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

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

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

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

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

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

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

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

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

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

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

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

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

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

CNBC's Kayla Tausche contributed to this report.

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

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

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

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

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

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

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

Most of them fall into two buckets.

Bucket 1: Taxes related to individual income

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

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

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

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

Bucket 2: Taxes on corporations

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

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

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

Other taxes outside the buckets

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ARIZONA

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

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

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

ARKANSAS

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

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

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

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

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

TEXAS

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

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

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

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

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

COLORADO

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

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

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

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

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

KENTUCKY

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

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

KANSAS

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

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

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

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

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

Moran touched on the scarcity of Republican town halls.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Why we fight for universal healthcare - Los Angeles Times

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

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

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

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

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

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

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

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

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

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

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

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

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

Kansas Sen. Jerry Moran faced tough questions Thursday at a town hall meeting in his home county packed with critics of Republican efforts to overhaul health care, showing that even a tiny town deep in Trump territory in a Republican state isn't isolated from the political discontent in Washington.

Moran had his first town hall meeting of the short Fourth of July congressional break in Palco, a town with fewer than 300 residents about 270 miles (435 kilometers) west of the Kansas City area, the kind of event he's held hundreds of times over the past two decades. Palco is in Rooks County, where Moran grew up. President Donald Trump carried it with 84 percent of the vote in last year's presidential race, and there is no organized Democratic Party.

But about 150 people tried to squeeze into a community center room set up to hold less than half that number, with many of them from outside the area. While the audience applauded Moran for opposing a health care bill written by Senate GOP leaders, the applause was louder for speakers who advocated a universal government-run health care program such as Medicare for the elderly or Medicaid for the poor.

Moran announced last week that he would oppose the Senate Republican bill as currently drafted after a budget analysis suggested 22 million more people would be uninsured under the proposal by 2026. Moran said the legislation needs to protect coverage for people with pre-existing conditions and not hurt rural hospitals.

"I will choose country over party," Moran said. "I will choose Kansans over party."

Like many other Republican lawmakers, Moran has been a persistent critic of the Affordable Care Act championed by former President Barack Obama and filed legislation during the Democrat's administration to repeal it. Moran said a person's view of the 2010 law could depend upon whether they get coverage through an employer or have to search for it as individuals.

"There are people who tell me they are better off, and I believe them, and there are people who are less well off," Moran said of the Affordable Care Act.

The repeal push still has the support of many Republican voters in the area, including Ashley Kuhn, the 32-year-old director of a day care center down Main Street from where Moran had his town hall. She said she's seen her family's health insurance co-payments double and deductibles rise, and she blames it on Obama's signature health care law.

"Health care needs to be changed," she said.

But Moran's town hall drew supporters of Planned Parenthood and members of health care advocacy groups from as far away as the Kansas City area. They asked him whether any ordinary Kansan would benefit under the Senate GOP's plan and whether he would vote against any bill that didn't have public hearings.

Moran wouldn't rule out a "yes" vote in such an instance, telling the audience member who asked, "I know that's not the answer you were looking for" and getting a quick reply back, "No."

In a community where several stores and cars were festooned with anti-abortion messages, a Planned Parenthood lobbyist from Topeka, Elise Higgins, asked Moran what he would do to see that its patients still could have their services covered by Medicaid, Moran told her he didn't have a "good answer." An audience member said, "You need a better one, then, senator."

Some audience members came to press Moran to pursue a bipartisan solution that built on the existing health care law and moved the nation toward broader government coverage.

"Who doesn't want health care?" Jeff Zamrzla, a retired and disabled Marine and 59-year-old Democratic activist from Salina, about 100 miles (160 kilometers) to the east of Palco, said after the forum. "Who doesn't want to be able to live a life that's worth living?"

At times, audience members seemed more ready to debate each other than to press Moran. When one man said, "You can't get the Democrats to do anything," several people shouted back, "That's not true!"

Moran has built his reputation in Kansas politics as approachable and somewhat affable during 14 years in the U.S. House representing western Kansas and in the Senate since 2011. As a Senator from a sprawling state, he makes a point of visiting each of the 105 counties every two years. He planned events Friday in Sublette and Liberal in southwest Kansas. He defended the choice of Palco as a venue, saying residents of small towns should have chances to interact with elected officials.

Follow John Hanna on Twitter at https://twitter.com/apjdhanna .

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Sen. Moran gets tough health care questions in Trump country - ABC News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Senate Republicans are back in their home states for a weeklong break, and already, some of them have gotten an earful on the controversial GOP legislation to dismantle Obamacare. The message from their home-state constituents: Don't you dare vote for that bill.

Republican Sen. Susan Collins told reporters at a July 4 parade in Eastport that many Maine residents that she has spoken with while in her home state support her decision to oppose the legislation.

"There is a small group of people on the left who, right now, are very angry," Cruz told CNN affiliate KVEO. "We can engage in cordial and civil debate -- that's how democracy works and that's how it's meant to work."

McConnell was keenly aware of the political pressure that his colleagues would face on the health care bill when they went home. It was one of the key reasons he had worked furiously to try to have a vote before members left town.

But a flurry of meetings and closed-door negotiations still left the majority leader far short of the minimum 50 "yes" votes he needs to get the bill through the upper chamber. And within hours of his announcement to postpone the vote last week, three more members came out as "no" votes, bringing up the tally of Republicans publicly against the legislation to nine.

With 52 Republicans in the Senate, that's not a small number of senators McConnell has to move from the "no" column to the "yes" column. But the public opposition this week could make it that much more difficult for senators who are already against the bill -- and others who are on the fence -- to get to a "yes."

Over the July 4 recess, Senate leadership is continuing to engage rank-and-file members on potential changes to the health care bill, according to a GOP leadership aide. Leadership has also been in discussions with the Congressional Budget Office, so that the agency can swiftly release a new score of the revised Senate bill.

Those in the conservative wing of the conference -- Sens. Cruz, Mike Lee of Utah, Rand Paul of Kentucky and Ron Johnson of Wisconsin -- say the Senate legislation doesn't go far enough in rolling back Obamacare regulations.

Meanwhile, one of the most serious hang-ups for several Republicans including Sens. Dean Heller of Nevada, Shelley Moore Capito of West Virginia and Rob Portman of Ohio is the proposed cuts to Medicaid. The Senate bill proposes tying the growth rate for Medicaid funding to standard inflation instead of the more generous medical inflation. These senators are requesting that the funding stick with medical inflation.

Capito and Portman also have deep reservations about whether their states would retain enough opioid addiction treatment funding, and have requested $45 billion be included in the Senate bill.

But not every Republican senator is hearing from constituents opposed to the Senate health care bill.

At a July 4 parade in Ely, Nevada, a man called out to Heller, an opponent of the bill and one of the most vulnerable senators up for reelection next year, to "vote yes on that health bill" as the senator rode by on a horse.

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Senate health care plan: Recess isn't helping McConnell's hunt for 50 votes - CNN International

To state the obvious: Partisan video clips are not designed to make the other party look good. Theres an art to these things. You compile the worst moments by the other team, or by an opponent, and try to make them go viral.

But a strange, flailing campaign by the Republican National Committee to demand a Democratic fix for the Affordable Care Act goes unusually far in misrepresenting what the opposition party is doing or saying.The RNCs push began on Wednesday with a series of tweets at Democrats such as Hillary Clinton, demanding they put up plans of their own. Clinton responded, predictably, by linking to the ACA plan she ran on in 2016, which included fully funding insurance subsidies and letting younger people buy into Medicare.

Unbowed, the RNC released a compilation of Democrats being asked by talking headswhy they would not work with Republicans to fix the ACA. Most analysis of the videohas been that its simply bizarre. As Republicans know, the opposition party does not need to run on its own detailed health plan to win elections.

But the video makes it look like Democrats are not just evasive, but stumped when askedwhat theyd be willing to change to fix the ACA. Thats not whats been happening. Here are the three main clips, with the answers that were sliced out of the video printed in bold. With Sen. Bernie Sanders (I-Vt.):

NBC News: Would it be smart for Democrats to offer their own alternatives, their own fixes for Obamacare now, and try to bring Republicans on board?

SANDERS: Well, thats exactly thats a very good point. And that is some of the ideas that we have been talking about. For example, I, personally, speaking only for myself, think that for a start, while we move to pass a Medicare-for-all single-payer program; short term, we should lower the age of Medicare down from 65 to 55. Secondly, I think we need a public option. That means in every state in the country, if you dont like what the private insurance companies are offering, then you have a public option with decent benefits. Thirdly, weve got to deal with the cost of prescription drugs in this country.

With Sen. Mark R. Warner (D-Va.) less substance, possibly because the question was about President Trumps complaint that Democrats were not working with Republicans:

CNN: Do you share part of the burden for a failure to improve Obamacare?

WARNER: Im viewed as one of the most bipartisan guys in the United States Senate. Every bill I work on, Ive got a Republican partner. There has been no outreach by the Republicans to the Democrats. They decided theyre using this sort of strange process called reconciliation that allows them to pass a bill with 51 votes, not the normal 60. Unfortunately, the bill thats come out of that has been pretty godawful.

With Rep. Jackie Speier(D-Calif.):

CNN: Why arent you working to fix this, rather than just saying no? What do you say to them?

SPEIER: What I would say to them is: Theyre absolutely right. There are a lot of amendments we have to make to Obamacare, just like there were a lot of amendments that were made to Medicare after it became law in this country. We have to fix the cost elements in the Affordable Care Act. We have to have more cost containment. I am with them in wanting to do that.

Left out of the video is that most Democrats want to respond to the immediate threat to the ACA, as cited by panicky insurers, by fully funding the taxpayer subsidies that make plans on state exchanges more affordable. And lets be fair:left out of seven years of Democratic attacks on the GOP was that Republicans did have health-care bills of their own, theoretically ready to go as soon as the ACA was repealed. (The last six months have revealed that they were less ready than advertised.)

But sometimes, these attempts by one party to shape a narrative are so dishonest than you wonder what the point was. Here, it seems that Republicans are trying to bait Democrats into endorsing a single-payer health care bill as Sanders plans to do when the AHCA/BCRA debate is over. For weeks, the White House has argued that the coming health-care choice is not between the ACA and its repeal, but between the Republican bill and a pricey single-payer plan.

There are two problems with that. One: Obviously, Democrats who get behind a single-payer bill will have answered the whats your plan question. And two, to the great delight of Democrats, the Republicans health-care bills are far less popular than the concept of single-payer Medicare for all.

Link:

Republicans try to shift health-care blame back to Democrats - Washington Post

Sen. Ted Cruz at an event for the Federalist Society in November 2016. Cliff Owen/AP hide caption

Sen. Ted Cruz at an event for the Federalist Society in November 2016.

At an event Wednesday night, Texas Sen. Ted Cruz was met by about 150 protesters who oppose the Senate's efforts to repeal and replace the Affordable Care Act. On a hot evening, they stood outside a hotel in McKinney, a north Dallas suburb, shouting "shame on Ted" and "save Medicaid."

The by-invitation, town hall-style event was held one day after the senator's appearance in McAllen was disrupted by protesters concerned about health care as well as immigration.

Cruz is holding several town halls across Texas during the current congressional recess; he will also be in San Antonio and Austin this week.

The audience Wednesday night was mostly veterans who are friendly to the senator. The event was sponsored by the conservative group Concerned Veterans For America.

Protesters gather outside Sen. Ted Cruz's veterans event Wednesday evening in McKinney, Texas. Wade Goodwyn/NPR hide caption

Protesters gather outside Sen. Ted Cruz's veterans event Wednesday evening in McKinney, Texas.

There were just four to five questions from the audience and all were screened in advance. The Texas senator spent much of the event advocating for more health care choices for veterans beyond the VA hospital system. He also reiterated his opposition to the Affordable Care Act but acknowledged that getting the votes in the Senate to repeal it remains a challenge. He was also one of a small group of Republicans to oppose the Senate health care bill, arguing that it didn't go far enough to roll back Obamacare, as the ACA is also known.

Cruz said it is critical for Congress to focus on lowering premiums and to "honor our promise to repeal Obamacare it isn't working and people are hurting across the state and across the country."

One protester held a sign reading "Say NO to Trumpcare," in opposition to the Senate's effort to repeal the Affordable Care Act. Wade Goodwyn/NPR hide caption

Sen. Bill Cassidy of Louisiana also faced a confrontational town hall last week. An attendee in Baton Rouge reportedly interrupted his remarks to ask him to "vote against that hideous bill." He said he hasn't decided how he will vote on the Senate's health care bill because he wants to "judge the final product." Republican Rep. Susan Collins, who also opposed the Senate bill, told reporters in Eastport, Maine, that she's been hearing from constituents who are "deeply concerned" about the Senate bill.

At least seven more Republican members of Congress and more than 20 Democrats have town halls planned around the country this week, several of which will focus on health care.

Town halls became popular and contentious venues for voicing concern over health care in the summer of 2009 when President Barack Obama's Affordable Care Act was being debated in Congress. Many of those gatherings turned into shouting matches and, in some cases, physical fights.

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'Shame On Ted': Health Care Protests Greet Ted Cruz In Texas - NPR

The economics of health care is a devilishly complicated subject. Between the complexity of the market, the degree of regulation and the unusual nature of the things being sold, the topic is so vast that any single economist is practically incapable of grasping the whole picture. Thats why Im skeptical of arguments that rely strongly on economic theory. Unlike the market for oranges or blue jeans, health care defies simple theoretical analysis. Debates between advocates of government-centered and free-market systems tend, out of necessity, to focus on only a few points and leave much of the picture unaddressed.

To me, a much more compelling argument is simply to look around the world at the various health-care systems that have been tried. One system stands out from all the others in the developed world -- that of the U.S. Most countries have some form of universal health care. The U.S., however, up until the advent of Obamacare, allowed most people to buy or not buy insurance as they chose or were able. The results seem clear -- Americans pay way too much for their health care. In dollar terms, the U.S. spends more than anyone except Switzerland and Norway:

Health-care spending per capita in 2014

Source: World Bank

But since these countries have higher incomes, as a percent of its economy the U.S. spends a uniquely large amount:

Health-care spending as a percent of GDP in 2014

Source: World Bank

This would be fine if the U.S. got more bang for its buck. But most health outcomes in the U.S. are about the same or worse than in those other rich countries. The Commonwealth Fund, a private foundation, has done an excellent job of documenting this disconnect between what the U.S. spends and what it gets in terms of results. Though the U.S. does better at combating cancer, it has lower life expectancy overall, and suffers far more from chronic conditions. A stark example is the rate of death from childbirth, which has risen in the U.S. even as it has fallen steadily in other countries.

Some might believe that the U.S. needs to spend more to achieve the same outcomes, because Americans are more irresponsible with their health in the first place. But whether Americans are more likely to lead unhealthy lifestyles, theres plenty of evidence that much of the money the country spends on health care isnt going to any useful purpose. Analysis of health spending shows that Americans just pay higher prices for most health-care goods and services -- the same MRI or hospital toothbrush will cost an American much more than it will cost a British, Canadian or Japanese person. For example, in 2012, an appendectomy would cost the average American patient $13,851, but only cost the average Australian $5,467 and the average British person $3,408. That implies that much of the excess money Americans spend on health is just wasted.

This is striking evidence. At some point, endless discussions of economic theory need to yield to blunt fact -- government health-care systems just seem to do better than the U.S. system.

That is understandably a bitter pill for many free-market types to swallow. Faced with the superior performance of universal health-care systems, some supporters of a less regulated system have argued that the U.S. is somehow subsidizing the rest of the world. The most common of these arguments claims that high U.S. prices go to pay for innovation that the rest of the world copies for free.

This was the theory advanced by Craig Garthwaite, a health-care economist at Northwestern Universitys Kellogg School of Business, in a recent interview with Vox:

The rest of the world drafts off of the innovation generated by the profits of the United States. If Im running the health care system in another country, and if I have the United States here to generate huge profits to provide incentives to develop new drugs, I can choose to provide lower prices that take innovation less into account. I mean, the world of the Western European systems might be a little bit different if they had to think more carefully about that point.

Garthwaites interviewer, Sean Illing, takes him at his word, but we shouldnt. Innovation-mooching cant possibly explain the cost differences between other rich countries and the U.S.

The numbers just dont add up. Total U.S. biomedical research spending was only about $158 billion in 2015. Suppose, just for the sake of argument, that Canada, Germany, the U.K. and all the other countries where health care is dramatically cheaper than in the U.S. copied every last bit of U.S. R&D for free and didnt do any of their own research. Even in that extreme case, they would only be saving $158 billion, which is a much smaller amount than what the rest of the developed world currently spends on health overall. So mooching off of the U.S. cant explain the big gap between them and the U.S.

Also, as economist David Eil points out, about half of U.S. biomedical research is funded by the government. Excess costs in the private U.S. health care and health insurance industries arent going to pay for those government-funded innovations.

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Eil provides several other reasons not to buy the innovation-copying story. There seems to be little reason why higher innovation costs should be reflected in the price of hospital toothbrushes. Whats more, lots of expensive research doesnt even succeed -- research efforts fail all the time. So the true amount of money that other rich countries are mooching off of the U.S. health care system is going to be a lot smaller than $158 billion.

In other words, dont believe the argument that the cost difference between the U.S. and other countries is the inevitable price of a more innovative health-care system. Americans really are being greatly overcharged for their care. For whatever reason, health seems to be one industry where government does things more cheaply than the private sector.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story: Noah Smith at nsmith150@bloomberg.net

To contact the editor responsible for this story: James Greiff at jgreiff@bloomberg.net

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The World Doesn't Mooch Off US Health-Care Research - Bloomberg

Another bid by President Trump to repeal and replace a major Obama administration achievement recently got a boost when the Environmental Protection Agency, now led by anti-environmentalist Scott Pruitt, moved to repeal a 2015 clean water rule. Thats a shame.

The Waters of the United States rule was meant to protect the drinking water supply for more than 100 million Americans by clarifying which waterways are covered by the landmark Clean Water Act of 1972, which limits the chemicals and other pollutants that can be discharged into navigable U.S. waters. The interpretation of previous rules was muddied by a pair of U.S. Supreme Court decisions, and the 2015 rule brought a good measure of clarity.

When Trump in February signaled his intention to scrap the rule, which is widely known as WOTUS, he complained that it covers puddles and ditches and gets in the way of farmers trying to feed a hungry nation and builders trying to keep the economy on track.

Thats pure Trump remolding the facts to suit his purposes. The clean water rule might indeed apply to a small pond, but only if it connects with larger waterways and therefore allows any pollutants dumped in it to spread through tributaries to the nations drinking water supply. As for ill-defined puddles, the rule expressly excludes them. It does apply to irrigation ditches that function as tributaries of downstream waters, but thats merely a reiteration of preexisting rules. It expressly excludes ditches that fill up only after it rains.

Pruitt appears to be quite at home with the presidents contempt for fact and science. A strong proponent of Trumps ill-considered decision to withdraw the United States from the Paris climate agreement, Pruitt on Friday announced an initiative to critique climate science by recruiting people to debate each side of an issue on which the vast majority of the scientific community long ago reached consensus.

That hostility might explain why both of them dislike the Waters of the United States rule so much. It relies on science to determine whether bodies of water are interconnected and thus protected under federal law, although it acknowledges that science cannot always provide a bright line boundary to determine where water begins or ends. Trump and Pruitt apparently would make that determination based on the convenience of polluters.

The WOTUS rule has never been fully implemented. It has been blocked in court because of lawsuits by more than a dozen states, including Oklahoma where the suit against the Environmental Protection Agency was filed by then-state attorney general and now-EPA administrator Pruitt.

Repealing the rule is one thing although that wont necessarily be simple or come without legal challenges. But then what? A new rule-making process can be long and cumbersome, and there will no doubt be lawsuits to keep water sources pure, and lawsuits to allow them to be sullied. The administration will likely continue to reject science (and clean water) in the name of decreasing regulations on polluters. Lawyers, at least, will be happy. As long as they dont drink the water.

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With healthcare reform stalled, Trump and Pruitt want to repeal and replace clean water standards - Los Angeles Times

JUDY WOODRUFF: But, first, lets turn to the Senate Republican bill to overhaul parts of Obamacare.

The Senate may be in recess this week, but Majority Leader Mitch McConnell is working behind the scenes to craft a bill that will appeal to enough Republican votes to pass.

One of the key stumbling blocks, the provision to cut Medicaid spending by more than $770 billion over 10 years. That has sparked serious concern among many governors, among other reasons, over what it could mean for opioid abuse treatment and related health needs.

The Medicaid expansion under the Affordable Care Act provided new coverage to many. Reportedly, Senator McConnell has been considering a $45 billion fund to deal with opioid abuse.

New Hampshire is one state that is dealing with a crisis. It has the second highest rate of opioid deaths relative to its population.

I spoke with the states Republican governor, Christopher Sununu, a short time ago, and started by asking him why he doesnt support the current Republican Senate proposal.

GOV. CHRIS SUNUNU, R-N.H.: Well, I think its important to start off by understanding that Obamacare has failed, it is not sustainable, it is not affordable. Specifically here in New Hampshire, the health care exchange is really on the brink.

Were looking at upwards of 40 percent cost increases to individuals. Thats just not affordable to anyone. So, I do applaud the Senate and the Houses efforts and the Trump administrations efforts to really take Obamacare as a reform that has to happen.

That being said, what theyre really doing here is, theyre kind of conflating two issues. Theyre looking at Medicaid, traditional Medicaid entitlement reform, which absolutely has to be a viable discussion in Congress, and Obamacare reform. And theyre really putting the two together. Thats the end result there.

The cost implications, if you will, are really drastic to the state of New Hampshire. Youre looking at over $1.5 billion at best over the next 10 years. Thats not just a challenge for us in the state. Its not practical. Its just not practical at all.

We have no sales tax, we have no income tax. We dont have the taxes to raise, nor would we ever want to, like other states do. So we have to find a better solution there.

So I commend them for taking up the challenge. But right now, as it sits, the Senate plan is not a viable solution for this state.

JUDY WOODRUFF: So, Governor, specifically with regard to the opioid use crisis in your state of New Hampshire, what would this bill, this proposal mean for that?

GOV. CHRIS SUNUNU: Well, we have been on kind of ground zero, if you will, for the opioid crisis.

We have one of the fastest growing economies, one of the best qualities of life. Because we are a small state, that allows us to be very innovative in our approach. And so we have been able to sustain great success in the state, in spite of the opioid crisis.

But part of that, when you look whether its Medicaid expansion or other programs that have allowed individuals to get care, recovery services, medical care that they otherwise may not have would have been able to receive, that has been a big boon for our state and its been a big boost to those individuals and allowed those doors to be opened to them in ways that otherwise it wouldnt have.

So, when you look at both the cost implications, how Medicaid expansion right now as its proposed to being winnowed down, if you will, over the next few years, again, those costs are real severe and theyre again something that just is not practical for the state of New Hampshire.

JUDY WOODRUFF: What would it mean to the program that you have in place now in New Hampshire?

GOV. CHRIS SUNUNU: Well, when you look at folks that are coming through recovery or treatment or folks that are looking to fight that addiction, you have remember addiction with opioids is not something that you get through in a couple of years.

Its a lifelong struggle. Its a lifelong kind of battle, if you will, that folks have to have the programs in place not just for six months or a year, but for the long-term. And we have to have those recovery programs. We have to have those treatment options in place.

With opioid addiction comes some very severe medical conditions as well, whether liver or heart issues that come with that. Right now, were able to treat those. Were able to be preventative with a lot of those, as opposed to just allowing the old way of doing things where everyone would just pile into the emergency room.

So, going back, taking instead of one or two steps back, but three or four steps back, all the way to the point where were cutting services that, pre-Obamacare, were in place, right, were looking for a system that, for New Hampshire at least, is worse than there were even pre-Obamacare.

So my message to the Senate is very clear. Look at Obamacare reform as is. Look at that program, what we can do to reform it. Understand that the opioid crisis is affecting a lot of states, not just New Hampshire. Understand what those implications might be.

Its not just in the funding, but its in the flexibilities that states have to have.

JUDY WOODRUFF: Right.

GOV. CHRIS SUNUNU: You have to have a flexible system.

And being able to do that will allow us as governors to implement the programs that much easier.

JUDY WOODRUFF: Now, its been reported, as I think you know, that the Senate majority leader, Mitch McConnell, is looking at possibly adding something like $45 billion to deal with opioid abuse around the country over a period of years.

Would that make a difference?

GOV. CHRIS SUNUNU: When you look at $45 billion to deal with the opioid crisis, absolutely thats going to make a difference. Theres no doubt about it.

If its money going in to kind of hopefully get votes in the Senate bill, thats a different issue. Im not going to sign onto that. But there is no doubt that more resources would help this crisis. It allows recovery centers to have more longer-term programs, open up treatment options.

We can break down some of the permitting process to get more of those beds open for individuals, peer-to-peer recovery services. We have been able to be very, very innovative here in New Hampshire, really on the cutting edge. And thats how we have been able to sustain such a growing economy, such a high quality of life, in spite of the crisis.

We dont want to start throwing a wrench in those gears right now and slow down the incredible process we have been able to make in New Hampshire.

JUDY WOODRUFF: I ask you about that money because specifically other governors, I know John Kasich of Ohio and others who have an opioid crisis in their own states, have said thats just not enough money to make a difference over a long number of years.

GOV. CHRIS SUNUNU: Well, as I said earlier, you know, this is something that is not going to get solved in the next couple of years. It is going to be a lifetime issue for a lot of these folks.

We have to have lifetime-style programs in place to kind of ease them not just off of the opioids theyre in, making sure they have peer-to-peer support recovery programs, making sure they can enter the work force and hopefully get on better private insurance plans, as opposed to just relying on expanded Medicaid or the health care exchange.

So, when youre able to create systems that work efficiently Im an engineer by trade. Im all about creating an efficient system. When youre able to do that and implement that, there is a lot of savings you can have on the back end.

I do believe dollars can help. Theres no doubt about that. But when you look at the total implication of this Senate bill, $1.5 billion at best over the next 10 years, I dont mean to sound glib, but $45 billion here and there really isnt making the dent and really making the long-term effects that we have to be addressing as part of a long-term Medicaid reform.

JUDY WOODRUFF: Governor, one other thing, the argument that the Republicans in Congress have made on Medicaid and that is and the presidents budget director, Mick Mulvaney, has said Medicaid is unsustainable on the path that its on now, its grown way too expensive, it cannot continue like this, cuts have to come, there has to be a change in the trajectory.

GOV. CHRIS SUNUNU: Well, look, I would absolutely agree with that.

Look, Washington is dealing the Senate and the House and the president are dealing with nearly $20 trillion in debt. That is real money owed to someone, and a lot of it oversees.

So, our spending over the last eight years has gone completely out of control. And so they do have the challenge ahead of them of reeling that spending back in, creating more efficient systems.

Reeling it in is one thing. Going above and beyond from even where we were eight years ago is another story. And thats where we kind of draw the line and say, look, lets deal with Obamacare here, lets deal with Medicaid entitlement reform in another discussion, another discussion that frankly has to probably be a longer discussion, have to really get the input from the states, nothing that should be rushed.

So if we can deal with those two issues separately, I think we can have just much better outcomes and a much more viable solution for all the states.

JUDY WOODRUFF: Governor Chris Sununu of New Hampshire, thank you very much for talking with us.

GOV. CHRIS SUNUNU: Thank you, Judy.

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Senate health care plan 'not viable' for New Hampshire, says Gov. Sununu - PBS NewsHour

Senator Bernie Sanders energized many voters across the country during his failed bid for the 2016 Democratic presidential nomination, and now hes hitting the road again to speak with Americansbut with a different end goal in mind. The independent senator from Vermont is set this weekend to hold rallies in traditionally Republican-voting states to speak out against the GOPs health care plan, which isaimed at gutting the Affordable Care Act, otherwise known as Obamacare.

Sanders has titled the rallies Care Not Cuts, pointing to the Congressional Budget Office estimate that tens of millions of American would lose coverage under the plan formulated by Senate Majority Leader Mitch McConnell and his Republican colleagues. The Sanders events are scheduled to take place in Kentucky and West Virginia on Sunday.

McConnells legislation, which would throw 22 million Americans off of health insurance, would be a disaster for the country and an even worse disaster for the people of Kentucky,Sanders said in a statement. Under the Affordable Care Act, Kentucky has made significant progress in lowering the number of its uninsured people. Further, the expansion of Medicaid there has been of significant help in the fight against the opioid epidemic which has ravaged Kentucky.

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Sanders recently held similar rallies inPennsylvania, West Virginia and Ohio aspart of the Dont Take Our Health Care tour sponsored by the progressive group MoveOn.org. Sanders has been highly critical of the GOPs health care efforts in both the House and the Senate. Shortly after the Senate bill was introduced,he tweeted that itwas themost harmful piece of legislation Ive seen in my lifetime.

If you cut Medicaid by over $800 billion, there is no questionbut that thousands of Americans will die,Sanders said on CNN to expand on his initial statement. This is barbaric. Frankly, this is what oligarchy is all about.

McConnell had planned to take a vote on the legislation before the Senate adjourned forits Fourth of July recess, but he delayed it after realizing the GOP didnt have the 50 votes necessary for the bill to pass. Republican lawmakers have been subject to protests during their break, and reports suggest the GOPs path to passing the bill could be tenuous.

The legislation is incredibly unpopular among Americans, with one poll finding just 12 percent of the country approved of the plan.

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What's Next for Bernie Sanders: Fighting Republican Health Care Plan in Red State Rallies - Newsweek

Going into this week's holiday recess, activists were already planning to target public events and festivities on July 4 in anticipation of appearances by elected officials.

Republican Sen. Susan Collins, who opposes the current plan, said she was still a "no" while talking to reporters at a parade in Eastport, Maine, which is known as the biggest Fourth of July event in the state.

"What I've been hearing the entire recess is people telling me to be strong, that they have a lot of concerns about the health care bill in the senate, they want me to keep working on it, but they don't want me to support it in its current form," she told reporters.

Collins, a center-right Republican, argued the bill would be too harmful to her constituents because of the impact of Medicaid cuts on rural populations and the elderly.

"I've found that Mainers are very well informed about the legislation, and they're deeply concerned about what it's going to mean for themselves and their neighbors," she said.

Collins added that she'll remain against the bill unless it's "dramatically changed."

Heller participated Tuesday in a parade in the small town of Ely, Nevada, with a population of about 4,200 people. One man urged Heller to "vote yes on that health bill" as the senator rode by on a horse.

Another Republican, Sen. Ted Cruz, faced a large group of protesters at a parade in McAllen, Texas. Speaking to CNN affiliate KVEO, Cruz said the demonstrators were an illustration of democracy at work.

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

Cruz was one of four senators who opposed the Senate bill as written before McConnell decided to delay a vote on the legislation. He joined three other conservative Republican senators who argued the bill did not go far enough in repealing Obamacare

Meanwhile, more moderate Republicans, like Heller and Collins, opposed the bill's Medicaid cuts. By the time the Senate went into recess, the total tally of "no" Republican votes inched up to nine. McConnell can only afford to lose two Republican votes in order for his legislation to pass the chamber.

Outside Sen. Pat Toomey's office in Philadelphia, demonstrators gathered for a "Tuesdays with Toomey" protest, where several people laid down on a sidewalk holding signs in the shape of tombstones. (Toomey was largely supportive the bill when heading into recess.)

Left-leaning groups will continue to hold events, rallies, and sit-ins across the country during the remainder of the week.

Activists associated with the Health Care for America Now coalition are gathering Thursday, for example, on the Williamstown Bridge that connects Ohio and West Virginia to target two senators from the two different states -- Sen. Rob Portman of Ohio and Sen. Shelley Moore Capito of West Virginia. The two senators announced their opposition in a joint statement last week after the Senate decided to delay its vote.

Portman's office sent out photos of the senator meeting with constituents during the recess, as well as a description of his efforts on health care.

"In his discussions with his colleagues, Rob is working to ensure that those on expanded Medicaid continue to have good health care options under a new system, whether it's under the current Medicaid structure or affordable health care options on the private market," Portman spokeswoman Emily Benavides wrote in a statement.

There's still time for activists and voters alike to see at least a few of their senators before they head back to Washington. Sen. Jerry Moran, R-Kansas, who expressed reservations against the bill, is hosting three town-hall style events at the end of the week.

Democratic senators last week retorted saying Republican leaders in the Senate never solicited Democratic input during the behind-the-scenes crafting of the bill.

This story has been updated.

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Republicans opposing GOP health care plan hear from voters during recess - CNN

As Republicans on Capitol Hill struggle to find common ground on a plan to repeal and replace the Affordable Care Act, and as Democrats criticize their plans as too expensive for the neediest in society, one subject is absent from the debate -- why is health care so expensive to begin with?

Medical care prices increased 4 percent in 2016 according to the Bureau of Labor Statistics, and premiums under Obamacare's second-lowest costing "silver" plans rose 7.5 percent in 2015. Plus, the U.S. spends far more per capita on health care -- $9,892 in 2016 -- than any other nation. That's a trend that doesn't show any sign of changing, according to the Organization for Economic Cooperation and Development (OECD).

Meanwhile, health care costs wereoutpacing the general rate of inflationlong before the theACA or Obamacarebecame law, and are projected to continue to do so.

"The encouraging part, if you will, is that the U.S. is much more expensive than other countries -- and there's no reason why we need to be," said David Cutler, an economist at Harvard University who specializes in the health care industry.

So, what are some of the factors contributing to the high costs of health care -- factors that will seemingly continue to increase Americans' health care bills, no matter what version of health care legislation passes?

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Administrative costs contribute to 25.3 percent of all health care spending in the U.S., the highest of eight nations analyzed in a 2014 study published in the peer-reviewed journal Health Affairs. Cutler says that's partly because the U.S. has so many payers -- from a slew of private health insurance companies to government programs like Medicare and Medicaid -- that hospitals and physicians have to negotiate with in the regular course of business.

Duke University Hospital, for instance, has roughly 900 beds and 1,500 billing clerks, Cutler noted.

"That's how many they need to get the bills paid," Cutler said.

There's little ability -- or incentive -- to cut those administrative costs.

"So the system keeps on being inefficient and just grows in inefficiency," Cutler added.

In some ways, health care costs continue to soar for the same reason people spend lots of money on electronics, said Robert Graboyes, a senior research fellow and health care scholar at George Mason University's free markets-focused Mercatus Center.

"Because we really like the stuff, and it's getting better and better," Graboyes said.

Americans want the newest and latest technology available, and the American health care system can often provide that quickly. But, that quality and speed comes at a cost, Graboyes said.

In some cases, medical experts point out that newer or more expensive treatments aren't necessarily better for patients.

It's generally easier to sue doctors in the U.S. than in most other countries. So, doctors often employ what's known as defensive medicine -- the practice of ordering as many tests and exploring as many options as possible so a patient would have a more difficult time to sue a doctor for missing some possible solution.

A 2010 study published in the peer-reviewed Archives of Internal Medicine found 90 percent of the 1,231 physicians surveyed said doctors order more tests and procedures than patients actually need to preemptively protect themselves from litigation.

More than 30 states have certificate of need laws -- laws that require health care providers or would-be providers to first obtain permission from the government and often their competition like nearby hospitals to establish or expand a facility. The laws are intended to reduce health care costs, but Graboyes and other researchers at the Mercatus Center argue the laws do just the opposite by limiting the supply of medical care and limiting competition, thus allowing existing providers to make more.

State governments also place too many restrictions on nurse practitioners, Graboyes said. In most states, nurse practitioners cannot practice medicine without a physician's supervision, although an increasing number of states are adopting laws to allow nurse practitioners -- who require less education and can charge patients less -- to practice on their own.

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In most industries, the consumer knows what the price tag will be up front. That isn't the case with health care, where the full cost of the tab may not be clear for weeks or months, and even then, the consumer isn't charged the actual cost of the service. In the meantime, the patient's insurance company negotiates the price of procedures with the provider until the parties reach an agreement.

In some ways, health care is comparable to higher education, another sector with rising costs easily outpacing inflation rates, Graboyes said. When something is partially subsidized by a third party like the government through grants in the case of college or private insurance companies or the government in the case of health care, Graboyes explained, the service provider has little incentive to lower costs.

"Both (are) heavily subsidized," Graboyes said. "We have insulated both consumers and producers from real prices, real costs and increasingly we've left the burden on taxpayers to fill the gap. And what you've got in both cases is enormously increasing costs in both industries."

Perhaps the biggest driver in high medical costs, Graboyes believes, is a Medicare reimbursement framework that doesn't incentivize providers to lower costs to stay competitive, and private insurers are highly unlikely to reimburse at rates lower than Medicare.

A few providers in the U.S. and abroad are experimenting with a more direct approach to patients paying for primary care, in which patients pay a monthly fee to the office as they would pay a premium, then pay directly for visits and procedures.

But for now, the U.S. has a "deeply irrational system of pricing that drives things towards the more expensive," Graboyes said.

"These are the things that are not being talked about really by either party," Graboyes said.

Cutler believes it would be much easier to begin lowering health care costs once everyone or at least the vast majority of the population is insured.

"When countries cover everybody, they then turn to saving money," Cutler said.

The underlying reasons why health care costs continue to soar aren't that complicated, Cutler said. But Republicans and Democrats alike have to be willing to take a step back to look at the system as a whole, and identify common goals.

"The point that I'm trying to make is exactly that, is if (the Senate bill) fails, we should focus on things with mutual agreement," Cutler said.

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Why is health care so expensive in the first place? - CBS News - CBS News

Sen. Susan CollinsSusan CollinsKey GOP senator: Healthcare was only topic constituents talked about Constituents lobby GOP senators on healthcare at July Fourth celebrations Five changes GOP might make to healthcare bill MORE (R-Maine) says healthcare was the only thing on the minds of constituents she met with on the Fourth of July.

Collins on Wednesday told the Washington Post that while she usually hears people's thoughts on a wide range of issues when she meets constituents, all she heard this year was reaction to the GOP's push to repeal ObamaCare.

Shesaid her constituents at the parade overwhelmingly supported her position against the Senate GOP healthcare bill, the vote for which was delayed until after Congresss Fourth of July recess.

I heard, over and over again, encouragement for my stand against the current version of the Senate and House healthcare bills. People were thanking me, over and over again. Thank you, Susan! Stay strong, Susan!

Collins was a key Republican whose early resistance to the healthcare billcontributed to Senate GOP leaderships decision to delay votes on the bill.

She was one of the four Republicans in the senate who announced public appearances in Fourth of July parades after the issue took center stage in Congress.

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Key GOP senator: Healthcare was only topic constituents talked about - The Hill

Chris Christie, at right, uses the beach with his family and friends at the governors summer house at Island Beach State Park on Sunday.

The now-infamous photo of New Jersey Governor Chris Christie and family enjoying a beach closed to the public said a lot about Christies hugely inflated sense of entitlement.

But it also said something about the current state of health care politics. Christie was holding up the New Jersey state budget and shutting down state beaches over his demand that Horizon Blue Cross Blue Shield, the states largest insurer, put $300 million of its reserves into a state opioid treatment program. With that, Christie was championing the one health care cause that has become safe for everyone, including conservative Republicans.

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But he wanted to fund it with money from Blue Cross rather than through a state budget appropriation. With no political capital going into this budget battle, and less after the beach expose, the unpopular New Jersey governor failed in that effort. But his willingness to go to the mat over it shows how the opioid epidemic has become not just a scourge, but also a big political bargaining chip.

In Washington, Senate majority leader Mitch McConnell is working to win votes to repeal the Affordable Care Act by adding $43 billion in special funds to treat opioid addiction. At the same time, the Senates health care bill would dramatically slash Medicaid funding, to the detriment of the poor, the elderly, and children. While senators seeking more money for treatment as part of the health care bill are sincere, their leaders are blatantly open to using the extra opioid money to pay them off.

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The toll of opioid abuse is undisputed: According to the American Society of Addiction Medicine, drug overdose due to opioid addiction is the leading cause of accidental death in the United States. Its also a heartbreaking everywhere problem, class-blind and colorblind. That makes it popular with politicians of all persuasions, including Republicans.

If you ask people of color about it, youll hear a lot of anger about their contention that their kids were dying from opioid and similar addictions for a long time, but it was not addressed by the political power structure until it hit white neighborhoods, said Philip W. Johnston, the former head of the Massachusetts Democratic Party, and a federal health care administrator during the Clinton presidency who now runs a health care consulting company. Maybe the gun issue will become popular if the killing begins to invade white areas, he added.

Whether or not you believe there would be less interest in opioid addiction if it didnt cut across income lines and affect many whites, fighting it comes down to money and how much public funding is committed to it. What states are willing to kick into it is an important piece of it. In New Jersey, where Christie made the opioid fight a personal cause, he wanted an insurer to pick up the costs. Meanwhile, you cant separate the battle against opioid addiction from federal Medicaid funding, which Christie is also trying to do.

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Christie heads the bipartisan opioid commission created by President Trump, where at the commissions first meeting, some appointees decried the Senates effort to cut Medicaid. Were kidding ourselves if we dont think whats happening over in Congress regarding issues of health care matters to this issue, said Governor Roy Cooper of North Carolina, a Democrat. If we make it harder and more expensive for people to get health care coverage, its going to make this crisis worse. But as of last week, Christie was unwilling to lobby against the GOP proposal to reduce Medicaid funding. Taking a wait-and-see approach about a cut in funding that could seriously harm New Jersey residents, he said, Im not going to go down to Capitol Hill and pour gasoline on myself and set myself on fire.

As it turned out, he got burned even more badly just by sitting on that beach.

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Christie feels the heat from the beach and health care politics - The Boston Globe

The Republican National Committee (RNC)on Wednesday released an ad attacking Democrats for being unwilling to work with the GOP to repeal and replace ObamaCare while not offering their own plan

The ad features video footage of Democrats such asSen. Elizabeth WarrenElizabeth WarrenWhy Trump should renominate Inga Bernstein for the District of Massachusetts Dems try new slogan: Have you seen the other guys? Clinton responds to GOP request for healthcare plan with campaign page MORE (Mass.) and Hillary ClintonHillary Rodham ClintonVoter fraud commission may have violated law Budowsky: Will Trump appease Putin? Clinton responds to GOP request for healthcare plan with campaign page MORE attacking the House and Senate plans to repeal ObamaCare.

Weve got to fix whats broken. Where's your plan, @HillaryClinton? pic.twitter.com/CmRB4mCsZd

Itopens with Sen. Bernie SandersBernie SandersClinton responds to GOP request for healthcare plan with campaign page Dem challenging Paul Ryan raises 0K in campaign's first 12 days Republicans ask Dems: Where's your healthcare plan? MORE (I-Vt.) and Democrats admitting that ObamaCare is fraught with problems, as well as footage of Democrats being questioned about their own replacement plan. The lawmakers' answers are not included.

The adalso features footage of former President Bill ClintonBill ClintonRepublicans ask Dems: Where's your healthcare plan? Puerto Rico faces off with bondholders over statehood Poll: Trump disapproval at 57 percent MOREcalling ObamaCare the "craziest thing" and hittingit for rising premiums and coverage gaps.

"Democrats know ObamaCare is broken," the ad concludes. "We have a plan to fix it."

"Where's their plan?" it asks.

RNC Chair Ronna Romney McDaniel in a statement demanded Democrats put aside "political games" and work to fix America's broken healthcare system.

Everyone agrees Obamacare has been a disaster for the American people," McDanielwrote.

"While Republicans work to fix our broken healthcare system, Democrats have dug in their heels in the name of partisanship, instead focused on obstruction and resistance," she added. Its past time do-nothing Democrats in Washington put aside their political games and work together with Republicans to provide affordable and accessible healthcare to all Americans.

Several Senate Republicans have criticized their own party for negotiating and writing a healthcare bill largely behind closed doors and without input from Democrats.

Healthcare is such an important thing. I think we should have debated it in open, in committee hearings, have both sides bring in witnesses, Sen. Rand PaulRand PaulTime to pass National Concealed Carry Reciprocity Republicans ask Dems: Where's your healthcare plan? Pressure on McConnell to deliver ObamaCare repeal MORE (R-Ky.) said last month.

I would like a more open process, that's for sure, saidSen. Lisa MurkowskiLisa MurkowskiRepublicans ask Dems: Where's your healthcare plan? Constituents lobby GOP senators on healthcare at July Fourth celebrations Senate GOP pressures budget refs for better score on ObamaCare replacement MORE (R-Alaska), another key vote on the bill.

Senate Minority Leader Charles SchumerCharles SchumerSessions condemns 'cowardly, unprovoked attack' on NYPD officer Schumer: 'Baffling' Trump doesn't have specific agenda for Putin meeting Schumer mourns slain NYPD cop MORE (D-N.Y.) late last month pushed President Trump to meet with Senate Democrats to discuss a bipartisan healthcare deal.

"I repeat the offer I made to President Trump and my Republican friends yesterday: Let's start over. Drop this fundamentally flawed approach ... and we can discuss the problems that our Americans are actually concerned about: the cost, the quality and availability on healthcare," Schumer said from the Senate floor.

Schumer stressed that Democrats were ready to talk about improving healthcare when lawmakers return from the July Fourthholiday recess.

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Republicans ask Dems: Where's your healthcare plan? - The Hill

An announcement is expected on Thursday, and the companies hope to complete the transaction by the end of the year. Ambry Genetics declined to comment.

The Japanese government is helping to drive the diversification efforts. A state-backed investment fund, the Innovation Network Corporation of Japan, is teaming up with Konica Minolta in the Ambry acquisition. According to the people familiar with the deal, Konica Minolta would take a 60 percent share in Ambry, with the rest to be acquired by the fund.

Ambry, which is privately held, would retain its current leadership, these people said. The management team includes the company founder and chairman, Charles L. M. Dunlop, who has said his own experience with prostate cancer now in remission influenced his decision to make public anonymized information from Ambrys database.

Pooling data from many people is considered crucial to finding genetic elements that contribute to illnesses.

For Konica Minolta, the acquisition would confirm the acceleration of efforts to diversify beyond photocopiers and printers, areas where revenue and profit have been shrinking.

The Japanese company has identified health care, and cancer screening in particular, as a possible mainstay of business. It has been developing its own cancer-detecting technology using light-emitting nanoparticles to mark proteins that are drawn to cancer cells.

Other Japanese businesses have tried similar expansions. Fujifilm, for instance which, like Konica Minolta, built a name decades ago in photography has established a profitable health care and cosmetics division, helping it survive the end of the analog film era.

Other Japanese groups health care ventures have been less successful, however.

Follow Jonathan Soble on Twitter @jonathan_soble.

Chad Bray contributed reporting from London.

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Konica Minolta, With Eye on Health Care, Nears Deal for U.S. ... - New York Times