N.Y. nurses in union fight with German healthcare company

NEW YORK DAILY NEWS

Saturday, June 10, 2017, 4:00 AM

President Trump has declared this the era of America first, but for some unions pressured by corporate forces at home the hope for salvation lies in stronger ties to Europe.

Last week a delegation from the New York State Nurses Association traveled to Germany to meet with union health care leaders there.

The goal was to address a common foe: Fresenius Medical Care, a multinational for-profit health care enterprise headquartered in Germany but with hospitals and private clinics dotted around the globe, including New York.

For several years, NYSNA nurses and health care technicians and assistants from 1199 Service Employees International Union have tried without success to bargain new contracts with Fresenius for the companys five dialysis centers around the city.

The major issues for NYSNA have focused less on wages than on the unions request to give weight to nurses input on staffing and patient-care issues.

In all its contracts with other health care companies across the state, NYSNA said, its nurses are part of a committee that gives feedback to management around such issues and patient concerns based on their observations and interactions with clients.

According to the union, however, Fresenius has resisted any model that takes account of nurses input and feedback. And 1199 SEIU said has wages and benefits problems with Fresenius.

Perhaps the greatest sticking point for both NYSNA and 1199 is Fresenius new mega-clinic in Park Slope, known as Degraw for the street its on.

The unions charge that Fresenius a for-profit company that made $1 billion in profits last year initially promised to staff the new facility with union workers. That would have saved the jobs of their members in the companys existing, smaller clinics, some of which will likely close as patients are shifted to the new facility.

But now, say the unions, after roughly two years at the bargaining table, Fresenius has not only taken that promise away, it also insists on a contract promising there will be no effort to unionize workers at the Degraw dialysis center.

That, they say, amounts to union-busting, a prospect that has inspired them to call for a one-day job action in response.

From 4 a.m. through the evening Monday, the nurses, nursing assistants, social workers, medical clerks and other staff at five Fresnius dialysis centers will be on strike. Those most affected will be the facilities thousands of patients, all of them in various stages of kidney failure.

Health care workers do not take strikes lightly, said 1199 SEIU executive vice president Laurie Vallone. Weve tried really hard to work with [the company] in so many ways. Its just been a series of frustrations, one after the other.

While undertaking a traditional union response at home in New York one they hope will bring out the public and political support from elected officials at a Monday noon rally outside a Brooklyn clinic on Atlantic Ave. theyve opened up another front in Europe.

Fresenius is based in Germany, and unions have a lot more voice and say in Europe, said Eric Smith, area director and negotiator for NYSNA. The main health care union over there, Ver.di, is having many of the same staffing issues that we are at Fresenius hospitals and clinics.

Two NYSNA reps traveled to Berlin and Frankfurt last week and met with Ver.di reps, who had a job action of their own going on at a Fresenius hospital.

The main goal of the visit was to sit down with Niko Stumpfoegger, the unions director of health services and also a member of the Fresenius board.

Stumpfoegger also sits on the European Workers Council, and he promised NYSNA to bring up the nurses struggle when the safety board meets next month.

In Germany, thanks to the Workers Council that has input into actual corporations, Fresenius has to listen to the union in a much more formal way, Smith said. Were crying out to Germany for help to say this company is really not respecting unions in New York, that they are converting union jobs to non-union in a new clinic in an illegal way, and we need their help.

Worldwide, Fresenius employees 110,530 workers, and 60,000 of them are in clinics across the U.S. - in Oregon, Texas, Tennessee, Ohio and Massachusetts, as well as New York.

Its domination of the kidney care market a rapidly growing sector of the health care industry due to widespread diabetes and high blood pressure was actually lampooned by late-night host John Oliver recently, who did a segment on Fresenius and its main competitor, DaVita.

A spokeswoman for Fresenius said its negotiations over the past years with both unions were done in good faith.

We have extended equitable contract offers that increase wages and protect certain union health and pension funds. Our goal, just as it has been since the start of negotiations, is to reach a fair agreement that reflects the tremendous value our employees bring to our company and the patients they care for. Despite the effort to pressure the company by disrupting essential dialysis services in our communities, we welcome continued discussions to reach an agreement, the spokeswoman said in a statement.

Above all, our focus is on the continued care of our patients ... We have a plan in place to ensure our patients will receive the life-sustaining care they need despite any union actions that may occur during our ongoing negotiations.

Fresenius nurse Gloria ONeill said the last thing staffers want to do is go on strike even for a day.

Her Brooklyn clinic, where she says she is often the only nurse on duty all morning, serves severely ill patients from a nearby nursing home. None of them is ambulatory, ONeill said.

We see them three times a week, for years at a time, ONeill said. There is a very close bond with them. Theyre often brought in alone; some dont have any family at all.

Everything we do is for our patients, [but] this company doesnt even want to hear our feedback on patient care. We are there to advocate for our patients. Thats why this is so important.

The nurses have a strike protocol in place that designates at least one of them to be on call at each clinic. If there is a patient emergency, the nurse is allowed to cross the picket line to provide treatment.

We gave the names to the company, Smith said. Its our understanding they have moved most of their Monday patients to Sunday, but in the event there is an emergency, a NYSNA nurse will be there to provide patient care, even during the strike.

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NY nurses travel overseas for solidarity in union fight against German healthcare company - New York Daily News

At a press conference Friday, United Healthcare announced it was bringing at least 700 jobs to Dublin. (WSYX/WTTE)

Seven hundred health care jobs will be added in Dublin with the potential for several hundred more. That announcement was made Friday as much of that industry remained in limbo.

UnitedHealth Group has been renovating an office building on Parkwood Place in Dublin to house the new employees. The health insurance company will soon employ roughly 4000 people in Ohio to service the 2 million people enrolled in their plans.

Governor John Kasich made the announcement official during an event Friday.

"We're talking about people's health," Kasich said. "Is there anything people care more about for their spouse or for their family than whether people can get quality care? We're trying to make sure that we deliver health to people based on lower costs and higher quality."

The future of the health care industry is up in the air. House Republicans passed a bill to repeal and replace Obamacare but that bill has stalled in the Senate. Senate Republicans are trying to come up with their own plan. UnitedHealth Group hasn't been waiting around for Washington to act.

"We've adapted to numerous changes over time," said Rick Dunlop with UnitedHealth Group. "We spend a lot of time paying attention to how the business is changing and evolving and to support the members the best way we know how."

The office will open in September. The renovated building will have space for up to 1000 workers in the future.

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700 jobs added at Dublin health care company - ABC6OnYourSide.com

Lets talk about the facts and reality of a single-payer health care system. The cost of such a system would literally double the state budget. It may offer no out-of-pocket expenses, but there would be plenty of costs.

First, there is the obvious: the tax burden of an estimated $9,200 per person, which a lower-wage Californian certainly cannot afford. Middle-class residents wont like it much, either.

But there are even greater costs, like the rationing of health care coverage which would likely result. Providers would be paid at very low Medi-Cal-type rates. How many specialists would be able to stay in business with such payment schedules? How many providers would flee to other states, where they could be paid fairly for their services? How many people would cross the borders into California for medical care?

That is the worst kind of adverse selection more wanting coverage coming in, more providers leaving. This will cause a huge shortage of doctors and greatly increase wait times for services.

I grew up in Michigan, a Canadian border state where many of my neighbors and friends were Canadian and had moved to Michigan because someone in their family was in need of a medical service that was not offered under the Canadian health care system (or, if so, they were not able to receive it within an acceptable time frame).

How many health conditions would worsen because of a single-payer system? How do you attach a cost to that? Would you be happy to wait several months for an MRI or a CT scan?

The Fraser Institute reported in 2016 that the average wait time is 11.1 weeks for an MRI in the Canadian system. Thats significantly better than when I was young, but still, it is a lot of time. Fraser also reported a four-week wait for an ultrasound and 10.6 weeks to see a specialist. The wait time to go from a general practitioner to a neurosurgeon for neurosurgery was 46.9 weeks. If someone needed brain surgery, a patient could die before the surgery. Is that what we want in California?

The single-payer system under Senate Bill 562 would eliminate the employer-based health care system. This is the only part of our health care system that has operated well, and continues to do so. Employers like providing health care coverage to their employees, as its an important employee benefit and a great recruiting tool. Employees look for jobs at companies that offer good health coverage. Its a win-win.

The single-payer plan is purportedly being considered to cover the approximately 4 percent of people who are uninsured in California. Why destroy the entire system for around 4 percent, when the costs to do so are so high? Why not just amend the existing system to deal with the serious problems?

The reality is, the majority of people who are uninsured are uninsured because they choose to be uninsured, such as the young, healthy people who think nothing can ever happen to them. If we could just pull them into the pool, that would offset some of the expenses of the older, sicker individuals.

Lets fix the problems, rather than destroy the system entirely. California cant afford a single-payer system. It will eliminate jobs, force providers out of the state, and create yet another government bureaucracy that we dont need.

The government should not tell us what procedures we can or cannot have done with regard to our health care. We should have that choice.

Dorothy Cociu, RHU, REBC, GBA, RPA, is president of Advanced Benefit Consulting in Anaheim and vice president of communications, Orange County Association of Health Underwriters. She is also past president of the Orange County Association of Health Underwriters and California Association of Health Underwriters.

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Don't kill choice in health care - OCRegister

Rep. Mark Meadows (R-NC) said Congress is in talks with the Trump administration to combine health care and tax reforminto one daunting bill.

The House Freedom Caucus Chairman said he thinks Congress must be prepared to accomplish this "herculean" task before September.

"The quicker we can get these tax reforms in place ... the better the economy goes," Meadows told Neil Cavuto on "Your World."

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The hard-line conservative said there is a "real sense of urgency" in both Congress and White House to fulfill campaign promises on health care and tax reform. The 2018 elections loom over Congress, threatening Republicans' sliver of a majority in the Senate.

The House of Representatives passed a bill to repeal and replace ObamaCare on May 4, but the bill has made slow progress in the Senate.

The investigation into any ties between the Trump campaign and Russia has consumed Washington, stifling the president's legislative agenda, prompting lawmakers to consider combing the bills.

Congress will at least start the tax debate in the next four weeks, Meadows promised.

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Rep. Meadows: Congress Might Combine Health Care & Tax Reform in One Bill - Fox News Insider

New York Times

Republicans' Secretive Plan for Health Care New York Times Republicans in the Senate will need 50 votes to pass their version of the American Health Care Act. Several senators have expressed reservations about the House version of the bill, which withdraws federal support for Planned Parenthood and rolls back ... Parliamentarian threatens deadly blow to GOP healthcare billThe Hill McCaskill uses facts to slam Senate Republicans' health care processMSNBC Senate GOP vows to continue doomed health care effort in secretSalon Washington Post -Roll Call -Berkshire Eagle (subscription) -Politico all 587 news articles »

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Republicans' Secretive Plan for Health Care - New York Times

Rep. John Conyers and Sen. Bernie Sanders in Washington, D.C., on June 4, 2015. Sanders and Conyers have both supported single-payer.

Saul Loeb/AFP/Getty Images

Single-payer health care is all the rage. At the start of the Obama presidency, the push for a Canadian-style, single-payer, taxpayer-funded universal health system was widely seen as a cause championed only by the hopelessly nave. Now, as the New York Times reports, support for single-payer is emerging as the consensus position among congressional Democrats, with 112 of 193 members of the House Democratic caucus co-sponsoring Rep. John Conyers Expanded and Improved Medicare for All Act. In New York and California, meanwhile, Democratic lawmakers are pressing for state-based single-payer systems, and were seeing similar efforts pop up in other states as well. Bernie Sanders deserves much of the credit. Creating a single-payer system for all Americans was the centerpiece of his campaign for the Democratic presidential nomination, and Id honestly be surprised if the next Democratic nominee didnt take up the cause. Elizabeth Warren, to name one potential 2020 presidential candidate, is open to single-payer health care, and shes not alone.

Granted, support for single-payer is not quite as widespread among rank-and-file voters as it is among influential lefties. A Pew survey from January found that while 60 percent of Americans favored universal coverage in some form, only 28 percent supported single-payer per se. But other polls have found more favorable results, and my guess is that support for single-payer will keep increasing in the months and years to come. This is despite the fact that I believe creating a single-payer system would be a costly mistake, for reasons ably outlined by Chris Pope in National Review and Megan McArdle in Bloomberg View.

Why do I think single-payer health care will keep growing more popular? Part of it is the availability heuristic. The more familiar the idea of a single-payer health care system becomes, and the more mainstream Democratic politicians embrace it, the safer it will be for people to support the idea. A single-payer system is no longer seen as a crazily socialistic idea relegated to the fringes of the political debate. Its an idea that is taken seriously by serious people.

Indeed, a key part of the new push for single-payer health care is branding it Medicare for all. Medicare is a single-payer system that offers coverage to every American over the age of 65. Though no one would describe Medicare as perfect, its pretty popular. So naturally the idea of opening Medicare to everyone has a lot of appeal. Of course, theres a case to be made that Medicare has in some ways made Americas health system worse by serving the interests of politically powerful hospitals over those of patients, but I digress.

The single-payer cause also benefits from the fact that Obamacare has been a mixed bag. While coverage expansion via Medicaid appears to have gone fairly smoothly in the states that have signed up for it, the move to expand coverage via Obamacares new state-based insurance exchanges has been far rockier. If the exchanges represent the best managed competition can do, its no wonder many have concluded that the smarter move is to further expand public insurance programs, as weve been doing for decades under Democratic and Republican administrations alike. Medicare for all is, according to this line of thinking, simply the next logical step. Here too there is another way of looking at things: Had Obamacare used the exchanges more narrowly as a vehicle for insuring the uninsurable, not as a means of transforming the entire individual insurance market, it might have proven more popular and effective.

The most important reason for the single-payer boomlet is the health policy failures of Republicans.

But the most important reason behind the single-payer boomlet, I believe, is the health policy failures of Republicans. While the GOP has spent years attacking Obamacare, it has proven utterly incapable of offering an attractive alternative. If the GOP had such an alternative, it would nudge centrist Democrats in its direction. But as long as the right doesnt have a workable plan for fixing Americas health system, it should come as no surprise that the center of gravity on health policy is shifting left.

Lets say you buy the idea that Obamacare-compliant private insurance plans are way too expensive for the healthy and way too stingy for the sick, an argument Republicans have been making since the advent of the Affordable Care Act. Do you really trust the GOP to fix those problems? Or, given the parameters of the GOPs American Health Care Act, do you suspect theyll just slash subsidies for the poor and the sick and use the money to cut taxes for the rich? At the moment, the latter belief is an entirely rational one.

If faced with a choice between the AHCA and Medicare for all, Republicans shouldnt be surprised if swing voters wind up going for the latter. The AHCA is an inchoate mess that evinces no grander philosophy for caring for the sick and vulnerable. Single-payer health care is, if nothing else, a coherent concept that represents a set of beliefs about how health care should work. If Republicans want the single-payer dream to go away, theyre going to have to come up with something better than the nothing they have now.

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The Health Care Debate Is Moving Left - Slate Magazine

By Andrew Siddons and Sandhya Raman, CQ Roll Call

Moderate Republicans on Thursday said they were getting closer to supporting an emerging Senate health package but are continuing to press for a slower phaseout of the Medicaid expansion than the House-passed bill set out.

The Medicaid expansion question seems to remain the biggest unresolved issue as Republicans try to finalize a bill they can vote on before the end of June. To meet their timeline, they would have to send a bill to the Congressional Budget Office for a cost estimate by early next week, according to a Republican aide.

Majority Leader Mitch McConnell has proposed phasing out higher federal payments for people who sign up for Medicaid under the health laws expansion in three years. Ohio Republican Rob Portman and others such as Nevada's Dean Heller are pushing for a seven-year phaseout ending in 2027. Senators also are debating how much to reduce federal funding for Medicaid as compared to current law.

Portman told reporters Thursday that he was not ready to take a position on the Senates health care proposal, but said the fact that there was a plan at all made it easier to negotiate.

Were closer because theres a proposal out there, and this gives everybody the opportunity to weigh in, including me, whereas when it was just a wide-open discussion it was hard to come up with any consensus, he said.

While he wouldnt predict the ultimate length of time states would have to phase down the expansion of their Medicaid programs, Portman said he was pushing for a dedicated funding stream to help people struggling with drug addiction.

Medicaid, he said, is the major payer for the kind of drug treatment that is necessary right now with the opioid crisis and so many people being addicted. The alternative is bad for those individuals and their families but also more expensive for all taxpayers. He said he had an amount in mind, but wouldnt specify it.

Heller, another lawmaker from a state that expanded Medicaid who wants a longer phaseout, signaled that the Senate discussions were moving in the right direction. When asked if Senate leaders were receptive to a seven-year phase-out, he said, Theyre listening.

Heller also said he would oppose lowering the Medicaid growth rate beneath the level set out in the House-passed health care bill (HR 1628).

I just dont want to do worse than what the House did. And theres a push to bring it below the House, so thats an issue, Heller said.

Heller, who is up for re-election next year, also said he opposed language in the House bill that could allow states to loosen any protections for those with pre-existing conditions and opt out of providing the essential health benefits required by the 2010 law.

Sen. John Hoeven, R- N.D., told reporters that tax credits to help lower-income people pay for insurance were also still up for discussion.

Weve got to get a more robust refundable tax credit in place so you make sure that folks have coverage and you also need federal reinsurance for folks with chronic care and pre-existing conditions, he said.

Hoeven, responding to questions about whether some of the health laws taxes would remain in place for a longer time than the House bill in order to pay for a more generous package, said it would likely depend on the CBO estimate.

Groups that have pushed for the tax repeal upped their lobbying on Thursday in response to the uncertainty. Scott Whitaker, president of the Advanced Medical Technology Association, which represents the makers of medical devices, urged the Senate to immediately end the medical device tax.

Will device manufacturers spend hundreds of millions seeking next-generation technologies to improve patient lives? Or will they instead be forced to set those funds aside to pay the job-killing device tax? We need to bank on American innovation and kill this tax, he said. Not delay it. End it.

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Senate Moderates Say They Are Closer on Health Care - Roll Call

In his session at America's Health Insurance Plans (AHIP) Institute & Expo 2017 Institute & Expo, in Austin, Texas, Kaveh Savafi, MD, senior managing director for the health industry at consulting firm Accenture, discussed some of the biggest technology trends that are happening in the business world and drawing relevance to the world of healthcare.

Here, Safavi discusses his talk, Technology for People: The Era of the Intelligence Digital Health Enterprise.

Managed Healthcare Executive (MHE): Discuss some of the trends youre tracking for healthcare.

Safavi: The first trend is AI is the new UI, where AI means artificial intelligence and UI stands for user interface. Thats the concept of the actual experienceor the way that people interact with technology itselfis going to become smarter.

Ecosystem powerplace is the next trend were paying attention to. That means its really becoming clear that the amount of technology being used in healthcare today can never come from a single entity or company. Thus, its likely that people are going to work with technology platforms that are created with parts from multiple different companies and the companies themselves are going to have to figure out how to cooperate.

The third trend is what we call The workforce marketplace, which broadly refers to the fact that the distributed workforceand the ability to go out and find people you need to do workis no longer going to be limited to the traditional marketplace of your own employees. This is an extension of whats been talked about for a long time, but this is describing the technology as making it inevitable that the workforce you seek will come from different places than you normally would find them.

Design for humans is the fourth trend. Thats essentially the recognition that technology has to be designed to fit the way that humans live their livesas opposed to making people fit the technology. There are obviously healthcare examples, but in other cases there are lots of examples of where the technology has found its way much more easily into the way that you do workas opposed to you having to go figure it out.

The last one is a topic that we call The uncharted. By that, we mean that the technology is creating business and regulatory challengesand maybe ethical and social challengesthat we have no concept of; other than that we know that were opening up Pandoras box. Were going to see more and more that organizations are going to have to get together and think about how they want to address some of these unintended consequencesor even the necessary frameworks theyre going to needin order to be able to take full advantage of the technology.

MHE: Tell me more about what youre referring to with The uncharted.

Safavi: These issues go from very simple thingssuch as standard setting around blockchain, all the way to whats the responsible use for real artificial intelligence.

MHE: Make the connection for healthcare with The workforce marketplace.

Safavi: It ranges from clinical to non-clinical, and its all different parts of the business. We use a term called the liquid workforce, which is present everywhere. We did some surveys that showed that 71% of healthcare executives report that theyre already using on-demand labor platforms. That could be to a limited extent, but its not totally foreign in healthcare. And 80% said that they have to re-think their business model based on these types of technologies.

We see this on the delivery system side and on the provider side. You see examples of this with radiologists and pathologists and with home-based nursing. On the health plan side, youre starting to see nurses in utilization management; theyre call center employees. Other organizations have done the same thing; theyre gone to a distributed call center model.

You generally see people go to a liquid workforce in areas where youre looking for a highly-specialized skill or a very generalizable skill.

Whats complicated is the fact that, while this is going on, the artificial intelligence trend is going on. Thats where automation and artificial intelligence are being substituted for a certain amount of labor. And that impacts the nature of the work of your own workforce.

For example, say you have an employed workforce and they show up at your facility. The step may not be that were going to have a model where we can work with independent contractors and we can take them wherever theyre located, to a technology is going to replace a big part of what they do. Then the remaining people are going to have a very differentiated skill set.

Theres an ebb and flow here, in terms of how this works. The technology allows you to distribute your labor. At the same time, the technology begins to complement the labor in a different way.

MHE: Whats challenging about this particular trend?

Safavi: This will be a challenging trend to manage. Thats based on the pace of the technology replacing the work that people do. Youll see this in call centers and customer service on the payer side. On the provider side, youll see this with medical case management or utilization management, where nurse managers will be doing some of this work.

Some subset of nurse managers work is actually relatively routine. Thats information intake or the proving routine medical advice. Still another part of their work requires clinical judgment. Were already beginning to develop alternatives that can be a substitute for some part of these experts labor. That means the nurse managers spend all of their time doing the things for which theyre licensed. The things theyre not licensed for get done by a machine.

Thus, youre going to be looking for a higher-level of skill. Not only will this be a distributed workforce, but it will also be a higher-skilled workforce.

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Five tech trends transforming healthcare - ModernMedicine

What to make of the seeming momentum for aRepublican health-care bill in the Senate?

On the one hand, a bit of caution might be in order. There still isn't a bill. There isn't a Congressional Budget Office score. Republicans must keep their relative moderates on board without losing the most conservative senators; they may be achieving that, and they're still a few steps away from that. It wouldn't be the first time that a bill seemed to have momentum only to fall short once the actual votes werecounted.

That said, it's also quite possible that Mitch McConnell and other Republican leaders have threaded the needle.

A daily round-up of superb political insights.

Jonathan Bernstein's Early Returns

I continue to see the bill's progress not as a case of Republican politicians having enthusiasm for what they are passing, but a real fear of receiving the blame for killing off the repeal of Obamacare, the party's biggest legislative agenda for the last sevenyears. Right now, Paul Ryan and House Republicans overall are winning because they passed something (it doesn't matter what). It remains quite possible that congressional Republicans will wind up backing their way into actually enacting a law despite many, perhaps even most, believingthere's a good chance it will backfire on them.

In other words, this is not a case like the passage of the Affordable Care Act, in which most Democrats who supported it really wanted the bill to pass even if they understood the electoral danger involved. If any Republicans in Congress strongly support the bill they've been working on, they're doing a very good job of hiding that enthusiasm. This time, it's all about ducking blame.

1. Dan Drezner was ... not impressed with my case for how Donald Trump could reach adequacy. I of course agree with everything he says about Trump, and we're not actually likely to get a trial run for this one (because it won't be imposed on him), but I still think many people are vastly underestimating how much of a difference a first-rate chief of staff can make.

2. Dave Hopkins on the James Comey hearing. As he says, perhaps the most notable thing was that Senate Republicans were hardly eager to defend Trump.

3. Diana B. Greenwald and Mark Tessler at the Monkey Cage on Palestinian public opinion about institutions.

4. My Bloomberg View colleague Noah Feldman on new trouble for Trump from Comey's testimony.

5. Alyssa Rosenberg on Comey's performance.

6. And Kevin Kosar on the U.S. Post Office.

Get Early Returns every morning in your inbox. Clickhereto subscribe.

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

To contact the author of this story: Jonathan Bernstein at jbernstein62@bloomberg.net

To contact the editor responsible for this story: Brooke Sample at bsample1@bloomberg.net

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Republicans Aim to Win the Health-Care Blame Game - Bloomberg

Once again, womens health is in the crosshairs.

The budget unveiled by the White House last month adds insult to the injury of the GOP health bill passed earlier by the House of Representatives, which the Congressional Budget Office says will lead to 23 million more uninsured Americans and cuts $800 billion from Medicaid legislation The New York Times dubbed, especially disastrous for women. Taken together, womens ability to access necessary treatment and services and to secure insurance to pay for it are at a risk unseen in the contemporary era.

Now, as the Senate returns from recess and gets to work drafting its measure, we must be sure to hold Congress accountable. A bill that puts women last is unacceptable.

Included in the disastrous House bill are provisions blocking women from going to Planned Parenthood for preventive care (including birth control and cancer screenings), gutting maternity care and other essential health benefits, and making health care unaffordable for millions by allowing insurance companies in states that waive coverage rules to charge women whove given birth, or survived cancer, more for their premiums. If this bill and the budget becomes law, all women but especially working-class women, and poor women, as well as their families will suffer dire consequences to their health and lives. We cant let this happen.

Given this reality, its time to reflect on what it really means to support women and girls, truly creating a country where every American thrives.

Lets be clear once and for all: The entire conversation is a nonstarter without full support for womens health. Its on us to make sure every senator understands this.

During my eight years in the White House, I chaired the White House Council on Women and Girls. I was responsible for bringing elected officials, business and community leaders together to help drive the economy, expand access to the middle class, and most importantly, working to ensure equality and opportunity for all Americans, especially women and girls.

Of all this work, that last point providing equality and opportunity to all drove the agenda of the council. President Obama created the council to ensure that federal agencies were prioritizing the needs of women and girls in their policies, programs and legislation with the understanding that it is the governments highest purpose to help ensure all Americans are able to compete on a level playing field and achieve their dreams. He knew that the issues women face today, such as access to paid family and medical leave, equal pay for equal work, and affordable health care, are all connected and intertwined.

Planned Parenthood has a key role to play in access to affordable health care for women, and by extension their access to equality. Yet, Republican leaders in Congress have continued to push to defund Planned Parenthood and block women from going there to receive care. That is the opposite of what the White House Council on Women and Girls stood for, and if enacted, would result in millions of women losing access to care.

While much about the House of Representatives efforts to repeal the Affordable Care Act was troubling, one of the most egregious moves was voting on the bill without even waiting for the Congressional Budget Office to update its analysis of the impact the legislation would have on the American people or the federal budget.

As the Senate has now turned to writing its version of the health care bill, as a former White House official who spent a lot of time focusing on women and girls, I am also troubled that Senate leaders appointed 13 men and zero women to their working group responsible for drafting their version of an ACA repeal bill. How could they not know that our interests cannot be adequately represented if we are not at the table?

As we wait for the Senate to produce its bill, it is tempting to give in to the anger and frustration that is so prevalent in our national discourse these days. But what motivates me to keep fighting are the incredible personal stories of access, treatment, recovery and hope that the Affordable Care Act made possible.

Planned Parenthood is a foundational part of that effort, and its work in providing access to care has helped people across our country take control of their health and lives. Two and a half million people visit Planned Parenthood each year for preventive health care, including birth control, cancer screenings and STD testing and treatment. One in five women in America relies on Planned Parenthood over her lifetime. For more than 100 years, it has helped women in this country get the care they need, which in turn has enabled women to contribute so much to this country.

The ACA was born of advocacy and I believe advocacy will save the ACA and health care for millions of women. Thats where voters come in. As the Senate drafts its version, I hope that millions of Americans tell their senators they must protect the health of women.

Valerie Jarrett is a former senior adviser to President Barack Obama and former chairwoman of the White House Council on Women and Girls. She wrote this commentary for CNN.

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Senate should aim to correct health care course - The Philadelphia Tribune

In early May, the American Health Care Act (ACHA) made its way out of the U.S. House of Representatives by a very tight vote. The bill, now under consideration by the Senate, made it through thanks to two critical amendments that garnered the support of key California Republicans.

The Congressional Budget Office (CBO) has now confirmed what we long knew: The amendments made a bad bill worse, not better. There was, indeed, no valid excuse for supporting the AHCA.

This bill is troubling. If passed, the CBO estimates 23 million people would lose health insurance by 2026, with low-income and elderly Americans hit the hardest. Insurance companies could charge more to persons with pre-existing conditions, and states could cut vital health benefits.

The latest CBO analysis further confirms that the AHCA would put millions in jeopardy, and that the amendments introduced by Rep. Tom MacArthur, R-N.J., and Rep. Fred Upton, R-Mich., championed by Republican House members as the reason they supported the bill, did little to change its projected devastating impact.

Here in Los Angeles County, weve spoken regularly with Rep. Steve Knight, R-Santa Clarita, our areas only Republican representative, on the impact of the Affordable Care Act (ACA) on his district, and the potential effects of replacing the ACA with the proposed AHCA.

More than 80,000 people in Knights district currently benefit from the ACA, with close to 21,000 enrolled in Covered California and almost 60,000 adults newly covered as part of the Medi-Cal expansion. These people could all lose coverage under the AHCA.

The ACAs massive expansions in coverage allowed community providers to dramatically expand access to care.

The Antelope Valley Community Clinic, for example, opened in 2010, the year the ACA was passed. In just five years, the clinic went from providing 12,000 patient visits and 25 employees to 100,000 visits and 235 employees. Thanks to the ACA, the clinic expanded its facilities and became a one-stop shop for physical, mental and oral health needs for the underserved in the High Desert.

Antelope Valley residents can finally access comprehensive preventive services that keep them healthy and productive in society. If patients lose coverage under the AHCA, the clinic would be forced to choose between scaling back services or laying off staff. This would cost taxpayers more in the long run, as the newly uninsured would delay care and rely on the emergency room when they experience an avoidable health emergency.

In addition to the impact on the clinics, the broader community would suffer under a repeal of the ACA. Health care is a major employment sector in Los Angeles, and health care comprises the bulk of our middle-skill job growth.

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Congressman Knight has been very responsive to the clinics, hospitals, health plans and community partners in the district. Yet he ultimately supported the AHCA. He believed the Upton and MacArthur amendments would mitigate the impact of the bill on those with preexisting conditions.

Unfortunately, the CBO has debunked that myth, and its time for our legislators to look at the real impact of the bill.

There is no denying that these cuts are a serious attack on our nations healthcare system and will have a devastating impact on the most vulnerable among us, including children, women, seniors, people with disabilities, and low-middle class families.

As the Senate produces its version of the bill, in light of the analysis by the CBO its our hope that Knight and other House Republicans will reconsider their support for any bill that reduces coverage, disadvantages the sick, and leaves their communities worse off.

Louise McCarthy is president and CEO of the Community Clinic Association of Los Angeles County. James A. Cook is CEO and founder of the Antelope Valley Community Clinic.

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Rep. Knight, the GOP health-care plan would hurt your district: Guest commentary - LA Daily News

The Senate parliamentarian has warned Republicans that a key provision in their healthcare reform bill related to abortion is unlikely to be allowed, raising a serious threat to the legislation.

The parliamentarian, Elizabeth MacDonough, has flagged language that would bar people from using new refundable tax credits for private insurance plans that cover abortion, according to Senate sources.

If Republicans are forced to strip the so-called Hyde language from the legislation, which essentially bars federal funds from being used to pay for abortions unless to save the life of a mother or in cases of rape and incest, it may doom the bill.

MacDonough declined to comment for this article.

Unless a workaround can be found, conservative senators and groups that advocate against abortion rights are likely to oppose the legislation.

Republicans control 52 seats in the Senate; they can afford only two defections and still pass the bill, assuming Democrats are united against it. Vice President would break a 50-50 tie.

Normally controversial legislation requires 60 votes to pass the Senate, but Republicans hope to pass the ObamaCare repeal-and-replace bill with a simple majority vote under a special budgetary process known as reconciliation.

The catch is that the legislation must pass a six-part test known as the Byrd Rule, and its up to the parliamentarian to advise whether legislative provisions meet its requirements.

The toughest requirement states that a provision cannot produce changes in government outlays or revenues that are merely incidental to the non-budgetary components of the provision.

In other words, a provision passed under reconciliation cannot be primarily oriented toward making policy change instead of impacting the budget. Arguably, attaching Hyde language to the refundable tax credits is designed more to shape abortion policy than affect how much money is spent to subsidize healthcare coverage.

The abortion language that conservatives want in the healthcare bill may run afoul of a precedent set in 1995, when then-Senate Parliamentarian Robert Dove ruled that an abortion provision affecting a state block grant program failed to meet reconciliation requirements, according to a source briefed on internal Senate discussions.

One GOP source identified the parliamentarians objection to the Hyde language along with Republican infighting over how to cap ObamaCares Medicaid expansion as two of the biggest obstacles to passing a bill.

A Republican senator confirmed that negotiators have wrestled with the procedural obstacle facing the anti-abortion language.

That has come up and there well could be a challenge, the lawmaker said.

The lawmaker, however, said that the problem is surmountable, arguing there are ways around it.

One possibility would be to change the form of assistance to low-income people by changing it from a refundable tax credit to a subsidy filtered through an already existing government program that restricts abortion services, such as the Federal Employee Health Benefits program or Medicaid.

A second Republican senator said discussions on the topic are ongoing.

GOP negotiators picked upthe pace of their discussions with the parliamentarian after the Congressional Budget Office released an updated score for the House-passed bill in late May.

President Trump is pushing the Senate to pass its version of the legislation byJuly 4.

If GOP leaders are forced to strip the Hyde language from the healthcare bill and cannot find an alternative way to seal off insurance tax credits or subsidies from abortion services, they would lose the support of anti-abortion rights groups, a devastating blow.

Weve made it clear in a lot of conversations and some letters that any GOP replacement plan has to be consistent with the principles of the Hyde Amendment, said David Christensen, vice president of government affairs at Family Research Council, a conservative group that promotes Christian values.

Abortion is not healthcare and the government should not be subsidizing elective abortion, he added.

Christensen predicted that activists would be up in arms if abortion services arent barred under the bill.

If the Byrd Rule were to be an obstacle to ensuring the GOP replacement plan in the Senate does not subsidize abortion, thats something that would be a serious problem for us and the pro-life community, he said.

Republican senators who are thought to be safe votes to support the GOP leaderships ObamaCare repeal and replace plan may suddenly shift to undecided or opposed.

Would that be a deal killer? Id have to think about it. Im inclined to think it would [be], said Sen. Jim InhofeJames InhofeSessions allies say he will weather Trumps wrath Ethiopia at tipping point as Congress mulls human rights bill Top GOP senators tell Trump to ditch Paris climate deal MORE (R-Okla.).

Senate Finance Committee Chairman Orrin HatchOrrin HatchParliamentarian threatens deadly blow to GOP healthcare bill Price, Hatch contradict Mulvaney on Medicaid cuts No certainty on cost-sharing payments to insurers MORE (R-Utah), who has jurisdiction over the tax credits in the healthcare bill, acknowledged it could be tough to pass the bill without the anti-abortion language.

I think a lot of people do think thats essential, he said.

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Parliamentarian threatens deadly blow to GOP healthcare bill - The Hill

As the House waits on the Senate to come up with its version of a bill to partially repeal and replace the 2010 health care law, GOP leaders on Thursday announced the chamber would move some health care bills that are part of the third phase of its overhaul strategy.

The American Health Care Act (AHCA) that the House passed in May was meant to be one of three phases of the effort because of limitations Republicans face in moving the measure through the budget reconciliation process. That process has prevented Republicans from advancing policies they typically all agree on, like allowing insurers to sell across state lines, GOP leaders have argued.

The Senate is currently debating changes to the AHCA needed to get through the divisive politics of the upper chamber, where they can afford to lose the votes of only two of the 52 Republicans, in a scenario where Vice President Mike Pence would break a tie.

Speaker Paul D. Ryan declined to say how he prefers to deal with the measure if the Senate sends it back to the House with alterations.

Ill reserve judgment on whether we go to conference or not, the Wisconsin Republican said Thursday at his weekly press conference about the health care overhaul. I just want them to pass a bill. Im really not expecting massive changes because of the reconciliation rules.

The Senate, however, is reportedly considering dropping provisions that were key to securing needed votes in the House, like the ability of states to seek a waiver to opt out of community ratings regulations, which require insurance companies to offer the same prices to everyone, regardless of their health status.

With the limitations of reconciliation, Republicans said they would advance additional health care legislation in phase three of the effort. Phase two is made up of executive actions that Human and Human Services Secretary Tom Price is undertaking to tweak the current law.

The House has already advanced a few phase three measures, and next week theyll take up more of them, House Majority Leader Kevin McCarthy said Thursday.

Specifically, he named the Veterans Act, introduced by Texas Rep. Sam Johnson, the Broader Options for Americans Act, introduced by Ohio Rep. Pat Tiberi, and the Verifying First Act, introduced by Pennsylvania Rep. Lou Barletta.

These are bills that will take 60 votes [in the Senate], that have moved out of committee here, the California Republican said.

McCarthy also announced that the House on Tuesday will take up the Veterans Affairs Accountability Act. This will actually hold VA employees accountable, it will protect the whistleblowers and it will be better care for the veterans, he said.

Looming in the background while the House works on these other measures are a number of upcoming fiscal deadlines, including the need to deal with the debt limit by late summer or early fall and to fund the government past Sept. 30, the end of the current fiscal year.

Ryan said House Republicans continue to discuss their options on both matters and have not made any decisions. He dismissed criticism that Republicans are behind

We always knew we were going to have an abbreviated budget process in this first year, like we do with every new administration, Ryan said. So were trying to figure out whats the best way to deal with our appropriations process, our budget process given the ambition [of] tax reform and savings and the constricted timetable we have.

Several House Republicans have expressed interest, given that compressed timetable, in putting together a 12-bill omnibus measure from the start and passing it by August. However, some members believe that may even be too ambitious given that the Appropriations Committee has not marked up any of the 12 bills. The first markup is scheduled for Monday on a military and veterans affairs spending bill.

On the debt limit, GOP leaders have to wrestle with how to deal with member calls for spending cuts or other overhauls to the budget process to be considered along with any increase. That pressure comes alongside a call from Treasury Secretary Steven Mnuchin for a clean debt limit free of other policy attachments, an approach Democrats have advocated for as well.

Asked if Republicans could, as a practical matter, assemble and enact a package of spending cuts with a debt limit increase by August, Ryan said, As a practical matter, the answer is 'yes,' that can be achieved. The question is, can we assemble the vote coalition and the ability to do that.

The speaker said hes not taking any options off the table in regards to the debt limit.

Were having that kind of conversation with our members about what is the best way to proceed and how can we address these fiscal deadlines we have -- budget caps needed to fix defense, debt limit, all of those things, Ryan said.

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House GOP Leaders Schedule More Health Care Votes - Roll Call

But as the party ramps up its efforts to take control of the House and hold onto a spate of red-state Senate seats in the 2018 midterm elections, some operatives see all the Russia talk as a distraction from an even more potent campaign issue: Health care.

Even those following the Russia probe's twists and turns closely say the GOP's push to repeal the Affordable Care Act is easier to explain and matters more to moderates and working-class voters that Democrats need to win back.

"I would encourage all of our candidates to make sure that health care stays front and center of the election," said Guy Cecil, the chairman of the Democratic super PAC Priorities USA.

"The visceral, gut reaction that people have makes it more powerful than Russia," he said.

New polls out Wednesday showed that Americans are increasingly attuned to the Russia investigation -- and the fallout from Trump's decision to fire FBI Director James Comey because he wouldn't shut that investigation down.

Still, many Democrats acknowledged that it's much easier to craft a digital advertisement or a 30-second television spot based on the direct pocketbook impact of the House GOP's health care measure -- which the Senate is expected to address in the coming weeks -- than it is to explain the breakneck developments in the Russia investigation. And health care, unlike the Russia investigation, is free from concerns about the trustworthiness of Comey, who many Democrats still blame for Hillary Clinton's loss.

Voters, Cecil said, have "a gut understanding; it's a day-by-day understanding of the impact of health care. They understand what it means to have coverage. The fact that it affects something that is personal, that happens to them daily, makes it a very powerful issue."

No matter the outcome of the Russia investigation, "health care will be a cornerstone issue in 2018," said Markos Moulitsas, the founder and publisher of the liberal blog Daily Kos.

"It motivates the base like few other issues, and more and more, moderates are aligned with liberals," Moulitsas said. "It's a win-win."

In the backlash over the Republican health care efforts, many progressives see a new opportunity to counter -- if the party returns to power -- with a push for a national single-payer, or "Medicare for all," plan.

But Russia also gives progressives an opening to call for Trump's impeachment -- something the party's leaders on Capitol Hill have not yet done.

"Russia shows just how anti-democratic the Republican Party is, happy to let a foreign power intervene in our elections in the pursuit of power. It proves the dishonesty of Trump and his regime and his party. It proves their incompetence," Moulitsas said.

"But most importantly, it provides a real basis for impeachment. So the issue isn't 'what Trump did was bad, look!' but 'we have no option given what Trump did except impeachment,'" he said. "So 2018 will be about two things: impeach Trump, and let's get single-payer health care. And both those issues will mobilize the liberal base like nothing else, and neither should turn off moderate voters."

Zac Petkanas, who was immersed in the Russia investigation while leading the rapid response efforts of Clinton's campaign and then the Democratic National Committee before launching his own firm, said there are simple ways for Democratic candidates to make their case against Trump on Russia: A president who cheated the system and a congressional GOP unwilling to defend the country and hold him accountable.

"And that goes to the corruption that people already believe exists in Washington; that goes to the abuse of power that people see running rampant in this city," Petkanas said.

Still, he acknowledged, the Russia investigation doesn't pack the clear, personal impact of health care.

"When I'm talking to candidates," Petkanas said, "I tell them that they should be saying 'health care' five times for every time that they say the word 'Russia.'"

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Even amid Russia probe, many Democrats see health care as their real winner - CNN International

With medical costs continuing to rise along with the uncertainty about the future of health insurance coverage, new research shows more Americans are going without the health care they need.

A survey released Wednesday from Bankrate.com found that one in four American families have not sought medical care because they couldn't afford it. Thirteen percent of respondents had no insurance, while the rest had a mix of employer-sponsored, individual and Medicaid coverage. The bulk of uninsured respondents were millennials. Younger, healthier people traditionally go without coverage.

However, "Even insured people found co-pays and deductibles far less affordable than they expected," said Robin Saks Frankel, credit card analyst at Bankrate.com

Two years ago, a Kaiser Family Foundation study found that only three in five households have enough set aside to meet an individual deductible of $1,200 or a family deductible of $2,400. Only about half of U.S. households had enough money to cover higher deductibles than those.

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President Obama's former economic adviser Austan Goolsbee joins CBSN to discuss the costs of the American Health Care Act, the GOP's replacement ...

Health care advocates and economists agree that forgoing health care can have devastating long-term consequences. It can mean patients get sicker and require even more expensive treatment when they end up in the emergency room. These types of unexpected medical bills can lead to a huge financial burden for the patient that could take years to pay off, said Frankel.

If you're struggling with medical costs or skipping the care you need, here are four strategies that may help make your health care more affordable.

Schedule your annual physical. If you have insurance, there's no reason to skip this important appointment. Under the Affordable Care Act, annual physicals are 100 percent covered. That means no co-pay, and your deductible doesn't have to be met beforehand. Spotting medical problems while they're small can prevent big problems (and bigger medical bills) down the road. If your physical yields some unwelcome results, you can talk to your doctor about the cost of future diagnostics and care. See the next item.

Don't be afraid to negotiate. If you're due for an expensive test, procedure or a series of doctor visits, be sure to ask about the price and your out-of-pocket costs ahead of time. You can research the costs at various labs and facilities in your area at websites such as Healthcare Bluebook. Then talk to your doctor or insurer about what you've found and how you can get a lower price. Separately, your doctor may offer payment plans or discounts for extended treatments. Be sure to ask.

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President Trump is pushing Republican senators to get on board with the legislation passed by the House to roll back Obamacare, but key Republica...

When you do receive a medical bill, review it carefully. Always make sure it's itemized, and check for errors. All health care providers use special billing codes, so mistakes can easily creep in. If you suspect you've been overcharged or mischarged for something, check with your provider and your insurer.

Pay less for prescription drugs. For many people, medication is the biggest health expense. Consider ordering regular, long-term medicines in bulk for lower prices. For less frequent medications, shop for the best prices in your area using comparison websites such as GoodRx. And always discuss any possible generic alternative with your doctor. Low-income patients should check with drug companies directly for any prescription relief programs they may offer, especially for expensive specialized drugs.

Sign up for your FSA or HSA. If your employer offers a Flexible Spending Account or Health Savings Account, be sure to take advantage. For an FSA, your contributions are made pretax, and the money can be used, among other things, for co-pays and health expenses before your deductible. HSAs are used if you have a qualifying high-deductible insurance plan. Contributions are also pretax, and no tax is paid when money is withdrawn for qualified medical expenses. Employers often contribute to workers' accounts as an incentive to get them to sign up for high-deductible health plans.

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Are you skipping that doctor visit or pill you need? - CBS News

It is an old joke among health-policy wonks that what the American people really want from health-care reform is unlimited care, from the doctor of their choice, with no wait, free of charge. For Republicans, trying to square this circle has led to panic, paralysis, and half-baked policy proposals such as the Obamacare-replacement bill that passed the House last month. For Democrats, it has led from simple disasters such as Obamacare itself to a position somewhere between fantasy and delusion.

The latest effort to fix health care with fairy dust comes from California, whose Senate voted last week to establish a statewide single-payer system. As ambitious as the California legislation is, encompassing everything from routine checkups to dental and nursing-home care, its authors havent yet figured out how it will be paid for. The plan includes no copays, premiums, or deductibles. Perhaps thats because the legislatures own estimates suggest it would cost at least $400 billion, more than the states entire present-day budget. In fairness, legislators hope to recoup about half that amount from the federal government and the elimination of existing state and local health programs. But even so, the plan would necessitate a $200 billion tax hike. One suggestion being bandied about is a 15 percent state payroll tax. Ouch.

The cost of Californias plan is right in line with that of other recent single-payer proposals. For example, last fall, Colorado voters rejected a proposal to establish a single-payer system in that state that was projected to cost more than $64 billion per year by 2028. Voters apparently took note of the fact that, even after figuring in savings from existing programs, possible federal funding, and a new 10 percent payroll tax, the plan would have still run a $12 billion deficit within ten years.

Similarly, last year Vermont was forced to abandon its efforts to set up a single-payer system after it couldnt find a way to pay for the plans nearly $4 trillion price tag. The state had considered a number of financing mechanisms, including an 11.5 percent payroll tax and an income-tax hike (disguised as a premium) to 9.5 percent.

On the national level, who could forget Bernie Sanderss proposed Medicare for All system, which would have cost $13.8 trillion over its first decade of operation? Bernie would have paid for his plan by increasing the top U.S. income-tax rate to an astounding 52 percent, raising everyone elses income taxes by 2.2 percentage points, and raising payroll taxes by 6.2 points. Of course, it is no surprise that Medicare for All would be so expensive, since our current Medicare program is running $58 trillion in the red going forward.

It turns out that free health care isnt really free at all.

How, though, could a single-payer system possibly cost so much? Arent we constantly told that other countries spend far less than we do on health care?

It is true that the U.S. spends nearly a third more on health care than the second-highest-spending developed country (Sweden), both in per capita dollars and as a percentage of GDP. But that reduction in spending can come with a price of its own: The most effective way to hold down health-care costs is to limit the availability of care. Some other developed countries ration care directly. Some spend less on facilities, technology, or physician incomes, leading to long waits for care. Such trade-offs are not inherently bad, and not all health care is of equal value, though that would seem to be a determination most appropriately made by patients rather than the government. But the fact remains that no health care system anywhere in the world provides everyone with unlimited care.

Moreover, foreign health-care systems rely heavily on the U.S. system to drive medical innovation and technology. Theres a reason why more than half of all new drugs are patented in the United States, and why 80 percent of non-pharmaceutical medical breakthroughs, from transplants to MRIs, were introduced first here. If the U.S. were to reduce its investment in such innovation in order to bring costs into line with international norms, would other countries pick up the slack, or would the next revolutionary cancer drug simply never be developed? In the end, there is still no free lunch.

American single-payer advocates simply ignore these trade-offs. They know that their fellow citizens instinctively resist rationing imposed from outside, so they promise unlimited care for all, which is about as realistic as promising personal unicorns for all. In the process, they also ignore the fact that many of the systems they admire are neither single-payer nor free to patients. Above and beyond the exorbitant taxes that must almost always be levied to fund their single-payer schemes, many of these countries impose other costs on patients. There are frequently co-payments, deductibles, and other cost-sharing requirements. In fact, in countries such as Australia, Germany, Japan, the Netherlands, and Switzerland, consumers cover a greater portion of health-care spending out-of-pocket than do Americans. But American single-payer proposals eliminate most or all such cost-sharing.

Adopting a single-payer system would crush the American economy, lowering wages, destroying jobs, and throwing millions into poverty. The Tax Foundation, for instance, estimated that Sanderss plan would have reduced the U.S. GDP by 9.5 percent and after-tax income for all Americans by an average of 12.8 percent in the long run. That is, simply put, not going to happen. So Americans are likely to end up with a lot less health care and than they have been promised.

Santa Claus will always be more popular than the Grinch. But the health-care debate needs a bit more Grinch and a lot less Santa Claus. Americans cannot have unlimited care, from the doctor of their choice, with no wait, for free. The politician that tells them as much will not be popular. But he or she may save them from something that will much more likely resemble a nightmare than a utopian dream.

Michael Tanner is a senior fellow at the Cato Institute and the author of Going for Broke: Deficits, Debt, and the Entitlement Crisis. You can follow him on his blog, TannerOnPolicy.com.

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Embracing the Hard Realities of Health-Care Reform - National Review

CINCINNATI Continuing the White House's infrastructure week, President Donald Trump took his pitch for rebuilding America to the very people that elected him on Wednesday.

With the Ohio River as his backdrop, Trump marketed his plans as a crucial step to rebuilding a crumbling U.S infrastructure system.

"It's time to recapture our legacy as a nation of builders," Trump said. "And to create new lanes of travel, commerce and discovery."

The future, he predicted, was going to be "beautiful and the future's going to be bright."

"Together we will fix it," the president promised corporations and citizens gathered on the banks of the Ohio. "We will create the first class infrastructure our country and our people deserve."

Related: Both Parties Say Trumps Infrastructure Plan Needs Repair

Trump also pushed another legislative priority: repealing and replacing Obamacare.

Obamacare, Trump said, is "crashing. It's dead, it's in a death spiral."

He blamed Democrats for obstructing the long promised Republican repeal and replace of the Democrats' signature healthcare law, calling them "obstructionists" and lamenting the lack of bipartisanship on "every single thing."

Hours earlier, Adm. Michael Rogers, the director of the National Security Agency, and Daniel Coats, the director of national intelligence, refused during a Senate Intelligence Committee hearing Wednesday to confirm or deny allegations that Trump asked them to interfere in the FBI's probe into Moscow's interference in the 2016 elections.

Trump also surprised some White House staff and Hill lawmakers alike Wednesday by tweeting news that Chris Wray, a former DOJ assistant attorney general and New Jersey Gov. Chris Christie's personal attorney during the "Bridgegate" scandal, to replace ousted FBI Director James Comey.

One White House official, speaking on condition of anonymity, told NBC News most of us learned about it from the tweet.

Asked soon after the presidents tweet if there would be a public announcement to come, Principle Deputy Press Secretary Sarah Huckabee Sanders told NBC News the president just did it, referring to the tweet.

The White House released an official announcement on Wednesday afternoon.

The nature of Trumps tweets have come under scrutiny of late, with Press Secretary Sean Spicer telling reporters Tuesday that the presidents tweets should be taken as official statements.

Wednesday's "infrastructure week" stop on the Ohio River dovetailed with a push Monday from the White House to privatize Air Traffic Control, separating the entity from the Federal Aviation Administration and making it a non-government non-profit.

We will work directly with state and local governments to give them the freedom and flexibility they need to revitalize our nations infrastructure, he said.

Trump, who is often touted by his vice president as a builder, will stress his campaign promises to rebuild America on Thursday when he meets with state and local leaders to discuss the need for an increased focus on roads and bridges.

That same day, Comey will testify on Capitol Hill.

As Trump wrapped his infrastructure push, Comey's prepared remarks went live online.

Some supporters in Cincinnati, however, scoff at the focus on Comey's testimony and continued media coverage of probes into whether there was improper communication between Trump officials and Russia during the 2016 campaign.

Alex Adams, 19, agreed, discarding "this fake Russian story that there was collusion" and said he was "ticked off" by attempts to discredit Trump's powered-by-the-people win.

Randy Chrisman told NBC News on Wednesday he's "disappointed" that there are "so many distractions" from the Trump is trying to do.

Trump's tweeting can sometimes do more harm than good, some supporters say.

"Sometimes it would be good if he said less, maybe, on Twitter," Chrisman said. "But that's what he chooses to do."

The concern for Chrisman and supporters like him, however, remained squarely on infrastructure.

"You know, we've built some really good things but keeping up with it and keeping the maintenance of it - some of its really hurt the system," he said, anxious to hear what Trump would propose.

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Trump Pivots to Health Care, Infrastructure on Eve of Comey Hearing - NBCNews.com

H

ow to rein in the escalating cost of health care is generating fierce debate across the U.S. Most politicians and health care professionals are focusing on big targets like legislation and the pharmaceutical industry. But the savings were all looking for may well come from far smaller sources, like the personal health devices that many Americans have so readily adopted.

About half of all Americans have one or more chronic conditions heart disease, diabetes, kidney disease, arthritis, and asthma, to name a few. Many chronic conditions arise from unhealthy lifestyles that include the usual suspects: poor diet, little or no exercise, and stress. These conditions account for the majority of deaths in the United States, and up to 86 percent of health care expenditures.

Look at diabetes as an example. Nearly 30 million Americans are now living with diabetes, and another 86 million have prediabetes, a higher-than-normal blood sugar level that can lead to diabetes. This disease accounts for unnecessary loss of vision, amputations, heart disease, kidney damage, and premature death. It also costs Americans $245 billion a year. But chronic diseases like diabetes need not take such huge personal or economic tolls. Easily implemented changes that digitize components of health and health care can lighten the load for people, their doctors, and the country at large.

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Millions of Americans currently use devices to monitor their health and fitness. These include scales, activity monitors (Fitbit, Apple Watch, Microsoft Band, and the like), heart rate and blood sugar monitors, and more. The data they record can help people take more control over their health and lifestyles. They can also help doctors keep track of their patients health, as information from these devices can be uploaded into electronic health records. Data from such devices could also alert doctors or first-aid workers to a problem that requires immediate attention, like a stroke or heart attack.

Fitbit likely wont improve your health, study says

Personal health devices are already or soon will be sophisticated enough to detect medical conditions. For instance, if your fitness device indicates that your usual activity level has fallen off but your heart rate is higher than usual, it could be a sign that you are coming down with the flu or other infectious disease.

To be sure, the jury is still out on how effective these devices will be. According to one randomized trial, Fitbit wearers did indeed exercise more but not enough to ensure weight loss and improved fitness the keys to battling chronic diseases.

On the other hand, at least 21 ongoing studies are examining how the Fitbit activity tracker could be used to help make cystic fibrosis patients healthier, to diagnose and treat chronic obstructive pulmonary disease, to help teens stop smoking, and more. A trial by Takeda Pharmaceuticals and Cognition Kit is using Apple Watches and Microsoft Bands to monitor physiological signs for indications of oncoming bouts of depression. Poole Hospital in the United Kingdom and its partners are developing a solution using the Band to provide more effective care for people with epilepsy.

For many users, these devices are a fun way to keep track of their performance. Users can connect with and compete with friends, and give themselves pats on the back via badges and positive feedback. In effect, the devices and their associated apps can gamify personal health and fitness.

But whats fun for users could also help curb health care spending. Offering users of personal health devices more tangible incentives, like cash or discounts on health insurance, could encourage more physical activity the most important way to prevent and treat many chronic lifestyle-related diseases.

Employers and insurers are already trying this approach. Under a provision of the Affordable Care Act, employers can offer wellness incentives to their employees (paid for by insurers) if they agree to wear a fitness tracker or pedometer or use a fitness app to record their activity. Incentives such as gift cards and rate discounts are available through some national insurers. UnitedHealthcare, for example, offers employees covered through some of its plans up to $4 a day for meeting certain daily walking goals.

Two years in, what has Apple ResearchKit accomplished?

There is, of course, a potential downside to collecting such personal data. One concern is that smart devices could be used to determine if an individual has a preexisting condition maybe even one he or she wasnt aware of. A company could use that information to dump the individual as a customer or place him or her into a high-risk and high-cost customer pool. Health data collected by an employer as part of a wellness program, or by an insurance company as part of an incentive program, may not be subject to the same privacy laws as health data collected by doctors or hospitals. This information is held in databases that dont necessarily have the same security regulations as electronic health records. It could be sold or hacked.

Employers could also use data from fitness devices to weed out unhealthy employees who might end up costing them more money because of chronic lifestyle-related diseases. And if an employer decides to adopt the gamification approach and make fitness a group effort, it could subject employees to fat shaming, or even discrimination penalizing employees for pounds causing extra stress and possibly contributing to unhealthy lifestyle behaviors and the lack of motivation the program was supposed to resolve.

I believe that despite the dearth of overwhelmingly convincing data on the effectiveness of personal health monitors and their inherent risks, the health industry will turn to them as a way to reduce costs. It must do something. U.S. employers currently insure about 170 million people and spend, on average, more than $12,500 in premiums for each employee and his or her family. By 2025, that figure will reach $24,500. A big chunk of that bill is due to preventable chronic diseases.

Activity trackers and other devices can motivate their users to live healthier lifestyles, especially as technology improves to become more precise and accurate (were not quite there yet). Incentives to use these devices are likely to grow, though employers, insurance companies, and health care providers will have to convince people that the data generated by the devices wont be used against them.

This digital health care revolution may not be the all-encompassing solution to the tsunami of chronic disease that threatens to break the health care bank, but it is one that can doubtlessly have a great and lasting impact.

Yiftah Ben Aharon is co-founder and CEO of GlucoMe, a digital diabetes clinic.

Yiftah Ben Aharon can be reached at yiftah@glucome.com

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USA TODAY 12:46 p.m. ET June 7, 2017

President Trump(Photo: Evan Vucci, AP)

The theme of President Trump's trip to Cincinnati today was supposed to be his plan to shore up America's infrastructure, but his list of talking points is getting crowded.

The president announced on Twitter this morning that he'll also meet with "ObamaCare victims" and will discuss health care. Watch the president's speech live in the player above.

Later, White House officials indicated he'd talk jobs and energy, too, and would surround himself with coal miners and steel workers in hard hats.It's also possible the president could talk about his troubles back in Washington, where former FBI Director James Comey is set to testify Thursday before Congress.

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

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Live stream: Trump discusses health care during Ohio visit - USA TODAY

Health care presents one of the biggest opportunities for startups--as well as some of the biggest frustrations. The market size and the potential to make an impact in people's lives are nearly unrivaled, as is the level of regulation. Still, in 2016, venture investors poured $12.2 billion into health care, backing companies that promise to change everything from cancer care to the process of finding a new doctor. Here are some of the standouts.

Flatiron founders Zach Weinberg (left) and Nat Turner.

CREDIT: Saskia Uppenkamp

Google Ventures-backed Flatiron Health has developed a cloud-based technology platform that's currently used by about 260 cancer clinics. The New York City startup takes the patient data it collects from those centers--without identifying details, of course--and shares it with pharmaceutical companies and researchers. The company raised an $8 million series A round in 2013. A little more than a year later, it raised $130 million, and a year after that, an additional $175 million, bringing its valuation to about $1.2 billion. Flatiron is one of fewer than a dozen billion-dollar-valuation "unicorn" companies in the health care space.

Major Investors: Google Ventures, First Round Capital, Roche, Allen & Co.

CREDIT: Courtesy Company

Freenome, headquartered in South San Francisco, is one of a slew of so-called liquid biopsy (i.e., blood test) companies to break out over the past few years. The goal is to use a patient's DNA, rather than a tissue sample, to diagnose cancer. Freenome says its tests do better than the current options for diagnosing prostate, breast, colorectal, and lung cancers. The company is using a $65 million round of funding, led by Andreessen Horowitz, to head into clinical trials.

Major investors: Andreessen Horowitz, Founders Fund, Charles River Associates

CREDIT: Courtesy Company

Another health care unicorn, Clover Health is an insurance start-up aiming to use data science to improve preventive medicine. The San Francisco-based company tracks dozens of clinical and social data points to help elderly and low-income patients avoid hospital visits. It currently handles claims for about 25,000 Medicare Advantage patients in New Jersey. With a recent $130 million funding round from Google Ventures and other backers, Clover plans to expand, and begin operations in three more states by this fall.

Major investors: First Round Capital, Sequoia Capital, Greenoaks Capital

CREDIT: Courtesy Company

New York City-based ZocDoc allows users to find in-network health care providers, book appointments online, and read reviews from other patients. About 6 million patients in the U.S. use the service each month. Providers pay a subscription fee to be listed, and then ZocDoc integrates with their practice management software. ZocDoc recently added a feature that lets patients type in their symptoms using natural language and then matches them with an appropriate provider, such as a doctor, dentist, nurse practitioner, or physical therapist. The company has raised a total of $223 million.

Major investors: Amazon founder Jeff Bezos, Khosla Ventures, Goldman Sachs

CREDIT: Courtesy Company

In 2013, the FDA ruled that genetic-testing company 23andMe, which has raised a total of $233 million, could no longer sell one of its signature services: test results that indicate a person's propensity to develop inherited diseases. Since then, Mountain View, California's 23andMe has mainly been using its genetic testing services to provide information about ancestry and origin. But in April of this year, the company finally won FDA approval to sell direct-to-consumer tests that provide genetic health risk information for conditions such as Parkinson's, Alzheimer's, and hereditary thrombophilia.

Major investors: Google Ventures, New Enterprise Associates, WuXi Healthcare Ventures

CREDIT: Courtesy Company

London-based Babylon Health, which has raised a total of $85 million, started as a telemedicine company, enabling doctors to make diagnoses via video and allowing patients to rate the quality of each interaction. But it's received more notice lately for another program it's piloting in the U.K.: an AI-powered chatbot that analyzes a patient's condition against a database of symptoms, while incorporating the patient's own medical history and responses to the chatbot's questions.

Major investors: Vostok New Ventures, Hoxton Ventures, Mustafa Suleyman

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The 6 Hottest Startups in Health Care - Inc.com