The industry that makes medical devices from artificial hips to miniature pumps for IV drips is looking for a fallback plan to repeal a widely reviled sales tax that almost met its end in GOP health care legislation.

The 2.3 percent excise, one of several taxes and fees in the Affordable Care Act that pay for expanded insurance coverage, has been the subject of ferocious lobbying by manufacturers seeking its permanent death. Yet for now it's on track to be reinstated on Jan. 1 after a two-year hiatus, leaving industry leaders worried it will hurt employment and stifle development of innovative, even lifesaving products.

"We know it resulted in job loss when it was in effect and we also know it resulted in decreased investment and development," said Patrick Hope, executive director of the Medical Imaging & Technology Alliance, one of several trade groups fighting reinstatement of the tax.

The tax covers a range of medical equipment sold to hospitals and physicians but excludes consumer items such as eyeglasses, hearing aids and diabetes kits.

Various failed versions of Republican bills to repeal and replace the Obama health care law would have killed the tax that is also unpopular with many Democrats in Congress, some representing states with thriving clusters of medical device firms.

The U.S. medical device market was valued at nearly $148 billion in 2016 with projections it will increase to $173 billion by 2019, according to Emergo, a leading industry consultant.

Companies shed 29,000 jobs from 2013-2015 when the tax was in effect, according to government data cited by the Advanced Medical Technology Association, or AdvaMed. No corresponding employment data exists yet for 2016-2017 when the tax was suspended though another trade group, the Medical Device Manufacturers Association, said a member survey found 70 percent added jobs while R&D spending increased by 19 percent on average.

Skeptics argue it's impossible to draw a straight line from the tax to overall performance by the industry and point to a variety of other factors, from consolidation to global competition, that influence trends in employment and R&D commitment.

John McDonough, a professor of public health policy at Harvard University, said he doubted the tax seriously harmed most firms while it was in effect, or that it would wreak much havoc if reinstated next year.

"The medical device industry stands out in its determination to be the one industry to get off the hook," said McDonough, noting that insurers, drugmakers and hospitals were also assessed higher taxes and fees under the ACA.

Proponents of the tax, originally estimated to raise $29 billion in net revenue over 10 years, contend industry sales can only benefit from more Americans having access to health insurance. Still, the tax has long been targeted for repeal, not only by congressional Republicans but also many Democrats who strongly back the health care law and the other taxes that go with it.

Critics have cited a 2015 analysis by the Congressional Research Service that declared the levy "challenging to justify" in terms of traditional economic and tax policy. That same report, however, also projected "fairly minor" impacts on production and employment in the medical device industry.

Boston Scientific Corp., a leading maker of heart stents and other devices, said the two-year suspension allowed for a doubling of its collaboration with Mayo Clinic on projects to help cardiovascular patients.

Clinical Innovations, a privately-held medical device company in Salt Lake City, said tax savings of about $500,000 a year helped it speed up the redesign and launch of a balloon-like device that helps doctors manage potentially fatal occurrences of postpartum hemorrhaging in women.

"For a company like us, that's a significant savings, and frankly where we tend to cut if we have to pay a tax like that is on the development side," said Ken Reali, the firm's chief executive.

In 2015, 46 Democrats joined Republicans in approving a House bill to repeal the tax. That effort ultimately fell short, but Congress later added the two-year suspension of the tax to a budget bill.

Minnesota has about 27,000 people working in the sector with an average salary of $63,567, while in Massachusetts nearly 24,000 are employed in the industry and earn $66,787 on average, according to AdvaMed. Those states rank second and third behind California in medical device employment.

Minnesota's Democratic U.S. Sens. Al Franken and Amy Klobuchar have both voiced support for repealing the tax, as have Democratic Sens. Elizabeth Warren and Edward Markey of Massachusetts.

Yet many Democrats, Warren included, insist they would only vote to eliminate the tax if another revenue source for the ACA was available to replace it.

So how to halt the tax before January, absent a full repeal of the health care law?

Several possibilities exist. One option would be to include in an overhaul of the U.S. tax code sought by President Donald Trump. It could also be tied to efforts to stabilize insurance markets, or attached to other vehicles such as an appropriations bill or the pending reauthorization of a separate health insurance program for children. All come with procedural challenges and uncertainties.

"It's a full court press," said Greg Crist, a spokesman for AdvaMed.

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Health care divide leaves tax on path to reinstatement - ABC News

Holly Zachariah The Columbus Dispatch @hollyzachariah

MARYSVILLE Stephenie Headings, with the unchecked enthusiasm that only a 7-year-old could muster when facing a couple of hours of medical exams, asked the same questions time and again.

Is it my turn yet, Mom? she asked, bouncing on tiptoes in her cowboy boots and running over to peek in a room where a man in camouflage fatigues was testing someones hearing. Can I go in?

Rebekah Headings laughed. Dont worry, she told her youngest of four daughters as she corralled them through a free health-care clinic Saturday morning. Youll get to go in there, too.

The Headingses, a family of six, were among those who visited the Ohio National Guards GuardCare, an annual clinic presented each summer or fall in a different medically underserved community in the state in partnership with the Ohio Department of Health and local health departments.

This weekend, GuardCare is visiting the Union County Health Department, 940 London Ave. in Marysville; a similar event was held in Madison County this past weekend. The program continues from 8 a.m. to 3 p.m. Sunday and no appointment is necessary.

Anyone can make use of the services offered. No proof of income, insurance or residency is required. Thats not what GuardCare is about. Its about training. And so much more, said Maj. Gen. Mark E. Bartman, adjutant general of the Ohio National Guard.

He said most people know about the Guards federal and state missions to deploy overseas to assist a U.S. war effort and to help when called upon in state disasters. But thats not all.

Our third mission is our community mission. We have soldiers and airmen that live in almost every county in the state of Ohio," Bartman said. "GuardCare is an opportunity for them to give back to the community in which they live.

People this weekend can visit any or all of 17 medical stations set up in conference rooms, hallways and offices at the health department, depending on their needs. There are the routine screenings found at most health fairs: vital signs, blood work, hearing checks and the like. But the event in Marysville is expanded to include such things as dental exams, screening for sexually transmitted diseases, Pap tests and full general physicals.

Jennifer Thrush, spokeswoman for the Union County Health Department, said the departmentworked hard to make sure advertising reached particular groups such as the working poor, the self-employed, senior citizens and families with young children.

For so many hard workers, there still is a barrier to health care, Thrush said. High deductibles, not being able to find a primary-care physician, expensive co-pays. This event helps remove those and provides free access to health care and preventive services in our backyard, in one day, for everyone, anyone at all.

Union County health-care providers, medical students and others volunteered, along with more than 100 National Guard personnel, to deliver the services.

For the Headings family, the day couldnt have been more important.

ThoughRebekah's husband, Dennis, gets a stipend through his job, the family of cattle and sheep farmers from Plain City spends a lot out of pocket on health insurance, and last year, the children lost their insurance.

This is a huge deal for us, Rebekah Headings said about Saturday. She pointed to a nasty scar on the left knee of one of her girls, one that came from a fall in the barn in February. We can use our health savings account for the unexpected, stuff like that, and get our basic needs taken care of here.

Both parents got vaccines, and cholesterol and blood-sugar checks. Dennis had an EKG. The kids got vaccines, and one found out she has some cavities that need to be addressed. They also got physicals for the sports they play after school.

Attending the health program used up a few hours of a nearly perfect summer Saturday morning, but no one in the family minded. Their health, after all, comes first.

Were so grateful, Rebekah Headings said.

Stephenie, for her part, pretty much charmed her way through every station and delighted in the freebies everyone gave her, including a water bottle, a toothbrush and her favorite a purple latex glove blown up like a balloon.

Ohio Army National Guard Spc. Adam Hagelberger administered her vision test even though she had to stretch her neck to reach the machine.

"OK. Read me the next line," he told her.

K-D-S-O-N

"And the next one?," he asked.

S-D-O-H-N.

Not perfect, he said. But good just the same.

She giggled.

Hagelberger, a combat medic with the Guard, said GuardCare each year is invaluable for him.

"You can sit through all the PowerPoint presentations in class that you want, but theres nothing that helps us more than hands-on training, he said. We are part of the U.S. Army, yes, but we are the Ohio National Guard. Thats important. Giving back to Ohio matters to us.

hzachariah@dispatch.com

@hollyzachariah

See original here:

Ohio National Guard brings health-care clinic to Marysville - The Columbus Dispatch

We need a clean, transparent election.

Recently there were statewide headlines raising concerns that Oregon Secretary of State Dennis Richardson has a serious conflict of interest issue in his role as the elections chief. I share those concerns and want to make sure more people are aware of them because the health care of hundreds of thousands of Oregonians like me is at risk.

Here is the issue: Julie Parrish, who serves both as a state representative and as Mr. Richardsons political consultant, is now wearing a third hat. She is the chief petitioner of Referendum 301, through which she will cut funding for the state reinsurance pool and the Medicaid program. If she is successful, Oregonians who buys their own health insurance as I do will see a premium increase. The reinsurance pool, according to state insurance regulators, reduced 2018 premiums for people like me by 6 percent. In addition to cutting funding for the reinsurance pool, Referendum 301 will cut $1.3 billion from the state Medicaid budget, which will result in the loss of health care of some 360,000 Oregonians. Our local representative, Cedric Hayden, is a co-petitioner as well, which is very disappointing.

I cannot afford that additional extra premium increase and as a cancer survivor, it is life threatening for me to go without insurance. I do not have insurance coverage through my job, as is the case for many Oregonians. Referendum 301 will unfairly target people like me. And as a personal support professional for people with physical and intellectual disabilities, I worry about what my clients will do if their health care is suddenly cut off.

With so much at stake, it is critical that everything relating to this referendum be by the book and held to the highest standard.

As media recently reported, Mr. Richardson has paid Rep. Parrish $330,000 and she continues to receive monthly payments from him through his political action committee even as she is gathering signatures on the health care referendum.

This creates an extraordinary situation: Mr. Richardson will be responsible for overseeing the signature verification for his consultants referendum. If Referendum 301 qualifies, he will be setting deadlines for the voters pamphlet statement and will be overseeing when and what the voters see about the referendum before they cast their ballots.

There are other red flags. Mr. Richardsons former communications director is being paid for work related to Referendum 301. And the top contributor to Referendum 301s political action committee is also a top contributor to both Richardson and Parrishs candidate committees, writing five-figure checks to each.

What other coordination is happening or will be happening between Mr. Richardson and the Referendum 301 campaign? Right now, theres no way to know short of filing costly, slow and cumbersome public records requests on a daily basis.

All of this news came out only after the Oregon Nurses Association, which is concerned about how Referendum 301 will affect patients, made a reasonable request. They asked Mr. Richardson and his team to act immediately to develop a full transparency policy regarding his communications with Representative Julie Parrish that includes all matters relating to the special election Referendum 301 to ensure that all matters are handled with an impartiality and in the full view of Oregon voters.

Mr. Richardson has so far ignored this fair request.

Oregonians deserve clean, fair and transparent elections at every step of the process. In order to avoid any real or perceived conflict of interest issues, Rep. Hayden should also call for a clean election and for Mr. Richardson to release all the records relating to his political consultant and the referendum.

For me, and for the people like me who cannot afford even higher premiums or to lose health care altogether, the stakes are very high. We just narrowly escaped an immediate rollback of health care coverage at the federal level. The fact we are facing similar cuts from our local politicians is incredibly disheartening and frightening. Secretary of State Richardson, Julie Parrish, and Cedric Hayden should hold themselves to the highest ethical standard in this election and be fully transparent and forthright about Richardsons conflict of interest issues.

Maleta Christian of Myrtle Creek is a personal support worker for people with intellectual and developmental disabilities.

Continue reading here:

My health care is at stake - NRToday.com

Nearly a quarter of Americans said health care is the most important issue facing the country today, according to a new CNN poll conducted by SSRS. It beat out the economy (15%), immigration (11%), foreign policy (8%) and Donald Trump (8%). Fewer than 5% named each of several other issues, like the environment, civil rights, government spending and education.

About one-third of Democrats said health care was the top issue, while 22% of independents did, the CNN poll found. Only 18% of Republicans felt this way, even though Congressional Republicans spent much of this year trying to overhaul Obamacare. The effort stalled in the Senate last month.

In a Gallup poll also released Thursday, 17% of Americans identified health care as the nation's biggest problem. While dissatisfaction with the government/poor leadership took the top spot, health care beat out unemployment and jobs by more than two-to-one and the economy by nearly three-to-one.

Republicans and Democrats were nearly tied in naming health care as the most important problem, with 21% of the GOP and 19% of Democrats mentioning it, Gallup found.

Related: CNN Poll: Nearly seven in 10 judge Congress a failure so far

The majority of Americans (56%) want the two parties to work together to make changes to health care policy, according to CNN's survey. The rest are divided: Just over one in five said the GOP should both stop trying to repeal Obamacare completely (21%), and the same share said Republicans should keep trying to repeal it anyway (21%).

CNN's Ryan Struyk and Jennifer Agiesta contributed to this report.

CNNMoney (New York) First published August 10, 2017: 5:07 PM ET

Continue reading here:

Health care is one of the nation's biggest problems: Polls - CNNMoney

A A

Dear Mr. Berko: In 2008, you referred me to a congressman who solved a problem I had with a stupid bureaucrat at the Financial Industry Regulatory Authority. It took several phone calls and letters, but two months later, it was fixed. I felt obligated to make annual contributions to his political action committee. We have become friendly and have lunch occasionally. At our most recent lunch, I asked why Congress cant put a health care bill together. His surprising answer was: Ask Berko!

C.S., no state

Dear C.S.: All members of Congress and their staffs enjoy a platinum-plated Cadillac health care plan which pays generously for everything, including rhinotillexomania, halitosis, alopecia, mythomania and mange. This let them eat cake Congress needs a taste of our medicine to understand our despair and distress.

Most politicians are molded from the contents of a colostomy bag. But Ive known this congressman for decades, and hes honest as a stone. What hes reluctant to tell you is that big money and special interest groups with big money always take precedence over the publics interest. So, what do 535 members of Congress have in common? Wanting to get re-elected!

Most folks dont know that there are over 9,000 pharmaceutical and biotech companies peddling products to American consumers. All have interests in our health care law. So they contribute hugely to influence how 535 members of Congress vote. They care about whats best for them.

There are 1.4 million physicians, 61,000 chiropractors, 14,000 podiatrists and 200,000 dentists who have an interest in our health care law. Their sizable contributions to Congress will influence their representatives votes. They care about whats best for them.

Its hard to believe there are just 35 health insurance companies in the U.S., though many different health plans (estimated at 4,700) under different names are divisions of major insurers. They have an interest in our health care law, not in your health. They spend millions influencing the votes of the 535 members of Congress. They care about whats best for them.

There are about 6,000 hospitals in the U.S., with over 1 million beds. They have an interest in our health care law. Sizable checks to members of Congress buy the votes they want. They care about whats best for them.

There are 12,000 lobbyists spending $6 billion on 535 members of Congress (thats $11.2 million per member), knowing their dollars will influence the outcome of health care legislation. Lobbyists care only about whats best for their clients.

Finally, there are 1.45 million lawyers, or 27,000 lawyers per member of Congress. Many earn their incomes suing/advising hospitals, drug companies, Medicaid, Medicare and the insurance industry. They contribute massive amounts of money to influence the health care legislation. They care about whats best for them.

Private-interest groups

These are the players who are important to Congress. Folks like us cant compete with their money, power and influence. The golden rule says, He who has the gold rules. House and Senate seats are costly, and private-interest groups that have the gold tell members of Congress how to vote.

In 2012, candidates who won House seats received an average of $1.7 million in contributions, while winning Senate candidates received an average of $10.5 million. Elizabeth Warren of Massachusetts sold her soul that year, sucking in $42 million to win her seat. Running for Congress takes big buckets of bucks. So incumbents must cater to special interest groups and their private agendas if they wish to be re-elected. Like sharks smelling blood, members of Congress smell money. Its money that buys the votes to keep them in office. And those dollars dont come from folks like us. So members of Congress learn to be Janus-faced; they excel at walking your walk and talking your talk, and then they follow the money. The common ruck like us doesnt have the green for $75,000-a-plate dinners or to make meaningful contributions to election campaigns. Members of Congress, beholden to special interest money and challenged by the publics needs, invariably choose the former. And in the process, theyve learned to imitate tested empathetic noises, convincing you theyre in Washington only to represent your interests. Congress has segued further into a sad comedy of baboons and buffoons.

Continue reading here:

Berko: Here's why Congress can't make a health care bill - The Columbian

(CBS/WBTW) More Americans now have access to health care than in decades past, but the cost and quality of service can vary widely depending on where someone lives.

With the continuing battle in Washington over thefuture of health care in the United States, experts at personal-finance website WalletHub decided to do some digging into the quality of health care on a state-by-state basis.

According to the latest data from the Centers for Medicare & Medicaid Services, the average U.S. adult spends nearly $10,000 per year on personal health care, and that number is expected to continue to increase over time.

But as costs rise, the United States remains well behind other wealthy nations when it comes tolife expectancy, quality of life, and overall health coverage.

To determine in which states Americans receive the best and worst health care overall, the analysts at WalletHub compared all 50 states plus the District of Columbia across 35 measures of cost, accessibility, and outcome.

Among the factors they took into consideration were the cost of medical and dental visits; average monthly insurance premiums; quality of hospital care systems;life expectancy;cancer rates; heart disease rates; and infant, child, andmaternal mortalityrates.

Hawaii topped the list with the lowest heart disease rate in the nation and a particularly high number of insured adults aged 18 to 64. Iowa, Minnesota, and New Hampshire also ranked high on the list.

According to the analysis, the top 10 best states for health care are:

In contrast, Louisiana was rated the worst state for health care overall, with the highestheart diseaserate in the nation, the third highest cancer rate, and a low number of dentists per capita.

North Carolina ranked 5th on the worst state list (47th overall), with the highest average monthly insurance premiums.

South Carolina ranked 7th on the worst state list (45th overall), but WalletHub offered no explanation as to why.

The 10 worst states for health care include:

To see how the other states stack up, seeWalletHubs full report.

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SC, NC rank among 10 worst states for healthcare - WBTW - Myrtle Beach and Florence SC

Former Hong Kong finance minister Antony Leung Kam-chung has launched an ambitious project to recruit the citys talent to train health care professionals on the mainland, which is experiencing a serious shortage of high-quality carers.

Leung is trying to reverse the trend through his leadership of New Frontier, an investment group that owns Care Alliance, which operates a number of mainland health care facilities, including for the elderly and rehabilitation.

There is great demand for rehabilitation on the mainland, which is still looking at standards and the operation of services. But in Hong Kong the level of our services is relatively mature, Leung said, adding that Beijing, Shanghai, Guangzhou and Shenzhen faced a shortage of one million carers.

How could we help to set and raise standards of rehabilitation on the mainland? I think Hong Kong could certainly help in the future, Leung said.

New Frontier said it would pump 1 billion yuan (HK$1.17 billion) into healthcare projects in southwestern parts of the mainland. This comes after it earlier this year pledged to inject at least 1 billion yuan into a Shenzhen-based medical group so it can take part in the Greater Bay Area plan, an integration scheme involving Hong Kong, Macau and nine Pearl River Delta cities.

Leung met Hong Kong journalists in Chengdu last week to introduce the Care Alliance Rehabilitation Hospital, a new facility in which New Frontier has invested more than 100 million yuan. The hospital is set to open late next month.

New Frontier has entered a partnership with a few Hong Kong institutions to train health care workers on the mainland.

For example, experts from the Vocational Training Council will provide training courses for carers in all health care institutions under New Frontier, while the Society for Rehabilitation will provide training for mainland physiotherapists and occupational therapists working in the firms Chengdu rehabilitation hospital.

Two young Hongkongers have joined the growing trend of taking part in exchanges between Hong Kong and mainland health care personnel by working as interns at a separate hospital under the Care Alliance.

Opting for elderly care might be a rather unusual career choice for Yeung Kwok-ho, 22, and Dickman Wai, 21, who have started a two-month internship after completing a higher diploma course in elderly care services at the citys Institute of Vocational Education.

I want to understand how elderly care homes operate on the mainland and whether there are any practices we can adopt, said Wai, who was motivated to study elderly care after seeing his grandmother suffering in a Hong Kong care home.

Would the elderly in China respond differently to the same techniques I use in Hong Kong?

The pair, who were the first two students in their programme to take up internships on the mainland, will help organise physical exercises for the elderly and cognitive training for those with dementia.

Continue reading here:

Hong Kong experts to train mainland Chinese health care workers under new scheme - South China Morning Post

President Donald Trump signed into law Saturday legislation that extends a program allowing veterans to receive private health care.

The bill, which allocates $2.1 billion for the six-month extension of the Choice Program of the Department of Veterans Affairs, was signed by the president at his private golf club in Bedminister, New Jersey, where he is on a 17-day working vacation, according to the White House.

The program, which was set to run out of funds earlier than expected in mid-August, pays for veteran visits to private doctors if they are facing lengthy waiting periods or travel times. The program was created in 2014 in response to a scandal at the VA hospital in Phoenix, Arizona, where patient wait times had been manipulated.

VA Secretary Dr. David Shulkin has made it a priority to eliminate a rule requiring veterans to live at least 40 miles from the nearest VA facility or wait more than 30 days for an appointment to be eligible for the Choice program.

The law also authorizes an additional $1.8 for the VA to lease 28 major medical facilities and to strengthen a program overseeing the recruitment and training of VA employees.

Congress passed the bipartisan legislation before it began its August recess, but not before raising concerns among veterans groups and Democratic lawmakers about the trend toward privatization of the VA.

Several veterans groups, including Disabled American Veterans and Iraq and Afghanistan Veterans of America, expressed concern to Congress in a letter on July 26.

"If new funding is directed only or primarily to private sector 'choice' care without any adequate investment to modernize [the] VA, the viability of the entire system will soon be in danger," the groups said.

Shulkin has maintained the administration is not trying to privatize the VA, but to modernize and strengthen the agency's operations.

"President Trump is dedicated to maintaining a stronger VA, and we will not allow VA to be privatized on our watch," Shulkin wrote in an op-ed published July 24 in USA Today. "What we do want is a VA system that is even stronger and better than it is today. To achieve that goal, VA needs a strong and robust community care program."

Continue reading here:

Trump Signs Bill Extending Veterans Health Care Program - Voice of America

The House of Representatives passed the American Health Care Act. Though advertised as their repeal-and-replace bill, the AHCA amended and in some waysenhanced ObamaCare. In July, the Senate just said no to any action whatsoever on our failing healthcare system.

Congressional Republicans seem unable to envision a solution for healthcare that restores the proper relationship between doctors and patients where the payer is the patient.

The Obama administration promised byexpanding MedicaidAmericans would be freed from job lock and able towork less. This is another example of Washingtons attempt to orchestrate peoples behavior and its refusal to admit the purpose of any healthcare system is to improve access to quality care.

In a recent survey of businesses with fewer than 50 employees, economist Casey Mulligan found that ObamaCare contributed to killing at least250,000 jobs. These losses, whether direct fires or fewer hires, are driven by ObamaCares mandate that small businesses must guarantee workers health insurance.

If people cant find jobs, they either drop out of the labor force or apply for disability, which remains near record levels at8.8 millionAmericans.

Businesses higher cost from soaring insurance premiums for hiring that 50thworker explains more terminations and fewer new hires. But what is reducing current workers desire to work? Mulligan attributes this to theimplicit marginal income tax.

This implicit tax is not explicit like income tax, whereby raising your income to where you lose free government insurance reduces your incentive to work and earn more. A Medicaid recipient who works extra hard and increases his income could be rewarded by losing of thousands of dollars in welfare payments.

To pay the$2 trillion price tagfor ObamaCare,additional taxeswere levied on American workers. Many people decided to leave the workforce, collect benefits, and avoid paying income taxes. This promoted a vicious downward spiral with an ever-expanding Medicaid pool and an ever-shrinking taxpayer pool.

More ominous even than ObamaCare suppressing job growth, wage growth, and economic output, is the ACAs effect on care.

Healthcare discussions always seem to focus on the number of insured individuals with no proof that having insurance will lead to timely care.After paying the huge bureaucratic and administrative costs of ObamaCare, there is too little money remaining to pay for care. Already low doctor reimbursement schedules continue to fall.The hardest hit is theMedicaid population:only 53 percent of U.S. physicians acceptnew Medicaidpatients.

The experience of New Mexico Medicaid proves that ObamaCare reduces access to care. With expansion, New Mexico Medicaid added more than 300,000 new enrollees, causing a shortfall of $417 million. To balance the state budget, they had tocut low doctor reimbursementseven lower. The result is more insured people with fewer doctors to provide care.

Americans now experience the worst possible scenario. National spending is up, productivity is discouraged, and insurance premiums are more unaffordable. While more Americans have insurance, care is increasingly difficult to access.

Washington, D.C., should return healthcare to long-excluded free market principles instead of continuingfailed government controlslike ObamaCare.

There is no better example of an effective policy choice than the Texas model of limited government. Ranking as nearly the most economically free state according to theFraser Institute, Texas leads the nation ineconomic growthandjob creation, wherealmost 30 percentof all U.S. jobs were created in the last decade in a state with only 9 percent of the population.

Unleashing major economic activity comes from a host of pro-growth policies. However, the key decision is to limit the size and scope of government. Healthcare is a policy area that desperately needs the same key: less government.

Congressjust threw awayan opportunity to repeal oppressive ObamaCare. Eliminating its onerous mandates would have restored jobs, reduced bureaucratic waste in healthcare, and increased access to care.

America needs a system that puts patients back in the driver seat so they can shop for their health care and make their own health decisions. Healthcare should not be a system that de-incentivizes work, discourages risk-taking and innovation, keeps people dependent on federal handouts, and letsAmericans diewaiting inline for care. Its time for a market-based, patient-centered approach.

Dr. Deane Waldman, MDMBA, is Director of the Center for Health Care Policy at the nonprofit Texas Public Policy Foundation, Professor Emeritus of Pediatrics, Pathology and Decision Science, and the author of The Cancer in the American Healthcare System.VanceGinn,PhD, is senior economist in the Center for Fiscal Policy at the Texas Public Policy Foundation.

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

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The Senate's healthcare double whammy: fewer jobs and less care - The Hill (blog)

Both liberals and his GOP primary opponent quickly seized on the comment, blasting it out to reporters and on Twitter.

The Republican from Nevada, who faces one of the toughest 2018 re-election battles in the Senate, was lobbied hard by both sides in the recent effort to repeal and replace the Affordable Care Act.

He ultimately sided with President Donald Trump and his party's leadership by deciding to support the "skinny repeal" bill, a vote that could help him in the GOP primary but could complicate his general election bid next November in his purplish home state.

"I wake up every morning trying to figure out what's best for the state of Nevada, what can I do for Nevada families. And obviously we got in the middle of this health care battle and I feel real pleased at the way this thing turned out and we're turning the page now to tax reform," he said, according to video from CNN affiliate KRNV.

Throughout the summer, Heller expressed concerns about earlier efforts by conservatives to curb the provision of Obamacare that expanded Medicaid in many states, including Nevada.

The "skinny" bill, however, would have only repealed parts of Obamacare like the individual mandate but left in place Medicaid expansion, which was a big reason why Heller supported it in the end.

Heller campaign spokesman Tommy Ferraro said in a statement that Heller's comments to KRNV reflected his satisfaction at voting for a bill that repealed what they considered the "onerous provisions" of Obamacare.

"When asked about the health care debate, Dean Heller reaffirmed that he stands by his vote to repeal the most onerous provisions of Obamacare that hurt Nevadans who can least afford it," he said.

After his comments on KRNV, in which he said he was "pleased" at the outcome, the liberal group American Bridge started circulating video of Heller's comments, calling him "spineless."

"Fake news: I'm pleased with my vote to repeal Obamacare, a bill the @POTUS wanted to sign and @DannyTarkanian criticized."

While Republican leaders have said they're now ready to transition to tax reform, Trump ramped up pressure this week on the Senate to figure out a health care solution too.

Heller teased the upcoming tax reform fight, saying he'll be heavily involved. "You think I was in the front of that battle, wait 'til I sit on the finance committee, I'll be right on the front of finance for tax reform also," he said.

Read the original post:

Dean Heller on health care: 'I feel real pleased at the way this thing turned out' - CNN

Of the 20 states -- and DC -- where preliminary 2018 premiums and insurer participation are available, premiums will rise in every location but one, according to the Kaiser analysis. The lone exception is in Rhode Island where premiums in Providence are expected to dip by 5% as compared to 2017. The premium increases range from 3% in Detroit, Michigan to 49% in Wilmington, Delaware. Fifteen of the locations are projected to see a premium increase of double digit percentages.

Those rate increases are, according to the Kaiser study, the direct result of the uncertainty around the law and its future. Here's the key bit from Kaiser on that:

"In the 20 states and DC with detailed rate filings included in the previous sections of this analysis, the vast majority of insurers cite policy uncertainty in their rate filings. Some insurers make an explicit assumption about the individual mandate not being enforced or cost-sharing subsidies not being paid and specify how much each assumption contributes to the overall rate increase. Other insurers state that if they do not get clarity by the time rates must be finalized -- which is August 16 for the federal marketplace -- they may either increase their premiums further or withdraw from the market."

It doesn't -- or shouldn't -- take a political genius to see how those numbers could translate into a political context. Close your eyes and imagine seeing this ad:

[images of sick, sad looking patients on screen]

Narrator: "Donald Trump and Republicans in Congress are gutting our health care. Premiums are spiking. And Trump? 'Let Obamacare fail...I'm not going to own it."

Add in a little localized factoid -- "in Pennsylvania, premiums are surging by 25%" -- and you have the makings of a devastatingly effective ad.

And, unlike, say the Russia investigation, which remains difficult to weaponize in a political context because of its abstractness and complexity, health care is a tremendously potent issue in a campaign.

It touches everyone on a daily, weekly or, at a minimum, monthly basis. It is not some pie-in-the-sky idea. It is a real-life struggle and challenge. It impacts lives. Those are the sorts of issues that really matter in politics -- ones that speak to the heart more than the head.

We've seen proof of health care's power as an issue in both the 2010 and 2014 midterm elections. In 2010, conservative outrage at what they viewed as major overreach by the federal government into their health care fueled the Republican takeover of the House. In 2014, the broken promise of "If you like your health care plan, you'll be able to keep your health care plan" led to the Republican takeover of the Senate.

This Kaiser study is the sort of thing that you will see in lots and lots of Democratic ads over the next 15 months. And it's a line of attack Republicans -- at least to this point -- have no obvious answer to.

Excerpt from:

This health care study might be a silver bullet for Democrats in 2018 - CNN

Hard-line conservatives began an uphill fight Friday to force a fresh House vote this fall on erasing much of President Barack Obama's health care law without an immediate replacement, the latest instance of Republican rifts in what's been a fractious week for the GOP.

The effort by the House Freedom Caucus seemed to have no chance of passing Congress. The GOP-led Senate turned down a similar repeal-only bill last month, and top House Republicans have little interest in refighting a health care battle they were relieved to put aside after their chamber approved legislation in May.

With the party's repeal effort collapsing last month in the Senate, the conservatives' push gives them a fresh chance to show hard-right voters they've not surrendered. It also provides a chance to call attention to Republican lawmakers who've pledged to tear down Obama's law but haven't voted to do so with Donald Trump in the White House.

"It's not about calling out anyone, it's about doing what we said," said Rep. Jim Jordan, R-Ohio, a Freedom Caucus leader. "And I do think people deserve to see if their member of Congress is going to do what they campaigned on."

The conservatives filed a petition Friday calling for a House vote on dismantling Obama's law that would not take effect until January 2019. They say that would give Congress time to enact a replacement and pressure Democrats to cooperate, a premise Democrats who oppose the repeal effort reject.

To force a House vote, conservatives need signatures of 218 lawmakers, a majority. That seems like an uphill task because many GOP moderates oppose annulling Obama's law without a replacement they'd support, and all Democrats are opposed.

Asked how Speaker Paul Ryan, R-Wis., views the conservatives' push, spokeswoman AshLee Strong said, "The House has already passed a plan to repeal and replace Obamacare."

This week has also featured an extraordinary verbal barrage by Trump against Senate Majority Leader Mitch McConnell, R-Ky., over the Senate crash of the health care drive.

After tweeting caustic criticisms of McConnell, Trump insinuated to reporters that McConnell should consider resigning if he can't push health care, tax and infrastructure legislation through his chamber. McConnell had said Trump had "excessive expectations" about how quickly Congress could pass complicated bills.

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House conservatives want fresh health care repeal vote - ABC News

USA TODAY Published 10:36 a.m. ET Aug. 11, 2017

Johnny J. Hollis, Jr., pastor of Mercy Baptist Church in Montgomery, Ala., talks to classmates, Dorothy McAdory, right, and Darlene Cotton last week after a session on health disparities at the Greater Shiloh Missionary Baptist Church in Birmingham.(Photo: Deborah Barfield Berry, USA TODAY)

Some black churches in the South have taken a dramatic step: banning fried chicken from their Sunday menus.

It is part of a broad effort to combat the persistent truth that blacks suffer from conditions like heart disease and diabetes at much higher rates than whites.

USA TODAY's Deborah Berry visited an event in a Birmingham, Ala., church last week where the Alabama Baptist State Congress of Christian Education convened a training for community leaders on ways to bring better health care to people in church, in barbershops, and in neighborhood grocery stores. But participantssaid they are concerned that any roll back of the Affordable Care Act could make their jobs harder.

Berry joined us on USA TODAY's Cup of Politics podcast to talk about the effort.

Read or Share this story: https://usat.ly/2wPlJ2q

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Podcast: Black churches take on the fight against racial disparities in health care - USA TODAY

(Bastien Inzaurralde/The Washington Post)

BRUNSWICK, Ga. The long August congressional recess, which Republicans hoped would begin a conversation about tax reform and must-pass budget measures, has so far seen another round of angry town halls focused on President Trump and the stalled effort to repeal the Affordable Care Act.

Over just one day, in three small towns along Georgias Atlantic coastline, Rep. Earl L. Buddy Carter (R-Ga.) spent more than four hours answering 74 questions, many of them heated. Just three focused on tax reform; nearly half of all questions focused on health care.

We did our job in the House, Carter said at the top of a town hall at Brunswicks College of Coastal Georgia. It got over to the Senate, and it hit a stumbling block there. Now its in their court, and they need to get something done. Folks, were not giving up.

Carters town halls he is hosting nine total, more than any member of the House mirrored what was happening in swing and safe Republican districts across the country. The failure of the repeal bill kick-started a tax reform campaign, backed by Republican leaders and pro-business groups, who have booked millions of dollars in TV ads to promote whatever might lead to an uncomplicated tax code.

In the first spots, paid for by the American Action Network, a laid-off steelworker worries that without lower taxes for working families, more jobs will be lost to China. At rallies and forums in several states, Americans for Prosperity has pitched tax reform as a way to unrig the economy. And in a polling memo made public this week, the AAN found 65 to 73 percent of voters responding favorably to reform if it was pitched as a way to restore the earning power of the middle class and save billions of dollars per in year on tax preparation services.

But at town-hall meetings since the start of the recess, tax reform has hardly come up; health care has dominated. At a Monday town hall in Flat Rock, N.C., Rep. Mark Meadows (R-N.C.) pitched a plan to devolve ACA programs to the states, then found himself fending off constituents who backed universal Medicare.

[Bipartisan health policy coalition urges Congress to strengthen the ACA]

You can take the top one percent and tax them fully, and it still wont pay for Medicare, said Meadows.

At a town hall in Chico, Calif., in the most Democratic portion of a deep red district, Rep. Doug LaMalfa (R-Calif.) found himself fending off furious complaints about the repeal vote, with constituents accusing him of acting to bring about their death.

I hope you suffer the same painful fate as those millions that you have voted to remove health care from, one constituent told LaMalfa. May you die in pain.

Carters town halls did not reach that boiling point, but they revealed what the tone of congressional listening sessions has become angry, wistful and loaded with progressive activists.

The 1st congressional District, stretching from Savannah to the Florida border, has been held by his party since 1993. In 2016, the Trump-Pence ticket carried the district by 15.5 points, while Democrats could not find a candidate to run against Carter.

(Nolan Ford/North State Public Radio)

But on Tuesday, the constituents who signed up for the meetings on Eventbrite and walked past local police officers to take their seats seemed to skew left. Two groups founded after the 2016 election, Speak Up Now and Savannah Taking Action for Resistance, had members at town halls in Darien and Brunswick.

Carter, who peppered his answers with self-deprecating jokes, sometimes called on activists whod dogged him before. In Brunswick, he quickly pivoted from a question about Zionist influence in our foreign policy by promising to put America first. After three different constituents asked him to say whether he supported the presidents decision to ban transgender men and women from military service, he went from deferring to our commander in chief to saying what he believed.

I dont want em serving in the military, Carter said, as dozens of constituents booed and more than a dozen walked out. Im sorry.

At each town hall, Carter provided fact sheets to advance two messages one about how much work Congress had done in 2017, and one about how his party would not give up on repealing the ACA. A one-pager titled Health Care Reform: Myth vs. Fact, with citations from the Department of Health and Human Services, revealed just how much the party had suffered from Democratic attacks. Instead of rebutting the line that the AHCA would cut Medicaid, it framed the ACAs Medicaid expansion as a departure from the programs mission that denied choice to the working poor.

Medicaid was designed to provide a vital health care safety net for elderly, children, pregnant women, and individuals with disabilities, it read. Low and middle-income adults capable of holding down a job should have health care choices.

Behind the microphone, Carter found himself making that same point repeatedly, about a slew of ideas for expanded government programs, as Democrats cheered and Republicans simmered. In Brunswick, after Carter told a college student that free tuition was a pipe dream weve got a $20 trillion debt an older man took the mic and advised the student to get a job.

It wasnt the only time Carter stood back and watched as his constituents argued among themselves. Mary Nelson, 73, used her question time at Carters Darien town hall to insist that Republicans were all wrong about single-payer health care. She walked through an experience that her Australian relatives had gone through, and described a cheap system with no hoops to jump through that could be copied in America.

They are taxed out the wazoo in Australia, interjected Adrienne Stidhams, 48, a Trump supporter.

How much do we pay for premiums? Nelson asked rhetorically.

Like Meadows, Carter suggested that Democrats and Republicans could work together on health-care bills while the repeal effort stalled. When multiple constituents asked if he would let the probe of Russian meddling in the 2016 election play out, Carter defended the president and suggested that special counsel Robert S. Mueller III, a good man, would likely find out the facts before long.

Im worried about some of the people he has around him, Carter said, apparently referring to lawyers hired for the probe who have been attacked in conservative media for donating to Democrats.

There were no questions about the debt limit, which must be raised when Congress returns to avoid default. The three questions about tax reform focused on the possibility of the Fair Tax, a national sales tax to replace taxes on income, about whether companies keeping profits overseas could be taxed, and about tax fairness in general.

Carter jumped at the opportunity to talk about it. Whats being proposed right now is to bring our corporate tax down from 35 percent one of the highest in the world down to 15 percent, he said, citing a tax reform blueprint released this spring and a positive analysis from the conservative Tax Foundation. That will create jobs.

No constituents followed up with questions. Instead, there was more skepticism about the president and his plans, countered by constituents who asked Carter to defend the president from media attacks.

I tell ya, I dont think Ive ever seen a president thats been disrespected by the media like this, said Carter. He had more to say, but drowned out by booing, he moved on.

Read more at PowerPost

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At raucous town halls, Republicans have faced another round of anger over health care - Washington Post

We are, too.

We're freshman members of Congress from different political parties, but we know there is more that unites us than divides us. That's why we're part of the Problem Solvers Caucus: a group of more than 40 lawmakers, split evenly between Democrats and Republicans, committed to -- you guessed it -- solving problems.

As it stands, the Affordable Care Act is unsustainable. For too many Americans, health care is still too expensive. Premiums are rising and people are scared. This is a life-and-death issue for many Americans. They deserve to know that when they get sick, or their child falls ill, that a system will be in place to ensure they have access to high-quality, affordable health coverage. That should be the goal for any lawmaker, regardless of party.

We know that the Affordable Care Act isn't perfect, but we need to keep what works and fix what doesn't. The bottom line is: we need to stabilize the individual market right now -- and that is what our proposal does.

Second, we must stabilize the individual marketplace by creating a dedicated fund for states to use to bring down premiums and limit losses for providing coverage, especially for people with pre-existing conditions.

Third, our plan calls for an adjustment to the employer mandate from businesses that have 50 employees to those with 500 employees. The current mandate puts too many burdens on small businesses, making it almost impossible to grow beyond 50 employees.

Finally, our proposal will provide technical changes and guidelines for states seeking to improve their exchanges and offer better coverage for consumers.

This isn't the silver bullet solution to our healthcare troubles, but it's a start -- and it's the exact kind of common sense leadership that Americans are looking for. Instead of focusing on scoring political points, the Problem Solvers Caucus' goal is simple: get things done.

We both happen to have been trained as CPAs and lawyers. We're both freshmen members from suburban districts. One is from Long Island and Queens in New York and the other from outside Philadelphia, but we are joined by other members from all over our nation with varying backgrounds and years of service.

When we came to Congress earlier this year, each of us signed a freshman pledge to civility. That's what being an elected official is about. We chose to set aside our petty differences, look at the big picture, and realize that we have a sacred duty to improve the lives of the people who have entrusted us with the responsibility of representing them -- and our country -- in Congress.

We know that this is serious business. Ramming through legislation with support from only one party is not how the legislative branch of government was meant to operate, and as we've seen before and we're seeing again now, it just doesn't work.

We need leaders sobered by their responsibilities and individuals committed to stopping the nonsense that dominates our current national discourse and elevating the debate to the serious, responsible level our times demand.

Instead of focusing on areas of disagreement, let's focus on goodwill and compromise where we can find common ground. We believe our health care proposal is the start of many good bipartisan conversations. It is not only our duty, but our only hope.

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Congressmen: Our bipartisan plan for health care - CNN

By THOMAS BEAUMONT , Associated Press August 11, 2017 - 1:30 PM

CEDAR RAPIDS, Iowa Democrats used a bus emblazoned with the words "Drive for our Lives" to gin up opposition to vulnerable House Republicans who voted against Obamacare with the aim of upending the GOP's majority in next year's midterm elections.

The vote to repeal and replace the Obama health care law looms large for 21 GOP lawmakers, including Iowa Reps. David Young and Rod Blum. They represent competitive congressional districts where Democrat Hillary Clinton won or came close in last year's presidential election.

The collapse of the yearslong Republican quest to dismantle Obamacare has been a bitter pill for House Republicans who voted for the legislation in May only to see the drive fall apart recently in the Senate when the GOP failed to muster enough votes.

Now all that some lawmakers have to show for the politically tough vote is the word "mean" President Donald Trump's description of legislation that would have made deep cuts in Medicaid, allowed states to opt out of coverage for essential benefits and knocked 23 million Americans off insurance.

The bus motored into Iowa on Friday, stopping in Cedar Rapids, the largest city in Blum's eastern Iowa district.

The black-and-gray motor coach was parked in downtown Cedar Rapids as Diane Peterson urged Blum to listen to his district's independent voters, who outnumber those affiliated with either major party.

"Of course there are things in the ACA that need fixing," said Peterson, referring to the Obama health law's name, the Affordable Care Act. The 61-year-old Democrat and coffee shop owner from Hiawatha added, "But Republicans now need to reach out."

While Blum has allied himself with the House's conservative Freedom Caucus, Young angered conservatives when he initially opposed a House GOP health care bill, then weeks later swung behind it. Independents were frustrated with the two-term congressman's embrace of a partisan approach to repealing and replacing Obamacare.

"David Young is not as conservative as some would like here in southwest Iowa," said Council Bluffs Republican David Overholtzer, a 56-year-old accountant.

"Things need to get done," said Jeff Jorgensen, a western Iowa Republican county chairman. "He's doing OK, but his chances for re-election are tied to Trump's popularity."

The Des Moines Register's Iowa poll last month showed Trump's disapproval climbing to 52 percent. The increase was driven largely by independents, 59 percent of whom disapproved of Trump's job performance, compared to 50 percent in February.

Independents, who hold sway in Young's politically diverse district, want a bipartisan approach to health care.

"That's what I and others like me have been saying: Because of this fail, people might reach across the aisle and craft something together," said Mark Scherer, a 65-year-old manufacturing representative and political independent from a north Des Moines suburb.

Now, Young is threading the needle, talking bipartisanship as he faces the reality that Democrats are gunning for him in a state where Trump's approval is sinking and neither can boast a major legislative achievement.

"We've got to pivot for the good of the country to a more bipartisan solution," the 49-year-old Young, a former chief of staff to Iowa Sen. Chuck Grassley, told The Associated Press during a visit to far western Iowa. "It's probably an easier, clearer path."

A national poll released Friday by the nonpartisan Kaiser Family Foundation found that around 4 in 5 want the Trump administration to take actions that help Obama's law function properly, rather than trying to undermine it. Just 3 in 10 want Trump and Republicans to continue their drive to repeal and replace the statute.

Young defended his vote for the House GOP bill, arguing that Republicans added billions of dollars more to help people with preexisting conditions.

Democrat Janet Norris from Red Oak, who met privately with Young in her western Iowa hometown last week, called his reasoning "doublespeak."

"You need to assure me you care about us in the Third District, and not what Republican leadership tells you to do," she recalled telling Young during their private chat at the Red Oak fire station.

Norris doesn't rule out voting next year for Young, who has drawn seven potential Democratic challengers, but cringed and said, "I just don't feel like he's independent enough."

Young's newly expressed, less-partisan view is music to the ears of Republican Christi Taylor, 46, a physician from Waukee in Des Moines' burgeoning western suburbs, heavy with moderate Republicans and independents.

But she lamented Republicans' attempt to quickly pass legislation with support from only GOP lawmakers. "This is not something any one party should ram through," Taylor said, describing the House's effort as "naive and arrogant."

Democrat Bryce Smith from nearby Adel agrees with Young that the 2010 law needs tweaking, not shredding. The 26-year-old bowling alley owner complains that Young's bipartisan tone is convenient, in light of the spectacular collapse of Republican efforts.

"All of a sudden, now that this failed, we need to approach it in a bipartisan way?" Smith said in disbelief. "If it would have passed the first time, we would have never heard from him that we need to work on a bipartisan solution."

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Dems target swing-district House GOP on health care - Minneapolis Star Tribune

MSNBC

Trump's political antics push consumers' health care costs higher MSNBC At a press briefing a few weeks ago, White House Press Secretary Sarah Huckabee Sanders said there's all kinds of evidence that the Affordable Care Act is facing a collapse. To prove her point, Donald Trump's principal spokesperson told reporters, ... Study says uncertain future of health care will spike premium costsChristian Science Monitor Trump's 'mixed signals' on health care could lead to big premium increases, study findsThe Week Magazine Uncertainty over Trump's health-care policies driving double-digit insurance price hikesCNBC all 24 news articles »

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Trump's political antics push consumers' health care costs higher - MSNBC

(Jenny Starrs/The Washington Post)

President Trump stepped up his criticism of Senate Majority Leader Mitch McConnell on Thursday for not muscling through a health-care bill, escalating an extraordinary fight with a key leader of his own party.

Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldnt get it done, Trump wrote on Twitter. Must Repeal & Replace ObamaCare!

Trumps morning tweet was his second in 24 hours targeting McConnell for remarks the Kentucky Republican made earlier in the week suggesting that Trumps lack of political experience had led toexcessive expectations for passing major legislation.

[Trump takes issue with McConnells accusation that he had excessive expectations for Congress]

Trump has remained bitter about the failure of congressional Republicans to pass a bill overhauling the Affordable Care Act, a pledge the party has made since 2010 and a marquee campaign promise for Trump.

The sparring with McConnell was the latest sign of increasingly strained relations between Trump and Republicans in Congress, who have had few victories since January despite the GOPs control of the White House and both the House and Senate.

Since the collapse of a health-care bill, Trump has belittled GOP senators as looking like fools and suggested they change the chambers rules to make it easier to pass bills.

The presidents attacks on a leader popular among Senate Republicans comes as lawmakers are poised to try to tackle other shared but challenging priorities in the fall, including a tax overhaul. They also are faced with trying to craft a budget and raise the nations debt ceiling.

Discerning a particular strategy or goal from these tweets is hard, said Doug Heye, a Republican consultant and former Capitol Hill staffer. It just doesnt help enact any part of his agenda, and it sends a further troubling sign to Capitol Hill Republicans already wary of the White House.

Heye said that with Trumps job approval numbers declining among the Republican base, now is the time to build support within the party.

White House aides said Trump has a general frustration with McConnell that extends beyond the health-care debate.

You can see the presidents tweets, White House press secretary Sarah Huckabee Sanders told reporters Thursday. Obviously theres some frustration. I dont have anything more to add.

Barry Bennett, an adviser to Trump during last years campaign, said the president was speaking to a Republican Party that has become a firmly anti-Washington party.

It may not be a winning tactic, but its certainly a winning message, Bennett said.

McConnell, to this point, has been one of the most steadfast supporters of Trumps agenda in Congress, and at least publicly, Trump has enjoyed a smoother relationship with McConnell than House Speaker Paul D. Ryan (R-Wis.) and other GOP congressional leaders.

In April, McConnell orchestrated the confirmation of Trumps Supreme Court pick, Neil M. Gorsuch, changing the Senate rules so that Democrats could not block the nomination. The Gorsuch confirmation remains Trumps largest victory on Capitol Hill to date.

McConnells wife, Elaine Chao, another prominent Washington figure, also serves in Trumps Cabinet as transportation secretary.

In his remarks Monday to the Rotary Club of Florence, Ky., McConnell said, Our new president had of course not been in this line of work before. He added: I think he had excessive expectations about how quickly things happen in the democratic process.

[Can this marriage be saved? Relationship between Trump, Senate GOP hits new skids.]

McConnell said people think Congress is underperforming partly because artificial deadlines, unrelated to the reality of the complexity of legislating, may not have been fully understood.

Sanders confirmed that Trump and McConnell spoke by phone Wednesday, a conversation in which Trump made clear he wants to continue to press for passage of a health-care bill. The call was first reported by the New York Times.

The same day, while on a 17-day working vacation at his private golf club in Bedminster, N.J., Trump took his first shot at McConnell on Twitter.

Senator Mitch McConnell said I had excessive expectations, but I dont think so, the president wrote. After 7 years of hearing Repeal & Replace, why not done?

Earlier Wednesday, Dan Scavino Jr., the White House social media director, also went after McConnell on Twitter.

More excuses, wrote Scavino, an outspoken Trump loyalist. @SenateMajLdr must have needed another 4 years in addition to the 7 years to repeal and replace Obamacare.....

Sean Hannity, a Fox News host often sympathetic to Trump, also weighed in following McConnells remarks, writing on Twitter: @SenateMajLdr No Senator, YOU are a WEAK, SPINELESS leader who does not keep his word and you need to Retire!

In another sign of frayed relations between Trump and Republican senators, one of the presidents largest political benefactors is providing a $300,000 contribution to a super PAC that aims to unseat Sen. Jeff Flake (R-Ariz), who has been critical of the president.

Politico first reported that Robert Mercer, a hedge fund billionaire heavily involved in Trumps political ascendancy, is making a donation to a group supporting former Arizona state senator Kelli Ward, who is challenging Flake in a Republican primary next year.

Flake has been on a book tour promoting Conscience of a Conservative, in which he argues that the GOP is in denial about the Trump presidency.

Despite the public criticism, Trump and McConnell are in frequent contact, usually by telephone, to discuss legislative strategy, aides said. The last time they met in person was July 19, when Trump hosted Republican senators at the White House and implored them to continue working to repeal and replace the Affordable Care Act.

Privately, senior GOP congressional aides across Capitol Hill have said its Trump and his team not McConnell who deserve the blame for the collapse of the GOPs health-care plan. The aides gripe that Trump seriously damaged relationships with key Republican senators over the course of the months-long debacle.

Trump has singled out certain senators either via Twitter or by placing them next to him during staged White House meetings to make it look like hes squeezing them a visual that often leads to awkward still photos of the senators facial reactions.

At one point this summer, Trump was flanked at a White House meeting by Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who both voted against the health-care measure. At the mid-July meeting, it was Sen. Dean Heller (R-Nev.) seated next to Trump. The president called him out with cameras rolling for wavering on the health-care bill.

Look, he wants to remain a senator, doesnt he? Trump said as Heller laughed uncomfortably.

Heller ultimately voted for the bill, but the exchange with Trump is a scene that Democratic aides have vowed will appear prominently in future campaign attack ads against the senator, who is the most vulnerable GOP incumbent facing reelection next year.

Trumps long-standing feud with Sen. John McCain (R-Ariz.) hasnt helped the overall dynamic either. The senator voted against the health-care plan in a closely-watched late night vote even after Trump made a direct last-minute appeal by phone.

The pair have been at loggerheads on several occasions since Trump two years ago criticized the senator for being captured during the Vietnam War and refused to apologize despite a national outcry.

In addition to criticizing Trump and McConnell for the contours of the health-care debate, McCain this week has blasted the presidents comments on North Koreas nuclear ambitions in interviews with Arizona radio stations.

On Thursday, he also released legislation that would implement a new military strategy in Afghanistan a proposed amendment to the annual defense policy bill that McCain said he unveiled in the absence of a new coherent strategy from Trump.

Sen. Ron Johnson (R-Wis.), who has had a contentious relationship with McConnell, said Thursday that he was sympathetic to Trump in the wake of the health-care bills failure.

President Trump is at his desk with a pen ready to sign what Congress was going to send him and we didnt, Johnson said during an interview on CNN. And I completely feel his frustration. Im every bit as frustrated.

Asked whether he thought taking aim at McConnell on Twitter was the right tactic, Johnson demurred.

Ill let this president speak for himself and his tactics, he said.

Trumps social media firestorm marks his first concerted attacks against McConnell. Throughout the 2016 campaign, while other GOP lawmakers wavered in their support of the GOP nominee, McConnell never did. He criticized some of Trumps more outlandish statements, but it was usually muted compared with other Republicans, and McConnell preferred to deliver his critiques in private.

So when Trump lashed out at fellow Republicans, it was directed mostly at Ryan and McCain, who frequently criticized Trump in public. Trump even threatened to support primary opponents running against Ryan and McCain last year.

Behind the scenes during the campaign, McConnell served almost as a tutor to Trump on the key issue of handling the Supreme Court vacancy after the February 2016 death of Justice Antonin Scalia.

At McConnells urging, Trump released lists of more than 20 potential nominees, names that were culled by Trumps advisers from discussions with the Federalist Society, the conservative group focused on judicial matters that is close to McConnell.

Trumps handling of the court vacancy helped rally evangelical conservatives to his side, a key factor in his narrow victory last fall over Democrat Hillary Clinton.

However, inside the White House, Trump has a collection of advisers who have had antagonistic relationships with McConnell and Senate GOP leadership.

Stephen K. Bannon, Trumps chief strategist, came from Breitbart, where his news organization regularly antagonized McConnells leadership team. Stephen Miller, chief policy adviser to Trump, was not considered an ally to the Senate leaders staff when Miller was a top adviser to Jeff Sessions in the Senate.

Moreover, one of Trumps top legislative affairs advisers is Paul Teller, who served as Sen. Ted Cruzs top aide during a period when the Texas Republican accused McConnell of lying about trade legislation.

And Mick Mulvaney, Trumps budget director, was a constant critic of the Senate during his three terms in the House, regularly opposing fiscal compromise deals that McConnell brokered with the Obama White House.

Phil Rucker and Kelsey Snell contributed to this report.

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Trump steps up attacks on McConnell for failure on health-care reform - Washington Post

Source: National Business Group on Health

Marcotte said that the cost can vary depending on where the treatment is administered (i.e., a hospital or doctor's office or even in the home). The survey shows that 44 percent of companies plan to combat pharma costs in part by better managing where patients receive those high-price medicines.

Employers also increasingly have been offer high-deductible plans as a way to control costs. The study shows that by next year, 90 percent of large companies will offer this option.

Under these plans sometimes called consumer-driven health plans in industry lingo employees can put away tax-deductible savings in a health savings account, or HSA. For 2017, contribution limits are $3,400 for individual coverage and $6,750 for family plans. An extra $1,000 is allowed for people age 55 or older.

HSA balances can carry over from year to year, and withdrawals are tax-free as long as they go toward qualified medical expenses.

The survey also says that without such various cost-cutting measures being implemented by employers, overall costs would increase by 6.6 percent next year instead of the anticipated 5 percent.

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Employers to spend about $10000 on health care for each worker - CNBC

Story Highlights

WASHINGTON, D.C. -- Americans cited the U.S. government itself as the most important problem facing the U.S. this month (20%). This is down five percentage points from June, but still elevated amid the tension between the Trump White House and Congress.

What do you think is the most important problem facing this country today? [open ended]

Issues mentioned by 4% or more of respondents

The "government" category of responses includes many mentions of President Donald Trump, specifically, as the country's top problem, as well the Democratic Party, government gridlock and politics in general.

These findings are from an Aug. 2-6 Gallup poll.

Mentions of racism/race relations as the most important problem were at 7% this month, up from 4% in July. Yet mentions about the economy continued to drop, at only 6% in August. Immigration, a contentious issue throughout the presidential campaign and into the Trump presidency, held at 7%.

Before the latest escalation in souring relations between the U.S. and North Korea on Tuesday, 4% of Americans named North Korea as the most important problem. The war of words between Trump and North Korea's leader Kim Jong Un has been ratcheting up with North Korea recently declaring it has the capability to attack the U.S. and threatening to attack U.S. military installations on Guam. Trump on Tuesday warned the nation that these threats could be met with U.S. "fire and fury."

Government as the most important problem may be down from June, but mentions of it are still higher than was true for much of 2016. The highest percent mentioning government in the past five years was in October 2013 during the partial shutdown of the federal government. Factors that may have an impact on this choice include the Senate failing to pass a bill to repeal and replace the Affordable Care Act (ACA) and Congress passing sanctions against Russia over meddling in the 2016 presidential election.

Democrats (27%) are more likely than Republicans (15%) to say the government is the nation's top problem, however both figures are down slightly from 31% and 24% in June, respectively.

Healthcare Remains Significant Problem in Past Month

Seventeen percent of Americans this month identify healthcare as the most important problem, essentially unchanged from 16% last month. With the Republican ACA replacement plan dead, at least for the moment, along with reports of healthcare premiums rising, it is clear that healthcare remains on Americans' minds.

Mentions of healthcare have been generally higher in the past four months than at the start of Trump's term, except for a dip to 7% in June. That temporary drop occurred in the time between the House passing an ACA repeal bill and the beginning of Senate work on repeal legislation.

Republicans and Democrats are nearly tied in their citation of healthcare being the most important problem, with 21% of the GOP mentioning it and 19% of Democrats.

Bottom Line

So far this year, the U.S. government has consistently been top of mind when Americans are asked to name the most important problem in the U.S. The economy in general, which was the dominant concern during the Great Recession and its aftermath, remains far lower ranked today.

Healthcare may recede as a top problem if it falls out of the news because of Congress' reluctance to continue with Obamacare repeal legislation in the near term. On the other hand, if rising premiums continue, and the doomsday scenarios Trump is predicting come to pass, healthcare could remain as a most important problem. With discussions about tax reform looming on the congressional agenda, taxes, now at 2%, may rise as a most important problem in the next month or two. Military action with North Korea, or an intensification of words with the U.S., may vault that situation higher as well.

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Results for this Gallup poll are based on telephone interviews conducted Aug. 2-6, 2017, with a random sample of 1,017 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is 4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 70% cellphone respondents and 30% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

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Government, Healthcare Most Important Problems in US - Gallup