Theheadlinesfrom Capitol Hill give the impression that Congress is debating the future of U.S. healthcare. Thats somewhat misleading. The debate is about health insurance, not healthcare.

It is an important distinction. Insurance is a ticket to enter the healthcare system. Healthcare is what the system delivers. To be sure, if Congress rolls back insurance coverage, it will prevent millions of Americans from gaining timely access to healthcare. That is abad outcome in itself and worthy of the attention its getting.

Nonetheless, a real debate over healthcare would begin with an accurate diagnosis of our ailing system. We have theworlds most expensive healthcare, and despite the superior quality of American providers, science and technology ourlife expectancyandinfant mortality ratesare the middle of the pack among developed nations.

The cost, quality and patient experience of care varies widely among doctors and hospitals. Despite billions of dollars of investments in information technology, medical records still dont follow patients across providers, and we lack the real-time data insights that fuel quality improvement in other industries. Finally, our healthcare system emphasizes treating people when they are sick not keeping them well.

Federal policy on its own cannot improve the sectors leadership, culture, cost or quality. Those of us who provide care must step up and accept accountability for the results we deliver. But the federal government can help us chart a course toward more patient-focused, coordinated and cost-efficient care by giving us the right incentives, setting consistent rules and removing the roadblocks.

Thats why a new debate should begin with the topic that is currently missing from the headlines: payment.

We pay for most healthcare services today one by one, a system called fee-for-service. The more services a doctor or hospital delivers, the more they get paid. Sicker patients earn them (us) higher payments and drive each healthcare team member to concentrate on the services they alone deliver, not the patient as a whole person. As a result, we care for people in a fragmented, inefficient and costly fashion.

Conversely, if we were to pay providers based on the quality and cost of care they provide, they would more likely focus on keeping people well, managing patient illnesses and preventing costly interventions that send people to the hospital. This is known popularly as value-based care. It may be a poor choice of phrases, conjuring up K-marts blue-light special instead of Tiffanys light blue box, but the point is the right one: payment should reward the value of services not the volume. Value-based payment holds providers accountable for the quality of their care, and puts their payments at risk if they dont deliver.

The federal government can play a decisive role in moving the ball forward. Medicare alone accounts for20 percent of all healthcare spending. Under both Democratic and Republican administrations, Medicare has begun to embrace value-based payments.

But instead of accelerating this trend, the Trump administration has proposed slowing it down, albeit to avoid overwhelming small physician practices. If we stay on this course, it will penalize early adopters like Prevea Health and many of my fellow American Medical Group Association members, which have invested millions reengineering systems to provide value-based care. The administration should be helping lead the way, not putting on the brakes.

We also lack timely access to Medicare and commercial payer claims data about the very patients we serve. Data is the lifeblood of quality improvement, and without it, we lack the feedback we need to improve patients health outcomes. Congress can fix this by requiring both federal and commercial payers to provide access to this data.

But data is also a double-edged sword. Currently, Prevea is required to submit data to numerous payers in different formats. And we are not alone shouldering this incredible burden on financial and workforce resources that could be spent on patient care.

One study reported inHealth Affairsfound that physicians in four common specialties spend, on average, 785 hours per physician and $15.4 billion annually dealing with the reporting of quality measures. Congress should require federal and commercial payers to standardize the data submission and reporting processes.

In the depths of the Great Depression, FDR said, The country demands bold, persistent experimentation. It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something.

Bold, persistent experimentation is what we, as healthcare leaders, need to be asking of Congress. We know the healthcare system we have isnt serving our best interests. The debate we should be having in Washington and throughout our country is about creating a system that will.

AshokRai, M.D., is president and CEO of Prevea Health and the incoming chairman of American Medical Group Association,an Alexandria, Va.-based association representing multispecialty medical groups and integrated systems of care.

The views expressed by contributors are their own and are not the views of The Hill.

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The healthcare debate we're not having - The Hill (blog)

By Todd G. Buchholz By Todd G. Buchholz August 17 at 7:25 PM

Parrots can learn economics, claimed Victorian economist Alfred Marshall. Just teach the parrot to squawk supply and demand. So if a parrot can learn, why cant the U.S. government?

House and Senate GOP health-care plans, like Obamacare itself, have squawked loudly about subsidizing demand but said little about the supply of doctors, nurses and drugs. That is economic malpractice.

It is also so 20th-century. In an era of Amazon, Uber and Airbnb, the non-health-care economy is getting a shock treatment of new supply that is boosting accessibility while restraining prices. Health care needs a supply-side shock, too, and government can help.

Health care is not entirely immune to supply-side pressures. When Lasik eye surgery appeared in 1999, thousands of eye surgeons jumped into the act and prices fell by about 25 percent in 10 years. Shortly after the Food and Drug Administration approved Botox for furrowed brows in 2002, dermatologists, nurses and spas jumped in, keeping prices from rising. The government does not subsidize these cosmetic procedures.

We are seeing other hints of supply-side improvements in medicine. In California, Heal.com will send a doctor to your house for $99. Does it work? In San Diego, Heal.com receives a 4.5 score on Yelp. Nearby hospitals receive a 3.0.

Now, of course, the hospital handles many more dire cases than a drive-up doctor making house calls. But note this: Many hospital patients are labeled LWOT (left without treatment). These are cases in which sick or injured patients feel so frustrated with waiting times that they drive off. In one California hospital, more than 20 percent of emergency-room patients are LWOT.

An aging population is pushing up demand, and without more supply, prices will catapult higher. Doctors are aging, too: More than 30 percent are 60 or older. Forecasts project a physician shortage ranging from 46,000 to 90,000 by 2025, especially among specialists.

Already, one quarter of the federal budget goes to Medicare and Medicaid. Taxpayers will find themselves frustrated with packed waiting rooms and higher taxes. So what can Washington do to help spark a supply-side shock in health care? Here are four important steps:

First, we need new medical schools. The United States accredited no new medical schools from 1986 through 2004. Recently, in response to the looming shortage of doctors, a number of new schools have been announced, for example, at the University of Nevada, Seton Hall and Washington State. Yet new schools face formidable licensing costs and delays from federal, state and local boards, which can deny accreditation for serious reasons such as unhygienic equipment as well as nonmedical worries such as the dimensions of parking garage spaces. Government agencies can work together to fast-track approval processes.

Second, state governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics, such as CVSs Minute Clinic and Walmarts Care Clinic. Research shows that, compared with doctors offices, such clinics deliver cheaper and equivalent care for patients who presented symptoms of ear infections, sore throats and urinary tract infections.

Third, the Food and Drug Administration should pursue reciprocity for drug approval with other advanced countries. Under current law, if a drug is approved by the European Medicines Agency, Americans cannot buy it unless the FDA slogs through its own long, expensive protocol. And theres precedent: In 2013, a potentially lethal meningitis outbreak spread through Princeton Universitys dorms. Princeton begged the government to allow it to buy a common vaccine made by Novartis in Switzerland. The bureaucrats eventually relented. Why cant the FDA permit reciprocity with other advanced countries for other cases?

Finally, legal reform could also save patients money. Fear of lawsuits cuts the effective supply of health-care services in two ways: First, malpractice insurance payments encourage early retirement. Second, fear prods practicing doctors to order unnecessary procedures, leaving fewer resources for those who need treatment. More than 80 percent of physicians say that they prescribe tests for fear they will be sued if they do not. The American Board of Internal Medicine has specified 45 tests that are often prescribed without merit, from annual electrocardiograms to imaging for temporary lower back pain.

Americans need more doctors, more nurses and more prudent care.Trying to solve health-care problems by focusing just on demand is like trying to cut rope with only the bottom blade of a scissors. Youll likely struggle to get the results you desire, and you might even hurt yourself.

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All of these health-care plans are so 20th century - Washington Post

Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way 58 percent opposed single-payer. Whats changed?

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firms vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients not reimbursement, Miller said.

In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.

A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians owned their practice 47.1 percent according to the American Medical Associations surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.

Theres also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon.

I would say there is a sense of frustration, a sense of maybe resignation that were moving in that direction, lets go there and get it over with, he said.

Merritt Hawkins emailed its survey Aug. 3 and received responses from 1,003 doctors. The margin of sampling error is plus or minus 3.1 percentage points.

The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians. Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.

Thats the debate were moving into, thats why youre seeing a renewed interest in single-payer, Martin said.

Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.

Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students increasing support for a single-payer system, an attitude they likely carry into their professional careers.

Most of the medical students here dont understand why the rest of the country doesnt support it, said Schroeder.

The Merritt Hawkins findings follow two similar surveys this year.

In February, a LinkedIn survey of 500 doctors found that 48 percent supported a Medicare for all type of system, and 32 percent opposed the idea.

The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the best care to the greatest number of people. More than 1,000 doctors were surveyed.

Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for a single-payer to replace the Affordable Care Act. The plan was drafted by the Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer.

Clare Fauke, a communications specialist for the organization, said the group added 1,065 members in the past year and membership is now the highest since PNHP began in 1987.

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Doctors warm to single-payer health care - Salon

The Trump administration, faced with increasing pressure from Republican members of Congress, backed away from causing an immediate crisis in healthcare marketplaces and agreed Wednesday to continue making payments to insurance companies that are widely viewed as critical to keeping the industry stable.

President Trump and his top aides have flirted for months with cutting off the money, known as cost-sharing reduction payments, which help subsidize insurance co-payments and deductibles for low-income and moderate-income Americans. Doing so would be one step toward causing the Affordable Care Act to implode as Trump has sometimes put it.

The decision to make this months payment, due next week, signaled that the administration has decided against immediately precipitating a collapse, potentially giving Congress time to pass a bipartisan package of fixes to some of the laws problems.

Leading Republican members of Congress have pressed the administration to keep making the payments, fearing that any move to cut them off would cause chaos in insurance markets. Trump has said voters would blame Democrats for any problems with the markets, but few Republican elected officials share that view.

The pressure to continue the payments increased Tuesday when the Congressional Budget Office reported that cutting off the payments would actually increase federal spending. Ending them would cause insurance premiums to rise sharply and thereby increase the cost of other government subsidies, the budget office said.

A White House official confirmed Wednesday that the administration had decided to make this months payment, which will total about $600 million. The question of whether to make future payments remains under review.

The announcement drew praise from Sen. Lamar Alexander (R-Tenn.), the head of the Senate committee that handles healthcare legislation.

The decision to continue the subsidies helps 18 million Americans who dont get insurance from the government or on the job, Alexander said in a statement.

When Congress returns from its recess in September, lawmakers should quickly pass legislation that would continue the payments through next year, Alexander said.

The continuation should be linked to changes in the current law to give states more flexibility on the kinds of insurance policies that consumers can buy, he added.

But some conservative lawmakers and organizations were quick to voice their displeasure, calling the payments a bailout of insurance companies.

That opposition illustrated the difficulty Alexander and like-minded lawmakers will face in trying to round up Republican support for legislation to stabilize a healthcare law the party has long wanted to repeal.

And if Congress does not quickly settle the issue, the continued month-to-month uncertainty about the payments is likely to cause insurers to hike premiums.

Already, industry executives have publicly blamed the uncertainty for higher premiums for next year. Insurers are coming up on deadlines next month for setting their premiums for next years open enrollment period.

The part of the healthcare law at issue greatly lowers the cost of insurance for millions of low- and middle-income consumers by requiring insurers to hold down deductibles and co-payments.

That requirement can save thousands of dollars for families with big medical bills who can qualify for the cost reductions if their incomes are below about 2 times the federal poverty level.

The requirement to hold down co-payments and deductibles, however, costs insurance companies a lot of money. To make them whole, the government reimburses them with the monthly payments.

Since early this year, the administration has refused to commit to continue sending the checks.

In late July, after Republicans failed in their effort to repeal the healthcare law, Trump said that he wanted to let Obamacare implode. An abrupt cutoff of the cost-reduction payments would be among the quickest ways to make that happen.

The cost-sharing reductions have long been a controversial part of the healthcare law.

Republican lawmakers went to court in 2014 to challenge the payments, saying Congress had never appropriated money for them. A federal district judge in Washington agreed last year. The Obama administration appealed, and the ruling has been on hold ever since.

At one point, Trump administration officials talked of dropping the appeal as a way to kill the payments. That option faded this month after Democratic state attorneys general won the right to intervene in the case, which would allow them to keep the appeal alive if Trump pulled out.

Although many of Trumps advisors oppose the payments, the budget office report Tuesday put them in a difficult position.

The report from the nonpartisan budget office said that cutting off the payments would have paradoxical effect of increasing federal spending.

Thats so because insurers would still be required to hold down deductibles and co-payments for low- and moderate-income consumers. To avoid losing money, some insurers would pull out of the marketplaces. Most, however, would raise premiums, the budget office projected.

The premiums for the medium-cost silver plans on the exchanges, which are the most popular plans among consumers, would go up by about 20% to 25% over the next couple of years if the cost-sharing payments ended, the budget office said.

The cost of those higher premiums would land primarily on taxpayers, not on individual consumers. Thats because nearly 80% of people receiving coverage on the marketplaces also receive a second kind of government assistance to help pay monthly premiums. As overall premiums rise, so will the cost of those other government subsidies.

The net result would be to increase the federal deficit by almost $200 billion over the next 10 years, the budget office said.

If the subsidy payments were ended, insurers pulling out of the market would leave about 5% of the population in counties with no marketplace insurer, the budget office also projected.

david.lauter@latimes.com

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Trump administration agrees to continue healthcare subsidy for now - Los Angeles Times

Pittsburgh Post-Gazette

Health care still an employee priority as businesses eye uncertain future Pittsburgh Post-Gazette Health care remains a primary concern for most employees in the job search process, though some companies say that age impacts how important of a consideration those benefits are. At Leroy Metz's Downtown law firm Metz Lewis Brodman Must O'Keefe, ...

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Health care still an employee priority as businesses eye uncertain future - Pittsburgh Post-Gazette

But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.

Aledade, which has raised about $75 million from investors, has an agenda so ambitious it sounds all but impossible: Dr. Mostashari wants to reduce the cost of health care while improving how patients are treated. He also wants to save the independent primary care doctor, whose practices have been battered by the perverse incentives of the American health care system.

And here is the most interesting part: His plan is working.

A few weeks ago, I visited two primary care practices in southeast Kansas that have worked with Aledade for more than a year. Their operations had been thoroughly remade by the company. Thanks to Aledade, the practices finances had improved and their patients were healthier. On every significant measure of health care costs, the Aledade method appeared to have reduced wasteful spending.

The whole idea is to align incentives between society and doctors and patients, Dr. Mostashari said, adding that Aledade has helped reduce hospital readmissions and decrease visits to specialists in many of its markets. Were reducing unnecessary and harmful utilization and improving quality of care.

Of course, such promises are not new at the intersection of health and technology. Many companies have made big bets and blown up among them Theranos, the lab testing start-up, which turned out to have been more puffery than product. Aledade faces its own share of hurdles, including whether its investors can ride out a long and costly expansion before it starts to realize any big paydays.

Still, its plan which mainly involves using software to achieve its goals looks promising.

The American health care system is a fragmented archipelago, with patients moving through doctors offices and hospitals that are often disconnected from one another. As a result, many primary care physicians who often see themselves as a kind of quarterback who calls the shots on a patients care have no easy way to monitor a patients meandering path through the health care system.

Aledades software addresses that by collecting patient data from a variety of sources, creating a helicopter view. Doctors can see which specialists a patient has visited, which tests have been ordered, and, crucially, how much the overall care might be costing the health care system.

More important, the software uses the data to assemble a battery of daily checklists for physicians practices. These are a set of easy steps for the practice to take call this patient, order this vaccine to keep on top of patients care, and, in time, to reduce its cost.

For example, say youre a doctor at a small practice in rural Kansas and one of your patients, a 67-year-old man with heart disease, has just gone to the emergency room.

In the past, wed only find out our patients were at the hospital maybe weeks afterward, said Dr. Bryan Dennett, who runs the Family Care Center in Winfield, Kan., with medical partner, Dr. Bryan Davis. With Aledade, Dr. Dennett is now alerted immediately, so we can call them when theyre at the emergency room and say, Hey, what are you doing there? Come back here, we can take care of you!

It is not just emergency room visits. Aledade tells doctors which of their patients is eligible for preventive care like vaccines or an annual wellness visit. The doctors said that during such visits they have discovered several conditions that would have ballooned into much bigger problems without treatment. The software lets doctors know when their patients have been discharged from the hospital, allowing them to schedule transitional care management visits.

Such visits are a gimme for the health care system they have been proved to reduce hospital readmissions (which are extremely costly), and patients say they find them valuable in navigating the health care system. And because these visits are so effective at lowering overall health care costs, Medicare pays doctors a higher rate to provide such care meaning that primary care doctors can make money by following Aledades alerts.

Yet even though Aledade thinks of itself as a technology company, its doctors said its software is the least interesting thing it does. Independent primary care doctors tend to be cautious about technology, especially if it seeks to thoroughly alter how they work. So the real battle Aledade faces is to integrate technology into doctors practices and to do so in an nonintrusive and pleasing way. The softwares instructions must also prove financially rewarding for clinics, while still somehow saving money for the overall health care system.

To do all this, Aledade which now operates in 15 states and has relationships with more than 1,200 doctors has had to become more than a software company. It has hired a battalion of field coordinators who visit practices and offer in-depth training and advice.

The company has also taken advantage of several health care ideas that were introduced or accelerated by the Affordable Care Act. One of these is known as the accountable care organization, or A.C.O., which lets groups of health care providers unite to coordinate care for a patient. Studies have shown that such a structure lowers overall medical costs; under the Affordable Care Act, Medicare encouraged the formation of these organizations by promising to share any savings it realizes with doctors. Aledade took the accountable care organization idea and made it its primary business model. (The structure was reaffirmed by a 2015 law passed overwhelmingly by Congress, so a repeal of the Affordable Care Act would not have affected its structure.)

For Aledade, the upshot is that it will only make a lot of money if it actually succeeds in reducing health care costs.

Say Medicare thinks that its going to spend $100 million next year on our patients in Kansas, Dr. Mostashari said. A lot of this is from bad stuff hospitalization, complications, you know, bad stuff. So we come in and say, if we can work with the primary care doctors to reduce bad things from happening while increasing quality, then we can save money for Medicare. Medicare says we thought we were going to spend $100 million on those patients, and we only spent $90 million. So, Medicare keeps half of the savings, and the other half of it goes to Aledade which we split with the doctors.

In addition to Medicare, Aledade has begun signing up several commercial health insurance companies under similar cost-savings plans. But given that the company gets paid only when it cuts health care costs (while improving health outcomes), Aledade and its investors are making a gamble.

In its first year of operation, for instance, Aledade managed to cut many costly procedures, yet its savings did not meet Medicares benchmark meaning it realized virtually no revenue from the savings program.

The results for its second year are due in October. This time, because Aledade said its savings grow over time, the company is likely to begin making money. Were very confident in our model, Dr. Mostashari said.

Email: farhad.manjoo@nytimes.com; Twitter: @fmanjoo

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A Start-Up Suggests a Fix to the Health Care Morass - New York Times

The Business Journals

Health care: Without subsidies, premiums will soar The Business Journals Health care: Without subsidies, premiums will soar. Staff, The Business Journals Aug 16, 2017, 11:13am EDT. Two ways mid-size employers can reign in health care costs. malerapaso. The Trump administration is considering ending its cost-sharing ... Trump's ObamaCare subsidy indecision triggers uncertainty over health care costsFox Business Deficit would balloon and premiums would jump if Trump ends healthcare subsidies, budget office saysLos Angeles Times Daily on Healthcare: Pressure builds on business leaders, including J&J CEO, to leave Trump councilWashington Examiner New Haven Register -Newsweek -ConsumerReports.org all 332 news articles »

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Health care: Without subsidies, premiums will soar - The Business Journals

Photo A man in Miami in 2015 directed passers-by to an insurance company where they could sign up for health coverage under the Affordable Care Act. Credit Joe Raedle/Getty Images

To the Editor:

Re How to Repair the Health Law (Its Tricky but Not Impossible) (front page, July 30):

The basic flaw in the Affordable Care Act is that it leaves us in the hands of insurance companies. That means rising premiums and deductibles, restricted provider networks and high out-of-network charges; huge multiple administrative bureaucracies and profits; and the costs that doctors and hospitals incur for dealing with them.

We should start with a basic principle: No American should be denied health care or suffer financially trying to pay for it. What makes that tricky and forces health policy into contortions is insisting on taking care of insurance companies and their hefty costs and finances.

The one way to provide all of us with health care and financial security that is most practical and least expensive is to take insurance companies out of the picture and enact improved Medicare for all.

Washington seems a long way from doing that. But progressive states like New York can create state universal public health coverage.

RICHARD N. GOTTFRIED, NEW YORK

The writer is chairman of the New York State Assembly Health Committee and the sponsor of the New York Health Act (A. 4738) to establish a single-payer system in New York.

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Health Care in New York - New York Times

U.S. Congressman Steve Pearce, of New Mexicos 2nd District, visited Hidalgo Medical Services on Monday to celebrate National Health Center Week and to explain Republican attempts to repeal and replace the Affordable Care Act Obamacare and his role therein.

The Republicans attempt to replace the health care act this summer was largely secretive, long foreseen and eventually unsuccessful. But it had eyes glued to screens across the world. And, according to Pearce, was as tumultuous as it seemed from afar.

Pearce explained to a group of HMS higher-ups, and local and state dignitaries what steps he took during Congress part in the process and why. He was especially vocal about why he held out against the House Republicans original bill.

If you were watching carefully, you would know that I was one of the 34, shrinking down to 25, to 24 votes of Republicans standing against the Republican bill, he said. I did that because I feel the Affordable Care Act is in the process of turning inward, and you never know if its going to collapse or not.

Pearce claimed that high costs and low penalties have led many young healthy people to bail out of the Affordable Care Act, which in turn has driven costs even higher. He also said that most health care exchanges, established on the taxpayers dime, had gone bankrupt, and lost many large insurers like Anthem and Blue Cross Blue Shield.

Even so, he said the original Republican bill was even worse. So, he refused to vote in its favor, earning the ire of President Donald Trump.

There are definitely problems, but the first bill was going to be worse off, Pearce said. So I got sent to the principals office, with the principal. You know from TV, hes powerful and you dont want to be close to him in opposition.

There, too, Pearce claimed he did not fold.

So, I am sitting there and hes saying, I need your vote, the congressman began in a play-by-play. It wasnt a question of whether the bill was good or bad, it was just I need your vote. I said, Sir, Im not going to give it to you. He [Trump] said, You didnt hear me. I want your vote. I said, I have 700,000 voting for me. I represent them, not New York. You dont vote for New Mexico. He was pretty gracious right then, but then Tweeted that he was going to get someone to run against me in the primary, so he can be pretty mercurial.

He said, though, that he believes certain Republicans determination eventually taught the president humility, or at least tempered his hubris.

Hes come to the realization, I think, that he cannot give orders and it occur, Pearce said.

Pearce said this is the second time his refusal to play along with his party has gotten him the cold shoulder. He said former Republican House Speaker John Boehner told him he was not a good team player.

So, if youve ever been placed in the outer darkness of the political sphere, I can describe in detail what it looks like, Pearce said. Thats OK, because Im still there. Mr. Boehner is not.

Southern New Mexicos congressman said that the House Republicans next attempt was only modestly better than the first, but that he had trusted in the system to get the right bill once all was said and done. So, he voted with the Republican majority to pass it on to the Senate.

There, he said on Monday, he hoped that the Senate would make changes and send the bill to a committee of both houses to come up with a final, and better, version he would be happy with. But, in an 11th-hour vote, Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) preceded Arizona Sen. John McCain in defeating the bill. Pearce criticized McCains actions as obstructing progress for personal reasons.

So, the vote that Mr. McCain made hes the one that later said, Lets see if he makes America great again now it appeared to be a personal vote, Pearce said. What it did was, it shut the process down. We dont have 60 votes to get it to the floor. And we have one bill a year we can take to the floor with 51 votes, its called reconciliation. It has to fit within very specific categories and this was the one bill. So when he cast the vote to stop the bill, he shut it down. You can talk about the bill for the rest of the year, you can not vote on it, but once you vote, it shuts down.

Pearce said he could not predict the repeals future.

Democrats will quietly agree in Congress that there are problems, he said. But now the process has shut down and theres no other vehicle to carry it. I dont know what will happen to it. Its just how the process works. The Founding Fathers wanted something where it was hard to pass legislation and they succeeded.

But, he attempted to calm any concerns HMS personnel had about the health center allocations he and the states other, Democratic, caucus members in Washington, D.C., have secured over the past decades.

Of all the sausage making, appropriations are the messiest, so I wont describe in detail how those are made, he said. But, know that your funding is going to be OK.

Democratic Sens. Martin Heinrich and Tom Udall could not make it to the celebration of Health Center Week on Monday, but sent along reps and videos praising the work HMS does and promising their support.

Pearce was on a break from the campaign trail for governor of New Mexico on Monday. He said that, so far, his team has focused on sowing name recognition in the two congressional districts he does not represent in the state, north of U.S. 40, which requires much travel and at least six hours on the phone per day.

Benjamin Fisher may be reached at ben@scdailypress.com.

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Pearce recounts health care bill process, praises HMS - Silver City Daily Press and Independent

Coloradans pressed Sen. Cory Gardner on health care during the Republicans first solo, in-person town hall in more than a year.

Gardner wasnt the only Republican senator who faced angry constituents this week, as Sen. Johnny Isakson held a contentious town hall in Georgia on Monday. The two Republicans heard a similar tune from their respective crowds, as people voiced concerns over healthcare.

While each attendee at Gardners Tuesday morning event had a green Agree sign and a red Disagree sign to wave, the preferred choice of dissent quickly became loud boos that muffled Gardners answers.

A moderator askedthe crowd to quiet down several times to allow the senator to speak.

When an emergency room nurse told Gardner the U.S. should shift to a single payer health care system, the crowd erupted in cheers. The nurse pointed to the Veterans Administration health system as a model to move toward.

I oppose socialized medicine, Gardner said before boos broke out in the crowd.

Veterans do have a government-run health care system, he said. Thats why we had to pass the Veterans Choice Act because they werent getting the care and service they were promised by the federal government.

Gardner also pointed to the ballot measure that Coloradans rejected in 2016 that would have provided medical coverage to all state residents through a payroll tax. About 80 percent of the state voted against it.

The conversation soon shifted to the environment when a woman with 350 Colorado, a grassroots movement dedicated to addressing climate change, asked the senator about a plan to expand coal mining in the state. She said she opposed the plan, which would allow coal to be mined in Gunnison National Forest.

Pointing to a child standing with her, the woman said, This is why Im here for them, because I want them to have clean air and water.

There was little opposition to Gardners initial response.

I want nothing more for them than to have a brighter, better future, clean air, and clean environment, the senator said.

As he continued, Gardner lost the crowds approval.

I do believe that we have to have an all of the above energy policy, Gardner said as boos started. I do believe that we have to have coal.

Taking place at Pikes Peak Community College in Colorado Springs, the town hall was the first in a series of three events Tuesday for Gardner.

Toward the event of the event, the father of a man killed in the Aurora movie theater shooting rose to speak. Tom Sullivan asked Gardner to push President Donald J. Trump to fire advisers such as chief strategist Steve Bannon. The question prompted a standing ovation.

Im not going to ask the president to fire somebody, Gardner responded. Instead, the senator said he would continue to stand up to the president when he disagreed with him.

One woman thanked Gardner for his response to the Charlottesville violence. The senator responded to Trumps tweet on Saturday, calling on the president to call evil by its name.

The woman said she saw a different Cory Gardner and I loved it.

Gardners rhetoric on the Charlottesville violence was stronger by his second town hall in Greeley.

Why we have a 20 year old neo-Nazi in this country today, I do not know, Gardner said. We have to stand up and fight that ideology and never let it happen again.

But when asked what specifically he could do, he added he didnt know that a particular bill will wipe out that hate.

Meanwhile, Isakson faced 600 constituents Monday at a town hall meeting on Kennesaw State Universitys campus, The Atlanta Journal-Constitution reported.

The event focused on similar issues to Gardners, including health care, which prompted boos from the crowd over the Georgia Republicans support of repealing and replacing the Affordable Care Act.

I dont have to do this. Im not up for election, Isakson said at one point during the event. But I do it because its your government, not mine.

Like Gardner, Isakson received a question asking him to push Trump to fire Bannon and other aides from the White House. Isakson tried to answer with No, but before the audience started yelling.

All you have to do is check the record and see how many times Ive risked my career for standing up the right thing, the senator said.

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Health Care Backlash With a Side of Charlottesville Outrage at GOP Town Halls - Roll Call

Baptist Healthcare agrees to acquire a Kentucky hospital system Louisville Business First Under the agreement, Baptist Healthcare would acquire all assets of Harden Memorial Health. In return, the Louisville-based organization would reinvest "significant capital" into the health care system and make an additional monetary commitment to ... and more »

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Baptist Healthcare agrees to acquire a Kentucky hospital system - Louisville Business First

To help with your planning, this Healthcare IT News Cloud Computing Buyers guide looks at the top four IaaS providers, Amazon, Microsoft, Google and IBM. A report from Synergy Research Group found that these platforms have over 60 percent of the public cloud market. (Amazon has the lions share with 33 percent share; the other three divide 27 percent of the market.) The market is far from stable, however; Microsoft and Google each achieved an annualized growth rate of 80 percent in the first quarter of 2017.

Latest Trend:Stronger security and disaster planning fuel healthcare's migration to the cloud

We also look at services from three companies who specialize in supporting healthcare providers with managed services: ClearData, CDW and VMware.

Shop carefully. Read the fine print and really make sure you ask a lot of questions, Snedaker says. Dont take a sales reps word for anything. Not to disparage sales reps, but if its not in the contract, it really doesnt matter what the salesperson said.

She also advises stress testing. Get your team to think up all the very worst case scenarios they can think of and bounce them against the contract. Does it still hold up?

Cloud computing has a clear advantage on the cost side. But healthcare IT managers know that cost is not the only priority. They have a special responsibility to deliver data reliably. And while cloud computing offers many advantages, its a big step and adequate planning is essential to ensure success.

As Snedaker says, Take your time in understanding the solution before you drop your data off at someone elses house.

Amazon was the pioneer in Infrastructure-as-a-Service, with the first public cloud offering in 2006 and it has built on that headstart. One reason it keeps that lead is pricing. Amazon Web Services (AWS) is very aggressive in pricing: it has already made two reductions just since the start of the year for storage and the Amazon Elastic Computer Cloud (EC2) which offers virtual computers for rent.

AWS also innovates at a fast pace. Many cloud platforms go weeks or months between service updates. AWS posts several service updates on its Whats New page almost every day.

To support healthcare providers, AWS recently removed the dedicated instance requirement from its HIPAA business associate agreement (BAA), and added 13 new services to the BAA since January 2017. The HIPAA eligible services that have been added this year include Amazon WorkSpaces, AWS Microsoft AD, and Amazon Cloud Directory.

It also created a new feature to simplify management of BA addendums. Using the AWS self-service Business Associate Addendum, a cloud account admin can instantly designate an AWS account as a HIPAA Account for use with PHI. Users can then sign in to AWS Artifact to confirm that the account is designated as a HIPAA Account, and review the terms of the BAA for that account.

One of AWSs new directions is the AWS Healthcare Competency Partners program for vendors who are offering services through AWS. PracticeFusion, Infor and Phillips are among the partners.

Learn more about AWS

The same company that provides IT departments with a deep inventory of hardware, software and specialized medical equipment also offers cloud management services. This option will be especially appealing to HIT departments that find themselves stretched. CDWs services include migration planning, project scoping and ongoing support. CDWs managed IT services include proactive maintenance, monitoring, notifications and reporting.

CDW has six data centers hosting cloud infrastucture and it can provide more IaaS support through partnerships with AWS, Microsoft and others. The offering helps clients find the right mix of services to map against their clients requirements. And CDW is not necessarily biased in favor of a cloud solution. It also operates and provides managed support for data center solutions.

Learn more about CDW Cloud Solutions

ClearDATA has only one focus: cloud computing for healthcare. It says that it employs a team that is trained in health IT operations and capable of supporting interoperability, patient engagement, data analytics and other health IT priorities. The environment is a HITRUST certified managed cloud infrastructure that adheres to HIPAA Privacy and Security Rules and the HITECH Act.

The companys solutions include backup, disaster recovery, data privacy, business continuity services and security risk assessment and remediation services. They also offer support for BYOD security; secure email; collaboration tools; security Risk Assessment and Remediation Services; desktop-as-a-service and archive-as-a-service.

End-to-end deployment services are available, reducing the workload on a providers IT staff during migration and deployment, and speeding up the process of moving into the cloud.

Learn more about ClearData

Since the last time we wrote about its cloud platform, Google added more support for healthcare applications. At HIMSS17 in February, Google announced support for the HL7 FHIR Foundation to help advance development of data interoperability standards.

Googles public network takes advantage of more than 100 global points of presence to reduce latency. To provide enterprise-grade connections with higher availability and lower latency than existing Internet connections, the company offers Google Cloud Interconnect and supports direct network peering for customers that can meet Google at one of many peering locations. To enhance security, Google developed its own hardware, Titan, to authenticate legitimate access at the hardware level. Titan uses a hardware random number generator, performs cryptographic operations in the isolated memory, and has a dedicated on-chip secure process.

For application security, Google provides a Data Loss Prevention (DLP) API to find and redact sensitive data stored in your cloud environment. The API makes it possible to inject data-sensing intelligence into legacy applications or build predefined detectors into your new apps.

To reinforce support for HIPAA standards, Google is providing a guide to HIPAA Compliance on GCP which offers best practices for healthcare security on Google cloud. Google will enter into Business Associate Agreements with its customers and notes that it has a 700-person security engineering team and regular independent third-party audits to provide external verification. Among the standards for which it has been audited are SSAE16 / ISAE 3402 Type II, ISO 27001, ISO 27017 Cloud Security, ISO 27019 Cloud Privacy, FedRAMP ATO for the Google App Engine and PCDI DSS v 3.1.

Learn more about Google Cloud Platform

IBM Cloud provides a full range of infrastructure-as-a-service options starting with basic block storage, public virtual servers and bare metal servers that compete with the cloud-only vendors. Big Blue also provides a range of more advanced platforms that directly support application development in a number of areas including big health data, analytics, and cognitive capabilities.

Its Bluemix platform is based on an implementation of the Cloud Foundry, an open-source application development platform that supports Java, Python, Ruby, custom frameworks and a range of applications including MySQL, PostgreSQL and more. The IBM Cloud is integrated with the Watson Platform for Health, which provides solutions for collecting, normalizing, and analyzing data from diverse sources. Watson IoT Platform Connect supports device management and the new Blockchain-as-a-Service platform enables the creation of a dynamic distributed network that functions according to logic embedded to define assets and manage transactions.

Security includes end-to-end encryption, role-based access, event monitoring and alerting. The HIPAA-enabled cloud foundation is supported by IBM SoftLayer. Data governance tools are available for managing patient consent and identity masking.

Learn more about IBM Cloud

Microsoft Azure has supported healthcare through its cloud infrastructure platform since 2011. Today it has 40 data centers and the company says it now has over 25,000 health organizations on its cloud services in the U.S.

One of Microsofts selling points is flexibility. It claims that its architecture simplifies the process of moving resources out of data centers and onto Azure to meet peak demands, and that it maintains more data centers in more regions than any other cloud provider. It also has the benefit of supporting Microsoft Office applications through its Office 365 cloud platform, which is provided in a Software-as-a-Service offering.

Microsoft claims more security certifications than its competitors with ISO/IEC, CSA, CCM, ITAR, HITRUST, HIPAA/HITECH and CIS certifications. And more BAA-covered services with agreements available for Microsoft Office 365, Dynamics 365, Power BI, Azure, Intune and Microsoft Visual Studio Team Services. And it offers a site recovery program.

It also claims an advantage with a $1 billion annual budget for security research and development. The companys cyber threat intelligence is based on over 450 billion authentications processed per month and 400 billion emails scanned. The company says this results in quick detection of emerging threats and delivery of responses.

Learn more about Microsoft Azure

VMware is in a transition with its support for cloud infrastructure. It recently sold its VCloud Air service to OVH, one of the largest hosting providers in Europe. VMware, part of Dell Technologies, is now focused on providing Cross-Cloud Services to work through any cloud platform. The strategy is designed to provide a simplified operational management structure for IT managers who can use the same set of VMware tools theyve used at their data centers in managing their cloud platforms.

VMwares partners, who include AWS and Microsoft Azure, will run the VMware software stack in their cloud to provide a platform that supports a VCloud network.

VMware will manage the operational layer, including security, so customers can concentrate on managing their own application layer. The strategy will allow healthcare IT teams to extend into public cloud providers using the same tools and operational processes they use on premises in their data center.

Learn more about VMware Cross Cloud Architecture

Cloud solutions arent a one-size-fits all product. In fact, there some key technical and pricing details to consider. Below is a primer on the key elements of cloud architecture:

Block Level Storage: Raw disk space formatted to support a required file system, typically deployed in a SAN (storage area network) environment. Useful to support a specific application.

File Level Storage: Generally less expensive to maintain than Block Level Storage, files are stored in a hierarchical structure (ie, folders) such as Unixs Network File Storage (NFS) or Windows Server Message Block (SMB).

Desktop as a Service: A virtualization service in which a cloud service provider supports desktop applications remotely.

Infrastructure-as-a-Service: A cloud platform that provides a hosted environment that can be used to deploy applications or data transfer. Examples are AWS, Google Cloud Platform, IBM Cloud and Microsoft Azure.

Hybrid cloud: A platform providing infrastucture-as-a-service that combines cloud services hosted at the clients data center and remotely at the vendors data center. Hyper-scalars: A cloud platform that can dynamically provide more computing resources as demand increases.

Latency: The delay between the time a data request is made and the data is delivered. Platform-as-a-Service: A cloud environment that provides services to run specific applications, development kits, database tools, and application management tools. Examples are IBM BlueMix, Oracle Cloud Platform-as-a-Service and SalesForce ApplCloud.

Public cloud: Hosted remotely at a vendors data center, a public cloud provides service to all of the vendors clients. Your applications and data will be hosted on servers shared by other enterprises.

Private cloud: Your enterprise is provided with a dedicated space providing cloud infrastructure that can be used for running your applications and data transferred. Your space is dedicated to your enterprise and is not shared with others.

Software-as-a-Service: Applications are provided remotely in a cloud environment that is maintained by the vendor. Examples are athenaClinicals, Salesforce Health Cloud, and PracticeFusion.

Throughput: The amount of data that a system can support in a specified time period.

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Cloud computing decision guide: Breaking down 7 top solutions for healthcare - Healthcare IT News

Xavier University has launched the Xavier Center for Artificial Intelligence, an effort to accelerate the use of artificial intelligence to improve healthcare.

Were bringing together the major global players in artificial intelligence to focus on technology that could transform the healthcare industry, said Marla Phillips, director of Xavier Health, which runs the Center for AI. We believe the implementation of AI in the healthcare field is needed now more than ever.

[Also:Big wave of artificial intelligence and machine learning coming to healthcare, University Hospitals of Cleveland CEO says]

Xavier Health, formed in 2008, is a center in the College of Professional Sciences charged with making a difference in the pharmaceutical and medical device industries by building bridges between the industries and the U.S. Food and Drug Administration. The Center for AI is a collaborative effort involving all three of Xaviers colleges Arts & Sciences, Professional Sciences and the Williams College of Business presenting new academic opportunities for students across the campus, the center said.

AI could be used to improve patient safety, reduce drug costs, and avoid product and drug recalls, in addition to the advances being made in healthcare diagnostics, including the early detection of conditions such as dementia and depression, the center said.

[Also:Artificial intelligence is giving healthcare cybersecurity programs a boost]

The centers first major initiative will be the AI Summit August 24-25 on Xaviers campus in Cincinnati. Xavier said it will lead representatives from the medical device and pharmaceutical industries and the FDA to further develop artificial intelligence to promote and protect patient health.

Summit attendees will form working teams tasked with developing plans that apply AI to solve their quality, regulatory and supply chain challenges. They will continue to meet in the months after the summit and present their solutions at the 2018 AI Summit. Solutions from the summit will be available for free for any company or organization to implement.

Representatives from the FDA, Johnson & Johnson, AstraZeneca, Eli Lilly & Co., Abbott, Dell and IBM Watson Health will be among the speakers at the summit.

Some people think that artificial intelligence is still just a concept, that its practical application is still years away, Phillips said. But its been used for years in many applications and has tremendous potential to make a difference in the pharmaceutical and medical device industries.

Twitter:@SiwickiHealthIT Email the writer: bill.siwicki@himssmedia.com

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Xavier University debuts center to advance AI use in healthcare - Healthcare IT News

August 15, 2017 12:35 PM

CHICAGO (CBS) Congresswoman Robin Kelly said a downtown Chicago forum produced a number of bi-partisan ideas for moving the debate over healthcare reform forward.

Congresswoman Robin Kelly hosted Monday a Solutions Only Congressional Field Inquiry on health care at the Dirksen Federal Courthouse in Chicago. WBBMs Political Editor Craig Dellimore reports.

Democrat Robin Kelly said the rules of the forum were no finger-pointing and solutions only. Experts and the audience discussed things like Medicare for all and promoting tele-medicine.

Also conversation that mental health had to be included in whatever we came up with; and also, fight the whole opioid issue.

Congresswoman Kelly believes there are enough people interested in solutions to get things done.

The goal of todays inquiry is to move beyond the partisan rhetoric and get to solutions that will make health care affordable and accessible for all Illinois families, Kelly said. Families are tired of the name-calling and finger pointing; they want solutions and its our obligation to find them.

A panel of six experts, representing a range of providers and advocates, provided evidence and answered questions from policymakers and attendees. The next step? Take the ideas to Capitol Hill.

Congresswoman Robin Kelly tweeted the following ideas during her Congressional Field Hearing on Health Care at the Dirksen Federal Courthouse in Chicago.

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Congresswoman Robin Kelly Hosts Solutions Only Forum To Move Healthcare Reform Forward - CBS Chicago

Sen. Bernie Sanders (I-Vt.) seemed comfortable Monday during a swing through Franklin County to meet with core constituents, includinghealth care professionals, senior citizens and dairy farmers. At all three stops, Vermont's junior senator discussed his Medicare-for-all proposal but he refused to address questions about how hard hell push Democrats to back the plan.

In the morning, Sanders toured the Northern Tier Center for Health clinic in Richford, where he peppered staff with questions about the opiate epidemic and access to dental care.

From there, he traveled to the Franklin County Senior Center in St. Albans and pitched his proposed legislation that would allow anyone to receive Medicare, the federal health insurance program currently available only to people over 65.

Were taking on the whole world to make this happen, he told a crowd of more than 50.

Residents dined on strawberry shortcake and listened intently as Sanders decried the outrageous cost of prescription drugs. He compared the U.S. health care system unfavorably to Canada's, which provides universal coverage.

So when Linda Davignon, of Clarenceville, Qubec, announced her hometown, Sanders asked her how much she pays for a doctor's visit. Nothing, she said as she shaped her fingers into a zero.

Sanders answered questions from the audience, including one about how to galvanize the Democratic Party.

I think the Democrats are making some improvements, Sanders said before going on to criticize party members for being hesitant to take on powerful interests such as pharmaceutical companies.

Outside in the parking lot, Sanders dismissed a reporters question about whether he would back primary challengers to Democrats running in 2018 who dont embrace his health care proposal a concern among some in the party.

Uh, thats political gossip which Im not particularly interested in, Sanders said, ignoring reporters' attempts at follow-up questions.

He was equally unobliging when a reporter tried to return to the subject later.

The Democratic Party the reporter began to ask.

Sanders interrupted: I understand the media fascination for the month of August is divisions within the Democratic Party Thats a lot of media creation.

"When you have a president who doesnt have the guts to say what the vast majority of the people understand to be true ... the message he is sending out to racists and neo-Nazis all over the country is, 'it's OK' ..." Sanders said. "Do I think the president bears some responsibility for that? Absolutely, yes."

Sanders final stop of the day was to Paul and Linda Stanleys hillside dairy farm in East Fairfield. A camera crew from VICE News, dressed in black, filmed as Linda introduced Sanders to a day-old calf named Pinky.

Holy moly! a delighted Sanders exclaimed as it ran wobbly legged by him.

After meeting the cow, the senator snacked on fresh cucumbers and cherry tomatoes at a picnic table and discussed the plight of the state's dairy farms, which are struggling with low milk prices and environmental regulations.

The conversation, though, never strayed far from the topic du jour. During a lull in the discussion about the farmers concerns, Sanders asked, What about health care?

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Bernie Sanders Talks Health Care, Cows During Franklin County Visit - Seven Days

On July 28 in the wee hours of the morning, the seven-year battle by Republicans to repeal and replace Obamacare ended with a whimper when three Republican senators defected to vote against a so-called "skinny bill." Many pundits attributed the failure of repeal and replace to the lack of presidential leadership and to divisions between moderates and conservatives.Sure, those issues mattered, but what led to the Republicans' downfall was their failure to recognize how much the winds had shifted.

Obamacare had poured money into Medicaid, the federal-state program of health insurance for poor and low-income people, and mandated that all states expand the program. Despite a 2012 Supreme Court ruling that made the Medicaid expansion optional, by 2017, 32 states had expanded Medicaid to cover new groups and add new benefits. Most of those states were led by Democrats, but a substantial minority by Republicans. When both the House and Senate proposed huge cuts to Medicaid, governors from both parties denounced the plans at their annual summer meeting.Republican Governor Brian Sandoval of Nevada, an expansion state, summed up many of his colleagues' views, declaring that he had great concerns and that he would oppose any bill that cut Nevadas Medicaid program. That should have given pause to the 20 Republican senators who came from the Medicaid expansion states, but they heedlessly plunged ahead.

The public had also changed its tune.Although Medicaid had started as a program of welfare medicine, over time it had expanded well into the middle class. A 2011 poll found that 85 percent of respondents opposed cuts to Medicaid.Medicaid had become as popular as social security and Medicare.

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Politicians arent the only ones who have a stake in Obamacare. So do numerous organizations that govern the delivery of medical services and that arrange for the financing of care.All these organizations are alert to any proposed change to the health care system and thus make up a cadre of potential resistance.

Senate Majority Leader Mitch McConnell speaks with reporters on Capitol Hill on July 25. Three Republicans crossed party lines to join Democrats in a 49-51 vote to kill the health care bill. REUTERS/Aaron P. Bernstein

The first to speak out were the provider groups.On March 8, the American Hospital Association sent a letter to the House of Representatives slamming the proposed Medicaid cuts, which would make significant reductions in a program that provides services to our most vulnerable populations.The following month, the American Medical Association released a similar letter, urging House members to vote against their own bill so that millions of Americans would not lose their insurance.Especially offensive to the AMA were plans to eliminate regulations that allow adult children to stay on their parents policies until age 26 and that ban insurance companies from denying coverage due to pre-existing conditions.

The Senate fared no better.When Republican senators proposed their first plan, the Better Care Act, AARP, the largest voluntary organization in the U.S., led the charge. In an open letter, the AARP slammed the Senate bill, labeling it Wealthcare and condemning the Age Tax that would allow insurance companies to charge older Americans five times more for coverage than everyone else. AARP also opposed the deep cuts to Medicaid, which would strip health care from millions of low-income and vulnerable Americans, and the cuts to Medicare, which weakens the program.

In July, the insurance industry, which had largely remained on the sidelines, weighed in.The CEOs of Americas Health Insurance Plans and the Blue Cross/Blue Shield Association blasted the Freedom Option,a new provision which would allow insurance companies to sell cheaper policies in the state exchanges without the popular mandated Obamacare benefits like maternity care.

Republicans also failed to deliver a message that resonated with the public.The mantra of opposition to big government was first adopted in 2009, when a Republican strategist urged Republicans to call Obamacare a "government takeover.That phrase was repeated each time House Republicans voted for repeal.The problem was that by 2017, people who had initially believed that Obamacare represented a government takeover or, worse, socialized medicine, had now witnessed the benefits for themselves and their families.Indeed, a June CNN poll reported that 51 percent of the public had a favorable view of Obamacare, while only 17 percent approved of the Better Care Act.

That shift in public opinion left Republicans without a coherent message for rallying support to repeal.Robbed of their big government bluff, Republicans could only lambast Obamacare for reasons the public no longer believed.Meanwhile, Democrats drew upon an alternative message, defining Republicans health care plans as divisive and un-American.When House Speaker Paul Ryan praised the House bill as an act of mercy, Rep. Joe Kennedy (D-Mass.) fired back: "With all due respect to our speaker, he and I must have read different Scripture. The one that I read calls on us to feed the hungry, to clothe the naked, to shelter the homelessand to comfort the sick. It reminds us that we are judged not by how we treat the powerful, but by how we care for the least among us."

Other Democrats charged that Trumpcare would strip insurance from tens of millions of Americans to fund a tax cut for the wealthy.Senator Chris Murphy (D-Conn.) declared that sick and older people will see costs skyrocket. Protections for people with pre-existing conditions will be gutted with insurance companies put back in charge.Former President Obama, too, chimed in with an uplifting message:This debate has always been about something bigger than politics.Its about the character of our countrywho we are and who we aspire to be.

The legacy of Medicaid, the opposition of interest groups and the lack of a coherent reason for repealing Obamacare ensured that Republicans would fail.Instead of engaging in the politics of destruction, Republican should work with Democrats to repair problems in the private insurance market and to actually serve the public that elected them.

Jill Quadagno is the Mildred and Claude Pepper Eminent Scholar Emeritus at thePepper Institute on Aging and Public Policy at Florida State University. She is the author ofOne Nation, Uninsured: Why the U.S. Has No National Health Insurance.Daniel Lanford, a postdoctoral fellow at the Scholars Strategy Network, also contributed to this article.

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GOP Doomed Its Own Health Care Proposals With 'Politics of Destruction' - Newsweek

It may not equal Social Security and Medicare as a "third rail" program that politicians touch at their own risk, yet Medicaid seems to have gotten stronger after the Republican failure to pass health care legislation.

Reviled by conservatives, the 1960s Great Society program started out as health insurance for families on welfare and disabled people. But the link to welfare was broken long ago, and the federal-state program has grown to cover about 1 in 5 Americans, ranging from newborns to Alzheimer's patients in nursing homes, and even young adults trying to shake addiction. Although Medicaid still serves low-income people, middle-class workers are more likely to personally know someone who's covered.

Increased participation and acceptance means any new GOP attempt to address problems with the Affordable Care Act would be unlikely to achieve deep Medicaid cuts.

"This was an important moment to show that people do understand and appreciate what Medicaid does," said Matt Salo, executive director of the National Association of Medicaid Directors, a nonpartisan group that represents state officials. "The more people understand what Medicaid is and what it does for them, the less interested they are in seeing it undermined."

With Republicans in control of the White House, both chambers of Congress, and 34 out of 50 governorships, it would have been hard to imagine a more politically advantageous alignment for a conservative overhaul of Medicaid.

President Barack Obama's Affordable Care Act expanded Medicaid to cover more low-income adults, many of them working jobs without health insurance. Thirty-one states have accepted the ACA's expansion, covering about 11 million people.

The GOP bills would have phased out funding for Obama's expansion, and also placed a limit on future federal spending for the entire program a step now seen as overreach. Spending caps in the House and Senate bills translated to deep cuts that divided Republicans.

And GOP governors who had expanded the program couldn't swallow the idea of denying coverage to hundreds of thousands of constituents. Some went public with their opposition, while others quietly warned their congressional delegations about dire consequences.

Medicaid "is not yet at the Medicare and Social Security level because it isn't framed as something that you contribute to during your working years and you get it later as a commitment," said Diane Rowland of the nonpartisan Kaiser Family Foundation. "But I think there is a recognition that for all its flaws...it's really the nation's health care safety net."

An AP-NORC poll taken last month found the public overwhelmingly opposed to GOP Medicaid cuts, by 62-22.

"You just can't do this to people who are in situations that they didn't put themselves in," said Sara Hayden of Half Moon Bay, California. Unable to work as a data journalist due to complications of rheumatoid arthritis, she was able to get health insurance when her state expanded Medicaid.

Hayden estimates that one of the medications she takes would cost about $16,000 a month if she were uninsured. She pays nothing with Medi-Cal, as the Medicaid program is known in California.

"If they are going to repeal and replace, then I am dead in the water," she said.

Brian Kline of Quakertown, Pennsylvania, works as a customer service representative, and got coverage after his state expanded Medicaid in 2015. Early last year he was diagnosed with colon cancer. After treatment that Medicaid paid for, his last CT scan was clear.

"You just wonder if the Republican bill had passed...what would have happened to me?" said Kline. "Would I have had access to my doctors and the tests to make sure my cancer didn't come back? I'm not sure what the answer to that question would have been."

Many Republicans view Obama's Medicaid expansion as promoting wasteful spending, because the federal government pays no less than 90 percent of the cost of care, a higher matching rate than Washington provides for the rest of the program.

"That is not a good recipe for encouraging states to implement better, lower-cost models of care," said Mark McClellan, who oversaw Medicare and Medicaid under former President George W. Bush.

Nonetheless, the debate showed Congress can't just elbow its way to a Medicaid overhaul.

"You are going to have to be gentle and thoughtful, working in a bipartisan way to see what ideas will reach across the aisle," said Republican economist Gail Wilensky, also a former Medicare and Medicaid administrator.

The push for Medicaid changes will now shift to the states. Some on the political right are seeking federal approval for work requirements and drug testing. From the left, activists in the 19 states that have not yet expanded their programs are contemplating revived campaigns.

An area that could find bipartisan support is health promotion, since Medicaid beneficiaries tend to have higher rates of smoking and other harmful lifestyle factors.

Katherine Hempstead, who directs health insurance research for the nonpartisan Robert Wood Johnson Foundation says Medicaid has come out a "winner" for now.

"I imagine these challenges to Medicaid will rise again," she added. "But I think its supporters will also rise again."

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New life for Medicaid after GOP's health care debacle - ABC News

NEW YORK (Reuters) - Several big-name hedge fund investors trimmed their stakes in healthcare companies in the second quarter as the sector led the broad U.S. stock market higher, rallying amid a Republican effort to repeal and replace President Obama's signature healthcare law.

Jana Partners sold all of its shares in nine healthcare companies, ranging from small-cap biotech company Acadia Pharmaceuticals Inc (ACAD.O) to health information company WebMD Health Corp (WBMD.O) to insurer Aetna Inc (AET.N), according to quarterly filings released Monday.

Billionaire Daniel Loeb's Third Point sold 175,000 shares, or about 18 percent of its stake, in health insurance company Humana Inc (HUM.N) and 5 million shares of hospital products maker Baxter International Inc (BAX.N), or approximately 10 percent of its prior position. Shares of both companies are up more than 20 percent year to date.

Farallon Capital Management LLC, founded by Tom Steyer, dissolved its stakes in pharmaceuticals companies Eli Lilly and Co (LLY.N) and Bristol-Myers Squibb Co (BMY.N), according to filings. The hedge fund also trimmed stakes in AstraZeneca Plc (AZN.L) and Allergan Plc (AGN.N).

Healthcare stocks in the S&P 500 rose 6.7 percent in the second quarter, more than double the 2.6 percent gain in the broad S&P 500 index, after trailing the broad market following Donald Trump's surprise victory in the Nov. 8 presidential election.

Senate Republicans delayed a vote on a healthcare overhaul bill on June 27 after it became clear that they did not have enough votes for it to pass. One month later, a scaled-down plan to replace Obama's Affordable Care Act failed in the Senate.

Healthcare stocks have underperformed since the current quarter began on July 1, dipping 0.5 percent compared with a 1.9 percent gain by the broad S&P 500, suggesting that the move by hedge fund managers could signal the end of the rally.

"If sentiment from certain institutional investors weakens for healthcare it could negatively impact stocks" despite the sector's strong fundamentals, said Todd Rosenbluth, director of mutual fund research at CFRA Research.

Quarterly disclosures of hedge fund managers' stock holdings, in what are known as 13F filings with the U.S. Securities and Exchange Commission, are one of the few public ways of tracking what the managers are selling and buying. But relying on the filings to develop an investment strategy comes with some risk because the disclosures come 45 days after the end of each quarter and may not reflect current positions.

Overall, hedge funds gained 1 percent in the second quarter, according to Chicago-based fund tracker Hedge Fund Research, less than half of the 2.5 percent gain in the first quarter.

There were few signs that hedge fund managers were attempting to call a bottom in energy stocks as the falling price of oil helped send the sector down 7 percent in the quarter. Third Point sold all of its stake in Rice Energy Inc (RICE.N), Halcon Resources Corp (HK.N), Enerplus Corp (ERF.TO), and Pioneer Natural Resources Co PXD.N..

Jana Partners sold all of its stake in Resolute Energy Corp (REN.N), while Omega Advisors sold its entire stake in seven energy companies, including Cheniere Energy Inc (LNG.A), Eclipse Resources Corp (ECR.N), and Williams Partners LP (WPZ.N).

Reporting by David Randall; Editing by Jennifer Ablan, Phil Berlowitz and Steve Orlofsky

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Big-name US hedge funds shed healthcare stocks during the rally in second-quarter - Reuters

Dreaming of a state-run single-payer healthcare system? Wake up and enter the real world. Want universal healthcare for all Americans? Medicare for all is the solution.

Not this year or next, but possibly in the future when Democrats recapture the presidency and Congress.

Thats the clear-eyed, pragmatic fight to engage in, and one advocated by U.S. Rep. John Garamendi (D-Walnut Grove), a longtime healthcare warrior.

Medicare is far, far more efficient than private insurance companies, he said. Using the tax system to collect money for healthcare delivery is extremely efficient. No profits. No commissions. No advertising.

Garamendi, 72, earned his healthcare credentials decades ago. He has been fighting for universal coverage since Jerry Brown was governor the first time.

The congressman, whose mostly rural district covers the Sacramento-San Joaquin Delta and spreads into eight counties, was first elected to the state Assembly in 1974. Later, he moved to the state Senate, where he headed the Health and Welfare Committee.

Garamendi became Californias first elected state insurance commissioner and won legislative passage of a bill to create a commission that would have devised a universal healthcare system. But Gov. Pete Wilson vetoed the measure. Garamendis reform plan, however, became the model for President Clintons ill-fated healthcare proposal in 1993.

In 1994, Garamendi ran for the Democratic gubernatorial nomination, advocating a top-to-bottom healthcare overhaul. He lost to then-state Treasurer Kathleen Brown, Jerrys sister.

After a stint as Clintons deputy Interior secretary, Garamendi again was elected insurance commissioner, later became lieutenant governor and left for Congress in 2009.

So Garamendi has paid his healthcare and political dues. A dawn-to-midnight workaholic who grew up on a cattle ranch in the Sierra gold country, he has won and lost but always spoken his mind.

And he believes California has virtually no chance of going it alone on a single-payer system with the state handling everyones healthcare coverage.

It would be very difficult, particularly given the present federal government, he told me.

Thats an understatement. It would require permission by the Republican-controlled Congress and President Trump for California to use federal Medicare and Medi-Cal money to finance its own healthcare system. Thats not possible.

Plus, lets face it, there are about 6 million California seniors on Medicare. Theyre frequent voters. Think theyre going to trust Sacramento to take over their Medicare coverage? Think again.

Dr. Steve Tarzynski, president of the California Physicians Alliance, agrees.

The reality is that at the moment, a single-payer bill cannot pass the Legislature, he wrote in a recent Times opinion piece. Fighting for one in the immediate term is a waste of time.

Maybe in the future, he continued. But for now millions of California voters with relatively good insurance coverage and those on Medicare are fearful of a radical change in their protections.

The state Senate blindly passed an exorbitantly expensive $400 billion a year single-payer bill June 1. Assembly Speaker Anthony Rendon (D-Paramount) wisely quashed it, calling the measure woefully incomplete. Now bellicose single-payer bullies are threatening to recall him.

Brown already had dismissed the measure.

Where do you get the extra money? the governor asked. I dont even get it.

Former Los Angeles Mayor Antonio Villaraigosa, who is running for governor, called the bill snake oil.

Single-payer pushers in Sacramento the California Nurses Assn. tried to sell their skimpy proposal as Medicare for all. But in reality it was just the opposite. It would have wiped out Medicare in California, grabbed the federal money and forced seniors into the new state program.

Updates from Sacramento

Garamendi wrote an op-ed piece for the Sacramento Bee advocating an eventual Medicare-for-all program nationally. It would be by far the simplest solution to achieving universal coverage, he said.

Medicare is one of our most trusted and popular government programs, he asserted. For more than 50 years, Americans have trusted Medicare to provide care to the elderly and disabled, funded by the payroll taxes of American workers. Medicare spending rises at a much slower rate than private insurance. It could be modified and expanded to cover more people.

It is an idea whose time is coming.

Its coming, but its not here yet not with Trump and the GOP controlling Washington.

Unlike single-payer, Medicare for all would allow beneficiaries to buy supplemental private insurance, as many seniors do now.

Garamendi told me he wouldnt attempt to increase current benefits. Nor would he try to cover immigrants here illegally. Those would be poison pills politically.

For people fearful of government-run healthcare the old socialized medicine bugaboo Garamendi notes that much of America already is covered by government insurance.

There are more than 46 million seniors and 9 million disabled on Medicare. About 75 million are enrolled in Medicaid for the poor, called Medi-Cal in California. Roughly 22 million federal, state and local government employees benefit from government-funded healthcare. So do 1.3 million military personnel. That totals almost half the population.

In California, the main focus should be on pressuring Congress to retain and patch up the Affordable Care Act, which has reduced the number of uninsured in this state from roughly 7 million to less than 3 million. The GOPs repeal threat has been beaten back, but it isnt dead.

The governor and Legislature can keep making incremental healthcare improvements in California by continuing to restore Medi-Cal benefits that were severely cut during the recession.

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Forget about single-payer healthcare. This California congressman has the real solution: Medicare for all - Los Angeles Times

After a presidential administration changes hands, top federal officials often move into industry or advocacy jobs, while the new administration picks people from those groups to fill its own top openings. This "revolving door" of politics gives interest groups greater access to members of Congress or to the administration, which allows them to advance their policy positions.

Here are some of the job changes in healthcare that have occurred since around the time President Trump was sworn in to the White House.

Former Obama administration officials who joined the healthcare industry or advocacy groups:

Kevin Counihan: The former CEO of healthcare.gov, the federal Obamacare exchange, was recently hired by insurer Centene. He will be working as the regional vice president for the company's Midwest division and out of its headquarters in Clayton, Mo.

Dr. Patrick Conway: The former administrator for innovation and quality at the Centers for Medicare and Medicaid Services, and director of the Center for Medicare and Medicaid Innovation, will take the helm of CEO of Blue Cross Blue Shield of North Carolina in October.

Kevin Griffis: The former assistant secretary for public affairs at the Department of Health and Human Services is now vice president for communications at Planned Parenthood Federation of America, a position announced in April.

Drew Littman: The former counselor for HHS is now policy director at the law firm Brownstein Hyatt Farber Schreck LLP, where his clients include companies in the healthcare and biotechnology fields.

Trump's picks from the health industry or advocacy groups:

Lance Leggitt: Now chief of staff for HHS Secretary Tom Price, Leggitt is a former healthcare lobbyist for Baker Donelson.

Randy Pate: The current CMS deputy administrator and director of the Center for Consumer Information and Insurance Oversight, who also oversees healthcare.gov, came to the administration from the insurer Health Care Service Corporation, which is part of the Blue Cross Blue Shield Association. He was was vice president of public policy there.

Charmaine Yoest: The assistant secretary of public affairs at HHS came to the administration from Americans United for Life, an anti-abortion group for which she was president and CEO until February 2016.

Teresa Manning: The deputy assistant secretary for population affairs, which oversees family planning programs, had worked as a lobbyist with the National Right to Life Committee and as a legislative analyst for the conservative Family Research Council. When she was appointed, she was working as a law professor at George Mason University.

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Healthcare's door revolved as Trump moved into the White House - Washington Examiner