An oversized poster of the Seinfeld character Kramer watches over Phil Rizzutos daily routine. When Rizzuto, named for the famous New York Yankees shortstop, swallows his 6 a.m. pills, Kramer is looming over him, looking quizzical. Same for the 9 a.m., noon, 6 p.m., and midnight doses, each fistful of pills placed in a carefully labeled Dixie cup. I live on medication, he says.

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Rizzutos daily life in Haverhill, Massachusetts, is a litany of challenges: His aides have to hoist his paralyzed legs from his bed to his motorized wheelchair and back again; keep the bag that collects his urine clean; tend to the gaping wound on his backside, which developed when he was left to lie still in bed too long; and help him avoid the panic that could claim anyone in his situationthat last one is particularly difficult since Rizzutos obsessive-compulsive disorder drives him to want to do everything for himself.

After more than a year of emergency and rehabilitative care following a devastating car accident, Rizzuto moved into a YMCA-run housing complex in this gritty New England town. But he still endured constant medical emergencies. I was back and forth and in and out of the hospitals so much, it was like I didnt know I had an apartment here, the 56-year-old says, sitting in his small studio. His open wound kept getting infected; his diaphragm, weakened by his injury and his inability to quit smoking, left him gasping for breath; his urine-collection bag slipped out; his demons kept getting the better of him. The government eventually covered the cost of his care, but the relentless need for medical attention was exhausting and demeaning.

Then he opted into a Massachusetts health-care program called One Care that focuses on people with complex medical needs who are on Medicare. One Care provides 71 hours of aide support a week, a twice-weekly visit from a massage therapist, twice-monthly psychiatric care, a wheelchair support group, and a nurse practitioner who oversees and coordinates Rizzutos care. If he struggles between visitsor just wants to talkshes available by phone, even on weekends and after hours. Now, his life has a routine and a discipline that keeps emergencies at bay. The difference its made he says, unable to fully express his gratitude. He estimates his hospital visits have dropped at least 75 percent since the One Care program took charge of his health. I would hate like hell to not have them.

The program that has helped Rizzuto is part of a nationwide movement to improve care for people struggling with very complicated medical needsso-called super-usersthe 5 percent of patients who account for about half of the countrys health-care spending. (Surgeon and New Yorker writer Atul Gawande outlined the problem and one solution in a definitive 2011 piece about the Camden Coalition of Healthcare Providers.) Some of these super-user programs say they provide cost savings of as much as 20 to 40 percent after a few years, as well as provide the kind of advantages offered to Rizzuto: fewer stressful hospital visits, better mental and physical health, and the satisfaction of being treated like a person instead of a package of problems. The program accomplishes this by shifting the focus of medical care. Instead of responding to complications, the care team tries to prevent them. You cant even get to the medical issue until youve figured out: Do they have a place to sleep, do they have housing theyre not going to lose, do they have food in their refrigerator, do they have a refrigerator? says Christopher Palmieri, the president and CEO of the nonprofit Commonwealth Care Alliance, which manages 80 percent of One Care patients, including Rizzuto.

Despite its successes, this care movement, which doesnt go by any catchy nameone doctor gave it the clunky title high-impact, relationship-based primary careis scattered among a handful of states and is advancing only very slowly across the country. There is general agreement that these programs must address a range of social and pragmatic needs, like transportation, housing, nutrition, isolation, emotional well-being, and medical problems. But the details of each program are different. Everyones trying their home brew, says Dr. Harlan Krumholz, a cardiologist and health-care researcher at Yale University and Yale-New Haven Hospital.

The one thing all of the super-user care programs have in common is a mantra that could have come from Cosmo Kramer himself: Stay the hell out of the hospital. Hospitals, these folks argue, often make sick people sicker. Theyre sources of infection to vulnerable patients. Theyre disorienting. They run costly tests and look for issues that are better left alone. Super-users, says Krumholz, represent a failure of the system.

Medical care is dangerous, says Dr. Rushika Fernandopulle, the co-founder and CEO of Iora Health, a leading practitioner of a more holistic approach to health. Fernandopulle says a big part of his companys business model involves fighting to keep people out of the hospitalnot just because its expensive, but because the care they will get puts them at higher risk for other problems. Medicare patients saw roughly a 40 percent drop in hospitalizations after Iora took over their care, Fernandopulle says.

For Fernandopulle, one patient in particular illustrates this phenomenon of snowballing medical care. That patient was an 80-year-old woman, fairly healthy but with hypertension and arthritis, who one day saw red in the toilet after urinating. She told her primary-care doctor, who sent her to a urologist; the urologist worried it might be cancer and ordered a catheter inserted. Before the procedure, a nurse asked the octogenarian if she ever felt weak or dizzy. (Of course she didthink about it.) When the woman said yes, a heart monitor was ordered: It showed a dip in her overnight heart rate. A cardiologist then scheduled the woman for a pacemaker.

This is what I mean by the vortex, Fernandopulle says, noting that inserting a pacemaker would be risky and provide no clear benefit. The womans condition might be explained in a much more low-tech way: a beet salad, for example, could be the culprit behind the red pee, and a prescribed medication might trigger the heart irregularity. I called the cardiologist and politely declined the pacemaker for this patient, Fernandopulle says. Part of the problem is that, while each doctor gets paid for each procedure he or she performs, usually no one gets paid for taking a step back and using common sense to think about what would genuinely help the patient.

The health-care system as a whole is out of balance, says Dr. Donald Berwick, the former head of the Centers for Medicare and Medicaid Services under President Obama. We put far more into hospital care than we do keeping people from having to be in the hospital. Hospital stays cost more than anything else in the health-care system; an average inpatient admission runs nearly $2,000 a day, and an intensive-care stay can easily cost $7,000 a day. In 2012, a typical hospital stay topped $10,000, according to the federal Agency for Healthcare Research and Quality. Caring for an Iora patient, on the other hand, typically costs about $3 a day and can reduce hospitalizations by 40 to 50 percent, Fernandopulle says. All of the physicians and advocates we interviewed who support this type of high-needs care are quick to note that their goal isnt to deprive people of medical care. If someone doesnt get needed heart surgery, they will end up in worse shape; no one will benefit. Their aim is appropriate, Goldilocks care: not too much, not too little.

The model hinges on establishing strong, trusting relationshipsbut that doesnt always come easily. Some patients jump on board; sometimes it takes six months to establish a connection, Tremblay says, recalling one patient who refused to talk to her for nearly five months before finally accepting help. She has become profoundly invested in her patients care. Every time we send someone to the hospital, its stressful, for both the patients and caregivers, Tremblay says. We send someone in [and] we kind of shudder, Are they going to come out better?

One big challenge to providing care for patients with complex needs is finding them. Commonwealth Care, for instance, has struggled to identify people who will benefit from its program. Any Massachusetts resident who receives both Medicare and Medicaid is eligible to join One Care. Commonwealth Care Alliance, which serves most of these patients, had to hire extra staff to track down potential clients. When Commonwealth Care started four years ago, 43 percent of these potential clients were considered unreachable, for reasons like having an unknown address. Today, that rate has shrunk to 32 percent.

Why is it so hard to track down needy patients? Some people are so isolated and disengaged that theyre largely invisible. Others patients are expensive and challenging today but might soon recover. And still others are doing fine now but might have a setback that throws them off balance for months. In fact, 60 to 80 percent of patients who are super-users now wont be a year from now, Sevin says, and different people will be.

There are also people who will be perennially expensivebecause their disease requires a costly drug, for instance. And there are those who will be expensive for a short timesay, for the few months after an organ transplant. Theres no point in wasting time trying to bring either groups medical expenses down.

Fernandopulle says the only effective way to identify people at risk for super use is to ask them two questions: How do you think your health is? and How confident are you in managing your health?

If they answer, Poor, poor, they are at huge risk, he says.

On a recent sweltering day, Rizzuto met his wheelchair support group at a small zoo in suburban Boston. Keeping cool in the above-90-degree heat wasnt easy for Rizzuto. Paralysis robs people of their ability to regulate body temperature. One of Rizzutos aides, Bill Regan, came prepared with water, ice packs, sandwiches, and a spray bottle that he frequently spritzed on Rizzutos face and legs.

Rizzuto says these interactions with other people in wheelchairs help lift his mood, though on this trip he seemed more focused on watching a brown bear, several snakes, and tiny, hyperactive cotton-topped tamarins. He never could have made it around the zoo without a motorized wheelchairthough it took Rizzuto a year to convince the state to buy it for him. One of the first things Commonwealth Care Alliance does when signing on a new One Care client is to assess the persons equipment needs, Tremblay says.

One Care is a partnership between Massachusettss Medicaid agency and the federal Centers for Medicare and Medicaid, and it focuses solely on patients ages 21 to 64 with multiple, complex medical and behavioral issues. (An older program, Senior Care Options, takes the same approach for patients over 65.) Most of Commonwealth Cares 13,500 One Care clients earn less than $20,000 a year; some are homeless; the majority of them have a serious mental illness or substance-use disorder, as well as multiple other chronic health conditions.

This high-touch care approach is beginning to save money, says Palmieri. A report last year by the Commonwealth Fund found that among 4,500 members of One Care, patients enrolled for 12 continuous months had 7.5 percent fewer hospital admissions and 6.4 percent fewer emergency-room visits. For those enrolled in the program for at least 18 months, hospital admissions dropped 20 percent, the study found.

Although each model of high-touch care is different, the basics are the same: focusing on prevention, ensuring basic needs are met, reducing unnecessary treatment, and building relationships with patients. At Stanford University, for example, one young man with severe anxiety and obsessive-compulsive disorder required constant reassurance (in addition to his multiple medications) from doctors and emergency departments. In a traditional care system, emergency-room staff might roll their eyes and quickly send him on his way. Instead, Dr. Alan Glaseroff, the co-founder of Stanfords Coordinated Care program to treat high-needs university employees and their family members, gave the 19-year-old his phone number. At first, whenever his anxiety or OCD took control, the young man called Glaseroff or another care coordinator as many as seven times a day.

But slowly, over the course of three years, the man learned to think before he called. If he saw spots in his eyes, hed wait for a few minutes to see if they went away. He was taught to use mindfulness techniques, and if the symptom persisted, he would run through a checklist to see if it was really something to be concerned about. He ended up calling the clinic every two to three weeks, rather than multiple times a day, and learned not to lean on the clinics staff for minor issues. Now, he hardly needs us, Glaseroff says.

Creating viable long-term plans like this means far fewer emergencies. In fact, in its first three years, the Stanford program cut emergency-room visits for its 253 patients by 59 percent, hospital admissions by 29 percent, and total cost per patient by 13 percent, says Glaseroff, who teaches this model of care in two-day workshops across the country. According to the study, the Stanford practice saved the university $1.8 million and now has nearly twice as many patients.

The secret to the cost-savings, Glaseroff says, is for patients to use hospitals and doctors only when absolutely necessary and to rely for most of their care on empatheticand relatively inexpensivemedical assistants, who check in with each patient about once a week. In the past four years, in an industry known for its high burnout and turnover, not one of his practices care coordinators has left, Glaseroff says. Theyre not allowed to diagnose and treat, but theyre really good at the people stuff, he says. The core is being given responsibility for people, not for tasks.

Patients in the program have responsibilities as well as rights, Glaseroff says. They are expected to show up for their medical appointments and to come on time out of fairness to others. Theyre told to call the clinic if they can before heading to the emergency room and then wait a few minutes for a call back, Glaseroff says. They are expected to do their part to engage with their care coordinator, even if the medical system hasnt always treated them well in the past. Its patient self-managementwhat people do within their chronic illness 365 days a yearthat matters the most, he says.

For the high-touch model to work financially, large numbers of patients have to stick around long enough to recoup the upfront investment in their care. Today, there are only a few pools of people stable enough to sustain this model: people who work for major employers, like Stanford University, and those insured by the federal government.

Iora provides health care to workers at large, stable employers like the Dartmouth College Employees, the New England Carpenters Benefits Fund, a union trust, and members of Medicaid Advantage plans, like Humana and Tufts Health Plan. This gives them a big group of customers with high needs and the corporate muscle to avoid being pushed around by hospitals that dont want to lose patients, Fernandopulle says.

If he loses customers to other insurance carriers in the first year or two, hell have all the upfront costs and none of the savings. A five-year time horizon allows Iora to recoup its upfront investment and get ahead of problemscontrolling diabetes before it leads to a heart attack, for instance, says Fernandopulle, whose company oversees care for about 20,000 patients in eight states.

Iora and another company with a similar approach, Landmark Health, also provide care to people on Medicare Advantagea government-funded, privately run program. About a third of people on Medicare now belong to Medicare Advantage programs, which were created by the Affordable Care Act. The Trump administration and Republicans have proposed huge cuts to Medicaid over the next decade. Its unclear, however, whether such cuts would paralyze efforts at innovation or provide more urgency to reduce health-care spending. It is a bipartisan issue that the current costs of health care are unsustainable, Yales Krumholz says, whether driven by empathy for those who are disadvantaged and suffering or by economic imperative.

But there are also built-in disincentives to this kind of high-touch care. One of the most obvious is that hospitals make money on patients. If they succeed in decreasing readmissions, they also limit their own earnings. Despite efforts to replace fee-for-service care with so-called global payments, the fact is that currently most health-care systems are still operating in an environment where reducing emergency-department and inpatient use hurts their bottom line, says Dr. Seth Berkowitz, a primary-care doctor at Massachusetts General Hospital who studies how addressing patients social needs improves their health and lowers costs.

Moreover, the model is challenging to scale, because all health care is local. State laws, hospital structures, and needs differ from place to place. What works in Florida doesnt work in Washington state, and vice versa, notes Fernandopulle, whose frequent-flyer miles attest to his attempts to learn about new markets.

Slowly, though, these scattershot efforts may be coalescing into a larger movement. Fernandopulle says its getting easier for companies like his to raise money in the private sector. Other factors seem to be coming together, too. Technology allows health-care companies to more easily identify people at risk of becoming super-users, track their progress, and standardize some of their treatments. Theres broad public consensus, gaining momentum in recent years, that health-care costs need to come down, says Dr. J. Michael McGinnis, the executive officer of the National Academy of Medicine, an advisory body formerly known as the Institute of Medicine. Now the issue is not whether; its how.

Rizzuto is lucky that he was treated for his 2012 car accident in Massachusetts. If hed had to recover in neighboring New Hampshire, where someone elses road rage landed him in a ditch and then in a month-long coma, hed probably still be making near-weekly trips to the emergency room. The crash left his spine broken in two places and exacerbated his post-traumatic-stress disorder and a concussion that still makes him feel like I have some scramblage with my brain.

The paralysis has left him with limited control of the outer three fingers on each handrestricting his ability to play his beloved guitarand he cant breathe deeply enough or with enough control to sing anymore. His core muscles are weak, too, Rizzuto says, explaining why his torso wobbles uncontrollably as he speaks. Im so close to being a quadriplegic, its crazy, he says. Rizzuto lifts his t-shirt to reveal small, circular burn marks dotting his chest. He knows he needs to quit smokingand will have to before his upcoming surgery to close the wound on his back, but it has been a struggle. Rizzuto says he often spaces out with a cigarette between his fingers and doesnt notice hes doing himself damage until its too late. Theres just so much to get used to, he says.

But he has also come to terms with his current life. Despite everything that has happened, he still has his adult twin sons, a daughter, a granddaughter, a safe place to live, and caregivers who really care. And so he goes on living the best life he can. He even hopes to start talking to high-school kids about his experiences. Im very fortunate, Rizzuto says. I dont know why. Maybe its because Im supposed to do something with this stupid accident that happened to me.

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Fixing the 5 Percent - The Atlantic

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Health Care Bill Latest: Will Republicans and Democrats Work Together? NBCNews.com Health Care Bill Latest: Will Republicans and Democrats Work Together? Thu, Jun 29. In an effort to reach a compromise, some moderate GOP senators are considering redrafting the health care bill to include items that could bring Democratic senators on ...

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Health Care Bill Latest: Will Republicans and Democrats Work Together? - NBCNews.com

As the U.S. Senate looked to a day of negotiating on health care legislation Thursday, President Donald Trump at 8:52 a.m. began unleashing tweets attacking the IQ, mental stability and physical appearance of MSNBC "Morning Joe" co-host Mika Brzezinski.

White House deputy press secretary Sarah Huckabee Sanders defended the president's behavior in a Thursday afternoon press briefing, saying "the American people elected a fighter," and that's what they got.

But Republicans and Democrats criticized the president for his tweets -- shocking even for Mr. Trump's Twitter account -- as the Senate struggles to propose a passable bill on health care. Mr. Trump met Wednesday with senators earlier this week as he attempts to negotiate the bill, and Vice President Mike Pence on Thursday met one-on-one with senators on Capitol Hill.

The tweets also detracted from the White House's designated policy focus of the week -- energy -- and two bills expected to pass in the House Thursday to crack down on immigrants who commit crimes and attempt to re-enter the country illegally, and on "sanctuary cities" refusing to cooperate with federal immigration authorities. Mr. Trump made stricter stances on immigration -- a theme drowned out by his tweets Thursday -- a central message of his campaign.

Both Republicans and Democrats criticized the president Thursday.

Sen. Lindsey Graham (R-South Carolina), who told CBS News' "Face the Nation" last month that the president is "his own worst enemy" with counterproductive tweets, said Mr. Trump behaved "beneath the office."

Alaska GOP Sen. Lisa Murkowski told Mr. Trump to, "Stop it!"

Rep. Lynn Jenkins, a Kansas Republican, said the president's Twitter outburst was, "not OK."

Rep. Carlos Curbelo (R-Florida) pointed out that the shooting at a congressional baseball practice -- after which Mr. Trump himself urged unity -- was just two weeks ago. House Majority Whip Steve Scalise (R-Louisiana) is still in the hospital after he was seriously injured by a shot to the hip.

Sen. Susan Collins (R-Maine) urged "respect" and "civility."

Rep. Mike Coffman (R-Colorado) used the hashtag, "StopTheTwitterTantrums."

Democrats were even more blunt.

House Minority Leader Nancy Pelosi (D-California) called Mr. Trump's tweets, "so blatantly sexist I don't even know that there's any question about it."

"I just don't know why the Republicans, they can tolerate almost anything: a candidate beating up a reporter and then cheering him on as he arrives in Congress, the tweets of the president of the United States," Pelosi added, referring to Montana Republican Rep. Greg Gianforte's assault on a reporter the night before he was elected to Congress.

Rep. Lois Frankel (D-Florida), in a press conference with more than two dozen Democratic members of Congress, called Mr. Trump the "cyber bully in chief."

"And once again, he is ... embarrassing our nation with what I call his bloody tweets," Frankel said.

Other Democrats pointed out that Mr. Trump is hurting legislative progress. Rep. Chellie Pingree (D-Maine), called the president's attacks on the media a "constant distraction."

Rep. David Cicilline (D-Rhode Island) asked anyone to tell him how the president's tweets help "create jobs" or "make health care better," issues Mr. Trump has said are among his top priorities.

Mr. Trump didn't stop criticizing the media Thursday. As the House and Senate wrapped up their legislative business before the July 4 holiday, Mr. Trump, at a Department of Energy event with Vice President Mike Pence and Secretary of Energy Rick Perry Thursday afternoon, repeated his frequent line that CNN is "fake news."

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Congress responds as Trump's attack on TV co-host distracts from health care, other business - CBS News

The biggest problem for Senate Republicans struggling to revive their healthcare legislation is the one that has bedeviled them from the beginning: Medicaid.

Deep cuts to the social safety net have led to a revolt from centrist GOP senators backed up by their home-state governors, who accepted federal funding under the Affordable Care Act to expand their Medicaid rolls.

They are all worried that the Senate bills unraveling of that expansion would leave millions of people without health insurance, a belief bolstered by a nonpartisan budget analysis that found 22 million more people would be uninsured in the bills first decade as law.

That would turn off Senate conservatives, whom Senate Majority Leader Mitch McConnellMitch McConnellGOP leaders prepared to make big boost to healthcare innovation fund GOP scrambles to win centrist votes on ObamaCare repeal Overnight Energy: Trump vows to bring American energy dominance MORE (R-Ky.) is also struggling to win over.

Sen. Pat Toomey (R-Pa.), asked Wednesday how important it was to keep Senate language restricting Medicaids growth, told reporters its very important.

Pressed on whether his support for the legislation hinges on its inclusion, he said, Its very, very important to me.

Senate leadership is working under a tight time frame, aiming to wrap up negotiations by the end of this week and then send a revised version of the bill for the Congressional Budget Office (CBO) to score over the weeklong recess. But theres deep skepticism that can happen by Friday.

Medicaid has long been seen as a high hurdle to getting healthcare reform done in the Senate.

It was less of an issue in the House, which passed its ObamaCare repeal-and-replace legislation in May after a battle that centered more on what rules insurers would have to meet in offering insurance.

Conservatives in the House and Senate alike have sought changes to ObamaCare that would lower premium costs and have looked to weaken ObamaCares rules to allow insurers to offer cheaper coverage plans.

In the Senate, Medicaid has been a much bigger part of the debate, in part because 20 Republican senators almost half of the conference represent states that accepted the expansion. These senators are concerned about how changes to the healthcare law will affect constituents across their states.

The Senate bill begins ratcheting down the federal match for expansion states in 2021, reverting it to pre-ObamaCare levels by 2024. The House took a more conservative approach and included language in its bill that would have ended the expansion in 2020.

But the Senate approach has not won over all of the senators from Medicaid expansion states, who were advocating a seven-year phaseout of the extra federal funds for Medicaid expansion.

Another unresolved issue is how to calculate spending on the Medicaid program.

Both the House and Senate bills institute a per person cap on Medicaid funding for each state. That cap would be adjusted annually for inflation, but there are disagreements on what formula should be used.

The current language in the Senate bill includes deeper cuts than the House beginning in 2025. It ties the growth rate for Medicaid funding to the consumer price index for medical care before switching it to CPI-U in 2025 which would lead to deeper cuts. This is the language that Toomey and other conservatives want to make sure stays in the bill.

In its analysis, the CBO estimated 15 million fewer people would be enrolled in Medicaid by 2026 under the Senate bill, which it said would lead to a $772 billion cut to the program.

After an effort to hold a vote on the bill this week was delayed, Capito and Portman cited Medicaid in announcing their opposition to the bill.

Portman and Capito represent Medicaid expansion states that have been hit hard by the opioid epidemic. Medicaid is a large payer of services for those with an opioid addiction.

The two had been pushing for $45 billion over a decade to combat the opioid addiction crisis. But the bill falls far short of their ask, instead including just $2 billion for fiscal 2018.

McConnell could put more money in that pot, but Capito indicated Tuesday that probably wouldnt be enough to win her vote.

Ohio Gov. John Kasich (R) who has been calling for a bipartisan compromise on healthcare said hes warned Portman against being won over by minor concessions.

I told him, If they hand you a few billion dollars on opioids thats like spitting in the ocean, compared with the billions the bill would cut from Medicaid, Kasich said at a press conference Tuesday.

One option for leadership would be to soften the Medicaid provisions for moderates and include more flexibility on insurance regulations for conservatives. An aide to Sen. Mike LeeMike LeeGOP scrambles to win centrist votes on ObamaCare repeal Overnight Healthcare: Conservatives seek changes to Senate bill | GOP may keep ObamaCare tax in health bill | Trump taps new surgeon general Conservatives seek changes to Senate healthcare bill MORE (R-Utah) confirmed he may be open to Medicaid changes if Americans were given more relief from ObamaCares Title I regulations, which are ObamaCares insurance rules.

McConnell has nearly $200 billion in savings to pad the bill in an effort to win enough support for passage. But its unclear if thats enough.

Tinkering around the edges, putting a little bit of money in for one program or another, is not going to be sufficient, Collins told reporters Wednesday. I want to see changes that would have a real impact on the Medicaid issues and the number of people insured.

When asked how to pay for a longer transition for Medicaid or a higher cap, Senate Finance Committee Chairman Orrin HatchOrrin HatchSenators introduce 'cyber hygiene' bill Overnight Finance: CBO says debt ceiling will be hit in October | Senate passes updated Russia sanctions bill | GOP senator rips sugar deal with Mexico GOP senator on Trump's 'face-lift' tweet: 'Every once in awhile you get a dipsy-doodle' MORE (R-Utah) didnt know.

Well thats the question for everything, he said. How are we going to pay for all this stuff no matter what we do?

So, how can leadership massage the bill in a way to get both conservatives and moderates on board?

Even porcupines make love, Sen. Pat RobertsPat RobertsMedicaid becomes big threat to GOPs healthcare revival GOP senator on resolving healthcare differences: 'Even porcupines make love' GOP chairman wants 'robust' tax reform process in the Senate MORE (R-Kan.) joked.

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Medicaid becomes big threat to GOP's healthcare revival - The Hill

Daughters of Charity Services of Arkansas is dedicated to Christian values in our service as we provide quality, holistic care to individuals and communities in southeast Arkansas.

In the late 1980s Daughters of Charity recognized the need for healthcare services in the Arkansas Delta, Lincoln County, and Desha County.

Our first medical clinic, St. Elizabeth Health Center, opened on December 3, 1990 with humble beginnings in the city of Gould, Arkansas (Lincoln County). The clinic was established in the remodeled city jail.

We acquired our second medical facility, DePaul Health Center in Dumas, Arkansas (Desha County) on August 10, 1992. In September 1998 we opened the wellness center in Gould to provide a state-of-the-art exercise facility for the residents of Gould and communities from across southeast Arkansas. We also acquired the dental practice of Charles Woodyard, whose staff added a much-needed component to our ministry work.

In February 2007 we moved our administrative office out of DePaul Health Center and into the newly renovated Adams Building on Main Street in Dumas.

At Daughters of Charity Services of Arkansas, we see and treat people of all ages.

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Daughters of Charity Services of Arkansas - dcsark.org

Senate Majority Leader Mitch McConnell told Republican senators he is delaying a vote on the GOP health care bill until after the Fourth of July recess because he does not have the votes to move it to debate, two senior Senate Republican aides told ABC News.

Senate Majority Leader Mitch McConnell confirmed the delay, saying, "We're going to continue the discussions within our conference on the differences that we have."

Sen. John Thune, R-Neb., stressed that the goal was to still replace Obamacare.

"While the schedule may have slipped a little bit, we are intent on rescuing Americans from a failed system that has driven up their cost and made it more difficult for them to find coverage," he said.

Earlier today Senate Majority Whip John Cornyn told ABC News, "I expect to have the support and get it done ... and yes, we will vote this week."

At least five Republican senators said they would oppose a procedural vote on the GOP health care plan as it stands, effectively blocking the bill from reaching the Senate floor.

In order to pass the bill in the Senate, Republicans can afford only two defections; in case of a tie, they have the option of calling in Vice President Mike Pence to cast the tie-breaking vote.

Before the delay was announced, Republicans senators were invited to the White House for a meeting with President Trump.

"The president invited us to come down," McConnell said at a news conference this afternoon. "The White House has been very much involved in these discussions. They're very anxious to help, and we appreciate the invitation, and I hope all of our members will head down"

After President Trump's meeting with almost all Senate Republicans on Tuesday afternoon, McConnell stood by his previous word on the delay, stating, "I had hoped, as you know, that we could have gotten to the floor this week but we're not quite there. But I think we have a really good chance of getting there. It will just take as you little bit longer."

He remains steadfast that the delay is not a substitute for inaction. McConnell told ABC News Chief Washington Correspondent Jonathan Karl, "It will be dealt with in one of two ways -- either Republicans will agree and change the status quo or the markets will continue to collapse and we'll have to sit down with [Democratic Sen. Chuck] Schumer, and my suspicion is any negotiation with the Democrats would include none of the reforms that we would like to make both on the market side and the medicaid side." McConnell concluded, "So for all of those reasons, we need to come up with a solution."

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Vote on Senate health care bill delayed amid lack of ...

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.

Read the original post:

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."

Read the original here:

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.

Read the original:

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.

Read more:

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

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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

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.

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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