WASHINGTON The top U.S. Senate Republican struggled on Wednesday to salvage major healthcare legislation sought by President Donald Trump, meeting privately with a parade of skeptical senators as critics within the party urged substantial changes.

Republican leaders hope to agree on changes to the legislation by Friday so lawmakers can take it up after next week's Independence Day recess.. Senate Majority Leader Mitch McConnell on Tuesday abandoned plans to seek passage of it this week because Republicans did not have 50 votes to pass the bill.

For seven years, Republicans have led a quest to undo the 2010 law known as Obamacare, Democratic former President Barack Obama's signature legislative achievement. Trump made dismantling it a top campaign promise during last year's presidential campaign but policy differences within the party have raised doubts Republicans can achieve a repeal.

Democrats have unified against the bill and Republicans control the Senate by a slim 52-48 margin, which means McConnell can afford to lose only two Republicans. So far at least 10 - including moderates and hard-line conservatives - have expressed opposition to the current bill, although some indicated they would vote for it with certain changes.

McConnell, with his reputation as a strategist on the line, met with a procession of Republican senators in his office on Wednesday. John Cornyn, the No. 2 Senate Republican, said party leaders will talk to every Republican senator who has concerns about the bill or is undecided.

The House of Representatives passed its healthcare bill last month, only after striking a balance between the center of the party and the right wing. Now McConnell must find a similar sweet spot.

During a lunch meeting on Wednesday Republicans made presentations on potential fixes. Senator Rand Paul called for jettisoning more parts of Obamacare to get conservatives on board.

TAX ISSUE

Senator Mike Rounds suggested keeping a 3.8 percent Obamacare tax on high earners' investment income, which the current bill would eliminate. Rounds said the tax could pay for more Americans to receive the tax credits that help pay for health insurance.

Senator Bob Corker, who also supports keeping the tax, said one of the issues he was focused on was helping lower-income Americans pay for health plans.

"My sense is there's a good chance that issue and other issues people are trying to get addressed can be addressed," Corker told reporters.

Trump said the bill was moving along well and predicted a "great, great surprise" but did not elaborate.

Maine Senator Susan Collins, a moderate, said it would be "very difficult" to reach agreement by Friday. Collins and other centrists were put off by the nonpartisan Congressional Budget Office's projection on Monday that 22 million people would lose medical insurance under the existing bill.

Finishing the legislation's revisions by Friday would be "optimal," Cornyn said, so the CBO can analyze the new version..

Even then, Democrats could mount a forceful resistance. They have repeatedly said they will not discuss a repeal but have expressed openness to negotiating improvements.

The Senate's top Democrat, Chuck Schumer, proposed Trump call all 100 senators to Blair House across the street from the White House to craft a bipartisan bill fixing Obamacare but Trump said did not think Schumer's offer was serious.

McConnell said Democrats had refused "to work with us in a serious way to comprehensively address Obamacare's failures in the seven years since they passed it."

The legislation has triggered protests at the Capitol and police said they arrested 40 people, including cancer survivors, on Wednesday for blocking Senate offices.

Obama's 2010 Affordable Care Act, which passed without Republican support, expanded health insurance coverage to some 20 million people but Republicans call it a costly government intrusion.

The Senate bill rolls back Obamacare's expansion of the Medicaid government insurance for the poor and cuts planned Medicaid spending starting in 2025. It also repeals most of Obamacare's taxes, ends a penalty for not obtaining insurance and overhauls subsidies that help people buy insurance with tax credits.

For graphic on who's covered under Medicaid, click: tmsnrt.rs/2u06kvB

(This story fixes attribution of quote in 10th paragraph to Senator Corker from Senator Rounds.)

(Additional reporting by Susan Heavey, Richard Cowan, Susan Cornwell, Steve Holland, Jeff Mason, Mohammad Zargham, Tim Ahmann and Jeff Mason; Writing by Lisa Lambert, Will Dunham and Frances Kerry; Editing by Bill Trott)

WASHINGTON Flush with cash, political groups outside the White House are aggressively coming to President Donald Trump's aid as he battles low public approval numbers, questions about his election campaign's ties to Russia and a stalled legislative agenda.

WASHINGTON Leaders of the U.S. Senate Intelligence Committee said on Wednesday they had reached an agreement that would allow them to see memos written by former FBI Director James Comey about his meetings with President Donald Trump.

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Senate Republicans struggle to salvage healthcare effort - Reuters

Mr. McConnell, who was re-elected handily in 2014, seems committed to his partys pledge to repeal the Affordable Care Act even if it might hurt some constituents back home. A study last year by the Kaiser Family Foundation found that the percentage of uninsured in Kentucky dropped from 18.8 percent in 2013, the year the health law was put in place, to 6.8 percent one of the sharpest reductions in the country.

Here in Whitesburg, a city of roughly 2,000 people at the base of Pine Mountain, Mr. Gormans sentiment seems to be the prevailing one. In nearly two dozen interviews with health care workers and patients, at the hospital and at a nonprofit clinic run by the Mountain Comprehensive Health Corporation, Kentuckians sounded both fearful and flummoxed by the health care drama on Capitol Hill.

It makes me very nervous, said Brittany Hunsaker, 29, a clinic social worker who counsels pregnant women addicted to opioids. Some of the most vulnerable people that we serve, we may not be seeing any more.

Several clear themes emerged. Most people said they want everyone covered, and were appalled, as was Mr. Gorman, when they learned the Congressional Budget Office had estimated the Republican plan would leave 22 million more people uninsured over a 10-year period. They are happy that lawmakers are trying to fix Mr. Obamas health law rising premiums are a worry for many but fear that Republicans, in their haste, will make a bad situation worse.

Sorting out the way forward is agonizingly complex. Kentuckys Medicaid expansion and successes under the Affordable Care Act are largely the result of former Gov. Steve Beshear, a Democrat who is out of office now. Meanwhile, Gov. Matt Bevin, a Republican elected in 2015, is pushing for a Medicaid waiver from the federal government that includes requirements for many beneficiaries to work or participate in job training.

Dr. Van Breeding, the clinics director of medical affairs, lamented that the Republican bill in the Senate had gotten mixed up in party politics, while patients had been forgotten. He summed up the situation this way: Senator Paul is worried about the financial aspect of it. Senator McConnell is worried about the political aspect of it. And Im worried about patients not having access to basic health care.

Kathy Collins, 50, who suffers from lupus, an autoimmune disease and who was uninsured until she got Medicaid coverage through the laws expansion is among Dr. Breedings patients. Sitting in her hospital bed here Tuesday morning, she said she was surprised to hear that Mr. McConnell, whom she had voted for previously, was leading the charge to roll it back.

He is? she asked. Well, then, hes no good for Kentucky.

Health care is a growing part of this regions economy, and people here are also deeply concerned that the repeal will bring job losses to a region already decimated by unemployment from the coal industry downturn.

Dr. Breeding says the number of uninsured patients at the clinic dropped from 19 percent to 4 percent as a result of the health care law. He said Mountain Comprehensive was barely getting by financially before the law was passed; business is much better now. Mountain Comprehensive has hired more people and now offers extended weekend hours and an optometry clinic services that have been financed by revenue brought in from the health law, Dr. Breeding said.

And those services mean more health care jobs.

If they do what they say they are going to do, then we may lose our jobs, said Vicki Roland, a surgical nurse. I think what we have works pretty good for the people. If they revamp it, Im not sure whats going to happen.

Mr. McConnells office did not respond to a request for an interview. But Mr. McConnell did make his case for why the bill would help Kentucky on the Senate floor last week, and in an opinion piece in The Cincinnati Enquirer on Sunday, in which he argued that the legislation would stabilize markets and deliver flexibility to state officials to address problems like the opioid crisis.

Despite his constituents concerns, Mr. McConnell has little reason to worry about a political backlash; he is widely credited with building the Republican Party in this state, and after three decades in the Senate, his seat is secure. In 2014, he clobbered his Democratic opponent, Secretary of State Alison Lundergan Grimes, winning by more than 15 percentage points.

He ran on a clear platform to repeal and replace Obamacare, as did Matt Bevin, the governor, as did Rand Paul, the other senator, as did Donald Trump, said Scott Jennings, a Kentucky Republican strategist with close ties to Mr. McConnell. And they all have one thing in common: They have overwhelmingly won their elections in Kentucky.

Still, there has been pushback. On Monday, nearly 100 opponents of the repeal protested outside Mr. McConnells northern Kentucky office. On Tuesday, more than a dozen organizations representing health care providers signed an open letter to Mr. McConnell, published in his hometown paper, The Courier-Journal of Louisville, imploring him to STOP the mad rush to pass this bill and instead seek advice from health care experts.

You said you have a responsibility to act, the letter said. We believe you have a duty to act responsibly. Kentuckians deserve better.

The local newspaper here in Whitesburg, The Mountain Eagle, published an editorial assailing Mr. McConnell for putting the bill together behind closed doors. Why the secrecy, Sen. McConnell? its headline read.

Dr. Breeding, recently named Country Doctor of the Year by Staff Care, a Dallas-based health care company, shares these sentiments. His message to Mr. McConnell: Dont rush it. Bring in the experts. Lets hammer it out.

To spend a day with Dr. Breeding is to get a glimpse of his patients challenges. His weekday mornings begin at 4:30 a.m., when he arrives at the hospital in Whitesburg. Dressed in his workout gear, he makes rounds, visiting patients whose ailments run the gamut: pneumonia, respiratory failure, colon cancer, lupus, black lung disease, dementia, heart attack, kidney infection and multiple myeloma, a bone cancer.

By 8:30 a.m., after a break for a brisk walk through town, he arrives at the clinic, where his nurse practitioner, Heather Yates, says she sees the health care debate from both sides.

Like her colleagues, Ms. Yates, 35, worries that undoing the Affordable Care Act will hurt patients. But she has had to cope with the high cost of premiums; when her husband was out of work, they qualified for subsidies under the Affordable Care Act but still paid $400 a month for an insurance policy with a deductible of as much as $1,500. Now the couple pays $1,000 a month, with a $6,000 deductible, for a plan that covers all expenses once the deductible is met.

Ive got a mix of emotions, she said. I do want everybody to have insurance, but I understand what its like to pay for it too.

Follow Sheryl Gay Stolberg on Twitter: @SherylNYT

A version of this article appears in print on June 29, 2017, on Page A1 of the New York edition with the headline: For Kentucky, A Fear the Cure Will Be Worse.

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In McConnell's Own State, Fear and Confusion Over Health Care Bill - New York Times

McConnell hopes to strike a deal on a revised version of the bill by Friday and send it to the Congressional Budget Office, according to The Washington Post. But resolving lingering differences could prove difficult in the short window.

Republicans face difficulties in winning over skeptical senators, as tweaks to appease conservatives could alienate moderates, or vice versa.The hurdles threaten to delay a key plank of the sweeping agenda Republicans hoped to pass when Trump won the White House and the GOP held onto both chambers of Congress.

Amid Republicans' push to win over skeptical senators, Trump set some lofty goals for the bill Wednesday.

"I think this has a chance to be a great health care at a reasonable cost. People can save a lot of money. We get rid of the mandates, we get rid of so much. Got rid of a lot of taxes. All the bad parts of Obamacare are gone. Essentially, it's a repeal and replace," Trump said.

A CBO score of the existing bill shows a mixed bag on those counts. It estimated that the bill would lead to 22 million more uninsured Americans by 2026 than under current law, a figure that multiple moderates criticized.

Average premiums would fall by about 20 percent relative to current law by 2026. But out-of-pocket costs could rise for many consumers "because nongroup insurance would pay for a smaller average share of benefits under this legislation," the CBO said.

The Senate plan would lead to an estimated $321 billion in deficit reduction from 2017 to 2026, according to the office.

The bill has received dismal approval ratings in polling so far. In addition, most major medical groups have opposed the proposal.

As Republican leaders pushed to strike a deal on the plan, some GOP senators increased their calls to figure out a bipartisan solution for Obamacare's problems. Sen. Lindsey Graham, R-S.C., told NBC News that if the GOP does not reach a deal by Friday, it may be time to start seeking a bipartisan solution.

Moderate Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, are among the other GOP senators who have said they would be open to a bipartisan solution.

On Tuesday, McConnell indicated that he did not see that as a possibility yet. He said of Democrats: "They're not interested in participating in this."

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Trump predicts a 'big surprise' on health care as Senate GOP pushes to win votes - CNBC

Photo Credit Tim Lahan

To the Editor:

Re How Health Care Went Wrong (Op-Ed, June 19):

Christy Ford Chapin praises the innovation of prepaid physician group practices as particularly elegant models. She suggests that concierge medicine is their modern-day successor. Not so. No matter the payment structure, fragmented medical practice cannot deliver consistent quality to individual patients and larger populations.

Concierge medicine is not only a step backward, but it is also a move toward an unequal, two-tier system. Ms. Chapin criticizes Kaiser Permanente as different from and lacking the benefits of those earlier elegant models; in fact, Kaiser is the archetype.

Kaiser Permanentes model is often heralded as focused on prevention and delivering the right care at the right time. Incentives are correctly aligned to help patients get and stay healthy, with care and coverage typically more affordable than elsewhere.

Our Permanente physician-led clinical teams constantly innovate to create integrated, person-centered and technology-supported care. The results are clear: Kaiser Permanente is first in more categories of care effectiveness than any other commercial health plan.

EDWARD ELLISON RICHARD S. ISAACS OAKLAND, CALIF.

Dr. Ellison is executive medical director of the Southern California Permanente Medical Group. Dr. Isaacs is chief executive and executive director of the Permanente Medical Group.

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Kaiser Permanente's Archetype for Health Care - New York Times

President Donald Trump may not have as great a grasp on health-care policy as he claims.

The president "seemed especially confused" during a meeting with senators Tuesday when a senator "complained that opponents of the bill would cast it as a massive tax break for the wealthy," The New York Times reported. Trump then said he would address tax reform later, according to the Times, which cited an aide who had a readout of the exchange.

Trump appeared to dispute the report in a pair of tweets Wednesday morning, alleging that the "failing" Times "writes false story after false story about me."

He added that he knows health care "well" and wants "victory" for the United States.

Trump ran on a campaign of repealing and replacing Obamacare, promising on the campaign trail to immediately do so if he won the presidency. He has repeatedly applied pressure on the House and Senate to pass an Obamacare replacement plan, though he has reportedly had less influence on senators than he did on House members.

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Trump reportedly seemed 'confused' that GOP health-care bill would be cast as a tax break for the rich - CNBC

Planned Parenthood supporters and other opponents of the Republicaneffort to repeal and replace ObamaCare formed a human chain around the Capitol Wednesday afternoonin a massive protest amid GOP attempts to save their healthcare bill.

Demonstrators held signs reading "Stand with Planned Parenthood" and "Don't Take Away Our Care" while chanting "healthcare, now!" The goal of the protest was to form a continuous human chain around the entire Capitol.

The protest was organized by liberal activist group MoveOn.org, which promoted the protest on Twitter leading up to the demonstration.

Were forming a human chain around the Capitol to protest #Trumpcare. Join us at 5 pm! #PeoplesFilibuster https://t.co/y2glkeJy5Z pic.twitter.com/cpEmYu1Lc2

The protest was also promoted by Sen. Kamala Harris (D-Calif.), who promised on Twitter that she would be attending.

RT to spread the word: Human chain at the U.S. Capitol tomorrow at 5 p.m. ET. Ill be there. Tell your friends, tell your neighbors.

Thousands of protesters had joined the march less than an hour after it was scheduled to begin. Protesters with massive Planned Parenthood banners and megaphones led chants, while other Planned Parenthood volunteers in special vests directed protesters.

Probably at least 1500 people at @PPact human chain around capitol building (this is less than half the video) pic.twitter.com/FvDIBK4f0R

Manny from @PPact doing an amazing job keeping us all in line to form the #humanchain @IndivisibleTeam @TopherSpiro pic.twitter.com/GptY8ZfWe5

Multiple lawmakers, dressed in black and wearing mourning veils, held a simultaneous "funeral" for Medicaid on the Capitol steps. The mourners included Democratic Reps. John Lewis (Ga.), Frederica WilsonFrederica WilsonDemonstrators form human chain around Capitol to protest GOP healthcare bill Florida governor signs strengthened 'stand your ground' bill into law Dem: Trump needs psychological help MORE (Fla.) and Joyce BeattyJoyce BeattyDemonstrators form human chain around Capitol to protest GOP healthcare bill Washingtonians take center stage at Will on the Hill Trump should work with Congress to block regulations on prepaid cards MORE (Ohio), among others.

Republicans are currently working to find a compromise to pass their version to repeal ObamaCare. Nine GOP senators have already announced their opposition to the Senate's version of the bill, forcing Senate leadership to delay the vote until after the July 4 recess.

Senate Republicans can only afford two GOP defections, assuming no Democrats vote to repeal the Affordable Care Act.

Last week, Planned Parenthood held similar rallies against the Senate bill in at least 20 states. The bill in its current state would defund Planned Parenthood for a year.

"As the Senate drafts its Trumpcare bill behind closed doors, with no hearings, the public is making its voice heard," Planned Parenthood said last week in a statement.

Taylor Lorenz contributed.

Read more:

Demonstrators form human chain around Capitol to protest GOP healthcare bill - The Hill

Former House Speaker Newt Gingrich discussed Medicaid spending on "Fox & Friends" on June 27, 2017.

Former House Speaker Newt Gingrich said all the media coverage that declares the Republican health care bills would cut Medicaid is wrong, because he claimed the program actually gets a significant boost over the years.

Reports about both the House and Senate bills have pointed out the measures reduce funding for Medicaid, the joint state and federal health insurance program for the very poor. Using the House bill as an example, Gingrich said its really the opposite.

"After all the news media talking about cutting Medicaid in the House Republican bill, I did some research," Gingrich said June 27, 2017, on Fox & Friends. "It actually goes up 20 percent over the next 10 years."

Gingrich said Republicans had a "communications problem" for not pointing this growth out when discussing the bill, resulting in coverage focused on deep Medicaid cuts.

Those news reports mostly focus on analyses by the nonpartisan Congressional Budget Office. The bill before the Senate would reduce Medicaid spending by $772 billion over 10 years by 2026, the CBO said. A similar analysis for the bill that passed the House in May would winnow Medicaid spending by $834 billion in the same time frame.

So where is Gingrich getting his 20 percent increase in Medicaid spending from?

We reached out to his office and didnt hear back. But it appears hes talking about the rate at which Medicaid will grow over the next decade something the programs slated to do whether Republicans pass a health care law or not.

The GOP proposals, however, put major limits on future funding for that growth.

Medicaid costs keep going up

Medicaid originally was a program for low-income children, pregnant women, elderly and disabled individuals, and some parents, but it excluded other low-income adults.

As part of its efforts to provide health coverage options for as many people as possible, the Affordable Care Act allowed states to expand Medicaid and help pay for it with more federal dollars. Thirty-one states plus Washington, D.C., currently have extended Medicaid benefits to essentially all adults making up to 138 percent of the federal poverty level. The poverty line for a family of four is $24,600 in 2017.

That coverage is expensive, and its only going to cost more as the years go on. For calculating how the GOP bills may affect Medicaid spending, the CBO used baseline figures from March 2016 to draw estimates for how much the program would cost.

"There are two reasons Medicaid costs go up: More people are being served and the cost of serving them is going up," said Joan Alker,Georgetown University public policy professor and executive director of the Center for Children and Families.

Costs could rise due to increasing drug prices, inflation, an aging population with more older Americans, or any number of other considerations.

"CBO's baseline projects what Medicaid will need to account for these factors," Alker said.

From 2017 through 2026, the federal government would spend more than $5 trillion on Medicaid under current law, the CBO projected.

Another way to measure that growth is to calculate the percent change from current spending levels to that estimated 2026 level.

If the Affordable Care Act stayed in place and nothing changed, the CBO said Medicaid spending would increase from $393 billion in 2017 to $624 billion in 2026. Thats a 58.8 percent increase.

Now come the semantics: The House and Senate bills both slow the rate of that increase in spending, although they do so in different ways and on different schedules. But they both assume major reductions in how high the dollar amount for funding increases.

Opponents of the GOP bills call that a cut. The CBO calls that "reductions in outlays." Gingrich is saying its an increase. How?

How the GOP bills slow Medicaid spending

It looks like Gingrich focused on the projection for how the House bill would affect future funding.

Starting with the $393 billion in spending in 2017, Medicaid spending would go up steadily each year to reach $474 billion in 2026, under the House bill. Thats a 20.6 percent increase.

The Senates plan would increase funding to $466 billion in 2026, or about 18.5 percent higher than 2017. The projections assume what would happen if the bills took effect, with reductions starting in 2018.

The CBO said that under the Houses bill, 14 million fewer people would be enrolled in Medicaid by 2026, relative to current law. The Senate bill would see 15 million fewer enrollees.

Keep in mind that Medicaid spending goes up under any scenario. Its just at a far lower rate under the Republican health care bills.

Policy analysts told us itmakes reductions to Medicaid with no allowance for how the program may need to grow in the future.

"If he's claiming that there's no cut in the (House bill) because Medicaid spending in 2026 would be higher than it is now, that's largely irrelevant," Ben Sommers, a Harvard University health policy and economics professor, told PolitiFact. "Given that this dramatically reduces spending to what would occur under current law, most people would call this a cut. "

Such reductions also put new limits on how many people have access to Medicaid. The changes all but guarantee states will have to alter eligibility requirements and take away benefits without regard to whether people actually need them.

"The bills restrain the rate of increase well below Medicaids actual rate of increase," said Sara Rosenbaum, a George Washington University health law and policy professor. "Of course its a cut. If federal growth is kept artificially low, the only choice is to spend more to make up the deficit."

Our ruling

Gingrich said under the House health care bill, Medicaid spending "actually goes up 20 percent over the next 10 years."

By any CBO projection and under any proposed legislation, Medicaid spending will increase over the next decade because health care costs are increasing. The House health care bill limits that increase to 20 percent,while maintaing the status quo requires a 60 percent increase, according to the CBO.

Both the bills in the House and the Senate limit thegrowth of spending.

The statement is partially accurate but leaves out important details. We rate it Half True.

See the article here:

Newt Gingrich misleads with point that House health care bill grows Medicaid spending - PolitiFact

Its hard to see how tinkering is going to satisfy my personal concerns, Ms. Collins told reporters.

A real-time count of every senators position.

Negotiations on Tuesday that leaders hoped would move senators toward yes only exposed the fissures in the Republican Party. Conservatives were demanding that states be allowed to waive the Affordable Care Acts prohibition on insurance companies charging sick people more for coverage and are asking for a more expansive waiver system for state regulators. They also wanted more money for tax-free health savings accounts to help people pay for private insurance.

Senators from states that expanded the Medicaid program and Senator Susan Collins, Republican of Maine would not brook many of those changes, especially the measure to severely undermine protections for people with pre-existing medical conditions. They wanted more money for mental health benefits for people addicted to opioids and money for states to cover people left behind by the rollback of the Medicaid program in both the House and Senate versions.

Three Republican senators Ms. Collins, Rand Paul of Kentucky and Ron Johnson of Wisconsin had announced they would vote against the motion to begin debate that had been scheduled to hit the Senate floor on Wednesday, joining Senator Dean Heller of Nevada, who made the same pledge on Friday.

A bevy of other senators from both flanks of the party seemed headed in the same direction if they did not see changes made to the Senate health care bill, leaving the measure in deep peril, since Republicans can only lose two votes from their own party.

The release of a Congressional Budget Office evaluation on Monday did little to help leaders roll up votes from either side of the fence. The budget office said the Senate bill would leave 22 million more uninsured after 10 years, while sending out-of-pocket medical expenses skyrocketing for the working poor and those nearing retirement.

The budget office did not provide conservatives with support for their demands either. The state waivers already in the Senate bill would probably cause market instability in some areas and would have little effect on the number of people insured by 2026, the analysis concluded. Adding still more waivers, including one that could allow insurers to price the sick out of the health care market, could deprive even more people of health care.

Even before Mr. McConnells decision, White House officials had braced for the likelihood that the procedural vote would fail and that they would have to revisit the measure after the Fourth of July recess when they hoped to be able to woo Mr. Johnson, who has been a surprisingly fierce critic of the bill from the right. The senator has repeatedly warned that this week is too soon to vote on the health care measure, as Republican senate leaders have insisted they need to do.

Vice President Mike Pence, attended the Senate Republican lunch on Tuesday and then broke off for private meetings with Mr. Heller, a seemingly firm no and the first moderate Republican to break with Mr. McConnell over the bill, and Rob Portman of Ohio, who is feeling pressure from his states governor, John R. Kasich, to oppose the bill and defend Ohios Medicaid expansion.

Mr. Portman was the subject of a spirited evaluation of his open criticism of the bill by Mr. McConnell, who was frustrated with the expansion-state senators who showed their hand early to other wavering colleagues, dooming the bill for now. Mr. McConnell was unhappy that Mr. Portman seemed to be abandoning his previous stance on fiscal rectitude by opposing Medicaid cuts in the bill.

But the Ohio senator was getting it from both sides. Mr. Kasich appeared in Washington on Tuesday to sharply criticize the Senate bill. The governor said he was deeply concerned about millions of people losing coverage under the bill.

Who would lose this coverage? Mr. Kasich said. The mentally ill, the drug addicted, the chronically ill. I believe these are people that need to have coverage.

At the same news conference, Colorados Democratic governor, John W. Hickenlooper, said his states Republican senator, Cory Gardner, understands the hardships and the difficulties in rural life.

This bill would punish people in rural Colorado, Mr. Hickenlooper said, raising the pressure.

Doctors, hospitals and other health care provider groups came out strongly against the Senate bill, as did patient advocacy groups like the American Heart Association. But business groups were ramping up their support. In a letter on Tuesday, the U.S. Chamber of Commerce endorsed the Senate bill and urged senators to vote for it.

The Senate bill will repeal the most egregious taxes and mandates of the Affordable Care Act, allowing employers to create more jobs, said Jack Howard, a senior vice president of the group. The bill, he noted, would repeal a tax on medical devices and eliminate penalties on large employers that do not offer coverage to employees.

A separate letter expressing general support for the Senates efforts was sent by a coalition of 28 business and employer groups including the National Association of Home Builders, the National Restaurant Association and the National Retail Federation.

But Senate conservatives found themselves squeezed between business sentiment and their conservative base. Club for Growth, an ardently conservative political action committee, came out strongly against the Senate measure on Tuesday.

The Club for Growth and the American people took Republicans in Congress at their word when they promised to repeal every word root and branch of Obamacare and replace it with a patient-centered approach to health care, the groups president, David McIntosh, said in a statement. Only in Washington does repeal translate to restore. Because thats exactly what the Senate GOP healthcare bill does: it restores Obamacare.

Even the Trump administration is divided over what comes next, especially on the payment of subsidies to health insurance companies to compensate for reducing out-of-pocket costs for low-income people.

Mr. Trump has threatened to withhold the monthly payments as a way to induce Democrats to bargain with him over the future of the Affordable Care Act. Administration officials said Mr. Trump did not want to make the payments if the Senate did not pass a health care bill this week. But they said Tom Price, the secretary of health and human services, had urged the White House not to cut off the payments abruptly.

A federal judge has ruled that the payments are illegal because Congress never appropriated money for them, but that ruling is being appealed. Any interruption of the payments could have a dire destabilizing effect on markets, insurers say. Blue Cross Blue Shield of North Carolina recently blamed the Trump administrations mixed signals on the subsidy for most of its proposed 23 percent spike in premiums next year.

Sean Spicer, the White House press secretary, defended the administrations position at his briefing on Friday.

If the president were to hypothetically say that hes going to make the payments in perpetuity or for a year, I think that continues to prop up a failed system, Mr. Spicer said. It continues to do wrong by the American taxpayer. And it also doesnt lend itself to the expediency that I think we want to help get a new health care system in place.

Originally posted here:

Vote Delayed as Republicans Struggle to Marshal Support for Health Care Bill - New York Times

And the American deficit has been getting worse. Each year, other high-income countries are improving their health at a much faster rate than the United States, and the United States currently ranks lowest on a variety of health measures, the report by the Institute of Medicine and the National Research Council noted.

I bring this up, senators, because you are considering a bill that would drive a stake through the Affordable Care Act. As you mull the legislation over your holiday recess, think about the consequences of cutting access to care for millions of mostly poorer, sicker and older Americans.

Of course, the dismal health situation is not all the fault of the health care system which, until the passage of the Affordable Care Act, was the only one in the developed world that routinely barred access or limited care for millions of people of modest means.That is because violence accounts for a large share of Americans excessive mortality, and accidents take a disproportionate toll. Nor is the health care system entirely to blame for the nations elevated obesity rate a leading cause of problems like diabetes.

Americans die from noncommunicable diseases at higher rates than citizens of many other advanced countries. And many people here have at times been reluctant to see a doctor because of the cost.

Mortality rate from noncommunicable diseases

Age-standardized deaths per 100,000 people,

selected countries, 2008

Percentage who say they have

skipped seeing a doctor because of cost

Among respondents to the 2016 Commonwealth

Fund International Health Policy Survey

Whats more, the United States higher tolerance of poverty undoubtedly contributes to higher rates of sickness and death. Americans at all socioeconomic levels are less healthy than people in some other rich countries. But the disparity is greatest among low-income groups.

Still, senators, you are not off the hook. Limited access to health care may not entirely account for the poor health and the early deaths of so many of your fellow Americans. But it accounts for a good chunk.

A study about equity in access to health care for 21 countries in 2000 revealed that the United States had the highest degree of inequity in doctor use, even higher than Mexico which is both poorer and generally more inequitable.

And as noted in a 2003 study by the Institute of Medicine, insurance status, more than any other demographic or economic factor, determines the timeliness and quality of health care, if it is received at all.

It doesnt require an advanced degree to figure out what limited access to a doctor can do to peoples health. A review of studies published this week in Annals of Internal Medicine reported that health insurance substantially raises peoples chances of survival. It improves the diagnosis and treatment of high blood pressure, significantly cutting mortality rates. It reduces death rates from breast cancer and trauma. Over all, the review concluded that health insurance reduces the chance of dying among adults 18 to 64 years old by between 3 and 29 percent.

Another assessment, published last week in The New England Journal of Medicine, found that access to health insurance increases screenings for cholesterol and cancer, raises the number of patients taking needed diabetes medication, reduces depression, and raises the number of low-income Americans who get timely surgery for colon cancer.

It said that expansions in three states of Medicaid, the federal health insurance for the poor whose rolls Republicans are prepared to trim by 15 million over a decade, were found to reduce mortality by 6 percent over five years, mostly by increasing low-income Americans access to treatment for things like H.I.V., heart disease, cancer and infections.

I understand, senators, that this sort of analysis may not sway all of you. Im aware of the view on the rightmost end of the political spectrum that ensuring peoples well-being, which I assume includes their health, is a matter of personal responsibility and not the governments job.

Yet there is a solid economic argument for protecting your fellow citizens access to health care that does not rely on arguments from empathy, charity or the like. A sickly, poorly insured population can be expensive.

As noted by a study from the Joint Center for Political and Economic Studies, poor health and limited access to health care not only raise the cost of providing such care but also reduce productivity, eat into wages, increase absenteeism, weigh on tax revenues and generally lower the nations quality of life.

The study, which focused on the disadvantages of African-Americans, Latinos and Asians, added up the costs of inequalities in health and premature death between 2003 and 2006 and came up with a price tag of $1.24 trillion.

The good news, senators, is that solving these inequities neednt be particularly expensive. The analysis relayed in The New England Journal of Medicine suggested that each additional life saved by expanding Medicaid costs $327,000 to $867,000. That is much cheaper than other public interventions, such as workplace safety and environmental regulations, which achieve a similar reduction in mortality for each $7.6 million spent on compliance.

Even better: Instead of taking away the health insurance of more than 20 million Americans, what if you could offer nearly universal access and still make that work within your broader agenda?

In 2015, according to the Organization for Economic Cooperation and Development, the United States government spent 8.4 percent of its gross domestic product to pay for health care for about half of all Americans, including Medicare, Medicaid and subsidies under the Affordable Care Act. That year, Britain spent 7.7 percent to cover virtually all of its citizens. Finland, Canada and Italy spent even less.

I understand, senators, that these places have what is known as single-payer systems which tend to stick in the craws of some of you. But think about it. If your primary motivation to repeal the Affordable Care Act is to provide a large tax cut for high-income Americans, think what you could do with a full percentage point of G.D.P. It could even be worth the effort to provide health care for all.

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When Cutting Access to Health Care, There's a Price to Pay - New York Times

Josh Holmes, Mr. McConnells former chief of staff, said, That the White House is asking people to take a tough vote and then running ads against members while were still in negotiations is so dumb its amazing we even have to have the conversation.

Mr. Priebus did not respond to numerous messages seeking comment.

A broad range of Republican senators across the ideological spectrum have indicated their unease with the compromise health bill, which was largely drafted in secret over the last month. But Mr. Trump has few ties with the group, and several Republicans who remain on the fence have tangled with Mr. Trump, either during the presidential campaign or since. As a result, the Republican Senate leadership has made it known that they would much rather negotiate with Mr. Pence than the president himself, according to several White House and congressional officials.

Mr. Trump jumped in only when it became clear Republican leaders were postponing the vote until after the recess, announcing Tuesday afternoon that he was summoning all 52 Republican senators to the White House for some last-ditch diplomacy later in the day.

Top Trump lieutenants like Stephen K. Bannon, his chief strategist, who lobbied members on the House bill, have been all but sidelined. Mr. Priebus has also played a much diminished role.

While Mr. Trump has spoken with several members of the Senate, he has no plans to visit the Capitol, according to an administration official. He spoke with Senator Ted Cruz of Texas, his main rival for the 2016 nomination, over the weekend, as well as Senator Mike Lee of Utah and one or two others, but the pace was nothing like the dozens of calls he made to help pass the Houses health bill, aides said.

Mr. Pence was scheduled to attend the weekly lunch held by the Senate Republicans on Tuesday and planned to engage in conversations with undecided Republicans like Senator Rob Portman of Ohio. The vice president is likely to add other senators to his must-see list, and he plans to host a health-care-related dinner at his house Tuesday night, with Mr. Lee and Senators Tom Cotton of Arkansas, Ben Sasse of Nebraska and James Lankford of Oklahoma, according to a senior administration official. Mr. Sasse has been an understated but strong opponent of the bill as written.

Seema Verma, Mr. Pences former adviser in the Indiana statehouse and now a top administration health care official, has been trying to reassure senators that their states will have flexibility on Medicaid under the bill while Mr. Pences former chief of staff, Marc Short, now the White House legislative affairs director, has been quarterbacking the effort from his hideaway in the Capitol.

Mr. Heller, the only Senate Republican who will face voters next year in a state carried by Hillary Clinton in 2016, is the top target for Democrats facing a Senate map with few opportunities in 2018. And there were already seven groups a mix of health care advocacy organizations and more partisan Democratic efforts on the air in Nevada assailing the Republican health care overhaul, according to a Republican ad buyer tracking the ad traffic.

That an ostensibly pro-Republican group would respond to Mr. Hellers criticism of the legislation he flayed the proposal in harsh terms on Friday but did not rule out eventually backing it by swiftly accusing him of siding with Nancy Pelosi was a shock to Mr. McConnell, who has made no secret of his impatience with Mr. Trumps impulsive style.

It is also caught him off-guard. Neither Mr. McConnells office nor his top outside political advisers were warned about an impending attack on one of their most endangered incumbents. They didnt check in with anybody, Mr. Holmes said. There was no clearing of channels, no heads up, nothing.

The anti-Heller assault began with a digital buy over the weekend, but it was unclear whether the pro-Trump group would follow through with its threat to spend over $1 million attacking the senator. As of Tuesday, the group had reserved just over $250,000 for ads in Las Vegas and Reno, the two largest media markets in the state, according to the ad buyer.

The move against Mr. Heller had the blessing of the White House, according to an official with America First. Mr. Trumps allies were furious that the senator would join Gov. Brian Sandoval, who accepted the Medicaid expansion under the health law and opposes the Republican overhaul, to blast the bill.

But the frustration on Capitol Hill with Mr. Trump and his allies runs far deeper than the ads aimed at the Nevada senator.

While Mr. Trump has taken to Twitter and made phone calls in an effort to lobby his party to pass the health overhaul, he has also provided Democrats with potential weapons, namely his description of the House bill he worked to pass as mean.

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As Trump's Tactics Fall Short, Pence Takes Lead on Health Care Bill - New York Times

Alison Chandra's unborn son faced daunting odds of making it to his first birthday. And keeping him alive meant risky, expensive surgeries that their small family couldn't afford.Still, Chandra admits, she felt a bit of shame as she walked into the welfare office.

I remember sitting across the desk from the woman in the office, Chandra told The Washington Post. She said its going to be okay. And I just I think I hugged her. It was the first time that someone was able to tell me that something in this whole nightmare was going to be okay.

There was a safety net and I was falling into it.

At a prenatal sonogram, Chandra and her husband learned that they were having a boy, and that he had a rare disorder called heterotaxy syndrome.

He was born with nine heart defects, two left lungs and five spleens of dubious function, Chandra said. His liver and gallbladder are down the middle of his body, along with his heart, which needs a pacemaker to pump.

[No, the government did not pay for Mitch McConnells polio care. Charity did.]

Ethan's thirdbirthday is Saturday, but he's been through four open-chest surgeries. They've cost millions, Chandra estimates, and almost all of his early care was paid for by Obamacare.

Even though the family is no longer relying on Obamacare, his mother says her son is the poster child for Obamacare. And she's using hisstory as a message to Republicans attempting to change the health-care law.

Senate Republican leaders are trying to overhaul the 2010 Affordable Care Act and pass a new health-care bill, though they are facing opposition from the conservative andmoderate wings of the party. Senate leaders announced on Tuesday that they'd postponed a vote on the legislation until after the July 4 recess.

Senate Majority Leader Mitch McConnell (R-Ky.) unveiled the legislation that would reshape a big piece of the U.S. health-care system on Thursday, June 22. Here's what we know about the bill. (Monica Akhtar/The Washington Post)

The Congressional Budget Office forecasts that the billwould cause about 22 millionmore Americans to be uninsured in the next decade. That number is just over a million fewer than the CBO estimate on the House version of the bill, which was passed hastily last month.

As the debate rages, the picture Chandratweeted of her son's adorable face, surgery scar and protruding pacemaker has rocketed around the Internet, along with its potent message:

Look my son in the eyes and tell him that he's fought so hard to be here but sorry, you're just not worth it anymore, she tweeted. I dare you.

And on Friday, she posted another image: Her son's $231,000 hospital bill from his recent heart surgery.

She's transparent in what she's trying to do: Put a cuddly human face on a debate about health care that she believes is filled with cost-benefit analyses and shouting.

She hopes their story helps people on both sides of the debate just quiet down a little bit and look at each other. Come over to my house and spend the day with us and just look at my kid. Hes more than just a hospital bill. He's more than his preexisting condition.

Obamacare isn't perfect, she concedes, but it's given her nearly three years with her son, who has developed an intense obsession with animals and is looking forward to a moose-themed birthday party Saturday.

Accepting government health care was a tough, embarrassing choice at first, she told The Washington Post, but it was the best way for her tofight for Ethan.

Chandra is a registered pediatric nurse and she and her husband were volunteers for Mercy Ships, a nonprofit that docks floating medical centers at needy countries, offering free specialized surgery and other medical care. She understands that health care is about healing, yes, but also involves triage and prioritizing needs in a world where health care costs money and resources are finite.

They had insurance when they got pregnant with Ethan, but it maxed out during the litany of prenatal tests.

We came home expecting to have our baby and go right back to the ship, she said. Suddenly we were facing this incredibly uncertain future for our kid.

Obamacare was a stopgap measure until her husband, an engineer, found a job with health benefits.

Ethan didn't ask to be born with a preexisting condition, Chandra said. It's hard to preach personal responsibility to a 2-year-old.

Obamacare was a way that our country provided for us to be able to fight for our kid.

Now, their family is fighting against attempts to get rid of some of the provisions that helped save Ethan's life.

[An emotional Jimmy Kimmel discusses newborn sons heart disease, makes passionate health-care plea]

A Republican-backed health-care bill has passed the House and senators are working to modify their overhaul to make it more palatable. But critics have said the bill would mean millions of people like Ethan, who have preexisting conditions, could lose coverage.

Chandra said she's also wary of language that would allow insurers to impose lifetime or annual caps, which could directly hurt her son, even though they've now switched to her husband's employer's health plan.

I don't think anyone can look a 2-year-old child in the face and say 'I think that you're not worth it,' " she said. What they're doing with a lifetime cap is saying you have used up enough resources. I'm sorry that you were born sick. I'm sorry that your mother chose life for you, but now that life is not worth saving anymore.

There is no cure for heterotaxy. Ethan will probably always bedependent on his pacemaker, for example. In the meantime, she says, she's doing everything in her power to help her son thrive, while poring over any medical advancement that could give them more time with Ethan.

She already considers herself among the lucky ones. Between his major surgeries, he's an active almost 3-year-old who makes mud pies and runs through the woods with his older sister.

And along the way, she's seen small victories in a battle she hopes lasts for decades.

Theres actually a specific moment when he realized that his life has changed, she said. He was walking with me. It was shortly after the surgery in February. He would stop every few steps and tell me 'I have to rest now.'

But he kind of stopped, he looked at me and he said, 'Mama, Im not really tired. Im not getting tired.'

And he said, 'Mama, Im Superman.' And he just took off running. He ran like a quarter-mile before he stopped.

Kristine Phillips contributed to this report.

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A 7-year-old told her bus driver she couldnt wake her parents. Police found them dead at home.

She loved the river. A brain-eating amoeba lurking in the water ended up killing her.

A 4-year-old dies days after going swimming. Was dry drowning to blame?

A teen chugged a latte, a Mountain Dew and an energy drink. The caffeine binge led to his death.

Read the rest here:

A mother's response to the health-care debate: Her 3-year-old son's $231000 hospital bill - Washington Post

WASHINGTON Facing a potentially disastrous defeat by members of his own party, U.S. Senate Majority Leader Mitch McConnell decided on Tuesday to delay a vote on healthcare legislation in order to get more support from Republican senators.

President Donald Trump summoned all 52 Republican senators to the White House on Tuesday afternoon to discuss how to proceed.

McConnell had been pushing for a vote ahead of the July 4 recess that starts at the end of the week. The legislation would advance a repeal of major elements of Obamacare and replace it with a new federal healthcare program.

The delay showed McConnell and Trump have failed so far to attract enough votes amid a solid block of Democratic opposition and attacks from both moderate and conservative Republican senators.

McConnell, who has a razor-thin majority in the Senate, told reporters that Republican leaders were still working to get the 50 votes to pass the bill, adding that the White House was anxious to help write legislation that could pass the Senate.

While the House of Representatives narrowly passed a measure last month to replace Obamacare, the Senate version stalled on Tuesday as a small but potentially crippling group of senators held out.

Moderate senators worried that millions of people would lose their insurance. Conservatives said the bill does not do enough to erase Democratic former President Barack Obama's signature domestic legislation.

U.S. stock prices fell on Tuesday after the decision to postpone the vote. U.S. stocks have rallied this year on hopes for tax reform, deregulation and changes to the health sector. Markets are beginning to doubt whether the Trump administration can fulfill its promises.

By early afternoon the benchmark S&P 500 index was down 0.5 percent and the Dow Jones industrial average was off 0.2 percent.

The market likes certainty and now theres uncertainty. What is this going to look like when this gets out of the next iteration?," said Peter Costa, president of trading firm Empire Executions Inc.

The bill's prospects were not helped by an analysis by the nonpartisan Congressional Budget Office on Monday saying the measure would cause 22 million Americans to lose medical insurance over the next decade even as it reduced the federal deficit by $321 billion over the next decade.

The report prompted Senator Susan Collins, a key moderate vote, to say she could not support moving forward on the bill as it stands.

At least four conservative Republican senators said they were still opposed after the CBO analysis.

Passing the measure would hand Trump a legislative win as he seeks to shift attention after weeks of questions over Russia's role in last year's U.S. presidential election.

'ROOT AND BRANCH'

McConnell has promised since 2010 that Republicans, who view Obamacare as a costly government intrusion, would destroy the law "root and branch" if they controlled Congress and the White House. Their electoral victories in 2014 and 2016 were directly tied to that promise, they say.

Republicans worry that failure to deliver will tell voters that they are unable to govern effectively in the run-up to next year's congressional elections.

If the Senate passes a bill, it will either have to be approved by the House, which passed its own version last month, or the two chambers would reconcile their differences in a conference committee. Otherwise, the House could pass a new version and bounce it back to the Senate.

Democrats remained united in opposition, blasting the Senate bill as a tax break for the wealthy.

(Additional reporting by Yasmeen Abulateb, Amanda Becker, Eric Walsh, Susan Heavey and Tim Ahmann; Writing by Richard Cowan and Frances Kerry; Editing by Jeffrey Benkoe)

COLORADO SPRINGS, Colo. At a glitzy weekend gathering of donors to the powerful Koch brothers' network, much of the talk was about the conservative political group's criticism of the healthcare bill moving through the U.S. Senate.

Irish Prime Minister Leo Varadkar held a phone call with U.S. President Donald Trump in which he discussed migration and Britain's exit from the European Union, the Irish government said in a statement on Tuesday.

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Pence to join Senate Republican leaders in healthcare push - Reuters

Of the two options, Obamacare is vastly more just. The Republican plan is ghastly. But America has a much better choice: health for all at far lower costs.

This might seem like an out-of-reach goal or a political slogan, but it is neither. Every other rich country uses the same medical technology, gets the same or better health outcomes, and pays vastly lower sums.

Why the disparity? Health care in America is big business, and in America big business means big lobbying and big campaign contributions, the public interest be damned.

Both parties have therefore ducked the hard work of countering the health care sector's monopoly power. Health care spending is now at $10,000 per person per year, roughly twice or more the total of other high-income countries, or a staggering $3.25 trillion a year.

We should aim to save at least $1 trillion in total annual outlays, roughly $3,000 per person per year, through a series of feasible, fair and reasonable measures to limit monopoly power. Our system would look a lot more like that of the other more successful and less expensive nations.

Here's a 10-point plan Congress should consider.

First, move to capitation for Medicare, Medicaid and the tax-exempt private health insurance plans. Under capitation, hospitals and physician groups receive an annual "global budget" based on their patient population, not reimbursement on a fee-for-service basis.

Second, limit the compensation of hospital CEOs and top managers. The pay of not-for-profit hospital CEOs and top managers, for example, could be capped at $1 million per year.

Third, require Medicare and other public providers to negotiate drug prices on a rational basis, taking account of research and development incentives and the manufacturing costs of the medicines.

Fourth, use emergency power to override patents (such as compulsory licensing of patent-protected drugs) to set maximum prices on drugs for public health emergencies (such as for HIV and hepatitis C).

Fifth, radically simplify regulatory procedures for bringing quality generic drugs to the market, including through importation, by simplifying Food and Drug Administration procedures.

Sixth, facilitate "task shifting" from doctors to lower-cost health workers for routine procedures, especially when new computer applications can support the decision process.

Eight, use part of the annual saving of $1 trillion to expand home visits for community-based health care to combat the epidemics of obesity, opioids, mental illness and others.

Nine, rein in the advertising and other marketing by the pharmaceutical and fast-food industries that has created, alone among the high-income world, a nation of addiction and obesity.

Ten, offer a public plan to meet these conditions to compete with private plans. Medicare for all is one such possibility.

There really no mystery to why America's health industry needs a drastic corrective.

All of these are examples of the vast market power of the health care industry. The sector is designed to squeeze consumers and the government for all they're worth (and sometimes more, driving many into bankruptcy).

The health care sector is a system of monopolies and oligopolies -- that is, there are few producers in the marketplace and few limits on market power. Government shovels out the money in its own programs and via tax breaks for private plans without controls on the market power. And it's getting worse.

Every other high-income country has solved this problem. Most hospitals are government-owned, while most of the rest are not for profit, but without allowing egregious salaries for top management. Drug prices are regulated. Patents are respected, but drug prices are negotiated.

None of this is rocket science. Nor is the United States too dumb to figure out what Canada, the UK, France, the Netherlands, Germany, Japan, Sweden, Norway, Denmark, Finland, Austria, Belgium, Korea and others have solved. The problem is not our intelligence. The problem is our corrupt political system, which caters to the health care lobby, not to the needs of the people.

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Jeffrey Sachs: America can save $1 trillion and get better health care - CNN

"We're not deadbeats," said Rebecca Wood, 38, who lives with her husband and daughter in Charlottesville, Virginia.

Wood's daughter, Charlie, was born more than three months early, weighing just one pound and 12 ounces. While she's now 5 years old and doing well, she suffers from complications of her extreme prematurity. She still gets most of her calories through a feeding tube in her stomach.

Wood and her husband have expensive medical bills as a result of these complications.

With the help of Medicaid, Charlie has made great strides. Forty percent of US children are on Medicaid.

After five grueling years, her parents now have confidence that she will realize their dream for her: to grow up to become an independent adult.

But if the Republican health care plans succeed, they worry that dream could die.

"There are these men, just far away from everything, snatching it out from under her," she said.

Arriving early for an appointment with her congressman in May, Rebecca Wood paced the streets of Capitol Hill to calm her nerves.

A few weeks before, on May 4, Virginia Republican Tom Garrett had voted for the American Health Care Act, a plan Wood thinks could endanger her daughter.

As she walked, Wood tried to gather the courage to confront Garrett and a yard sign along her path gave her confidence.

It was a quote from the anthropologist Margaret Mead: "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."

Now the stay-at-home mom was ready to tell her story to her congressman.

Wood's blood pressure soared causing doctors at Inova Fairfax Hospital in Falls Church, Virginia, to deliver Charlie at 26 weeks -- 14 weeks early -- to save both of their lives.

After the delivery, Wood went straight to the intensive care unit, her kidneys and liver suffering terribly. Deluded by her disease and the drugs to treat it, she tried to unplug her monitors so she could get to Charlie.

Wood wasn't healthy enough to see her daughter for another two days.

Her husband wheeled her to the neonatal intensive care unit where she looked down into the isolette at her 1-pound, 8-ounce baby and promptly burst into tears.

"I was afraid she wasn't going to survive. It terrified me that this was it," she said.

"I watched you fight and I cheered you on," she would write later in her blog. "On your difficult days, I prayed and begged. Sometimes you would forget to breathe. I gently nudged you as a reminder."

Charlie was discharged after three months in the hospital, though her growth and development lagged behind other babies. She still suffers from delays in speech and fine motor development and is vulnerable to infections, like pneumonia.

Her mother, however, was undaunted.

"I told myself in my head that whatever she could do, we would use whatever her ability is to give her life meaning. If she could hear, then we'd play music for her. If she could only see then we'd take her to look at art and look at the outdoors," she said.

Wood, who had been a social worker, stayed home to focus on Charlie. She took her to doctors' appointments as well as physical, speech, occupational, feeding, and music therapy sessions.

It worked.

By Charlie's first birthday, she could sit up by herself. At 20 months, she took her first steps. Today, she runs around the playground like any child her age. She'll start kindergarten in the fall, a milestone that makes her mother beam.

"She's amazing. She's an incredible kid, but there's a lot of work that went into getting her to where she is," she said.

As she climbed the steps to Garrett's office, Wood said she felt like the character from the iconic movie, "Mr. Smith Goes to Washington," about the reformer who tries to change the system.

Wood set her cell phone on the couch and obtained permission from Garrett's aide to record the conversation.

The very first thing Garrett did was to suggest that Wood was confused about the bill.

"I'm afraid that there's been some hyperbolic mischaracterization of what the reality on the ground is," Garrett said. "It's unfair to you. It's creating fear and anxiety where it need not exist."

Wood assured her congressman she wasn't confused or under anyone's influence. She'd read the GOP bill thoroughly.

She explained that her family has health insurance through her husband's job, but they're still responsible for deductibles, copayments, and other expenses -- which add up to more than $12,000 a year.

Medicaid pays for those extra costs.

Garrett told Wood not to worry, saying "they're not getting rid of Medicaid."

But the House bill, which Garrett voted for, would reduce federal spending on Medicaid by nearly a quarter by 2026 compared to current law, according to a Congressional Budget Office estimate.

Under the GOP Senate plan, which has yet to be put to a vote, some 15 million fewer Americans would be covered by Medicaid in 2026.

Wood is afraid Charlie will be one of them.

Garrett told CNN that care doesn't have to suffer when funding gets slashed.

"The reality is that sometimes you can move money and still get good outcomes," he said.

"So if you had a daughter like Charlie, would you have voted to pass [the GOP plan]?" Wood asked her congressman at their meeting in May.

"Absolutely," he answered.

"Some experts" support the plan, Garrett answered.

"Who?" Wood asked. "Tell me."

"Some have," Garrett answered.

Wood didn't get her answer, but she let it go. Their time was up.

"I know we're banging at each other, but you're doing exactly what you ought to be doing as a mom," Garrett told her.

"I'm sure you're a lovely person. I just disagree with you on this bill," Wood responded.

Before they parted ways, Wood took a photo with her congressman. She says if she looks unhappy in the picture, it's because she was.

"I don't think there are words that express how angry I am that somebody could vote for something that would hurt the people he's supposed to represent," she said.

CNN's Michael Nedelman contributed to this report.

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After fighting for her daughter's life, mom fears GOP health care bill - CNN

The Congressional Budget Office estimates twenty-two million fewer people would be insured by 2026 under the GOP's proposed health care plan. USA TODAY

WASHINGTON Ohio Gov. John Kasich ripped Senate Republicans on Tuesday for crafting a health care bill that would cause an estimated 22 million Americans to lose their health insurance.

They think thats great? Thats good public policy? an incredulous Kasich said at anews conferencein Washington on Tuesday. What, are you kidding me?

Kasich was referring toan analysisreleased Monday by the nonpartisan Congressional Budget Office, which estimated that the Senate GOP bill to repeal and replace Obamacare would increase the ranks of the uninsured by 22 million by2026, compared to current law.

Kasich has made his opposition to the GOP bill clear before, but Tuesday he ratcheted up his criticism at a joint news conference with ColoradoDemocratic Gov. John Hickenlooper.

Kasich said congressional Republicans should try getting health care through Medicaid or purchasing insurance with the miserly subsidies the GOP plan offers.

Why dont we have those folks go and live under Medicaid for a while? Kasich said. Why dont we have them go live on their exchange where they can get two, three, four thousanddollars a year to cover their health care exchange costs.

Kasich didnt reserve all his ire for his own party. He also blasted lawmakers of all stripes for acting like a bunch of fifth-graders.

We have a health care civil war going on, he said. Its all about recrimination.

He said Republicans should jettison their current bill and start over, while Democrats should stand and challenge the Republicans to negotiate with them.

Democrats have said they would work with Republicans to fix Obamacare if they stop their efforts to repeal or gut the law.

Read more:

Senate health care bill would lead to 22 million more uninsured, CBO says

Health care bill winners (wealthy) and losers (Medicaid recipients), according to the CBO

Senate GOP leaders face growing opposition to health care bill

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John Kasich on Senate Republicans' health care bill: 'Are you kidding me?' - USA TODAY

Elizabeth Tadesse has cared for elderly residents at the Holly Heights Nursing Center in Denver for eight years now, helping them get dressed and serving them pancakes in bed.

They really rely on us, Tadesse said.

But the health-care bill that senators are discussingthis week would slash funding to Medicaid, which generates 81 percent of her employers revenue and largely covers her wages.

The Better Care Reconciliation Act would reducethe countrys Medicaid spending by $772 billion over the next decade, the nonpartisan Congressional Budget Office projected in a report Monday. That could shut down nursing homes across the country, health-care leaders argue, and trigger widespread layoffs in one of the nation's fastest-growing fields of employment.

Janet Snipes, executive director of Holly Heights, said the proposed cuts would oblige her to reduce her workforce: currently about 170employees who care for 130 residents.

Shrinking the staff, she said, would hamper the center's ability to make life comfortable for the patients an effort that includes bingo and Nintendo Wii, in addition to standard meal and medical services.

We cant take a significant cut and not do staff reduction, she said. And when staff is reduced, care can be compromised.

Tadesse, who quit a job at Walmart to work at Holly Heights, is afraid Medicaid cutsmight reduce her hours.Certified nursing assistants at her facility make about $16 an hour, or $33,000 annually.

If they cut my hours, she said, it would affect me tremendously.

Under theSenate version of the GOP health-care plan, roughly 22 million Americans would lose their health insurance over the next 10 years, the CBO projected. About 15 million would be knocked off Medicaid, the public insurance for the countrys poor.

The largest savings would come from reductions in outlays for Medicaid spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law, the report states.

Though Medicare generally covers older people, Medicaid funds long-term services, including nursing home stays. Nearly two-thirds of Americas 1.4 million nursing home residents rely on Medicaidto cover their care.

Some enter the facilities with little financial resources. Others outlive their savings. Without Medicaidcoverage, doctors say hundreds of thousands would spiral into debt or live without critical services for the disabled.

The public money keepsnursing homes running, Snipes said, since most Americans cant afford the service on their own.

The cost to live at Holly Heights is about $6,000 a month. That includes medical care, food, social functions, laundry, hearing aids, and dental needs.

Mark Parkinson, chief executive of the American Health Care Association and National Center for Assisted Living, which represents about 11,000 nursing homes nationwide, said on a conference call Monday that Medicaid cutsunder the proposed health-care lawwould cost individualnursing homes an average of $100,000 a year overthe first three years.

That would spell disaster for a typical nursing home, which makes about $150,000 annually, he said.

Within a year or two, most buildings in the country would be below their break-even points, Parkinson said. This is not hyperbole.

Roughly 1.7 million people work at nursing homes, mostly in caregiving roles, according to AHCA figures. And health-care employment is rapidly growing especially in areas that serve the elderly. Providing comprehensive, around-the-clock care tends to be labor-intensive.

The Census Bureau estimates that the number of people ages 65 and up in the U.S. will grow from 40 million in 2010 to 72 million by 2030.

Employment of nursing assistants and orderlies, which covers nursing home employees, is expected to keep pace, with a projected growth rate of 17 percent through 2024 or double the growth rate for all occupations, according to the Bureau of Labor Statistics.

Nursing assistants make an average of $26,590 per year.Sara Rosenbaum, founding chair of the Department of Health Policy at George Washington University, calls the growth of such health-care employment a Medicaid workforce.

You destroy the Medicaid program, she said, and you can kiss your nursing homes goodbye.

Layoffs in nursing or health aide roles would disproportionately hurt female and black workers, BLS data suggest. Women fill eighty-seven percent of roles in the sector, while black workers hold 27.3 of the jobs. (The broader workforce is nearly half female and only 11.6 percent black.)

The Hebrew Home at Riverdale, a nonprofit nursing home in the Bronx,is home to roughly900 residents cared for by 800 employees. Theres art therapy, pet therapy comforts provided by fundraising. The bulk of operations, however, is supported by Medicaid.

Ninety percent of residents pay withMedicaid, said Daniel Reingold, chief executive of RiverSpring Health, a senior care organization in New Yorkthat runs Hebrew Home. And entry-level caretakers, who happen to be mostly women, make about $27,000 per year with benefits.

The jobs dont require college degrees and represent a path to stability in the Bronx, where 30 percent of residents live in poverty.

The economic impact that our employment brings to the Bronx is significant, Reingold said. Cuts like this could end up having an impact on wages and benefits.

Read more from the original source:

The GOP health-care plan threatens to kill jobs nationwide - Washington Post

Sen. Elizabeth Warren (D-Mass.) says its time for Democrats to run on single-payer health care across the country.

President Barack Obama tried to move us forward with health care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts, Warren, referring to Mitt Romney, said in an interview with The Wall Street Journalpublished Tuesday.

Now its time for the next step. And the next step is single payer, she said.

Warrens comments represent a shift to her position on the U.S. health care system.In March, she said her support for switching to single-payer in which the government handles coverage of health care costs, rather than insurance companies would depend on whether Democrats could find Republican lawmakers willing to help fix the Affordable Care Act passed under Obama.

Republicans, however, have focused on trying to repeal and replace Obamacare. And neither a bill the House passed nor one the Senate is considering both of which would cause more than 20 million people to lose health insurance, according to Congressional Budget Office estimates has any support among Democrats.

Last week, a high-profile effort to establish a single-payer health care system in California stalled amid concerns from both Democratic and Republican lawmakers in the state over how to pay for the estimated $330 billion to $400 billion measure. California Assembly Speaker Anthony Rendon (D) called the measure woefully inadequate.

National Democrats have been reluctant to call for putting single-payer at the top of their party platform. House Minority Leader Nancy Pelosi (D-Calif.), who supports single-payer, rejected the idea earlier this year, saying the issue should be left up to the states because Congress is not ready for it yet.

Republicans say single-payer is unpopular and turns off voters. Matt Gorman, communications director at the National Republican Campaign Committee, goaded Democrats to heed Warrens call for such a system.

The White House is also using the specter of single-payer to persuade Senate Republicans to vote for their partys health care bill.

White House Press Secretary Sean Spicer tweeted that plans by Sen. Bernie Sanders (I-Vt.) to introduce a bill that would create a single-payer system lays out the choice for GOP senators wary of the bill their leaders unveiled last week.

In her Journal interview, Warren called on Democrats to ditch half-measures and commit to progressive policies that they believe in.

Its not like were trying to sell stuff that people dont want. Its not that at all, she said. Its that we havent gotten up there and been as clear about our values as we should be, or as clear and concrete about how were going to get there.

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Elizabeth Warren Calls For Democrats To Embrace Single-Payer Health Care - HuffPost

Last Updated Jun 26, 2017 11:23 AM EDT

The Senate is days away from voting on a Republican plan to repeal and replace Obamacare, but leadership has, for the time being, fallen short so far of securing the 50 votes necessary to pass the measure.

Republicans actually need 51 votes to pass the legislation, but one of them can be Vice President Mike Pence's tie-breaking vote. Taking that into consideration, and assuming all Democrats vote against it, Republicans can only afford two defections. The Senate currently has 52 Republicans and 48 Democrats.

The 142-page measure, released Thursday, would end Obamacare's penalties for people who don't buy insurance, cut back an expansion of Medicaid, but would keep protections for people with pre-existing conditions, compared to the House-passed bill. It would provide tax credits, based on income, age and geography, which would make more money available to lower-income recipients to help them buy insurance. This differs from the House bill, which tied its tax credits only to age. Obamacare taxes would be repealed under the bill. The Senate bill would provide for expanded tax-free Health Savings Accounts, and it would also eliminate federal funding for Planned Parenthood for one year.

Hours after text was revealed Thursday, Sen. Rand Paul, R-Kentucky, announced with three other Senate Republicans that they opposed the bill in its current form because it doesn't go far enough in repealing President Obama's health care law. A day later, Sen. Dean Heller, R-Nevada, became the fifth Senate Republican to reject the measure.

However, unlike the hardliners opposiing the bill, Heller said he can't support the current version of the legislation because he believes it goes too far in cutting the expansion of Medicaid and would likely would take away health care coverage from millions of Americans and tens of thousands of Nevadans.

Some moderates, including Sen. Susan Collins, R-Maine, have also expressed concern.

Senate Majority Leader Mitch McConnell, R-Kentucky, has a challenging road ahead as he faces trying to bridge the divide between conservatives who want a more robust repeal of Obamacare and moderates who are wary about phasing out Obamacare's Medicaid expansion.

Here's a list of Senate Republicans who oppose the bill in its current form:

If three of the five continue to oppose the bill, and no Democrats support the bill, the measure will not pass. And even if McConnell is successful in getting it through the Senate, the process won't be over. The House and Senate would then have to reconcile their two bills and pass a final agreement in each chamber before it can be sent to President Trump's desk.

A cost estimate of the bill from the nonpartisan Congressional Budget Office (CBO) is expected to come out as early as Monday. The CBO's score of the House measure, which passed the lower chamber on May 4, found 23 million more people would be without health insurance over the next decade under the bill.

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Senate GOP health care bill vote: The whip count - CBS News

Senate Majority Leader Mitch McConnell leaves the chamber after announcing the release of the Republicans' health care bill on Thursday. J. Scott Applewhite/AP hide caption

Senate Republicans on Thursday unveiled their plan to repeal and replace the Affordable Care Act also known as Obamacare. The long-awaited plan marks a big step toward achieving one of the Republican Party's major goals.

The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal which he calls a discussion draft will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.

"We agreed on the need to free Americans from Obamacare's mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don't need or can't afford," McConnell said.

Instead, the bill entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.

This bill is better designed than the House version, according to Avik Roy, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can't afford insurance while making coverage cheaper for young healthy people.

"The bill will encourage a lot more of those individuals to buy health insurance," Roy says. "That, in turn, will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better-designed."

But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance."If you're paying a similar percentage of income, you're getting a less generous product under this new plan," she says.

The plan keeps some popular parts of Obamacare. It allows parents keep their children on their policies until age 26 and requires insurers to cover people with pre-existing conditions.

But it then allows states to opt out of that requirement.

"The protections around pre-existing conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions," says Pearson.

Those waivers would allow state to drop benefits required by Obamacare, such as maternity coverage, mental health care and prescription drug coverage.

Both bills would eliminate most of the taxes imposed by the Affordable Care Act.

And they would bar people from using tax credits to buy policies that pay for abortion and also block Planned Parenthood from getting any money from Medicaid for a year.

Perhaps the most sweeping move, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and the disabled and goes even further.

Today, Medicaid pays for all the care people need, and state and federal governments share the cost.

But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.

"The Medicaid cuts are even more draconian that the House bill was, though they take effect more gradually than the House bill did," Pearson says. "So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states."

Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.

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Coal and steel jobs were once plentiful in Steubenville, Ohio. Today, the local hospital is the top employer in the county. Courtesy of Rana Xavier hide caption

Coal and steel jobs were once plentiful in Steubenville, Ohio. Today, the local hospital is the top employer in the county.

When people talk about jobs in Ohio, they often talk about the ones that got away.

"Ten years ago, we had steel. Ten years ago, we had coal. Ten years ago, we had plentiful jobs," says Mike McGlumphy, who runs the job center in Steubenville, Ohio, the Jefferson County seat.

Today, the city on the Ohio River is a shell of its former self. And health care has overtaken manufacturing as the county's main economic driver.

1 in 4 private sector jobs in the county are now in health care. The region's biggest employer by far is the local hospital. Trinity Health System provides about 1,500 full-time jobs and close to 500 part-time jobs, more than Jefferson County's top 10 manufacturing companies combined.

Still, unemployment in Jefferson County stands at 7 percent, 2 percent higher than the state overall. And health care leaders worry that the Republican proposals to repeal and replace the Affordable Care Act could take many health care jobs away.

Specifically, they're concerned about the rollback of Medicaid that is central to both the House and Senate bills. Ohio was among the states that expanded Medicaid under the ACA, adding 700,000 additional low-income or disabled people to the rolls.

The Congressional Budget Office estimates that the Senate bill, the Better Care Reconciliation Act, would cut Medicaid spending by $772 billion over the next 10 years, whereas the House bill, the American Health Care Act, would cut the program by $880 million over the same period.

The local job center in downtown Steubenville, where people can get support applying to jobs. Jessica Cheung/NPR hide caption

The local job center in downtown Steubenville, where people can get support applying to jobs.

At Trinity Health, 1 in 5 patients are on Medicaid, slightly lower than the state average. Joe Tasse, the hospital's acting CEO, warns that cuts to Medicaid could imperil jobs as well as the hospital's bottom line.

"It would be pretty devastating," he says. "If Trinity Hospital were to fail, this region economically would fail."

Tasse says under the AHCA, Trinity could stand to lose $60 million over 10 years. He says that's the equivalent of a thousand or more hospital jobs.

His fears are backed up by the liberal-leaning Economic Policy Institute, which projects that more than 81,000 jobs in Ohio could be lost within five years under the AHCA, resulting in a 0.7 percent drop in the state's overall employment.

A big challenge, Tasse says, is that departments such as emergency care and obstetrics, which have high rates of Medicaid patients, are also among the most costly to operate. Given the 24/7 nature of the care they provide, they can't cut back on staffing on days when demand is slack.

Nurses at the telemetry unit of Trinity Hospital respond to patient calls and monitor patient vital signs. Jessica Cheung/NPR hide caption

Nurses at the telemetry unit of Trinity Hospital respond to patient calls and monitor patient vital signs.

"An OB department is really an emergency department for women and obstetrics," said Tasse, pointing out that most births are not scheduled. "If you want to have that service and provide it for your community, you have to incur that cost. There's really not a way around it. Unless you want to tell the women, 'Hey, we're closing our service,' which many hospitals have had to do. 'Here's your bus ticket or here's the car ride that you have to take to deliver.'"

Trinity's obstetrics and emergency care departments are now also dealing daily with the opioid crisis. At Trinity, 1 in 5 babies are born prenatally exposed to opioids, adding complications and cost. In the emergency room, nurses are seeing so many overdose cases that they are set up to meet patients in their cars at the entrance, armed with the antidote drug naloxone.

Under federal law, hospitals are required to treat anyone seeking emergency care. So if Medicaid were cut back, Tasse says they wouldn't turn patients away at the door. They would scale back in other ways.

"Where we've tried to move patients to preventive [care], identifying health problems earlier that would all go away," he says. He'd expect more patients showing up in the emergency department, "sicker [and] more expensive."

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After Decline Of Steel And Coal, Ohio Fears Health Care Jobs Are Next - NPR