How to understand health care, one subparagraph at a time – Marketplace.org

Legislation is like an old Roman city, says Nicholas Bagley, a law professor at the University of Michigan. The original is on the bottom and amendments are layered on top. To understand legislation, you have to know how it's changed, he says. Above, House Speaker Paul Ryan speaks to the media in March.-Mark Wilson/Getty Images

Congress is still off for its Fourth of July recess. They're back next week which means, at least on the Senate side of the Capitol, healthcare. Majority leader Mitch McConnell has said he's re-working his bill. But here's the thing, if you actually sit down and read the actual text in the 145-page draft of the Better Care Reconciliation Act, it's really hard to understand. So, we called in an expert to help us read it.

Nicholas Bagley is a professor of Law at the University of Michigan, he talked Marketplace host Kai Ryssdal through some of the legalese in the Senate healthcare bill. The following is an edited transcript of their conversation.

Kai Ryssdal: Let me, first of all, ask you how you think about reading these bills. Because you are not a lay person in this field, you have some expertise. So how do you go about it?

Nicholas Bagley: Well, it's hard. These bills are the latest layers that are added on top of many, many other bills that have come before in the health care space. And so when you read a bill, what you have to do is have all the bills that came before at hand so you understand when they say, "We're amending subsection A of subparagraph one," you know what that's referring to.

Ryssdal: All right, so let's dive in here. I want to get you to section 134 of this bill. The block title is "Flexible Block Brant Options for States" and it says, and I got a quote the law here because I need you to take this apart for me, "Title 19 of the Social Security Act as amended by section 133 is further amended by inserting after section 103 the following new section" and then it goes on. So first of all, are we going back to the Social Security Act of 1930 or whatever it was here?

Bagley: Yep, we're going right back to when the Social Security Act was first adopted. ... Title 19 of the Social Security Act, however, was added in 1965 and it refers to the Medicaid program, which is the joint federal-state program of health insurance for poor people. Section 134 says, "Hey, states, you traditionally will cover health care for your residents. We've decided to put a cap on how much we're going to help you spend, but we're going to come up with another option for you, too: If you want to take federal money and use it however you see fit to provide health care for your citizens, we'll give you a block grant." And that Section 134 of the act, which you've been talking about, is this block grant option. Some states will take it. Some states won't. But it's one of the things that has opponents of the Senate bill up in arms.

Ryssdal: And you have to sit there with all those bills back to the Social Security Act to figure out what's going on?

Bagley: You have to know what it's targeting. You have to pull up the U.S. Code. I mean, all legislation is kind of like an old Roman city, right? The lowest layers are the things that happened first, and then over time, amendments and changes are layered on top. And to understand it, you really have to read how the statue has been shaped and reshaped over time.

Ryssdal:All right, let me dig into another slice of this, which is that not only do you have to peel back the layers, you have to know your dates and your details. Section 119, "repeal of net investment tax subparagraph A in general, subtitle A of the Internal Revenue Code of 1986 is amended by striking Chapter 2A" blah, blah, blah, yada, yada, yada. And then it gets to effective date, "The amendment made by this section shall apply to taxable years beginning after December 31st, 2016." So obviously a year or something in the past, what does this mean? What is the net investment tax and what does that date have to do with reality?

Bagley: Yeah. This provision is relatively straightforward as statutory draft goes.

Ryssdal:Sorry, I apologize for laughing.

Bagley: No, it doesn't look it, but it really is. It wipes out a 3.8 percent tax that Obamacare imposed on the capital gains of people who make more than $200,000 a year. The point of repealing this tax on capital gains is to encourage people to invest more of their capital. And whatever you think about that goal, all the action is really in the effective date of this statute, because the provision is retroactive to the beginning of this year. And it can't possibly affect investment decisions that have already been made. So what we're seeing is the Senate bill offering a pure giveaway to some of the wealthiest Americans kind of lodged in a very technical, dry provision of their health care legislation. You know, reading statutes is all about the details. And when members of Congress want to hide something or don't want the public to notice, they will use squirrelly language, they will use anodyne language to make it seem like they're not doing very much. But the devil is always going to be in the details.

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How to understand health care, one subparagraph at a time - Marketplace.org

House Republican says health care bill in jeopardy over Planned Parenthood – Washington Times

Rep. Trent Franks said Wednesday that if Planned Parenthood funding is added to the GOP health care bill, numerousRepublican senators will no longer support it.

I think a lot of us are no votes, the Arizona Republican said. We cant continue to subsidize abortion as part of health care. Its just something thats not American. Mr. Franks said.

Some GOP senators, including Susan Collins of Maine, have said they were unlikely to support the bill without funds for Planned Parenthood. Ms. Collins intends on offering an amendment to allow the funding for Planned Parenthood to continue with the existing prohibition of funds being used for abortion procedures.

Unfortunately, in the Senate right now, under reconciliation, theyre constrained under this Byrd rule that doesnt give them any latitude for negotiation, Mr. Franks said. And so when theres any differences whatsoever, we really dont have the ability to put something in that would mollify people like Senator Collins and gain her vote.

Mr. Franks said that any funding for abortions would take away support of many in the party, but that House members are willing to negotiate.

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House Republican says health care bill in jeopardy over Planned Parenthood - Washington Times

Life, liberty, and the pursuit of healthcare coverage – The Hill (blog)

Independence Day, a day to remember and celebrate our nations quest for and ultimately our achievement of freedom from a monarch who had lost touch with the goals and aspirations of those who settled here, has less meaning for those struggling for their survival in todays America.

The 29 million Americans who lack health insurance of any kind surely do not have independence, as they live in fear of illness or injury for which they have no coverage. Should they fall ill, they will not have the same ability as insured Americans to seek out treatment, because their options for coverage will be limited.

Healthcare is a ticket to independence for all of our citizens. It ensures our ability to be get an education despite the physical or mental hindrance that any child faces.It enables us to pursue and succeed at any chosen career.It allows seniors to hold on to their independence after a serious medical event or a chronic health condition.

And of course it generates economic activity that provides tremendous stimulus to the economy.

This freedom is, however, in peril, not only for those currently without coverage, but also for the many millions more that will lose them under the bill offered to repeal and replace the Affordable Care Act (ACA) by the Senate Republicans, and the House bill that came before it.

The ACA, flaws and all, created independence for millions of Americans. Many of the newly insured sought treatment for a physical or mental condition for the first time in years.

Some people who had stayed in jobs that limited their mobility and their contentment because they feared losing medical coverage due to a pre-existing condition, became free to pursue new opportunities and greater success, and in this way, healthcare in general, and the ACA in particular, has supported that concept that our nation embodies every day, but particularly on Independence Day: The pursuit of happiness.

Under the Senate bill, 22 million Americans would lose their health coverage by 2026, according to the Congressional Budget Office (CBO). That is on top of the 29 million who dont currently have it. The devastation from the bill, however, would be even broader than the sheer number of people no longer covered, as innovative state initiatives to expand coverage and fill in gaps would be placed in jeopardy.

The Senate bill also takes aim at Essential Health Benefits, the minimal level of coverage that health plans must meet under the ACA. Comprehensive health benefits would be put at risk for all Americans, not just those that have gotten coverage under Medicaid and private healthcare as a result of the ACA.

Those requiring mental health and substance abuse care are particularly victimized by the Senate budget. Those with private coverage could lose mental health benefits since they would no longer be deemed essential.

Worse still are the cuts to Medicaid, which are projected to be enormous by the CBO $772 billion through 2026. Medicaid is the single largest payer of mental health services in the nation, and it is also playing a major role in responding to the nations opioid epidemic. Medicaid substance abuse programs have filled a gaping need during this crisis. As a nation, we cannot walk away from these commitments.

What began as campaign rhetoric to fix the shortcomings of the ACA and ultimately strengthen the law has devolved into a budget-cutting free-for-all. These cuts that fund the House and Senate bills give tax breaks to the wealthy and simultaneously remove independence for everyone else, and that is a troubling concept not only on the Fourth of July, but on any other day as well.

Gerard A. Vitti is the founder and CEO of Healthcare Financial, Inc., a company that assists individuals in obtaining healthcare benefits.

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

Continued here:

Life, liberty, and the pursuit of healthcare coverage - The Hill (blog)

Ted Cruz Clashes With Health Care Protesters At July 4 Celebration – TPM

At a rally and parade in the border town of McAllen, Texas on Independence Day, Sen. Ted Cruz (R-TX) clashed with a group of protesters who booed, heckled, and attempted to question him about his support for a bill that would repeal the Affordable Care Act.

According to the Texas Tribune, Cruz attempted towork the crowd and shake hands while avoiding the protesters, who held up signs reading Were pissed, No Medicaid cuts and No transfer of wealth 4 our healtha reference to the massive tax cuts for the wealthyin the Senate GOPs health care bill.Other protesters held signs attacking Cruz for his positions on immigration and climate change.

Cruz, who is running for reelection and fending off a challengefrom Rep. Beto ORourke (D-TX), acknowledged the loud protest when he took the podium to speak Tuesday morning.

I will say you have a right to speak, and I will always defend your right, he said, according to the Texas Tribune. He ended his speech, however, with a dig at the protesters, calling them our friends who are so energized today that they believe that yelling is a wonderful thing to do. When later asked by a reporter about the demonstrators, he dismissed them as a small group of people on the left who right now are very angry.

Cruzwrapped up his appearance by riding through the streets of McAllen in a vintage convertible.

After canceling a planned vote on their health care bill last weekafter a wave of defections from the far-right and center of the GOP caucus, only two Republican senators are holding town halls over the July 4 recess: Sens. Jerry Moran (R-KS) and Bill Cassidy (R-LA).Lacking a forum in which to question and confront their representatives, citizens are organizing through progressive advocacy groups like the Town Hall Project to confront Cruz and other lawmakers whenever and wherever they appear in public. The health care repeal effort, which could come up for a vote as early as this month, is a top item on their agenda.

According to the non-partisan Congressional Budget Office, the Senates Obamacare repeal bill would cause 22 million more people to be uninsured in 10 years than if current laws were left in place, as cuts to Medicaid and subsidies for low-income people price many out of the health care insurance marketplace entirely.

Cruz is currently pushing an amendment that would make the bill even more conservative. The proposal, which Republican leadership is weighing seriously, would allow states to sell cheap, bare-bones insurance plans that dont cover essential health benefits like prescription drugs, hospital visits, mental health services and maternity care.

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Ted Cruz Clashes With Health Care Protesters At July 4 Celebration - TPM

Bernie Sanders slams GOP health care bill, calls Trump CNN tweet ‘an outrage’ – USA TODAY

USA Today Network April McCullum, The Burlington (Vt.) Free Press Published 9:08 p.m. ET July 3, 2017 | Updated 9:10 p.m. ET July 3, 2017

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

Sen. Bernie Sanders, I-Vt., addresses an audience during a rally Friday, March 31, 2017, in Boston. Sanders and Sen. Elizabeth Warren, D-Mass., made a joint appearance at the evening rally in Boston as liberals continue to mobilize against the agenda of Republican President Donald Trump. (AP Photo/Steven Senne)(Photo: Steven Senne, AP)

Vermont Sen. Bernie Sanders has delayed his single-payer health care bill in order to leverage his national platform against the Republican health care proposal.

In an exclusiveinterview, Sanders answered questions about the health care bill, a federal investigation into the now-defunctBurlington College and President Trump's attacks on the news media.

Doctors, nurses, health care workers and patients who will lose access to health care or see costs rise attend a rally against the GOP health care bill at Harbor-UCLA Medical Center in Torrance, Calif., on July 3, 2017.(Photo: Reed Saxon, AP)

Sanders called the Republican proposal to repeal and replace the Affordable Care Act "a disaster for working families," and said he has delayed his own single-payer health care legislation to focus on stopping the bill.

The Senate Republican health care proposal would leave an additional 22 million people uninsured by 2026, according to the Congressional Budget Office, and defund Planned Parenthood and cut Medicaid.

Sanders said the reductions would harm families of nursing home patients who rely on Medicaid.

"This legislation is the most dangerous and harmful piece of legislation I have seen since I have been in the United States Congress," Sanders said. "It is a disaster for working families, and we have got to do everything we can to see that its defeated."

Read more:

Senate health care bill negotiations: These are the big issues on the table

McConnell: Senate will stick with working on health care bill

Fact check: Spinning the CBO uninsured Americans estimate

Sanders recently traveled to Pennsylvania, Ohio and West Virginia to rally opposition to the bill, and he said he hopes to takeanother trip next weekend.

Sanders has promised since at least Marchto introduce a single-payer health care bill, which he calls"Medicare for all."

The bill has no chance of passage in a Republican-controlled Congress, Sanders acknowledged but the senator said the bill is written and gaining momentum.

"Right now we are focusing all of our energy on trying to defeat this terrible piece of legislation," Sanders said, "and I did not want to conflate or confuse the two."

President Trump participates in the Celebrate Freedom Rally at the John F. Kennedy Center for the Performing Arts in Washington on July 1, 2017.(Photo: Olivier Douliery, EPA)

Speaking the day after President Trump posted on Twitter an altered video of himself wrestling and punching the CNN logo, Sanders said he was concerned about attempts to intimidate the news media.

"It's an outrage," Sanders said. "I think it basically encourages violence in this country at a time when there are a lot of unstable people walking the streets of America. And I think it is a very clear goal, a clear effort on the part of Trump to intimidate not just CNN, but to intimidate the media. His goal is for them not to expose what he does."

Sanders regularlylambastesthe "corporate media," a criticism that dates at least to his 1980s days as mayor of Burlington.

Read more:

Trump hurls more insults at 'Morning Joe' hosts, calls Scarborough 'crazy' and Mika 'dumb'

Trump escalates attacks on the media with CNN takedown video

President Trump lashes out at CNN, network claps back

As a presidential candidate, Sanders often used his rallies to speak pointedly at or about reporters, accusing them of ignoring what he viewed as the most importantissues in favor of political dust-ups.

Sanders referred to media coverage by Politifact, The Hill and Seven Days at three pointsduring the telephone interview to underscore his claims on health care and Burlington College. He said his critique of media is distinct from the president's aggressive stance.

"You know, every politician, every public official will have differences with the media in terms of how they cover a story. Right? Thats natural," Sanders said. "But I have never suggested ever that mainstream media is fake, that everything they write is a lie, that you shouldnt believe anything they write."

(Photo: Blaine McCartney, AP)

Sanders continues todefendagainst allegations that his wife, Jane, misrepresented the finances of Burlington College to secure financing to support a2010 real estate deal on the Burlington waterfront.

Jane Sanders left the school in 2011and the college closed in 2016 under a "crushing weight of debt," mostly from the property deal. College officialshave saidthe Justice Department and FBI are looking into the land deal, whileBernie and Jane Sanders have denied any wrongdoing.

"When she left Burlington College, the school was in better shape financially and academically than it had ever been," Sanders said in Monday's interview.

He dismissed the allegations against Jane Sanders as an attack from political operatives who cannot win elections based on issues.

"How do you win elections? What you do is you make very ugly personal attacks against public officials," Sanders said, "and thats often in the form of 30-second TV ads, but second of all, you go after them on so-called legal areas."

A publiccomplaint by Charlotte attorney Brady Toensing, a Republican state official, alleges that Sanders' office pressured People's United Bank into securing the loan for Burlington College. The news organizationsSeven Days and VTDigger havereported that the claim was based on hearsay shared by House Republican Leader Don Turner, R-Milton.

Sanders said he did not believe he'd met Toensing prior to the public complaint about Burlington College.

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Bernie Sanders slams GOP health care bill, calls Trump CNN tweet 'an outrage' - USA TODAY

The Phony Healthcare ‘Compromise’ Is Coming – Esquire.com

The campaign to make people sick to make rich people wealthier never sleeps. Axios tells us how:

Senate Republicans have asked the Congressional Budget Office to analyze Sen. Ted Cruz's proposal for further health insurance deregulation, and they've asked for one estimate of a health care bill that includes his changes and one that doesn't, according to a GOP aide familiar with the discussions.

Oh, they're very cute, they are. Keep submitting proposals until you get a CBO score you can plausibly use to con the country, the elite political press, and the mind of Susan Collins into thinking you're "moderating" the bill. Even trim the massive tax cut a bit, full in the knowledge you can get that back when it's time to produce a phony "tax reform" plan. Do it over what is essentially a four-day holiday weekend.

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The only variable in the calculation is the number of uninsured that will allow the big con to proceed. 20 million? 19? How many millions of American families will have to suffer so that Paul Ryan's sommelier will be kept properly busy for the next few years? How many millions of the sick and suffering will have to become sicker and suffer more before the TV pundits and op-ed cowhands declare that Mitch McConnell's genius has produced a "compromise"?

If you're going to wind up with a celebration-related injury, I suggest you do it this weekend. Labor Day may be too late.

This 21st Century Modern Presidency Is a Sh*tshow

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The Phony Healthcare 'Compromise' Is Coming - Esquire.com

The Republican healthcare plan bad medicine for women and the poor – The Hill (blog)

The GOP view towards womens health is a bit confusing.

The Senate bill, Better Care Reconciliation Act cuts funding to Planned Parenthood.

Eighty percent of Planned Parenthoods work is preventing pregnancy. The bill further eliminates protections of essential health benefits which would ensure access to preventive health services including well woman care and contraception as well as maternity care.

Every single medical group agrees that TrumpCare is a disastrous plan. Rep. Pete Olson (R-Texas) laughed about prenatal care coverage because he cannot have a baby, therefore he does not understand why it should be covered.

We already know that Republicans would like to end all access to abortion. Now it seems they would like to end all access to pregnancy prevention. Worse, it seems they would like to end safe pregnancy care and care for the children that will result from lack of access to pregnancy prevention.

Lack of access to contraception and prenatal care will mean more special needs children. That is a fact. So they are creating a system that will ensure children that will need expensive specialty care and they are taking away coverage for it.

That is quite special.

As far as I can tell every single person alive today got here through a mother for that reason alone we should cover maternity care. It is called a social contract.

We went through these arguments before passage of the Affordable Care Act how quickly the 13 white men who designed the BCRA forgot. If women have access to affordable maternity care, and contraception without cost sharing, it is good for all.

Mr. Olson What if I do not want to pay for your earlier heart attacks, nor your Viagra, nor your prostate disease?The whole idea of insurance is a risk pool. Im sorry I have to explain that to you.

After seven years of hand wringing over Obamacare, to come back with a bill that deconstructs Medicaid and aims its arrows at women lays clear that the war on women never stopped.

Supercharged by a president who hurls insults over Twitter, the Republican party has discarded an allegiance to right to privacy and small government where women are concerned. For us, apparently the decisions over our bodies cannot be a private one between a woman and her physician the one with the training instead it apparently belongs to politicians.

The peril of this path awaits. BCRA will do harm. It is a bill that will kill. Instead we could look to solutions.

The answer to rising premiums and deductibles and out-of-reach prescription drug costs, is not to rip away coverage to the most vulnerable in our society.

For all its faults, ObamaCare was based on RomneyCare the plan in place in Massachusetts at the time.

TrumpCare has no model to base itself after.

This is not American exceptionalism unless it is a race to the bottom.

We could look around the world and see that covering all citizens and reining in costs is achieved by single payer or some sort of government control.

That is achievable.

For many, particularly on the right, a single payer system in not palatable. So what if we were to form a hybrid system?

We know from all the data we have that preventive services save money. That seems like something we want everyone to have access to. It certainly seems appropriate that true emergencies and traumas be covered (since many in Congress seem to think that is how everyone has access to care anyway).

What if we expand Medicare to cover those services for everyone?

That would not raise the Medicare tax dramatically.

For the rest of care insurers could develop existing Medicare A advantage plans, which already sell across state lines. These could be tailored to different levels of need, much as Congress has been pulling their hair over.

There would need to be stipulations to allow insurance to remain affordable as it is in the rest of the world. It would have to go back to being not-for-profit. No more shareholders.

Caps on executive salaries and strict controls over what can be charged. While this may seem a difficult sell, it is better than eliminating care to our most vulnerable or the alternative destroying an entire industry what the two extremes far right and far left propose.

We would need to allow Medicare to negotiate prescription drug prices just as governments do in the rest of the world.

If pharmaceutical companies balk tell them to stop spending money on direct to consumer advertising. Why that is allowed is an anathema to me. The myth of high prices to pay for research has been exposed. They have had decades of record profits.

Lastly look at reimbursement appropriately be consistent in imaging costs and ensure that primary care can stay viable given that it is the most cost effective. Stop the unfunded mandates and the plethora of prior authorizations for everything even generic medications.

Given the amount of training involved, why not trust physicians instead of burning them out?

We need consistency in pricing for high end technology and procedures. Families should not fear bankruptcy due to a medical condition.

Allowing Medicare to set a pricing standard will ensure this to occur.

It is time to remember that we can learn from others and yes we can make America great again.

Dr. Cathleen London is physician based in Maine who developed a cost-effective alternative to the standard EpiPen in response to skyrocketing prices. London has been an on-air contributor on Fox News and local television stations around the nation. Her healthcare innovations have been featured in the New York Times.

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

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The Republican healthcare plan bad medicine for women and the poor - The Hill (blog)

Single-payer healthcare backers fan out at California Capitol to protest shelving of bill – Los Angeles Times

July 3, 2017, 1:53 p.m.

Supporters of a stalled single-payer healthcare bill returned to the Capitol in Sacramentoon Monday to express their anger that Assembly Speaker Anthony Rendon (D-Paramount) shelved the measure more thana week ago.

Backers of the bill, SB 562, disrupted a separate hearing on the Assemblyfloor by unfurling a banner from the gallerybefore being escorted out. They also attended a hearing of the Assembly Rules Committee, the panel in whichRendonheld back the bill, holding up signs on which they'd written personal healthcare stories. And asmall contingentstaged a "sit-in" near Rendon's office, chanting "SB 562."

Rendoncalled the bill "woefully incomplete" and has shown no appetite to advance the bill, but Pilar Schiavo, an organizer with Healthy California, an advocacy group backing the measure, said supporters plan to keep up the pressure.

"We continue to build. There is incredible grassroots movement around this," Schiavosaid, adding of the enthusiasm around single-payer, "it's too late to put it back in the box."

Read more:

Single-payer healthcare backers fan out at California Capitol to protest shelving of bill - Los Angeles Times

Here’s where Republicans’ health care plans stand – CNN

Story highlights

Despite tweets on Friday from President Donald Trump and several high-profile Republican senators, the "repeal, then replace later" option is not really on the table and isn't something that will be pursued by GOP leadership as they try to pull together the 50 votes they need to pass their health care plan. Negotiations are continuing as planned for a proposal that repeals and replaces Obamacare simultaneously.

As CNN reported Friday, there is almost no chance senators will vote on a health care bill the week senators return from recess. Expect the health care negotiations to be a multi-week process.

Senate Majority Leader Mitch McConnell is sending several different proposals and basic outlines to the Congressional Budget Office to help speed up the final scoring process, as CNN reported several times last week. Although the top White House legislative official, Marc Short, said Sunday on Fox News that McConnell sent two bills to CBO for scoring; that's not exactly the case. McConnell actually sent two outlines, plus several other proposals that may make it into a final bill.

The future of the proposal continues to depend on whether there is some compromise resolution on the same issues, including a softer landing for the eventual Medicaid reforms and how to craft some acceptable version of Texas Sen. Ted Cruz's regulations amendment into the final proposal. In his comments Sunday, Short appeared to give the White House endorsement to Cruz's regulations proposal, which if so would be no small thing.

Opioid funding and changes to regulations related to the use of health savings accounts appear to be settled and locked in.

A still looming, very real fight that will be coming when they return: whether to repeal the 3.8% investment tax in Obamacare or not. This is not at all settled, but sources tell CNN this is something that won't be dealt with until Congress returns to Washington.

Originally posted here:

Here's where Republicans' health care plans stand - CNN

‘Don’t take away our healthcare’ says Trump country – BBC News


BBC News
'Don't take away our healthcare' says Trump country
BBC News
The Central Appalachian mountain ranges in Kentucky are home to some of the poorest - and most fervent - Trump supporters. But what happens in the next few weeks hundreds of miles away in Washington could shape their future. Dr Van Breeding is ...

and more »

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'Don't take away our healthcare' says Trump country - BBC News

Democrats pressure 2020 senators on health care vote – Politico

Sen. Thom Tillis of North Carolina is one of the first-term GOP senators likely to face a tough battle in 2020. | AP Photo

Few GOP senators are up for reelection in 2018, but polling shows the Republican health care plan unpopular in several key 2020 states.

By Kevin Robillard

07/03/2017 05:21 AM EDT

With few Senate Republicans up for reelection in 2018, Democrats and other groups looking to defeat the GOP's plan to repeal Obamacare are looking to 2020 to pressure politically vulnerable senators.

Save My Care, a progressive group dedicated to defeating repeal attempts, is out with new surveys from the Democratic firm Public Policy Polling showing the GOP proposal, which would cut Medicaid funding and repeal Obamacare's tax increases, is deeply unpopular in Iowa, North Carolina and Colorado three swing states where Republican Senate wins in 2014 helped the GOP gain control of the chamber.

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In Iowa, where Trump won by a wide margin in 2016, 27 percent of voters approve of the bill, and 54 percent disapprove, according to PPP's automated poll in that state. In Colorado, where Clinton won, 26 percent approve and 59 percent disapprove. And in North Carolina, where Trump won by small margin, 33 percent of voters approve and 53 percent disapprove.

All three states have senators who are facing reelection in three years: Sen. Cory Gardner of Colorado, who is also the National Republican Senatorial Committee chairman; Sen. Thom Tillis of North Carolina; and Sen. Joni Ernst of Iowa. Of the three, Ernst is in the strongest position in the Save My Care polling, leading a generic Democratic opponent 48 percent to 41 percent. Tillis is trailing a generic Democrat, 48 percent to 44 percent, and Gardner is trailing 53 percent to 39 percent.

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The polling is designed to show the three senators they may face political peril even if they're not up for reelection in 2018. With narrow margins in the Senate, Democrats are aiming to deter as many Republicans as possible from becoming clear 'yea' votes, starting with Republicans who won seats that were previously held by Democrats during the GOP wave year of 2014.

"There is clear evidence that supporting this health care repeal will do lasting damage to a Senators standing with the voters in their state," strategists with Save My Care wrote in a polling memo. "Voters will reject Senators who support repeal."

The only Republican facing reelection in 2018 in a state won by Democrat Hillary Clinton, Nevada's Dean Heller, has been harshly critical of the GOP proposal. But AARP has run ads attacking the bill in Gardner's Colorado, and in Alaska, the home of Sen. Dan Sullivan. The American Medical Association has also released polling showing the bill is unpopular in Colorado, Alaska and Arkansas.

The Save My Care polls specifically asked whether Congress should continue working to repeal Obamacare or if lawmakers should focus on fixing the law when they return from the Fourth of July recess. In Colorado, voters prefer a fix by 59 percent to 36 percent. In North Carolina, a fix is favored by 53 percent to 40 percent, and in Iowa, the figures are 54 percent to 34 percent.

The polling also shows voters are much less likely to back Republican senators for reelection if they vote for the law, and that large majorities in each state say health care will be one of their top issues during the 2018 midterm elections.

Public Policy Polling conducted the survey of 870 voters in Colorado, 1,102 voters in North Carolina and 784 voters in Iowa on June 30 and July 1. Read the full results for Colorado, North Carolina and Iowa.

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Democrats pressure 2020 senators on health care vote - Politico

5 things for Monday, July 3: Trump tweets, health care, an attack in Iraq – CNN

1. Twitter 2. Senate recess Speaking of health care news, Republicans seem to be repealing and replacing that old "repeal and replace" line. Now, some GOP leaders and even Trump himself are floating a possible "repeal now, replace later" approach. 3. Iraq At least 14 people were killed, among them four children and a captain in the Iraqi police, when a suicide bomber detonated a device in a camp for internally displaced people in the Iraqi province of Anbar on Sunday.ISIS claimed responsibility for the attack and said they were targeting members of the Iraqi military. The attack comes as Iraqi forcespush ISIS elements out of their last major Iraqi stronghold, the northern city of Mosul.The city is expected to be fully liberated soon. 4. Arkansas shooting Twenty-eight people were wounded early Saturday in a shooting at a nightclub in Little Rock, Arkansas. In addition to 25 people who were shot, three people were injured in the ensuing chaos. Police believe the incident may be gang-related and likely happened after "some sort of dispute." To add to the confusion, an underground rapper was arrested shortly after the shooting, and a US Marshal initially said the arrest was connected with Saturday morning's incident. It wasn't. So far, no arrests have been made in connection with the shooting. 5. Bernie Sanders Sen. Bernie Sanders on Sunday denied an allegation that his office might have pressured a Vermont bank to speed up the loan process for a real estate acquisition his wife Jane orchestrated for Burlington College while president of the school.Sanders' latest remarks come amid reports the FBI might belooking into the land deal. A vice chair of Vermont's Republican Party, who was also involved in theTrump campaign, brought the accusations to the table last year and called for a federal investigation of Jill Sanders. BREAKFAST BROWSE

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Mayor of Mexican town 'weds' crocodile for good luck

Watch a fireworks show ... from above

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5 things for Monday, July 3: Trump tweets, health care, an attack in Iraq - CNN

Fight for what really matters on health care reform – Montana Standard

Too often, policy debates in Washington, D.C., devolve into partisan fistfights. Each side becomes so focused on landing a punch that they forget why they climbed into the ring in the first place.

Just a few years ago, one in five Montanans did not have access to health insurance, and people couldnt afford to get sick.

When we passed health care reform, we took a big step forward, and today, more Montanans have access to health care than ever before.

But the current health care system is not perfect, and there are still folks in Montana who are struggling to pay expensive premiums and high deductibles.

I have heard that message from Plentywood to Libby and everywhere in between as I travel the state holding face-to-face town halls, listening sessions and public events. I know that to bring down the cost of health care we need to do something now, but the Senate health care proposal that was unveiled last week is not the answer.

This partisan bill imposes a tax on folks in their 50s and 60s, and rips health care away from 22 million Americans and tens of thousands of Montanans.

It kicks nearly 80,000 Montanans off Medicaid, many of whom now have health insurance for the first time.

It threatens coverage for folks with pre-existing conditions like high-blood pressure and diabetes.

It could bring back the days of lifetime caps when folks paid for health insurance their entire lives, but were booted off when they needed coverage the most.

The bill fails to address the very issue Montanans need us to tackle: the rising cost of health care. And it ignores families who are facing another round of premiums hikes next year.

But it doesnt ignore the wealthiest Americans who will see $541 billion in tax breaks.

If this bill passes, working families will pay more money for less coverage, while millionaires and big corporations walk away with fatter wallets.

While some elected officials continue to prioritize scoring political points, I still remember why I got in the ring to fight for Montana.

I am willing to sit down with Republicans, Democrats, independents, and Libertarians and come up with a solution that keeps whats working in our current health care system and improves where it falls short.

I am optimistic that we can pass a good health care bill that works for every Montanan, but this will only happen if it is done in a bipartisan, transparent way with input from folks of all walks of life.

The final vote on the disastrous Senate health care bill was delayed because thousands of Montanans raised their voices together. Now it is time to throw in the towel on partisan bickering, and start fighting for what really matters.

-- Jon Tester, a farmer from Big Sandy, is Montanas senior U.S. senator.

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Fight for what really matters on health care reform - Montana Standard

33 percent in NC approve of Senate health care bill, Raleigh-based poll finds – News & Observer (blog)


News & Observer (blog)
33 percent in NC approve of Senate health care bill, Raleigh-based poll finds
News & Observer (blog)
When Senate Republicans return to the U.S. Capitol next week, their top priority will be passing their version of a now-stalled health care repeal-and-replace bill. But the Better Care Reconciliation Act is not that popular among North Carolinians ...

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33 percent in NC approve of Senate health care bill, Raleigh-based poll finds - News & Observer (blog)

Trump: If GOP health care bill fails, repeal Obamacare now …

"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date," tweeted Trump.

Trump's declaration -- which marks a political shift for him and could further imperil delicate negotiations on Capitol Hill -- came shortly after Sen. Ben Sasse, R-Nebraska, urged the President in a letter to repeal Obamacare now and replace later. The current Republican plan in Congress is to do both in one massive piece of legislation, though the Senate's bill has struggled to gain necessary GOP support.

Sasse quickly approved of Trump's tweet.

"Sounds great, Pres. @realDonaldTrump We are agreed. We need to break the logjam," he tweeted.

Trump's message Friday morning also marked a notable return to his efforts to push his agenda rather than distract from it, as he did on Thursday when he viciously and personally attacked MSNBC anchor Mika Brzezinski.

White House deputy press secretary Sarah Huckabee Sanders said Trump "hasn't changed his thinking at all" on health care as she fielded a question on Trump's tweet this morning on the health care reform efforts.

"We're still fully committed to pushing though with the Senate at this point, but we're looking at every possible option of repealing and replacing Obamacare. We are focused on doing that," Sanders said.

Sanders also said she did not know where Trump got the idea for that plan, noting that "people have been talking about this for quite some time."

"I don't know where specifically it may have come from," she said.

But Trump's tweet appears to mark a new public stance for him regarding health care.

"We're going to do it simultaneously," he said. "It'll be just fine. We're not going to have, like, a two-day period, and we're not going to have a two-year period where there's nothing. It will be repealed and replaced."

The President's tweet also could have the effect of further complicating health care negotiations. A GOP official close to leadership and supportive of the current repeal/replace effort told CNN: "Nothing like rolling a hand grenade into ongoing negotiations, eh?"

The concern, the official outlined, is that this now gives conservatives a reason to go back to their corner. While they were hardly at the breakthrough point, there's no question conservatives, particularly Sen. Ted Cruz, had been working in good faith to get to a deal.

Now the concern is conservatives can just say they wanted the 2015 repeal bill all along, and because the President clearly supports that plan, talks on a sweeping replacement plan can be scrapped.

A GOP Senate aide noted Trump's initial opposition to a straight repeal bill.

"We did this dance six months ago," the aide said. "We've litigated repeal, delay, replace. Thoroughly. The President spoke against it. This all might be more helpful if we weren't in the late stages of negotiations."

Appearing on CNN's "New Day" on Friday, Rep. Adam Kinzinger, R-Illinois, also rejected the President's suggestion.

"I think it's repeal and replace," he told CNN's Chris Cuomo. "We can argue whether they like the system we're bringing them in or not, but simply a repeal, even with the sunset the year or two down the road -- the problem (is) we know how Washington works."

He explained: "Sometimes on deadlines we still don't get things done. You can't leave the American people out like this. This is how sequester happened, because we thought we could fix the problem and never did."

Earlier this year, Hill Republican leaders floated the idea of repealing Obamacare and providing a transition period during which Congress would write a new law. But many Republicans opposed that idea, and along with Trump calling for passing both simultaneously, the party shifted tactics.

One reason behind that shift is repealing Obamacare without an immediate replacement plan would likely cause massive destabilization to an insurance market already unnerved by Washington's efforts to address health care. Many insurers are asking for another round of steep rate increases for 2018, and others aren't even willing to return to the exchanges at all.

The Affordable Care Act was troubled even before Trump took office, but the Republicans' quest to dismantle it has made things worse. Trump has caused confusion about whether he'll continue key components of the law. The two at the top of the list: the mandate that everyone have insurance and the cost-sharing subsidies for lower-income Americans.

Meanwhile, the future of the GOP health care efforts remains unclear. Senate Republican leaders scuttled plans for a vote on health care reform earlier this week as GOP leaders criticized the bill, but Trump was optimistic in his outlook Wednesday.

Trump declined to say what the surprise would be, but his optimism contrasted significantly with the nine Republican senators publicly expressing their opposition to the bill the President is championing.

The White House can only afford to lose two of the 52 Republicans in the Senate to pass the legislation.

CNN's Tami Luhby, Phil Mattingly, Lauren Fox, Manu Raju and Dylan Stafford contributed to this report.

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Trump: If GOP health care bill fails, repeal Obamacare now ...

Trump administration remains confident health-care bill will pass – Washington Post

(Bastien Inzaurralde/The Washington Post)

Top Trump administration officials insisted Sunday that the odds of passing health-care legislation when the Senate returns to Washington next week remain high, but others in the GOP charged that the bills problems require more than a quick fix.

Health and Human Services Secretary Tom Price and White House legislative affairs director Marc Short are fighting off a tide of discontent that has been exacerbated in recent days by President Trumps tweet that the Senate could simply repeal the Affordable Care Act and replace it later if it cannot pass the pending measure.

Price and Short both argued in television appearances Sunday that President Trump doesnt actually endorse the staggered approach. They said Trump was working the phones this weekend to urge senators to get on board with the Senate bill.

Still, Trumps comment a sharp departure from his campaign promises is undercutting the efforts of Senate Majority Leader Mitch McConnell (R-Ky.) to collect 50 GOP votes to support the current bill. Conservative Republicans are calling for separate efforts, urging quick action to undo Obamacare to allow more time for the difficult endeavor of structuring its replacement.

Those senators are still divided, however, on whether the replacement must be devised now or sometime in the future.

I want repeal to work, and the way you do it is you separate into two bills and you do it concurrently, said Sen. Rand Paul (R-Ky.), who declared on Fox News Sunday that we are at an impasse with the health-care bill on offer before the Senate.

We should do repeal with a delay, Sen. Ben Sasse (R-Neb.) said on CNN Sunday, saying that he was still willing to give the Senate bill another week before declaring it dead.

In an appearance on Face the Nation, Sen. Mike Lee (R-Utah) also endorsed repealing Obamacare with a delayed implementation that would give lawmakers time to craft a replacement, noting that approach might be easier.

Sometimes when you lump too many things into one piece of legislation, you doom its chances of success, Lee said. That might be where we are.

Lee is also one of the senators pushing a change to current legislation to insist that every state have at least one Obamacare-compliant insurance plan, in exchange for lifting the rules on the others. Short endorsed that change on Sunday, calling it perfectly appropriate, and part of the process of bringing everybody together.

But Republicans from the other side of the party spectrum are also distancing themselves from the Senate bill, as Democrats suggest they are ready for a bipartisan approach.

Last week, Senate Minority Leader Charles E. Schumer (D-N.Y.) asked the president to relaunch the health-care push in a bipartisan fashion, declaring that Democrats are ready to work across the aisle.

Trump surrogates scoffed at that offer Sunday, with Short declaring that Senator Schumer might talk about bipartisanship, but he has no interest in bipartisanship whatsoever.

Sen. Bill Cassidy (R-La.) used a Sunday appearance on NBCs Meet the Press to hawk the health-care proposal he drafted with Sen. Susan Collins (R-Maine), which they say was designed to build bipartisan support. Both have been skeptical of the current Senate bill. But on Sunday, Cassidy said he, too, is skeptical that Democrats are serious about cooperation.

Until a Democrat says they are willing to sign on to the Patient Freedom Act, which allows a blue state to do what theyre doing now, but allows a red state to do something different, Im not sure were ready for bipartisanship, Cassidy said.

Trump administration officials identified three areas that could need last-minute changes to win a more favorable impact score from the Congressional Budget Office and more support from members. Price said the administration and lawmakers are working to ensure that individuals transitioning off Medicaid do not fall through the cracks, that more coverage options are available and that opioid abuse is addressed.

Not all Republicans are convinced that those efforts will help. In an appearance on ABCs This Week, Ohio Gov. John Kasich, a Republican, warned against efforts to try to buy people off with little, last-minute fixes on issues such as opioid abuse programs that he called anemic. Its like spitting in the ocean. Its not enough.

Kasich had harsh words for both Democrats and Republicans, excoriating them for being too consumed with politics to be anything but shortsighted and disingenuous when it comes to fixing the health-care system, and complaining that sometimes my party asks too much.

Right now, theyre not ready, they are not ready to sit down and put the nation first in my opinion, Kasich said of congressional lawmakers. His problems with the bill, he said, cover the whole package.

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Trump administration remains confident health-care bill will pass - Washington Post

President largely sidesteps the bully pulpit in pushing health-care bill – Washington Post

With the Republican push to revamp the Affordable Care Act stalled again, even some allies of President Trump question whether he has effectively used the bully pulpit afforded by his office and are increasingly frustrated by distractions of his own making.

Trump has spoken out repeatedly during his tenure about the shortcomings of Obamacare, which he brands a disaster. But he has made relatively little effort to detail for the public why Republican replacement plans which fare dismally in public opinion polls would improve on the former presidents signature initiative.

The lackluster sales job, combined with recent controversial tweets and public statements targeting the media, has diminished the focus on the presidents leading legislative priority at a key juncture in the Senate, allies and analysts say.

Its a mystery, said Barry Bennett, a Republican operative who advised Trumps campaign last year and remains close to the White House. I dont know what theyre doing.

In recent days, Trump, who heads to Poland and Germany later this week, has seemed largely preoccupied by other things, including a Twitter feud with multiple news outlets. On Sunday, Trump sent around a video showing him body-slamming a CNN avatar, just days after calling an MSNBC host dumb as a rock.

(Bastien Inzaurralde/The Washington Post)

A top Trump lieutenant, Health and Human Services Secretary Tom Price, was pressed Sunday on whether the media attacks are interfering with the presidents push of the unpopular Senate bill.

The fact of the matter is that he can do more than one thing at a time, Price said during an exchange with host Chuck Todd on NBCs Meet the Press that grew testy at times.

Price argued that Trump has been holding multiple meetings within the White House itself, with physicians, with small-business groups, with other folks who have been harmed by Obamacare, with patients, individual stakeholders from across this land who tell him and have told us repeatedly that the current system is collapsing.

Trumps public efforts to dismantle the health-care law, however, contrast sharply with President Barack Obamas efforts to build support in advance of its 2010 passage. Obama gave a joint address to Congress on health care. He fielded questions at town hall meetings around the country. And he even bantered on live television with hostile lawmakers at a Republican retreat.

Not only has Trump been unsuccessful at swinging public opinion toward the legislation, but also he hasnt really tried that much, said George C. Edwards III, a professor of political science at Texas A&M University and author of On Deaf Ears: The Limits of the Bully Pulpit.

He hasnt been out there consistently making a case for the legislation, Edwards said of Trump.

Its not hard to imagine other things Trump could be doing to try to boost support for the GOP plan among the public and, by extension, on Capitol Hill, Bennett said.

Trump could make much better use of Twitter, urging his 33million followers to call their senators and ask them to back the GOP bill, Bennett said.

Trump could have visited several states last week, holding events that highlight the sharp rise in premiums under Obamacare, he said. And Trump could mobilize his supporters to come to Washington and rally outside the Capitol, demanding passage of a bill.

Trumps seeming ambivalence about selling the GOP plan may reflect that he has always been more animated about getting rid of Obamacare than he has been about what should replace it.

To the degree he has discussed what the American health-care system should look like, Trump has talked about insurance for everybody and coverage that would be much less expensive and much better standards that the bills produced by the House and Senate dont come close to achieving, according to analyses.

Trumps public statements about the bills, at times, have risked doing more harm than help, leading to questions about how dedicated he is to the task at hand a view bolstered by Trumps head-scratching comments that he considered the House bill mean and that it would be unfortunate but okay if senators are unable to pass a bill.

Trump further muddied the waters last week by floating the possibility on Twitter that lawmakers could repeal the ACA now and replace it later a view that Price on Sunday emphasized is not the administrations preference.

White House press secretary Sean Spicer said that theres no reason Trump should follow models used by Obama or other past presidents to build public support.

You use the model that works for you, Spicer said, noting that Trump has advanced a health-care bill further in the process at this point in his term than Obama. The ACA did not pass until the second year of Obamas first term.

Weve been more efficient, Spicer said.

Marc Rotterman, a GOP consultant based in North Carolina, said Trump needs to be more repetitive when speaking to the public about why the bill should pass.

When you push a measure, redundancy matters, and these constant tweets against the media distract from the real issue, which is getting health care done, said Rotterman, adding that hed like to see Trump deliver an Oval Office address on the subject.

To bolster support for their initiatives in Washington, presidents often travel to friendly territory outside the Beltway to make their case. Trump has traveled outside of Washington several times lately, but those events have mostly focused on other issues, and when he has mentioned health care, he hasnt dwelled on it.

During Trumps recent travels to Ohio and Wisconsin, he staged secondary events meant to highlight victims of Obamacare.

In a mid-June trip to Milwaukee, for example, Trump invited two local families to join him on Air Force One to talk about their struggles to pay for insurance under the ACA. Afterward, Trump and the families spoke briefly to the news media on the tarmac, with Trump telling reporters, these citizens deserve so much better.

His motorcade then whisked him to a technical college to talk about workforce development and apprenticeships an event that received the majority of local coverage.

At a Trump rally late last month in Cedar Rapids, Iowa, the president could have made an extended argument about the need for moving forward on health care. But Trump didnt discuss the issue in much detail as he pledged to deliver a bill with heart.

He made at least as many headlines for pledging to crack down on the use of welfare by immigrants and to use solar panels to help pay for a promised wall on the U.S.-Mexico border.

Ari Fleischer, the press secretary to former president George W. Bush, said Trump to this point deserves mixed marks for his use of the bully pulpit on health care.

Fleischer credited Trump with having kept his foot on the gas while the House was struggling to pass its version of the bill in early May.

In the Senate, Trump seems to be hindered by his low job-approval ratings, which have undercut his ability to reach out to some conservative Democrats, in particular, Fleischer said.

If Trump were more popular, Fleischer said, a handful of those Democrats would probably be more willing to support the bill, out of fear of incurring the presidents wrath. Instead, theyre now worried about drawing a Democratic primary challenger if they work too closely with Trump.

Since the focus turned to the Senate in recent weeks, Trump has also delegated much of the lobbying to Vice President Pence and senior administration officials, who have more extensive knowledge of the bill and a better sense of how to bring senators on board.

Trump is also faced with the prospect of selling a very unpopular product. A Congressional Budget Office analysis of the Senate plan projected that it would lead to 22million fewer Americans having coverage within a decade.

Only 17percent of adults nationwide approved of the Senate health-care bill, while 55percent disapproved, according to an NPR/PBS NewsHour/Marist poll released Wednesday.

Even among Republicans, support was tepid, with 35percent voicing approval and 21percent saying they disapprove. Other recent polls have had similar numbers.

Meanwhile, even as Trump has repeatedly railed about shortcomings of the ACA, public support for Obamas initiative has increased, polls have found.

In December, as Trump prepared to take office, 43percent of American adults viewed the ACA favorably, while 46percent viewed it unfavorably, according to a Kaiser Health tracking poll.

In the June poll, 51percent viewed the law favorably, compared with 41percent unfavorably. That was the best the ACA had fared since Kaiser started its polling in 2010.

The term bully pulpit was coined by President Theodore Roosevelt, who used the powers of the office to court reporters and deliver major speeches on legislation related to railroad regulation and food inspection.

Frances Lee, a government and politics professor at the University of Maryland, said presidents traditionally have poor records of changing public opinion when pushing unpopular initiatives, as Trump is attempting to do.

Use of the bully pulpit is mainly effective when presidents are pushing Congress to do something the public already favors, she said, citing the wide latitude Bush had with Congress after the Sept.11, 2001, terrorist attacks.

Still, there is no shortage of suggested initiatives Trump could be taking that he has not.

After the House narrowly passed its health-care bill in early May, Aaron Kall, the director of debate at the University of Michigan, penned a piece for the Hill newspaper, urging Trump to give an address to a joint session of Congress to bolster Senate support.

In an interview, Kall said he still thinks that would be helpful to Trump, given the large television audience such an address would command.

If Trump wants legislation to pass at this point, he really needs to adopt some new tactics, said Kall, editor of Mr. Speaker, the President of the United States: Addresses to a Joint Session of Congress.

Kall suggested that Trump also make himself available for television interviews focused on health care with outlets beyond the friendly confines of Fox News.

I think weve underestimated him sometimes, Kall said. With a few days preparation, I think he could withstand an interview on this subject. He has a persuasive story to tell. It just needs to be packaged in the right way.

Others say that Trump would be well-served by putting down his phone.

Asked Sunday whether Trumps tweets made it harder to work on health care, Sen. Bill Cassidy (R-La.) admitted that he gets frustrated when the media and lawmakers focus on what the president says on Twitter.

Our focus cannot be on the tweet, Cassidy said on Meet the Press. Our focus has to be on that kitchen-table family paying $20,000, $30,000 and $40,000 for their premiums, wondering how theyre going to make ends meet.

Jenna Johnson and Ashley Parker contributed to this report.

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President largely sidesteps the bully pulpit in pushing health-care bill - Washington Post

Sasse: ‘Repeal with a delay,’ then replace – CNN

"If Leader McConnell can get us across the finish line in a combined repeal and replace, I'd like to see that happen," the Republican freshman senator said in an interview with Jake Tapper on CNN's "State of the Union." "It needs to be a good replace, but if we can do a combined repeal and replace over the next week that's great. If we can't, though, then there's no reason to walk away. We should do repeal with a delay let's be clear, I don't want to see anybody thrown off the coverage they have now. I would want to delay so that we can get straight to work."

Sasse first suggested the option of repealing and then replacing the Affordable Care Act, President Barack Obama's signature health care law, in a letter to President Donald Trump on Thursday an idea that Trump also voiced, but was met by criticism from both Republicans and Democrats who worried that it could harm Americans by leaving them without coverage.

"On July 10, if we don't have agreement on a combined repeal and replace plan, we should immediately vote again on H.R. 3762, the December 2015 ObamaCare repeal legislation that the Congress passed but President Obama vetoed," Sasse wrote in the letter. "We should include a year-long implementation delay to give comfort to Americans currently on ObamaCare that a replacement plan will be enacted before expiration."

Later that day, Trump tweeted, "If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"

Vermont Sen. Bernie Sanders countered Sasse's argument on Sunday, calling the "repeal and then replace" option "absurd."

"I have a lot of respect for Sen. Sasse, but that idea is an absurd idea," the independent senator said in an interview on "State of the Union."

Republican Rep. Adam Kinzinger of Illinois has also rejected the suggestion of repealing and then later replacing the law, saying it could harm Americans.

"I think it's repeal and replace," Kinzinger told CNN's Chris Cuomo Friday on "New Day." "We can argue whether they like the system we're bringing them in or not, but simply a repeal, even with the sunset the year or two down the road -- the problem (is) we know how Washington works."

Sasse cast doubt on the CBO report Sunday, saying that "(r)egularly, government scorekeepers underestimate cost and they overestimate coverage."

"CBO is filled with lots of well-meaning people, and they're good at certain kinds of analysis, but analyzing macro long-term, highly complex, dynamic social programs, thev're almost never been right," Sasse added.

The current Republican plan in Congress is to do both a repeal and a replacement of the law in one massive piece of legislation, though the Senate's bill has struggled to gain the necessary GOP support.

"I think we need to do both repeal and replace, and I'm a little agnostic as to whether they're paired or separated," Sasse added in his "State of the Union" interview on Sunday, calling for the cancellation of the Senate's August recess so lawmakers can get to work on a replacement plan.

Senate Majority Leader Mitch McConnell said Friday that he will stick to the path of accomplishing both a repeal and a replacement together.

Finding a replacement for the law is "very challenging," but allowing Obamacare to remain in place is not an option, McConnell said, according to a video of his remarks posted on the website of the Courier-Journal newspaper, based in Louisville, Kentucky.

"We think that Leader McConnell and his senators within the Senate are working to try to get this piece of legislation on track," Price said. "Their conversations are ongoing as we speak, so we look forward to hopefully them coming aback after this 4th of July recess and getting the work done."

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Sasse: 'Repeal with a delay,' then replace - CNN

Why We Will Never Control Healthcare Costs – National Review

On one hand bioethicists bemoan the high costs of medical care and promote health care rationing forthe elderly, seriously disabled, and dying.

On the other, they promote expanding publicor insurance funding of health care to ensure that peoples desires are satisfied and to promote social justicemedicine harnessed in the service of hedonism,the ethical theory that pleasure (in the sense of the satisfaction of desires) is the highest good and proper aim of human life.

For example, California requires all group insurance plans to cover fertility treatments for gays and lesbians in the same way they do biologically infertile heterosexual couples. The Obama Administration promulgated a regulation so that Medicare now funds sex change surgeries.

Now this. Advocacy has commenced in the UK to have the socialized NHS fund uterus transplants so that men who identify as women can give birth. From the Daily Mail story:

Transgender women who were born male should be given womb transplants so that they can have children, leading NHS doctors have told The Mail on Sunday. And fertility experts say taxpayers should fund such transplants for those who identify as women, on the basis of equality enshrined in law.

Leading the debate on the controversial procedure is medical ethics lawyer Dr Amel Alghrani, who is pressing for a talks on whether womb transplants for trans-women should be publicly funded. Dr Alghrani, of Liverpool University, also predicts that a successful programme would lead to others demanding wombs including gay and straight men who wanted to experience the joys of carrying a child.

This would be wrong on so many levels, ranging from safety concerns for both patient and potential future baby, the prospect of doctors and hospitals being forced to participate even if it violates their religious or moral beliefsalready beginning to happento the question of whether going to such extremes to satisfy individual yearnings constitutes wise public policy.

But make no mistake: Powerful political and cultural forces will bearepushing us hard in this direction.

This much is sure: If the current trends continue, there is no way we will ever be able to adequately control healthcare costs.

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Why We Will Never Control Healthcare Costs - National Review

Ohio Gov. Kasich on health care: ‘Sometimes my party asks too much’ – Washington Post

Ohio Gov. John Kasich (R)lecturedcongressional leaders of his party on Sunday for being shortsighted, disingenuous and, ultimately, doomed to be forgotten by history if they persist withtheir approach to health-care legislation.

Sometimes my party asks too much, Kasich said on ABC's This Week, saying he and others would not be fooled by efforts to try to buy people off with little fixes to the Senate billto increase spending to combat opioid addiction or give more financial support to low-income people seeking health coverage.

[Republicans grow increasingly anxious about heading home without a health plan]

This is not the first time that Kasich has criticized the GOP for the health-care legislation it istrying to shepherd through Congress. Last month, he joined with two other Republican governors and four Democratic governors to urge the Senate not to reduce Medicaid coverage which the Senate bill contracts.

But Kasich stressed Sunday that it's not just Medicaid, and the fact that there's not enough money in Medicaid legitimately to treat people that has prompted his oppositionto the bill.

Its the whole thing, he said. It's the entire package, which I believe can and should be fixed.

The sins of the health-care package Kasich has identified go right to the heart of the bill, he said.If the Obamacare exchanges are collapsing, he stressed, you can't also give people three or four thousand dollars a year and think they can buy an insurance policy.

What kind of insurance policy can you buy at three or fourthousand dollars a year? Kasich asked.

[GOP health-care talks center on stark question: Help vulnerable Americans or help the rich?]

He also said that the latest proposal to inject the effort with money to combat opioid abuse $45 billion over 10 years was anemic. It's like spitting in the ocean. It's not enough.

Kasich didn't reserve his harsh words only for the GOP he criticized Democrats, too, and politicians generally as being slaves to their party instead of working to improve the country.

No one will ever remember you if you don't put the country first, Kasich warned members of Congress.

Right now, they dont want to concede anything, he concluded. Right now, theyre not ready, they are not ready to sit down and put the nation first in my opinion.

[Fresh polls find Republicans health-care proposal is still a clunker]

Notably, Kasich did not direct the same sort of criticism atPresident Trump, who he suggested would be open to negotiations with Democrats.

I think hed be fine with it, the governor said, noting that Trump is a real estate businessman and that negotiation is part of their DNA.

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Ohio Gov. Kasich on health care: 'Sometimes my party asks too much' - Washington Post