medical care, it could make it harder for her to go to the playground or enjoy "Sesame Street." When Hung puts it that way, she says she sees a change in lawmakers and congressional staffers.

"This is my life. When you say that a second, third, fourth, and fifth time ... then it gets through," she said. "I felt like it did make a difference and we were heard."

The Morrisons and Hung family have visited Capitol Hill five times and met with seven senators to talk about health care.

Among parents' top concerns is the prospect that the new health care reforms may allow insurance companies to put lifetime caps on health coverage. Before the ACA, insurance often limited lifetime coverage at $1 million.

These kids reach their lifetime maximum before they even come home, said Michelle Morrison, 33. Her son Timmy was born with a rare condition; his medical care in just his first six months of life exceeded $2 million.

Timmys medical needs did not end when he left the hospital. The now 6-year-old boy has been under anesthesia 45 times and travels from home in Maryland to Cincinnati Childrens Hospital for treatment. A recent hospital stay for three nights cost $16,612.77. It costs $1,354.16 a month for his respiratory equipment.

Timmy and his family have been meeting with senators and their staff to talk about the impact of the healthcare bill on medically fragile children.

Morrisons insurance covers much of Timmys expenses but she knows he will reach the deductible half way through the year.

"People refer to kids like Timmy as 'medically fragile,' which, in some ways, is kind of true," Morrison said. But she says her husband likes to call it "medically strong," instead. "Timmy has fought off more than most of us will in a lifetime."

Timmy was born just six days after the ACA eliminated lifetime limits for health insurance. That was a relief to his family. In his first six months, his bills exceeded $2 million.

Hung and Morrison know that their senators from Maryland oppose the new health care bill, so the women identified 10 states Alaska, West Virginia, Maine, Nevada, Arizona, Colorado, Ohio, Pennsylvania, Louisiana, and Arkansas which, at that time, had undecided senators. They asked families in those states for stories about their medically fragile children, and have been collecting them on a website. They collected 161 stories from 41 states and spent five days visiting 41 senate offices. They had 19 meetings and shook hands with seven senators. They've tried educating staffers and senators about lifetime limits.

Hung said Xiomara thought her Senate visit was "a very strange play date."

Hung and Morrison are not alone. Some parents have a bigger soapbox late-night talk show host Jimmy Kimmel revealed in a tearful opening monologue in May that his son was born with a heart defect and nearly died. He noted that before the ACA, congenital heart defects often counted as a "pre-existing condition" that would prevent someone from getting insurance coverage, and he urged lawmakers to think about how their health care changes would affect children.

"If your baby is going to die and it doesn't have to, it shouldnt matter how much money you make," he said. "I think that's something that whether you're a Republican or a Democrat or something else, we all agree on that, right?"

Other parents are sharing their stories on social media.

Ali Chandra tweeted out the bill from her son Ethan's most recent heart surgery. With her insurance, the cost to her was $500. Without insurance (or if her insurance had imposed a lifetime limit on care, which Ethan would have already used up in his short life), the bill would have been $231,115.

Just one of Ethan's procedures costs $231,000.

"A lifetime cap on benefits is the same as saying, "Sorry, you're not worth keeping alive anymore. You're just too expensive," Chandra tweeted. "Tell that to the boy who just tucked a sick firefly into bed with a leaf blanket and told me to keep the light on so he wouldn't be scared."

Ethan was born with heterotaxy, a rare condition that includes heart defects and organs being located in the wrong places. In his short life, Ethan has had four open chest surgeries and eight procedures under anesthesia. At the end of this summer, he will have a heart catheterization and dental work.

Ethan has had four open chest surgeries in his 3 years of life. Mom Ali Chandra has been lobbying to protect healthcare access for other medically fragile children like Ethan.

Because he needs more does that make him less valuable or less worthy of trying to save? I dont think so, said Chandra, 33, of New Jersey.

Between medical procedures, Ethan enjoys playing in the mud and jumping off the couch, like any toddler. Seeing him be a child reminds Chandra of whats at stake.

From the day they are born that is what you are fighting for," she said, "for them to not just live, but to thrive.

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For these moms, the health care debate is personal - Today.com

WASHINGTON U.S. Sen. Cory Gardner returns to Capitol Hill next week after a Fourth of July break in Colorado that was anything but a respite from the contentious debate over Republican plans to dismantle the Affordable Care Act.

Over the roughly week-long recess, Obamacare supporters ramped up their opposition with several ads and protests, including a Denver rally, a demonstration in Colorado Springs and a radio hit by AARP that specifically targeted Gardner, a Republican from Colorado.

Five protesters were cited Thursday at Gardners Denver office; a week earlier 10 demonstrators met a similar fate.

At the same time, a worry has taken root among some conservatives that the health care plan being drafted by Senate Republicans wont go far enough in repealing the ACA.

Gardner took two meetings on health care during the recess: a visit to the Yampa Valley Medical Center in Steamboat Springs and a conference with executives and doctors at the Pioneers Medical Center in Meeker.

What Gardner didnt do, and what he hasnt done since March 2016, is hold a town hall meeting a strategy that has frustrated liberal activists and set off a debate about the duty of elected officials to appear in public to hear their critics.

The total lack of engagement makes it feel like its a broken contract, said Katie Farnan of the anti-Trump group Indivisible Front Range Resistance.

Adding to the tension is the status of Republican efforts to unravel the ACA. Over the last two weeks, Senate Republicans have struggled to craft a bill that can appease enough GOP lawmakers to pass it without Democratic support.

Gardner and his colleagues will return to Washington with the goal of getting it done before Congress adjourns again for its August recess.

What that final product will look like remains an open question, as GOP lawmakers have exchanged several dueling ideas in recent weeks such as one suggestion that Republicans just repeal the ACA and replace it later.

That kind of malleability, activists said, is why its critical for Gardner to hear from his constituents.

They are making these laws that affect us dramatically, and they shouldnt be doing it without input from their constituents, said Chris Diehn, who said he was cited Thursday during a group sit-in at Gardners Denver office.

Beforehand, Diehn said he spoke for about 15 minutes with Gardner, who called the protesters to talk about health care.

We were just talking past each other, said Diehn, who is a member of the Denver chapter of the Democratic Socialists of America.

Though the bills final language remains in flux, there is little doubt in Colorado political circles about where Gardner will stand at the end of the day despite Gardner not taking a public position on the first Senate version when it was released in late June.

In the end Colorado conservatives know that Cory Gardner is going to vote to repeal Obamacare and when there is a final bill Cory Gardner is going to be there, said Guy Short, a political consultant and longtime Colorado delegate to the Republican National Convention.

This week, Gardner spoke optimistically of its progress while downplaying the idea of repealing the ACA without a replacement. You have started to see positive directions from the bill, Gardner said during a Thursday radio interview with KNUS that was posted online by BigMedia.org.

Even so, some conservatives have begun to grouse about the Senate bills direction, with national groups such as FreedomWorks pressing lawmakers to do more to undo Obamacare.

Sometimes its just important to take a stand, said Jim Hendrix, a Republican businessman from Yuma County who said he has known Gardner for about 30 years. You can watch which way the wind is blowing and that may be politically easy but thats not why you get sent to Washington.

He added that he was frustrated that Republicans in Washington hadnt done a better job of preparing to repeal Obamacare once they took power.

Its just disappointing to me, he said.

The latest version of the Senate bill would eliminate a number of ACA rules and taxes including a penalty for consumers who dont buy health insurance and scale back an expansion of Medicaid prescribed by the 2010 health care law.

It would cut the federal deficit by an estimated $321 billion over the next decade but cause 22 million more Americans to go without health insurance than if the ACA remained in place. Among those at risk of losing their insurance are 425,000 Coloradans covered by Medicaid because of Obamacare, according to the Kaiser Family Foundation.

In response to the criticism about Gardners lack of town hall meetings, Gardner spokesman Casey Contres said the first-term senator has tried to connect with constituents in other ways. Among them: five phone conferences sometimes called tele-town halls with 51,000 constituents.

Over the last few months Sen. Gardner himself or Sen. Gardners health care policy staff have had nearly 400 health care meetings with Coloradans or organizations that are involved in health care and have an impact on the state, Contres said in a statement.

By way of comparison, Democrats point to the 2009 outreach of U.S. Sen. Michael Bennet during the initial crafting of the Affordable Care Act.

That year, the Colorado Democrat held several town hall meetings across the state, including one session in Grand Junction when Bennet appeared alongside President Barack Obama.

Some of these stops were contentious; at one meeting in Burlington, Bennet was accused of talking past constituent concerns on health care. You just keep going on, you dont let anybody speak, said one resident at the time. Youre not listening to people.

Gardner, Democrats have argued, has a similar responsibility to meet with state residents.

The fact that Sen. Gardner refuses to engage with his constituents before voting to take away their health care just shows a fundamental lack of respect for the people hes supposed to be representing, Morgan Carroll, chair of the Colorado Democratic Party, said in a statement.

Bennet has hosted several town hall meetings this year though the current streak follows a long cold spell. For nearly two years, from May 2015 to March 2017, Bennet didnt hold a single one; a time period that overlaps with his 2016 re-election run.

As for the recent July 4 break, a Bennet aide said the Democratic lawmaker didnt schedule a town hall because he was on a congressional trip to Mexico, Honduras and El Salvador.

Owen Loftus, a former spokesman for the state Republican Party, said it makes little sense for Gardner or other lawmakers to hold town hall meetings, given the desire of activists or partisans to create an awkward moment for a future campaign ad.

They are not interested in hearing Cory Gardner talk. They want to shout him down. They want to embarrass him, Loftus said. I would not recommend a politician caving in to the demands of his or her opponents to have an event especially for them when you can have something like a tele-town hall where you can reach more people.

But Farnan, who helped organize a February town hall without Gardner where health care was discussed, said he has a responsibility to stand before his constituents and hear their concerns.

You need to defend your ideas, and you need to do it with your harshest critics, she said. Thats part of being a public servant.

See more here:

Cory Gardner returning to Senate after July 4 recess marked by fireworks over health care - The Denver Post

By analogy, suppose that your states government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement.

But if roads would be as well maintained as before, would that be a reason to oppose the move? Clearly not, since the resulting cost savings would reduce your county taxes by more than your state taxes went up. Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue. In each case, the resulting gains in efficiency would leave you with greater effective purchasing power than before.

Total costs are lower under single-payer systems for several reasons. One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.

The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France.

Despite this evidence, respected commentators continue to cite costs as a reason to doubt that single-payer can succeed in the United States. A recent Washington Post editorial, for example, ominously predicted that budget realities would dampen enthusiasm for single-payer, noting that the per capita expenditures under existing single-payer programs in the United States were much higher than those in other countries.

But this comparison is misleading. In most other countries, single-payer covers the whole population, most of which has only minimal health needs. In contrast, single-payer components of the United States system disproportionately cover population subgroups with the heaviest medical needs: older people (Medicare), the poor and disabled (Medicaid) and returned service personnel (Department of Veterans Affairs).

In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. Thats true, of course, but its an irrelevant objection.

In addition to being far cheaper, single-payer would also defuse the powerful political objections to the Affordable Care Acts participation mandate. Polls consistently show that large majorities want people with pre-existing conditions to be able to obtain health coverage at affordable rates. But that goal cannot be achieved unless healthy people are required to join the insured pool. Officials in the Obama administration tried, largely in vain, to explain why the programs insurance exchanges would collapse in the absence of the participation mandate.

But the logic of the underlying argument is actually very simple. Most people seem able to grasp it if you ask them what would happen if the government required companies to sell fire insurance at affordable rates to people whose houses had already burned down.

No home insurer could remain in business if each policy it sold required it to replace a house costing several hundred thousand dollars. Similarly, no health insurer could remain in business if each of its policy holders generated many thousands of dollars in health care reimbursements each month.

Thats why the lack of a mandate in the alternative plans under consideration means that millions of people with pre-existing conditions will become uninsurable if repeal efforts are successful. An underappreciated advantage of the single-payer approach is that it sidesteps the mandate objection by paying to cover everyone out of tax revenue.

Of course, having to pay taxes is itself a mandate of a sort, but its one the electorate has largely come to terms with. Apart from fringe groups that denounce all taxation as theft, most people understand that our entire system would collapse if tax payments were purely voluntary.

The Affordable Care Act is an inefficient system that was adopted only because its architects believed, plausibly, that the more efficient single-payer approach would not be politically achievable in 2009. But single-payer now enjoys significantly higher support than it did then, and is actually strongly favored by voters in some states.

Solid majorities nationwide now favor expansion of the existing single-payer elements of our current system, such as Medicare and Medicaid. Medicaid cuts proposed in Congress have been roundly criticized. Perhaps its time to go further: Individual states and, eventually, the entire country, can save money and improve services by embracing single-payer health care.

Robert H. Frank is an economics professor at the Johnson Graduate School of Management at Cornell University. Follow him on Twitter at @econnaturalist.

The Upshot provides news, analysis and graphics about politics, policy and everyday life. Follow us on Facebook and Twitter. Sign up for our newsletter.

A version of this article appears in print on July 9, 2017, on Page BU3 of the New York edition with the headline: Why Single-Payer Health Care Saves Money.

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Why Single-Payer Health Care Saves Money - New York Times

Steve Forbes, Opinion contributor Published 6:00 a.m. ET July 7, 2017 | Updated 7:27 a.m. ET July 7, 2017

Protest in New York.(Photo: Mary Altaffer, AP)

Who knows what if anything Senate Republicans will do about health care reform.

But there is a fundamental truth that is being overlooked in all the hyperbolic rhetoric over Medicaid, mandates, subsidies, accessibility and taxes: Free markets would turn our ailing healthcare system into a dynamic, innovative cornucopia of better and ever more affordable care for all of us. We'll see if Washington can rise to the challenge of starting to remove the formidable obstacles to such a market where patients would be in charge rather than the third party payers of government, big insurers and big employers.

There are a number of impressive examples of what the private sector is capable of providing us if government barriers were removed.

Senate health bill: Reports of Medicaid's demise greatly exaggerated

Face facts, GOP: Obamacare is a lifeline that's doing enormous good

Take one particular product from Stryker, one of the world's largest medical device companies. Its innovative SurgiCount scanners address the problem of "retained" surgical sponges. Despite being considered a "never event," surgical sponges are left inside patients an estimated dozen times a day in the US. A single such incident costs about $600,000 in corrective surgery, indemnity payments and legal settlements. SurgiCount avoids all that by electronically tracking the sponges used in an operation, rather than leaving that to chance in a manual count by harried operating room surgeons and nurses.

Innovation can be seen at the retail level as drug store chains Walgreens, CVS and Rite-Aid push further into health care delivery. The authoritative journalHospitals & Health Networksreported that this push will continue "to put pressure on traditional providers to 'up their game' on access or partner." What Hospitals & Health Networks didn't say is that it would at the same time enhance consumer access and choice.

In similar fashion, the University of Southern California Center for Body Computing's Virtual Care Clinic, along with eight partners, helps deliver wireless, on-demand health care to anyone with a smartphone. The Virtual Care Clinic system uses mobile apps, wearable sensors, data collection, "virtual" health care providers and more to connect users with USC medical expertise.

USC is calling it an "anytime, anywhere" disruptive health care model to deliver "borderlesshealth care." That would pair nicely with an ideasome Republicans have long advocated, topermit sales of health insurance across state lines.

POLICING THE USA:Alook atrace, justice, media

Senate health bill breaks GOP promises on costs and Trump's on coverage

These are but a few examples among many and there would be countless more if we achieved a genuine free market system. But the truth is that both parties over the years share responsibility for shockingly higher health care costs and an all-too-inflexible system.

The GOPmust share some of the blame for the cost spiral Obamacare has wrought for the past seven years. When Republicanscontrolled both Congress and the White House in 2003 to 2007, they could have passed many of the health care reforms they now advocate most notably permitting nationwide shopping for health insurance and greatly expanding the eligibility for tax-free health savings accounts.

Had President George W. Bush and the GOP Congress done so, it's highly improbable that Obamacare would have seen the light of day. The same nationwide free-market competition that holds down car and auto insurance premiums would have a similar effect on health insurance premiums.

More patient consumerism and choice are what's needed, not Medicaid for all.

Steve Forbes, a candidate for the Republican presidential nomination in 1996 and 2000, is thechairman and editor-in-chief of Forbes Media. Follow him on Twitter: @SteveForbesCEO

You can read diverse opinions from ourBoard of Contributorsand other writers on theOpinion front page, on Twitter@USATOpinionand in our daily Opinion newsletter. To respond to a column, submit a comment to letters@usatoday.com.

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Private sector has health care cures, if we'd only get out of its way: Steve Forbes - USA TODAY

Republican health-care proposals don't address the real problems and could potentially wind up being "very destructive" to large hospitals in urban areas, Mount Sinai Health System CEO Dr. Kenneth Davis told CNBC on Thursday.

GOP leaders are still trying to garner enough votes to pass their bill in the Senate, while others in the party are putting forward their own ideas.

"We're going to be losing an awful lot of Medicaid and that's going to provide the hospital systems with lots more patients with uncompensated care," Davis said in an interview with "Closing Bell."

Plus, people with pre-existing conditions will also find they can't afford their policies, he said.

"The hospitals by law are going to have to take care of them and it's going to be very difficult to see how a lot of hospitals that already have very small margins are going to survive in that environment. We are fundamentally not dealing with the basic problems in health care by these bills."

Senate Majority Leader Mitch McConnell told Kentucky voters on Thursday that he's still grappling with getting enough votes for passage.

"I'm in the position of a guy with a Rubik's cube, trying to twist the dial in such a way to get at least 50 members of my conference who can agree to a version of repealing and replacing" Obamacare, he said.

Meanwhile, Sen. Ted Cruz, R- Texas, and Sen. Mike Lee, R- Utah, are circulating the "Consumer Freedom Option." The amendment would let insurers offer at least one Obamacare-compliant plan on a state's exchange, which would cover pre-existing conditions and get funding from tax credits and stability funds. "Freedom plans" would also be offered for healthy, young people.

Davis said the problem with that proposal is it takes healthy people out of the risk pool.

"As a consequence we are leaving behind in that comprehensive policy those people with pre-existing conditions, chronic disease or people who think they are at risk for illness," he said. "Those policies are going to be terribly expensive because you don't have the healthy people in those pools to bring down premiums."

He believes the issue of the high costs of health care need to be addressed.

"That means we have to change the way we deliver care," Davis said.

He proposes moving from fee-for-service toward a system where care providers are paid to manage a group of patients ahead of time.

"If they manage those patients efficiently, they're going to have some margin. If they manage them inefficiently, it's their loss," Davis said. "We've got to change the way health care is delivered. These bills are not addressing those questions."

CNBC's Kayla Tausche contributed to this report.

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GOP health-care bill not addressing problems, could be 'very destructive': Mount Sinai CEO - CNBC

The GOP health bills would eliminate the 10 percent tax on the use of tanning beds. It was one of more than a dozen taxes introduced as part of the Affordable Care Act. Robert Gauthier/LA Times via Getty Images hide caption

The GOP health bills would eliminate the 10 percent tax on the use of tanning beds. It was one of more than a dozen taxes introduced as part of the Affordable Care Act.

There's a lot of talk on Capitol Hill about the tax cuts included in the Republican health plans, but unless you are a frequent user of tanning beds or have personal wealth that puts you in the top 1 percent, you might not feel much effect.

The House and Senate bills both change or eliminate more than a dozen taxes that were levied to help pay for the Affordable Care Act's insurance subsidies and to bolster Medicare and expand Medicaid. Republicans and other ACA critics have argued that the taxes are onerous for businesses and families.

The Congressional Budget Office estimates that the tax cuts and coverage changes in the Senate proposal would reduce the federal government's revenue by $700 billion over the next 10 years.

We're answering three key questions about the tax cuts:

Most of them fall into two buckets.

Bucket 1: Taxes related to individual income

The ACA levied a 0.9 percent increase in the Medicare payroll tax on income above $200,000 for individuals or $250,000 for couples.

It also added a 3.8 percent tax on net investment income as in stocks, bonds, interest and capital gains that kicks in after $200,000 for individuals and $250,000 for couples.

As Senate leaders consider revisions to their bill, some senators including Republican Bob Corker of Tennessee have suggested leaving the investment tax in place to provide more money for subsidies, but others have objected to that idea. This would be a major divergence from the House-passed bill.

Still, if both of those taxes in the ACA were repealed, high-income Americans would collectively pay about $231 billion less in taxes over 10 years, according to the CBO analysis.

Bucket 2: Taxes on corporations

Since the passage of the ACA, drug companies and medical device manufacturers have complained that the taxes levied on them have a chilling effect on innovation and affect their ability to hire more workers. They also argue that costs are passed along to consumers in the form of higher prices.

Under the Senate plan, drug companies would see an estimated $25.7 billion cut over 10 years, while medical device makers would get about $19.6 billion in savings. Some of the cuts would start as early as this calendar year.

In both bills, there's also relief for insurers. The GOP plans would eliminate a tax on all insurers based on their market share. Congress waived the tax this year, hoping the one-time move would help slow premium increases. The CBO analysis of the Senate bill found a permanent cut would save the industry $144.7 billion over the next decade.

Other taxes outside the buckets

Smaller but not insignificant cuts come from eliminating other taxes, including a limit $2,600 this year on how much workers can annually set aside tax-free in flexible spending accounts to pay for things like medications, eyeglasses or co-payments for doctor's office visits. The plans would also increase the amount people could put in tax-protected health savings accounts. The Senate proposal would also revert tax law back to pre-ACA days in setting the threshold for medical deductions at 7.5 percent of adjusted gross income; the ACA had boosted that to 10 percent. The House approach is even more generous.

And not to be forgotten: The GOP plans would delete a 10 percent tax on the use of tanning beds.

The short answer: Unless you're wealthy, probably not.

The ACA significantly increased average taxes on high-income people mainly through the investment income tax and the Medicare payroll tax. So the top 1 percent and other high earners are the group that would benefit most from the repeal, according to several analyses, including one by the Tax Policy Center, a nonpartisan think tank in Washington, D.C.

Under the GOP proposals, the top 1 percent those earning $875,000 a year or more in 2026 would get an average tax cut of about $40,000 per year, while middle-income people earning about $50,000 to $90,000 would see about a $300 cut, according to Howard Gleckman, a senior fellow at the center.

Those earning about $28,000 or less could save an average of $180 a year through the changes to limits on FSA and HSA contributions and the threshold on medical deductions, he says.

Even though the tax cuts and other changes would reduce Treasury revenue by about $700 billion over the next decade, spending cuts exceed that amount, so the deficit actually goes down by $321 billion, the CBO says.

The biggest spending cuts hit the Medicaid program, which provides health coverage for low-income children and adults and people with disabilities. Medicaid pays for nearly half of all births and much of the cost of nursing home care. Spending on Medicaid by 2026 would shrink by 26 percent compared with what it would be under the ACA.

As to other effects, the number of Americans without health insurance coverage would rise, the CBO says. Because the GOP proposals cut the tax penalty for not having insurance, it estimates that far fewer people would enroll in coverage. That, coupled with smaller subsidies to help lower- and middle-income people buy their own insurance and cuts to Medicaid, could lead to 22 million fewer insured Americans by 2026, the CBO says.

States could choose to try to make up for federal Medicaid spending cuts and maintain current levels of coverage, but that would probably involve raising state taxes, cutting other budget items such as education, or both.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Who Would Enjoy Tax Breaks Under The GOP Health Care Proposals? - NPR

Protesters around the country on Thursday responded to lawmakers who declined to hold town halls by bringing their complaints straight to the doors of their elected officials' offices.

From Arkansas to Arizona, supporters of Obamacare chanted, sang songs and in some cases, got arrested as they made their case against the Senate Republican health care bill.

ARIZONA

The Arizona chapter of the Progressive Democrats of America, a grassroots PAC operating inside the Democratic Party, said five of its members were arrested at a gathering outside the Phoenix office of Sen. Jeff Flake after a building manager called the police, claiming they were standing on private property. ABC affiliate KGUN reported that the four women and one man were taken into custody for trespassing after they repeatedly refused to leave the private property.

Protesters chanted "Where is Jeff Flake!" and "Nows the time to stand and fight! Health care is a human right!

In Tucson, Pima County Sheriff's deputies arrested two men at a health care-related protest at Sen. Jeff Flake's office Thursday morning, according to KGUN. Deputies say the men were arrested just before 9 a.m. for reported threats. One of the protesters allegedly referenced the shooting of U.S. Rep. Steve Scalise, according to KGUN.

ARKANSAS

In Arkansas, protesters waited in Sen. Tom Boozman's Little Rock office, but were told by a staffer to limit themselves to ten people inside the small waiting room.

"Let's please be respectful of each other," the staffer told the group.

"Well, we would like for our senator to be respectful," a protester responded. "If you're going to have constituents, and if he's going to be the U.S. Senator, he should have an office where constituents can come sit and speak their minds!"

At Sen. Tom Cotton's office, in the same building as Boozman's office, other protesters sang pro-Medicaid songs, to the tune of "Glory, Glory Hallelujah."

And another protester told a Cotton staffer, "The legislation is supposed to make cuts to VA services ... as a veteran Sen. Cotton should have other veterans in mind." The staffer responded, "We appreciate your service. Thank you."

TEXAS

Sen. Cruz was one of the few Senate Republicans to hold a town hall. Most of the questions at the event in Austin were on veterans' health care, but he did have a few spirited exchanges with supporters of the ACA.

"I'm happy to have a conversation, but if we're just yelling back and forth at each other, we can't have that," he told one heckler.

At the end of the event he thanked the largely friendly audience for a "respectful and spirited debate," adding, "we may not have convinced each other but that's part of the democratic process."

Protesters, who chanted songs, also rallied outside of Sen. John Cornyn's office in Austin.

Police were spotted escorting protesters away, and one of the officers was spotted frisking a male protester.

COLORADO

Obamacare supporters held a "Save Medicaid Rally" in Denver, where several hundred people showed up.

One female protester urged rally-goers to call Sen. Corey Gardner. "Call him at least once a day and tell him to vote no and to commit to us, before he leaves Colorado, to vote no on this ridiculous tax cut for the wealthy!" she said.

Activists at Sen. Corey Gardner's Denver office didn't get a face-to-face meeting, but they did get a 15-minute phone chat with their senator, who was not in the Denver area.

They told him they "demanded" that he vote "no" on the Senate bill -- but Gardner said he couldn't say how he would vote because the bill as presented is just a "discussion draft," not the final version.

"I cant commit yes or no," he told the activists, from the Denver chapter of Democratic Socialists of America.

KENTUCKY

A few dozen protesters chanted and held signs outside Sen. Mitch McConnell's office in Lexington.

"Don't get sick! Please die quick!" chanted protesters, mocking the GOP's healthcare plan.

KANSAS

Sen. Jerry Moran was treated warmly by a crowd at a town hall in Palco that seemed largely supportive of Obamacare, because he opposes the current Senate GOP bill.

He had a few exchanges with the liberal members of the audience, but all of them were respectful. This was a crowd that clearly appreciated being among the few that actually had an opportunity to talk to their senator over this recess.

If public hearings are not held in the Senate on the next Senate bill, will you withhold your vote? one attendee asked Moran of the health care bill.

I will not necessarily. That's not the criteria. I know that's not the answer you were looking for, Moran responded.

No! she said back, though she listened attentively as he explained why that wasnt the case.

Moran touched on the scarcity of Republican town halls.

I've been told that it's silly to hold town hall meetings, he said. You may not be my voters, but you are my constituents. And you deserve to have a conversation with me, he added, to applause.

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Protesters opposing GOP health care bill descend upon lawmakers, some arrested - ABC News

Six months into President Trumps term, the Republican majority in Congress has largely been consumed by its effort to repeal the Affordable Care Act. This is unsurprising, given the GOP has been fixated on repealing Obamacare for the past seven years.

At the time of passage, we all recognized that the ACA was far from perfect, but its benefits for many Americans were undeniable. Americas uninsured rate has dropped to its lowest point in 50 years, millions more Americans have access to a doctor and do not risk financial ruin when they get sick or injured.

Unlike most legislative battles, the partisanship surrounding the ACAs passage has continued through its implementation. Congressional Republicans have fought to weaken the law rather than address changing conditions in the healthcare market or any deficiencies. Now in control of the White House, President Trump has taken steps to undermine the Affordable Care Act and cause its collapse, by withholding payments to insurers and creating destructive uncertainty in the market. If insurers cannot count on the Trump Administration to make required payments, they must raise premiums dramatically or leave the market just the kind of death spiral the president hopes to create.

I supported the ACA in 2010 because I believed then, as I do now, that healthcare is a human right and it ought to be universal. I supported including a public option in the ACA that didnt make it into the final bill, because it would have further constrained costs and created additional competition.

That is a concept I still support, because in the wealthiest nation in the world, it is unconscionable that millions of Americans, including children, go without access to care. For millions of families, a bad diagnosis can mean bankruptcy. For the parents of children with a congenital heart condition or other birth defect, it means a lifetime of worry not only about their child, but what will happen when they hit their lifetime limit and potentially owe millions.

The ACA did not fix every issue in our healthcare system, but it created a framework to get us the rest of the way. Through Medicaid expansion, millions more low-income Americans became eligible for coverage. Moreover, by creating a system of insurance exchanges and subsidies to help those who did not get coverage through their employer, the ACA created a market-based solution to expand access and affordability. And it worked.

Now, seven years later, Congressional Republicans are forging ahead with a bill that President Trump called mean. It would force more than 20 million people off their coverage, allow states to opt out of protections for preexisting conditions and lifetime limits, and most importantly, gut coverage for millions of children, disabled and elderly Americans. This bill would cut $800 billion from Medicaid in the first 10 years and hundreds of billions more later to give a major tax cut to the wealthy.

The Senate bill is no better and may become worse still. The Republicans who tout it do so because of the tax cut it creates, not its purported health-policy solutions. Yet Republicans push forward because they feel compelled to repeal the ACA, no matter how many Americans suffer as a result. That either chamber would tout a bill that cuts off tens of millions of Americans and is supported by only 16% of the public is as perplexing as it is wrongheaded.

The battle we fight today should be about expanding coverage to millions more, not deciding how much coverage we should take away from people who already have it. Whether Congressional Republicans are successful in their repeal efforts or not, universal healthcare must be our goal.

As President Trump realized all too late, healthcare is really complicated. But our priorities should not be: We must endeavor to provide quality, accessible care to every American.

Rep. Adam Schiff (D-Burbank) represents the 28th Congressional District in the U.S. House of Representatives.

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Why we fight for universal healthcare - Los Angeles Times

An important question in the debate over proposals to repeal and replace the Affordable Care Act (ACA) is what might happen to the laws many provisions affecting the Medicare program. The American Health Care Act (AHCA), which was passed by the House of Representative on May 4, 2017, and the Better Care Reconciliation Act (BCRA), released by Senate Republicans on June 22, 2017, would leave most ACA changes to Medicare intact, including the benefit improvements (no-cost preventive services and closing the Part D coverage gap), reductions to payments to health care providers and Medicare Advantage plans, the Independent Payment Advisory Board, and the Center for Medicare and Medicaid Innovation.

However, both bills would repeal the Medicare payroll surtax on high-income earners that was added by the ACA, effective January 2023. That provision, which took effect in 2013, provides additional revenue for the Part A trust fund, which pays for hospital, skilled nursing facility, home health and hospice benefits. The Part A trust fund is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each). The ACA increased the payroll tax for a minority of taxpayers with relatively high incomesthose earning more than $200,000/individual and $250,000/coupleby 0.9 percentage points.

In addition to repealing the ACAs Medicare payroll surtax, both bills would repeal virtually all other tax and revenue provisions in the ACA, including the annual fee paid by branded prescription drug manufacturers, which would decrease revenue to the Part B trust fund. The bills would also reinstate the tax deduction for employers who receive Part D Retiree Drug Subsidy (RDS) payments, which would increase Medicare Part D spending.

According to the Congressional Budget Office, the provision in the AHCA and the BCRA to repeal the Medicare payroll surtax would reduce revenue for Part A benefits by $58.6 billion between 2017 and 2026. Proposed changes to the ACAs marketplace coverage provisions and to Medicaid financing in both bills would also increase the number of uninsured, putting additional strain on the nations hospitals to provide uncompensated care. As a result, Medicares disproportionate share hospital (DSH) payments would increase, leading to higher Part A spending between 2018 and 2026 of more than $40 billion, according to CBO.

Altogether, changes to Part A spending and financing in the AHCA and BCRA would weaken Medicares financial status by depleting the Part A trust fund two years earlier than under current law, moving up the projected insolvency date from 2028 to 2026, according to Medicares actuaries (Figure 1).

Figure 1: Repealing the Medicare payroll tax on high-income earners, plus other provisions affecting Medicare spending and financing, would deplete the Part A trust fund in 2026, 2 years earlier than under current law

Reducing the flow of revenues to the Part A trust fund by repealing the payroll surtax paid by high-income earners and increasing Part A spending due to higher DSH payments has direct implications for the ability of Medicare to pay for Part A benefits on behalf of Medicare beneficiaries. When spending on Part A benefits exceeds revenues, and assets in the Part A trust fund account are fully depleted, Medicare will not have sufficient funds to pay all Part A benefits (although the Medicare program will not cease to operate).

In addition to the impact on Medicares solvency in the short term, repealing the high-income earner payroll surtax and other proposed changes affecting Part A spending and revenues would also worsen the programs long-run financial status, increasing the 75-year shortfall in the Part A trust fund from 0.73 percent of taxable payroll to 1.18 percent, according to Medicares actuaries.

The projected date for depletion of the Medicare Part A trust fund has varied over time as a result of changes in policy and the economy affecting both revenues and spending (Figure 2). In the past, looming insolvency has prompted policymakers to debate and pass legislation that reduced Medicare spending, thereby improving the financial status of the Part A trust fund. For example, during the mid-1990s, when the Medicare actuaries were projecting trust fund insolvency by 2001, Congress enacted the Balanced Budget Act (BBA) of 1997, which reduced Medicare spending and extended the solvency of the Part A trust fund by an additional seven years. With the enactment of the ACA in 2010, Part A trust fund solvency was extended by several years as a result of the laws provisions to increase the Medicare payroll tax on high-income earners and reduce provider and plan payments (Figure 3).

Figure 2: The projected depletion of the Medicare Part A trust fund has varied over time as a result of changes in policy and the economy affecting both revenues and spending

Figure 3: The Medicare Hospital Insurance trust fund gained additional years of solvency with enactment of the ACA

Whether the Part A trust fund remains solvent for an additional 11 years, as projected under current law, or 9 more years, under proposed changes affecting Medicare Part A spending and financing in the AHCA and BCRA, Medicare faces long-term financial pressure associated with higher health care costs and an aging population. Even if the payroll surtax on high earners is retained, the Part A trust fund is likely to need additional revenue to finance care for an aging population, unless policymakers choose instead to reduce Part A spending by cutting benefits, restricting eligibility, or reducing payments to providers and plans. By cutting taxes on high-income earners and thereby reducing revenue to the Medicare Part A trust fund, the AHCA and BCRA would increase pressure on policymakers to take some type of action sooner rather than later.

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What Are the Implications for Medicare of the American Health Care Act and the Better Care Reconciliation Act? - Kaiser Family Foundation

One hour into Sen. Ted Cruzs town hall meeting on veterans issues in McKinney, Texas, on Wednesdaynight, a doctor stood up andtold him, You all are scaring the living daylight out of us with the health care nonsense youre doing.

Cruz, who has been a key playerin the Senates health care negotiations, responded that he is fighting to repeal President Barack Obamas signature health care law, and working to expand choice and competition to lower insurancepremiums.

The process of repealing it in Congress, its been messy. Its been bumpy. I am not certain well get it done, the Texas Republican said, according to a recording of the event. I hope we will. I believe we will.

The exchange highlighted broader questionsfacing Cruz ashe looks to repeal the 2010 law, a stance that helped propel him to national prominence. Does he make the bill more conservative, potentiallycompromising on other aspects of thelegislation? Or does he ultimately vote against thebill becauseit doesnt go far enough? And what will Texas voters think?

Fiveyears ago, Cruz looked into a television camera and said the effort to repeal the health carelawwould be an epic political fight.

There is going to be enormous pressure to compromise, Cruz said. I think we should repeal it in its entirety.

Cruzs comments came during a televised debate with Texas Lt.Gov. David Dewhurst, who also said he wanted to repeal the law.The pair were locked in a runoff for the Republican nomination for the Senate. They weresimilar in substance, but differed in style.

Cruz, a well-spoken lawyer who had never been elected to office, pulled off an upset to win the primary, a major tea party victory.

Fast forward to this summer, and the stridently conservativepolitical outsider is now working on the inside.

Cruzhas been engaged with 12 other colleagues in closed-door discussions on the legislation to repeal parts of the health care law. The senator who oncespoke ofthe pressure to compromise is now welcomed by his colleagues for his willingness to do so.

The quieter, behind-the-scenes style isa changefor Cruz, according to his fellow lawmakers. Four GOP senators used the same word to describe his role: constructive.

It is welcomed, said South Carolina Sen. Lindsey Graham, who was open about the disdain senators felt for Cruz. (Graham once joked that if Cruz was murderedon the Senate floor, a jury of senators would not convict the killer.) Grahamand Cruz both ran for the GOP presidential nominationlast year, losing to Donald Trump.

I think running for president was probably a good experience for him, Graham said. It shows the diversity of the party and being able to solve problems is a good thing.

Senators also positively describe Cruzs willingness to engage in one-on-one meetings. Sen. Rob Portman, who raised concerns about the health care legislations effect on Medicaid recipients, said Cruz cameby his office last week to discuss the stalled bill.

Hes been looking for ways to find compromise, the Ohio Republican said.

For Cruzs allies, his role in the deal-making is no surprise.

Ive known him in private and Ive known him to be a deal-maker the entire time that Ive been in Congress, said North Carolina GOP Rep. Mark Meadows. Many others in the public have not seen that.

Meadows, who chairs the hard-lineconservative House Freedom Caucus, said Cruz and GOP Sens. MikeLee of Utah and Rand Paul of Kentucky have been keeping his caucus up-to-date on Senate developments. But the North Carolina Republicansaid Cruz has been guarded when he talks to House members.

His communications with us have been more strategic and focused thanperhaps just saying, Well, let me share whats going on, Meadows said. Its almost seen as he doesnt want to undermine the credibility he has with some of these senators.

Chip Roy, Cruzs former chief of staff, now at the Texas Public Policy Foundation, said Cruz hasnt shifted his style, but is adjusting to a Republican-controlled government.

Hes trying to reflect and represent the people who sent him to Washington to change it, Roy said. What is different is the operating environment.

Meadows said he didnt expect too many Cruz supporters tobe deterred now that hes working from the inside.

For every person that may wish that he took a more strident position, I think theres at least one, maybe two, that would say were glad that Congress is finally making progress, the congressmansaid.

Cruz also still hasthebacking of conservative outside groups, who support his amendment allowing insurance companies to offer plans without certain coverage areas mandated by the2010 health care law, as long as the companies sell one plan that complies with the mandates.

But his amendment could renderthe current Senate proposal, known as the Better Care Reconciliation Act, too conservative for the more moderate members of the GOP conference. The bill remainsat a standstill, with the risk of nothing getting done to fulfill the promise Republicans have campaigned on for sevenyears.

If nothing gets done, Republicans, and even Cruz, could face a backlash from voters frustratedby inaction.

If theres three votes [against the GOP bill] and hes one of the three that could be a problem, said one Texas GOP operative. I think Obamacares that important to the Republican primary voter.

Others disagreed, since Cruzs opposition would likely be because thebill did not repealenough of the health care law.

The promise is to repeal Obamacare, not to pass anything that has the word health care in it, Texas Republican Party Chairman James Dickey said.

Democrats see Cruzs conundrum as a lose-lose situation for him.

Hes going to have to ultimately vote against this, and have reneged on his years-long pledge to repeal and replace Obamacare, said Matt Angle, a Texas Democratic consultant.Or hes going to vote for and help adopt something that is going to hurt people badly.

Cruz is one of only eight Republican senators up for re-election in 2018, and he already has a Democratic challenger in Rep. Beto ORourke.

The health care debate couldnt come at a better time for Beto ORourke because of the reliance of many of the red counties in Texas on government-sponsored health care, said Colin Strother, a Texas Democratic strategist.

Texas is one of 18 states that did not expand Medicaid under the 2010 health care law. But more than 4 million Texans are enrolled in the program, while roughly 3.6 million rely on Medicare, according to the most recent data provided by Texas Healthand Human Services and the Kaiser Family Foundation.

Localizing the bills impact by explaining how the GOP legislationcould affect Texanswould be a smart move for ORourke, Strother said.

However, Republican voters in the Lone Star State have supported politicians who campaigned on repealing and replacing the 2010 law.Given the statesconservative leaning, GOPoperativesbelieve Cruz is still in a strong position. Inside Elections with Nathan L. Gonzales rates this race Solid Republican.

Cruz also won last years presidential primary in Texas by nearly 17 points. Trump won the state in November by 9 points.

That victory margin for Trump was the smallest for a Republicanpresidential nominee in Texas in twenty years. One GOPconsultant raised concern overhistoric trends, in which the presidents party does not fare well in the first midterm election of the administration, and said its possible GOP voters would stay home.

Democrats say there is arenewed energy around ORourke, the young third-term congressman from El Paso. Republicans say ORourke, who supports a single-payer health care system, is too liberal for Texas. But Democrats think he could have achance.

Smart people are going to be wary that a Democrat can win in Texas right up until they do, said Strother, the Democratic strategist. I think thats kind of a natural state.

To have someone run as a bold progressive that says, Im not ashamed of who I am or what I believe in, thats a different dynamic that we havent seen statewide in Texas, Strother said. And I happen to think its something that we cant handicap for.

As ORourke travels the state taking on Cruz from the left, Republicans are not gearing up for a primary battle. Dickey, the party chairman, said he was not aware of any primary challenges to Cruz, andsaid the party does not take sides in primaries.

GOP Rep. Michael McCaul last year declined to say whether he would challengeCruz. Asked last week if he was considering a primary challenge, McCaul said, I dont want to talk about Ted Cruz.

McCaul criticized Cruz for focusingon his nationalambitions insteadof serving the LoneStar State, a criticism some Texans say the senatorstill faces today. In 2018, Cruz is looking to prove that hes laser-focused on Texas.

I think Sen. Cruz realizes that he took on some negative water from the presidential race and hes trying to move past and showpeople that hes focused on his job, one Texas GOP operativesaid. Its very clear that hes going to be in the Senate for while.

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Cruz Walks Health Care Tightrope, With Eye on 2018 - Roll Call