A Bad Health Care Bill New York Times Now we learn that in a revised version of the bill being discussed, states would be permitted to allow insurers to drop coverage for essential health benefits like cancer care and mental health services and price their policies based on people's health ...

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A Bad Health Care Bill - New York Times

Its been 20 years since Savannahs two oldest hospitals joined in a remarkable journey to expand their provider network throughout the region and better serve their communities.

The merger of two faith-based hospitals St. Josephs in southside Savannah and Candler in midtown avoided potential hurdles in what Paul P. Hinchey, president/CEO of St. Josephs/Candler Health System Inc., called really a great Savannah success story that provided a textbook model for such collaborations.

It was remarkable, Hinchey said. There was no acrimony. (Trustees) just cared about what was good for the merger and the community.

The combination, driven by a common philosophy and vision, provided a springboard to rapid growth that is still vibrant, Hinchey said.

Today, the system has 87 provider locations spanning 33 counties in southeast Georgia from Wayne County to Statesboro and Hilton Head, S.C. There are 714 patient beds St. Josephs Hospital with 330 and Candler Hospital with 384 beds in what Hinchey called the largest health care provider in the region.

It employs 4,000 people and last year provided almost $75 million in community assistance, including $27 million in traditional charity care and $2.4 million in community health improvement service and community benefits, according to its 2016 Community Benefits Report.

Were still growing, Hinchey said.

Most recently St. Josephs/Candler unveiled a planned $62 million micro-hospital in Pooler with the first step to open in early 2019 on an 18-acre parcel on Pooler Parkway near the intersection with Interstate 16.

When built out over a 10-year period, the 170,000-square-foot facility will provide a health care campus that addresses the needs of west Chatham County and surrounding communities.

Pooler Mayor Mike Lamb said in February that the St. Josephs/Candler Pooler Campus is the type of expansion of services he has sought since he became mayor in 2004.

We constantly are looking for more and more medical facilities and doctors because it helps our citizens not to have to travel all the way to Savannah, Lamb said. Any steps that will help our citizens has got to be a big plus for our community.

The mergers goals

From the start, Hinchey said the merger, technically a joint operating agreement, is built on three goals:

Consolidating clinical services to pool talented caregivers in one location rather than have them fragmented

Eliminating duplication of services to provide care more efficiently

Creating a more robust community outreach to the underserved

It worked seamlessly, Hinchey said, adding the boards of the respective hospitals quickly moved from a St. Josephs Hospital, Candler Hospital mentality and morphed into a single entity. The two words became one word.

It required some shifts in programs between the hospitals. For example, St. Josephs moved its obstetrics and pediatrics programs to the Mary Telfair Hospital at Candler. Most cardiology moved to St. Josephs Heart Hospital as well as orthopedics.

The April 1, 1997, agreement came at a time when the three major local hospitals Memorial Medical Center (now Memorial University Medical Center) within blocks of Candler were involved in revolving talks to restructure the local health care provider systems.

Candler and St. Josephs began their talks about possible collaboration in March 1996, shortly after and partly because of Memorials announcement that it would enter into exclusive affiliation talks with Columbia/HCA, the nations largest for-profit hospital chain.

Shortly afterward, Candler ended its 18-month-old talks with Memorial and opened talks with St. Josephs and, on Jan. 7, 1997, formally approved creation of a proposed unified health system that would rival the countys largest health care provider in size.

Everybody had to give up something

Cecil Abarr, a retired Braniger Organization executive and community volunteer, was chairman of the Candler Hospital board of trustees when discussions began on joining with St. Josephs.

The environment for hospitals was bad all over the country at the time, he said. There were just too many of them. We were starting to feel the pinch here.

A group of hospital board members began kicking around what the future held, and a series of meetings followed. Among the concerns were the proposed merger of the Catholic and Methodist hospitals and how it would work, he said.

A lot of things about the structure (of the merger) had to be worked out, he said.

A series of frequent meetings involving Abarr, Harvey Granger, who chaired the St. Josephs board, Walton Nussbaum Jr. and Archie Davis, among others, resulted in the merger within 16 months.

After getting along with the discussions, they decided they needed to meet with Sister Margaret Beatty at St. Josephs and get her approval, Abarr said.

She wasnt a part of the final planning, she just approved it, Abarr said. She was very excited about how we got along.

Beatty then was president of the Baltimore Regional Community of the Sisters of Mercy in the Southeast and a board member at St. Josephs Hospital. She now is vice president for mission services at St. Josephs/Candler. St. Josephs is a Sisters of Mercy hospital.

Everybody had to give up something, Beatty said of the merger. Everybody was taking a risk. We formed these human relationships where it didnt make any difference which hospital was involved.

Board members were all prominent citizens of Savannah all extraordinary leaders, she said. We came at it as a team, I think.

Another key issue was who would be named to head the new entity, and Abarr said Hinchey was named by agreement of both boards.

This is a real merger because were all really intertwined with key department officials all working for the benefit of both hospitals.

I think thats one of the key things that worked, Abarr said. Really we look at it as one operation now. Its pretty much a joint deal.

He said concerns of working two faith-based groups has long since past, he said.

That hasnt impacted the whole situation, Abarr said. Oh, it has been a tremendous success. They really work well together. Theres no question.

The stars were aligned

The Catholic Church- based St. Josephs and United Methodist Church-based Candler shared very similar cultures. Both are faith-based with a common philosophy and vision, Hinchey said.

It was, he said, a textbook example of a board-driven operating agreement rather than a CEO-driven agreement.

He said such collaborations should proceed not too fast, but dont drag your feet either.

You lose momentum through delay, he said. You need to start acting like a good married couple.

And Hinchey said the local agreement allowed for a rapid consolidation with the first steps completed within six months, not the 18-24 months commonly seen in similar mergers nationally.

Hinchey, who had been president of St. Josephs since May 1993, became president/CEO of St. Josephs/Candler on April 1, 1997.

A new 19-member board of trustees was elected with seven by Candler, six by St. Josephs and three by the Sisters of Mercys Baltimore Community. After six years it became a self-perpetuating board representing everybody.

The stars were aligned in this deal, Hinchey said. We had the right people here at the right time a perfect governance match. They (trustees) thought St. Josephs/Candler, not St. Josephs and Candler.

Looking back, Hinchey said, I wouldnt change a thing about it. I never had any doubts about it, but I do have a healthy respect for the amount of work it takes to do it.

As I start my 25th year as CEO, I was blessed to be there from day one and am gratified to see where it is 20 years later.

Timeline:

Since St. Josephs/Candler was created in an April 1, 1997, joint operating agreement, the health system has expanded across the region and increased services to include 87 provider locations spanning 33 counties in southeast Georgia and South Carolina in addition to the 714 patient beds at St. Josephs Hospital and Candler Hospital. The locations span from Wayne County to Statesboro to Hilton Head Island.

The St. Josephs/Candler Medical Group has added primary care practices in Claxton, Abercorn-Southside, Pooler, Plaza D by St. Josephs Hospital, the Islands, Metter, Hilton Head Island, Bluffton and the office of Dr. Jose Rendon.

1997: Consolidation of Obstetrical Service. Mary Telfair Womens Hospital Birthplace is expanded at Candler Campus.

1998: Surgical Services at both hospitals are consolidated. Home Health agencies are consolidated - CareSouth/Advantage and CareSouth/Quality were formed. Health System begins management of Appling HealthCare System, Baxley, Ga. S.A.N.E. (Sexual Assault Nurse Examiner) program formed at Candler Hospital to help preserve forensic evidence in sexual assault cases. CareCall Center, a telephone health information, community resource and physician referral hotline, begins operations. Opened The Childrens Place, a comprehensive pediatric acute care program tailored to serve the special needs of children who are sick as well as the concerned parents.

1999: Earned the rigorous Network Accreditation from the Joint Commission on Accreditation of HealthCare Organizations. At the time, SJC was one of only 3 networks in the state to be accredited and one of only 55 in the country. Opened the African-American Health Information and Research Center to help improve the health of African Americans in Chatham County and address health disparities.

2000: Opened the St. Marys Community Center in the Cuyler-Brownville neighborhood

2002: Became the first in the region and second in Georgia to earn the Magnet Designation for Excellence in Nursing Service from the American Nurses Credentialing Center. Opened a Level II neonatal intensive care unit called the Special Care Nursery. The Screen Machine, a mobile cancer screening vehicle, begins operations to reach local and outlying populations.

2004: Completed $2 million renovation and expansion of the Georgia Infirmary. The St. Marys Community Center earned the prestigious Achievement Citation from the Catholic Health Association for connecting people in need with vital and life-changing services.

2006: Nancy N. and J.C. Lewis Cancer & Research Pavilion opens.

2007: The Lewis Cancer & Research Pavilion is named to the National Cancer Institutes Community Cancer Centers Program, now called the Community Oncology Research Program, to bring the latest research and treatments to Savannah.

2007: Opened the Good Samaritan Clinic in Garden City to serve patients without insurance.

2008: Was the first to bring the da Vinci Robotic Surgical System to the region. Opened the St. Marys Health Center on Drayton Street to serve those without insurance.

2009: Opened west Chathams first hospital-operated imaging center in Pooler, located next to the Medical Group Pooler practice. Acquired radiation oncology practice in Hilton Head.

2010: Acquired the regions first CyberKnife. Nancy N. and J.C. Lewis Cancer & Research Pavilion became the first institution of its kind to become a member of the Eastern Cooperative Oncology Group (ECOG), a cooperative network of cancer researchers, physicians, and health care professionals at public and private institutions across the country offering state of the art clinical cancer trials.

2011: Begins major expansion into the Bluffton and Hilton Head area with the addition of a wound and hyperbarics practice and later adding an imaging center and a specialty physician office space in addition to the primary care doctors already there.

2012: Partnered with a chemotherapy and infusion oncology practice in Hilton Head and Okatie to create the St. Josephs/Candler SC Cancer Specialists practice. Collaborates with Wayne Memorial Hospital to open a physician.

2013: Earned the Foster G. McGaw Prize for Excellence in Community Service. The Heart Hospital becomes the first in the region to receive full accreditation as a Chest Pain Center. St. Josephs/Candler becomes the first in the region to complete a Transcatheter Aortic Valve Replacement.

2014: $15 million renovation to the tower at St. Josephs Hospital completed.

2017: Completed a $21.6 million expansion and renovation of St. Josephs Hospital. Announced plans for a Pooler micro-hospital to open in 2019.

2016 St. Josephs/Candler Community Benefits

TRADITIONAL CHARITY CARE

Charity Care: $26,516,391 (Outpatient and inpatient services provided at cost for indigent patients)

Unreimbursed Care: $12,812,265 (Medicaid uncompensated care at cost for the underinsured and GA hospital tax)

TOTAL TRADITIONAL CHARITY CARE: $39,328,656

Other benefits

Community Health Improvement Services & Community Benefit Operations: $2,430,578

Health Professions Education: $53,761

Subsidized Health Services: $961,341

Financial and In Kind Contributions: $844,798

Community Building Activities: $282,844

TOTAL OTHER BENEFITS: $4,573,322

TOTAL COMMUNITY BENEFITS: $43,901,978

In addition to the nearly $44 million dollars in formal community benefits, St. Josephs/Candler provided $30,929,422 in uncollected service cost and uncompensated Medicare cost in Fiscal Year 2016.

TOTAL COMMUNITY ASSISTANCE: $74,831,400

2015 Total Community Assistance $67,932,941

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St. Joseph's/Candler still growing health care 20 years later - Savannah Morning News

One of my most important jobs is making sure your tax dollars are spent wisely. We must restore fiscal sanity in Washington, forcing bureaucrats to live within a budget and focus on priorities just like you do with your personal finances.

Last week, every member of Congress submitted official requests to the Appropriations Committee listing priorities for federal spending in their home districts. This lays the groundwork for building a responsible budget. Here in North Carolinas 9th Congressional District, supporting access to rural health care is a priority.

Why? Six out of eight counties are eligible for rural health grants (Anson, Richmond, Scotland, Robeson, Cumberland, and Bladen). Four of those counties recently ranked in the bottom 10 in North Carolina for quality of health.

In much of our district, access to quality health care services can be difficult for patients. Funds for rural health care programs play a critical role in solidifying the fragile health care infrastructure in these communities.

One of my priority requests is the Rural Hospital Flexibility Program, which provides Critical Access Hospitals with crucial funding for updating equipment, delivery models, and care. Bladen County Hospital would benefit from this program.

Another request is for the State Offices of Rural Health, which in 2016 provided assistance to HealthQuest of Union County, Scotland Community Health Clinic, Southeastern Regional Medical Center, Cape Fear Valley Medical Foundation, and many other providers.

The State Offices of Rural Health helps rural communities, including technical assistance, recruitment of health care professionals to come serve in rural communities, and coordinating rural health needs statewide.

Technology is also improving how we provide health care to rural areas. Telehealth services allows patients to be diagnosed and monitored in their homes instead of requiring them to drive long distances to see their doctor. This not only increases access, but reduces costs since care doesnt always have to take place in an expensive setting, or involve expensive transportation.

To make telehealth services more widely available, I have requested support for the Office for the Advancement of Telehealth, which develops partnerships between the federal government, state agencies, and the private sector to create telehealth projects. These grants help reduce the isolation of rural health providers.

Some of my other priority projects include Transportation Investment Generating Economic Recovery (TIGER) grants, which is a big long name for a program to help rebuild transportation infrastructure. Specifically, Im working to support a request by the town of Pembroke and UNC Pembroke. To support economic development in Lumberton, Ive also requested flexibility with the population requirements of a USDA grant program which has previously provided vital assistance in Robeson County.

As a fiscal conservative, I will fight to ensure your tax dollars are spent wisely, including ongoing efforts to reduce wasteful spending and eliminate outdated programs. As your congressman, I will also fight on your behalf for appropriate, useful programs which deliver real results for our communities.

Our neighbors near Charlotte and Monroe live in what meteorologists describe as a radar gap, where the distance to the nearest National Weather Service Doppler radar and the curvature of the Earth mean meteorologists dont have consistently reliable data about storms.

On Tuesday, the U.S. House of Representatives unanimously approved the Weather Research and Forecasting Innovation Act (H.R. 353), which includes my legislation requiring the Commerce Department to study and quickly develop a solution to the radar gap. Last week, the U.S. Senate also gave unanimous approval to this legislation with support from Senator Burr.

Without local, reliable data, the National Weather Service has actually missed at least two tornados and issued warnings for the wrong neighborhood, among other problems. This legislative solution now heads to President Trumps desk to be signed into law.

http://robesonian.com/wp-content/uploads/2017/04/web1_robert-pittenger2017471439907.jpg

U.S. Rep. Robert Pittenger represents the 9th District in the U.S. House of Representatives, which includes of all Robeson County.

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Health-care access critical - The Robesonian

Its time to pull up a chair and talk about health care in our area. I know it is a pretty dry subject, but after driving around Chippewa Falls and Lake Hallie seeing Packers quarterback Aaron Rodgers smiling face on billboards, if Aaron can discuss it so can we.

Over the weekend of March 18-19 I was made aware of a statement by Mayo Health System CEO Dr. John Noseworthy. Were asking if the patient has commercial insurance, or theyre Medicaid or Medicare patients and theyre equal, that we prioritize the commercial insured patients enough so we can be financially strong at the end of the year. (Pioneer Press)

As I am writing this article, Dr. Noseworthy is trying to clarify his remarks to assure that everyone will be treated the same by the Mayo Health Care System. As they say, the cat is out of the bag and is bounding across the barnyard.

At this point in my writing I would usually give out additional facts and figures from noted newspapers and other sources. But Dr. Noseworthy saved me both the time and the trouble. Additionally, I doctor at Mayo Clinic and will keep his statement in mind. Thanks, Doc.

As President Trump and Congress learned once again, health care is a complex issue. In Lake Hallie sits a small urgent care center of the Marshfield Clinic. Down Highway 53 Oak Leaf Surgical Hospital rests against the hills. Eau Claire has the Mayo System and Sacred Heart Hospital. On the northeast side of Chippewa Falls, St. Josephs Hospital stands as a symbol of health care for over a century.

The competition for a health care dollar is intense, and with the number of providers in the area, our health care costs should be the lowest in the state, but they are not. That honor goes to Madison and the Fox Valley area, which includes Green Bay. Perhaps that is why Aaron Rodgers is smiling.

We really should thank our Congress, Rep. Paul Ryan and President Trump for killing the Trump Care bill. It appears that people want to see their doctor on a regular basis and dont want to go bankrupt doing it. But there is far more to the story.

We are headed to what every other civilized country has: National Health Insurance. It may not be pretty and it may not be easy at first, but it will our secure our future as a country that cares about its people.

The problem in health care is on display right now as two area health care providers take on each other in the newspapers and the courts. Marshfield Clinic Health System and the Hospital Sisters Health System are at odd over costs. I believe it is not a cost issue but a philosophy issue.

While Marshfield and HSHS fight, we are urged every night on TV and radio to see our doctor about some new cure, pill or procedure. We are part of the problem. Drug companies are part of the problem, advertising at all levels for health care related products are part of the problem. Insurance companies are part of the problem. Politicians are part of the problem.

Do I dare say it? Aaron Rodgers may be part of the problem. I am sure Aarons smiling face on those billboards cost something. I wonder what kind of health plan the Packers offer for their employees and players? If Aaron gets hurt on the field, is it a workmans comp injury?

I do not have all the answers, but I know something has to change. I know gas prices dropped in the area when a grocery store that has a gasoline station with it opened in Altoona. Perhaps that is not how things work in health care. As long as people do not have health insurance or single payer health care, maybe the law of supply and demand cant work.

However I have a hunch if the Mayo brothers or the six doctors who founded the Marshfield Clinic came back they would not approve of how health care is run now. Have a good week and stay healthy. If you see Aaron Rodgers, say Hi for me.

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John Andersen: Get educated about your local health care options - Chippewa Herald

Of all the shibboleths used to denigrate the Affordable Care Act, perhaps the most persistent is to label it a job-killer.

The label was strong on the wing during the presidential campaign, when one could hear it uttered by Sen. Ted Cruz (R-Texas), who called it the biggest job-killer in this country, and Donald Trump, who said repealing the law would save 2 million American jobs. The notion had a long history: In January 2011, only a few months after the law had been passed and three years before its major provisions went into effect, the newly Republican House was trying to pass a measure entitled the Repealing the Job-Killing Health Care Law Act.

This attack on the ACA never was based on facts. But a new report from the Altarum Institute, a nonprofit healthcare think tank in Ann Arbor, Mich., adds evidence that, in fact, the law is a job-creator. From 2014 through 2016, the researchers found, the law triggered the creation of 240,000 jobs in the healthcare field alone. The main reason is that increased insurance enrollments spurred more demand for healthcare services.

It really was the total change in coverage that made the difference, Ani Turner, one of the reports authors, told me. Turner wrote the report with Charles Roehrig of Altarum and Katherine Hempstead of the Robert Wood Johnson Foundation, who have been tracking job statistics in healthcare for several years.

These are good jobs too, Turner says. Although the available statistics breaking down jobs by occupation are a bit sketchier than the overall job growth numbers, its clear that more growth is happening among physicians, registered nurses, nurse practitioners and therapists the practitioners who interact with patients.

That reflects the long-term trend of job growth in healthcare, according to another paper published by Turner, Roehrig and Hempstead in March. They found that growth in 2007 to 2015 was strongest among the diagnosing/treating categories of employment (doctors, nurses, et. al.), at more than 20%, followed by other health occupations and non-health support occupations such as clerical workers.

The strong growth in healthcare professional employment has been accompanied by expanded enrollment in medical and nursing schools, as one would expect the demand for doctors and nurses has to be filled somehow. Enrollment in U.S. medical schools reached a record 20,630 in 2015, up 25% from 2002, according to the Assn. of American Medical Colleges. Nursing schools reported 320,000 enrollees in 2014, a 7% increase over the previous year.

The Altarum researchers warn that the job gains could be reversed if the ACA is repealed, whether through the GOPs misbegotten and (thankfully) moribund American Health Care Act or some other device. Providers and health systems may have already begun to slow hiring in early 2017, they observe, though theyre not sure whether the reason is the uncertainty about the ACAs future created by Republican dithering, or merely a return to the average growth rate of the pre-ACA era.

The Altarum paper measured the ACA-generated job growth in healthcare by examining the growth rate in healthcare jobs in 2015 and 2016, when coverage expansion began, compared to the average 1.7% growth rate in 2010-2013. They found that the increase in jobs lagged the coverage expansion by several quarters, but on the whole the rate jumped to 2.5% in 2015 and 2016. That yielded the figure of 240,000 new jobs directly attributable to Obamacares coverage expansion, which was about one-third of all the job growth in healthcare in those years.

When they checked the national trend against state average, they found that the that their expectations held: States with the highest percentage gains in their insured populations, such as Kentucky and California, also tended to experience the largest increases in healthcare job growth rates.

The anti-Obamacare crowd has been trying to torture job statistics almost from the inception to try to justify their job-killer meme. As part of their campaign, theyve claimed that the law has pushed more Americans into part-time work, since the mandate requiring employers to provide employees with coverage wont apply to part-timers.

Right-wing billionaire Charles Koch floated this claim via USA Today in 2014 and Andy Puzder, the CEO of the Carls Jr. and Hardees fast-food chains who was briefly a nominee for Trumps Labor secretary, tried it on for size last year. They were wrong. The truth is that the ranks of workers who are part-time for economic reasons that is, because they cant find work or are given fewer hours than they want or need has come down sharply since the enactment of the ACA to 5.5 million in March 2017 from 9.1 million in March 2010, a reduction of 40%.

The voluntary part-time workforce, however, has increased. These are people who choose not to take full-time jobs because they have better things to do, such as caring for their children or elderly family members. Theyve increased to 20.4 million last March from 17.9 million in March 2010. Full-time employment, meanwhile, has increased to 153 million in March 2017 from 138.8 million in the same month in 2010. (All these figures are from the Bureau of Labor Statistics.)

The trend was well understood by the Congressional Budget Office, which projected in 2014 that the ACA would shrink the supply of labor, not the availability of jobs, by about 2.5 million full-time equivalents by 2024. The reason is that the ACA would decouple health coverage from employment, allowing more people to stay home without losing their insurance. Its not the CBOs fault that its projection was misinterpreted by politicians and business leaders like Trump, who were either too ignorant to understand it or deliberately out to mislead the public.

Keep up to date with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook page, or email michael.hiltzik@latimes.com.

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'Job-killing' Obamacare actually created 240000 well-paying healthcare jobs - Los Angeles Times

Health care is one of the most virulent issues of our time.

After former President Obama signed the Affordable Care Act into law in 2011, Republicans in Congress pledged to repeal it. After winning the presidential election in November and holding onto control of both houses of Congress, Republicans vowed to replace the law with their own version of health care, one that would purportedly be more favorable to Americans.

Led by President Donald Trump and House Speaker Paul Ryan (R-Wis.), the GOP failed to even bring their legislation to the floor for a vote, however, marking a stunning defeat for the new president less than three months into his term.

On Long Island, the promised repealing of Obamacare could have severe ramifications, with New York Gov. Andrew Cuomo characterizing Republicans recent changes as potentially devastating statewide.

Politics aside, health care is a major issue that affects all Americans: the uninsured, those with high premiums, insured citizens hobbled by burdensome hospital or prescription drug bills.

On Sunday, April 9, Long Islanders will get a chance to view the pitfalls of the American health care system firsthand during a screening of the documentary, Fix it: Healthcare at the Tipping Point at Cinema Arts Centre in Huntington. The viewing will include state Assemb. Charles Lavine (D-Glen Cove) as a guest speaker.

The documentary provides an in-depth look into how our dysfunctional healthcare system is damaging our economy, suffocating our businesses, discouraging physicians and negatively impacting on the nations health, while remaining un-affordable for a third of our citizens, according to the venue.

The film will also highlight the very real ramifications for Americans struggling to choose between paying for drugs they need and other items they need to survive. The documentary not only covers the problems with Americas health care industry, but it also offers a way out: a single-payer system.

The event is co-sponsored by Action Together Long Island and Long Island Activists.

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'Fix It: Healthcare at the Tipping Point' Screens at Cinema Arts Centre - Long Island Press

A cursory review of all the textbooks, dictionaries, style guides, and news sources in the Anglophone world would reveal a complete lack of consistency in the conventions of how healthcare/health care/health-care (h/h/h) is written. Is anyone elses mind blown that no convention has been developed for how to write about a multi-trillion dollar industry? Mine certainly was. This is my attempt to rectify the lack of clear, well-researched direction on this subject.

If you were to look for an authoritative source on the topic, you would turn up a series of loose sets of rules and meritless rationales for conventions surrounding the veritable word cloud miasma that hovers around our industry. As such, I took to reading through the decisions handed down from the Court of Common Opinion in search of a compelling narrative for how we Anglophones the world over should free ourselves of this embarrassingly debilitating failure of language.

Frankly, this has annoyed the Internet for way too long. Health care is in the top 20% most searched words on Merriam-Websters online dictionary and understandably so. No one is looking up healthcare because its some hard, new word: people are looking up health care because they need to know conventions for how to use and spell it! And as I did yesterday, most people walk away from Merriam-Webster and similar sources with tails between legs, depressed they have to go through yet another day with no direction on whether they are using and writing h/h/h properly.

Michael Millenson recently tried his hand at unraveling this topic. He did a compelling investigational guest piece tracking down the history of usage and spelling for h/h/h on the blogThe Doctor Weighs In. Unfortunately, at the end of the article, Im still head-desking because Michael joins everyone else in what Im calling The Great Healthcare/Health Care Vacillation by not making an argument one way or another for usage and spelling.

The most developed, logical, and applicable set of conventions I have found was developed here by Deane Waldman, MD, MBA on his blog, Medical Malprocess. His refreshing approach is that we should use both healthcare and health care each for different purposes because the need for specificity is so great that no one version of this word/phrase would be sufficient. Here is my interpretation of how he has parsed these words:

health care (noun)

Definition: a set of actions by a person or persons to maintain or improve the health of a patient/customer

Examples:

healthcare (noun or adjective)

Definition: a system, industry, or field that facilitates the logistics and delivery of health care for patients/consumers

Examples:

To put it more simply, Dr. Waldman writes:

Health caretwo wordsrefers to provider actions.

Healthcareone wordis a system.

We need the second in order to have the first.

While this is a thorough and terribly useful set of conventions, the fact remains that in the US the most commonly accepted form in professional writing is health care (the Associated Press feels pretty strongly about it), regardless of the words part of speech and the concepts to which the author means to refer. My problem with this heavy-handed approach is that it flattens the language and allows the speaker and audience to discuss h/h/h with little specificity, leading to generalities made about h/h/h that are not valid for the other forms of the word/phrase/concept. As such, I think that Dr. Waldmans model, which judiciously incorporates both forms, should supplant all of, in my opinion, the half-formed and barely-enforced rules on how to write h/h/h.

You may be wondering why I (and others) care so much about this issue. The short answer is that healthcare has taken on more meaning as a closed compound word to describe the system/industry/field than is captured in the two separate words health and care. Health care does not sufficiently capture the increasing demand for nuance and specificity in referring to topics surrounding the practice and facilitation of services to maintain or improve health. Healthcare represents the political, financial, historical, sociological, and social implications of a system that provides health care to the masses.

As professionals in a fast-paced and demanding field, we should hold ourselves to a high standard of precision and accuracy in our language. More than a few (by that, I mean literally 100%) of the professionals in healthcare have found themselves at some point wondering whether they are writing this word/phrase properly. I say the time has come to end the Great Healthcare/Health Care Vacillation.

It is understandable for many to feel they have neither the time nor resources to dedicate themselves to the pursuit of grammatical perfection. However, our issue here is not simply a lack of differentiation between two words in some obscure intellectual niche. Our issue is that our entire profession, industry, and field lacks a single, unifying convention for how to portray itself to the world. There is no excuse for confusion coupled with a lack of conviction for the need and method to address the problem.

I am not so deluded to think this set of conventions will become common knowledge, but I can hope and pray that those of us tasked with writing about the healthcare system and the evolution of health care in practices will endeavor to establish and monitor a consistent set of conventions about something as powerful and pervasive as our health and the industry that supports it.

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The Final Word: Healthcare vs. Health Care - Arcadia ...

House Speaker Paul Ryan, right, and House Majority Whip Kevin McCarthy walk away following a news conference on the American Health Care Act on Capitol Hill on Tuesday. Susan Walsh / AP

"If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car," he wrote in the blueprint. "But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance."

That's the problem with letting people choose not to have health insurance if they don't want it, said David Cutler, an economics professor and health policy expert at Harvard University.

"One way or another, sick people cost money," Cutler said.

Treating heart attack victims in the emergency room is far more costly than preventing the heart attack with good medical care.

"The best thing that we can do to protect health is to prevent illness in the first place," said Dr. Leana Wen, Baltimore's health commissioner. "The emergency room is not the safety net. By the time that people get there, it's often too late."

Related:

A patient with schizophrenia may cost $50,000 a year to treat, but left untreated, could end up in jail at the taxpayer's expense, Cutler said.

"You can say, 'I want to pay for them through taxes'. You can say, 'I want them to die because they don't deserve coverage'. But you can't say, 'I don't want to pay for them but I want them to get care,'" he added.

The new GOP plan seeks to encourage but not mandate people to get insurance by letting companies charge higher premiums for those who have gone without coverage.

"Insurance is not really the end goal here," White House Office of Management and Budget Director Mick Mulvaney told MSNBC.

And it also would let states decide what kind of policies insurance companies should offer.

DeMoro, of the nurses union, sees it as a recipe for disaster.

The Obama administration even had trouble controlling insurers who sought to trim what they offered, she said.

"Even through the ACA, health exchanges, insurers routinely change plan designs yearly in ways to increase out-of-pocket costs and limit patient choice through narrower networks," she said.

That was one of the biggest complaints about Obamacare some customers lost access to doctors and hospitals they'd been using for years.

Related:

Cutler also worries people will try to game the system if they don't have to buy high-quality insurance.

"They can say, 'I am going to buy a crappy health insurance policy because I know if I get really sick someone will take care of me,'" he argued.

Holtz-Eakin doesn't think that's a risk.

"It's never been the case that we've had a race to the bottom with health insurance," he said. "That's not my model of how markets behaveInsurers offer policies that people want to buy."

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The GOP Wants More Health Care Choices. Is That Really a Good Idea? - NBCNews.com

White House budget director Mick Mulvaney said critics of the new GOP health care bill should not be too worried about getting people coverage.

Rather, the Republican bill and President Trump are focued on getting people affordable health care, Office of Management and Budget Director Mick Mulvaney told ABC News chief anchor George Stephanopoulos.

The bill actually helps a great many people, Mulvaney said on "This Week" on Sunday. It helps people get health care instead of just coverage.

Preliminary analyses from Brookings Institution and Standard and Poors estimate that six to 15 million people could lose coverage under the Republican proposal for repealing and replacing the Affordable Care Act known as Obamacare.

We think its going to be even better than Obamacare because the truly indigent are still getting care, and people with an income level just above the Medicaid limit will receive refundable tax credits, Mulvaney said.

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Trump budget chief: President is focused on health care, not insurance coverage - ABC News

5:03 a.m. ET March 12, 2017

Several signs were seen at the Save My Care Bus Tour healthcare rally at the Statehouse. The two-month nationwide bus tour, which is making stops across the U.Ss, protests efforts by Congressional Republicans and President Donald Trump to repeal the Affordable Care Act.(Photo: Kelly Wilkinson/IndyStar)Buy Photo

Many questions surround the introduction of a Republican health-care plan this week in Congress, and its likely to take months to address them all. But one question that members of Indianas congressional delegation must insist on getting an answer to promptly and thoroughly is the fate of the Healthy Indiana Plan.

Launched in 2008 and rebooted as HIP 2.0 in 2014, the plan now covers more than 300,000 Hoosiers. It was a hallmark success of both the Mitch Daniels and Mike Pence administration, and has been billed as a possible model for national health-care reform.

Yet, the new Republican plan could substantially reduce Indianas ability to help low-income Hoosiers with access to health care.

Under the new proposal, states would receive a capped-amount of federal dollars to spend on Medicaid. That makes sense in trying to bring the bloated federal budget under control, but it also is likely to force states to make difficult choices about who is eligible for coverage as well as what procedures are covered.

Adding to the pressure on the states is a plan to eventually end federal funding for the expansion of Medicaid, one of the core provisions of the Affordable Care Act. Those federal dollars have helped drive the rapid growth of HIP 2.0 in recent years.

Among the questions facing Gov. Eric Holcomb and state lawmakers is how much of the health-care costs for low-income citizens will be shifted to the state. Will Indiana be forced either to pour substantially more money into Medicaid coverage or to raise the bar on eligibility? Will reimbursement rates for doctors and hospitals be reduced? If that happens, will providers decide to stop accepting Medicaid patients?

Indianas representatives on Capitol Hill especially Reps. Susan Brooks, Larry Bucshon and Jackie Walorski, who serve on key House committees that will review the Republican plan need to press for clear answers.

Now that Congress and a new president are set to repeal and replace the ACA, its essential that we dont revert to the days when far too many citizens were excluded from the health-care system.

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Editorial: Don't undercut Hoosiers' health care - Indianapolis Star

The Congressional Budget Office is expected to issue its cost analysis of the House Republicans' Obamacare repeal bill on Monday. The White House and congressional Republicans are already downplaying the importance of the score. Subpar results could hinder efforts to fast-track the legislation through both houses on Capitol Hill.

The plan has come under fire from both sides of the aisle since it debuted Monday. Conservative groups and industry stakeholders have voiced their opposition. Republican senators say it probably can't pass their chamber. And Democrats, of course, oppose any partisan efforts to dismantle their flagship Affordable Care Act.

Related: What CBO got right -- and wrong -- on Obamacare

Related: Groups lining up in opposition to GOP health care plan

2. Fed rate hike? Markets seem to think it's a given that the Federal Reserve will raise interest rates Wednesday.

Federal Reserve Chairwoman Janet Yellen has said the Fed will move on a March rate hike if the economy stays on track. Friday's robust jobs report has made a bump all but certain.

The Fed last raised rates in December -- only the second time it's done so in about a decade. Most Fed leaders have forecast three or more rate hikes in 2017.

Related: Yellen signals March rate hike would be 'appropriate'

Related: U.S. economy added 235,000 jobs in Trump's first full month

3. Revised travel ban goes into effect: President Trump's revised order limiting travel from six Muslim-majority nations goes live on Thursday.

The scene at U.S. airports will probably be more orderly. But noise surrounding the ban's second iteration is ramping up. A federal judge will hear a lawsuit filed by Hawaii on Wednesday. Washington, Minnesota, Massachusetts, New York and Oregon are also asking a federal judge to block it.

More than 100 companies supported the legal fight against Trump's initial order. Many executives have maintained their opposition this go-round. That's particularly true in the tech industry, in which hiring immigrants is common practice.

Related: Federal judge to hear first lawsuit against new travel ban

Related: These 127 companies are fighting Donald Trump's travel ban

4. SXSW melee: Big ideas mega-conference South by Southwest kicked off in Austin, Texas, on Friday, and the action continues throughout the week.

Tech and media luminaries will rub elbows with a diverse cross-section of influencers at the event's panels and parties. Representatives from Alphabet (GOOG), Amazon (AMZN, Tech30), Facebook (FB, Tech30), Netflix (NFLX, Tech30), Lyft will all be in attendance.

5. Coming this week:

Monday - CBO releases score for House Republicans' health care bill

Tuesday - Fed meeting kicks off

Wednesday - Fed expected to announce rate hike; Labor secretary hearing; U.S. debt ceiling suspension expires

Thursday - Trump travel ban takes effect; OMB releases spending cut proposals

Friday - Steven Mnuchin attends G20 meeting

CNNMoney (New York) First published March 12, 2017: 8:01 AM ET

Originally posted here:

Health care bill gets a price tag; Fed weighs rate hike; SXSW buzz - CNNMoney

The bill probably can be fixed, but its going to take a lot of carpentry on that framework, Cotton said. | AP Photo

The House legislation to repeal and replace Obamacare would not only fail in the Senate but could also ruin Republicans' reelection efforts in 2018, Arkansas Sen. Tom Cotton said Sunday.

The bill probably can be fixed, but its going to take a lot of carpentry on that framework, Cotton told host George Stephanopoulos on ABCs This Week. As its written today, this bill in the House of Representatives cannot pass the Senate. And I believe it would have adverse consequences for millions of Americans. and it wouldn't deliver on our promises to reduce the cost of health insurance for Americans.

Story Continued Below

Cotton is among a number of Republicans who have expressed opposition to the Houses plan to replace former President Barack Obamas Affordable Care Act. House leaders unveiled their plan, the American Health Care Act, last week, and it has already been marked up and advanced through two committees as leaders move to send the legislation to the Senate and President Donald Trumps desk before a congressional recess in April.

Cotton, however, warned fellow Republicans in the House not to acquiesce to a plan they dont support.

I would say to my friends in the House of Representatives with whom I serve, Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote, he said.

The Arkansas senator advised the House to slow down and resolve issues with regard to Medicaid and the individual insurance markets before the measure reaches the Senate.

I'm afraid that if they vote for this bill, they're going to put the House majority at risk next year, he said. I just do not think that this bill can pass the Senate. And, therefore, I think the House should take a pause and try to get as close as we can to a good result before they send to it the Senate.

Originally posted here:

Cotton warns House GOP about health care bill - Politico

Gary Cohn, President Trumps chief economic adviser, said Sunday that Trump is open to negotiating with House conservatives who are demanding changes to the current GOP health care proposal.

The president has been very open and transparent on the issue, Cohn told Fox News Sunday host Chris Wallace.

He has been willing to accept improvements to the bill. Weve gone out of our way, and the president has said this, to say that anything that makes the bill better for Americans, we are willing to accept.

Some demands include an end the expansion of Medicaid by 2018 instead of 2020, and the removal of insurance mandates that provide certain benefits such as maternity care.

Cohn on Sunday also defended the bill, saying it provides Americans with health insurance coverage.

We believe if you want to have coverage, and we believe everyone should have coverage, were providing you access to coverage, Cohn added.

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Adviser: Trump willing to accept improvements to healthcare proposal - The Hill

Pence cast the current debate over health care as the best chance Republicans have to repeal and replace Obamacare, President Barack Obama's sweeping 2010 health care law, and said the administration needs all Republicans to be with them in this effort.

"For us to seize this opportunity to repeal and replace Obamacare once and for all, we need every Republican in Congress, and we are counting on Kentucky," Pence said. "President Trump and I know, at the end of the day, after a good a vigorous debate, we know Kentucky will be there, and we will repeal and replace Obamacare once and for all."

The comment was a not-so-subtle reminder to Republicans such as Kentucky Sen. Rand Paul, who has been openly critical of the proposed bill. Pence, speaking at Trane Parts and Distribution Center in northern Kentucky, specifically called out Republican lawmakers who stood with the administration, including Senate Majority Leader Mitch McConnell, also of Kentucky. Pence did not mention Paul.

When asked whether the event was meant as a challenge to Paul, a Pence aide demurred, saying it was no different than the vice president's other events.

"(Pence) will talk about the efforts that are underway to bring people together," the aide said about the vice president's work to win over conservatives. "I think he uses his relationships, and he obviously has longstanding relationships with folks. He understands the legislative process, so he views that as an opportunity to help work on the President's agenda and ushering it through Congress."

Kelsey Cooper, state communications director for Paul, said Paul "is glad to have Vice President Pence in Kentucky today to address healthcare reform, and looks forward to continuing to work with the administration and Congress for a real repeal of Obamacare and replace it with conservative market-based solutions that will bring down prices and give families more choices."

Trump, Pence and their administration have stood fully behind the Republican health care plan despite concerns raised by conservative lawmakers. The GOP proposal has not enjoyed a smooth rollout, but White House aides hope Pence will be able to argue confidently why repealing and replacing Obamacare is best done with this proposal.

The event is a continuation of Pence's health care road show, which has included Missouri, Wisconsin and Ohio. But unlike past events, this time the vice president came armed with a health care plan to sell.

Before addressing a small audience the Trane Parts and Distribution Center in Northern Kentucky, Pence headlined a roundtable discussion with business leaders from the area, where he fielded questions about how the health care law could impact their businesses.

"Most importantly of all, the top priority the President gave us: to work with members of Congress and make sure that the Obamacare nightmare is about to end," Pence said before laying out the issues he said he believes Obamacare caused, including rising premium costs and counties where only one insurer is left offering coverage.

"Folks, this can't continue," he said. "And I promise you, it won't."

Not all Republican are fully on board, though, including Republican Kentucky Gov. Matt Bevin, who attended Saturday's event with Pence.

Speaking with reporters on Friday, Bevin aligned himself with Paul in a subtle knock on the administration's plan.

"Sen. Paul has ideas of things he thinks need to be a lot stronger," Bevin said. "He's not as impressed with what has currently been offered as some who have currently offered it. Truth be told, I'm not either, so I'm with him. I think there are things that need to be done."

Bevin later said he was looking forward to the conversation, but the symbolism was already clear: The Trump administration's health care proposal is controversial enough among some conservatives that even the people appearing with the vice president to sell the bill are expressing skepticism about it.

"Of course there is disagreement as to what we should do with it," Bevin said Saturday. "This is America. Americans have opinions. There is a catastrophe that has been hoisted upon the American people, known as the Affordable Care Act. It has been anything but."

Conservatives were not the only critics following Pence to the Bluegrass State.

Several Democratic groups, including Save My Care, Indivisible and Black Lives Matter, protested Pence's visit, saying they would "stand against Republicans' bill to take away health care from millions."

The protest is part of the Save My Care Bus Tour, a two-month trip aimed at galvanizing support against the Republican health care plan.

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Pence applies subtle pressure to conservatives considering bucking Trump on health care - CNN

US president Donald Trump is in sell mode, and plans to throw his full deal-making prowess behind the new healthcare bill designed to replace Obamacare in coming weeks, the White House said this week.

The president is very proud of the product we have produced, White House press secretary Sean Spicer told a packed press briefing on March 7.

Since then, Trump has hosted Tea Party and traditional Republicans at the White House, dined with Ted Cruz and Cruzs wife, and offered a dark message about Obamacare to Americans in his weekly address, warning The law is collapsing around us. Bowling appears to be a key part of the charm offensive, with House Republicans hitting the lanes under the White House this week, and Tea Party ones scheduled to bowl next week.

But opposition is unrelenting. Retirees, doctors, hospitals, right-wing talking heads, conservatives Republicans, Tea Party Republicans, and even Trump campaign booster Breitbart have come out against the bill. They all want changes, but sometimes diametrically opposed ones.

Sure, other White House-backed bills introduced in Congress have faced stiff bi-partisan opposition in recent history, and still passed. The TARP bill, for example, which bailed out the USs big banks at the end of George W. Bushs term, was ultimately backed by an unexpected number of Republicans. But they made it plain at the time that decision was to avoid an absolute calamityan economic slump the likes of which we have never seen, as Republican leader John Boehner said after the vote.

Thats not the case here. Despite the Trump teams insistence that Obamacare is failing, the uninsured rate in the US is at an all time low of 10.9%, and a majority of Americans would like to see the health insurance system remain as it is. The new healthcare bill will need 218 votes to pass the 435 seat House and the vote is expected to be a nailbiter. Then it goes to the Senate, where if it loses more than three of the 52 Republicans in the Senate it will not pass. And before it goes to Trumps desk to be signed, it needs to go back to the House, which needs to approve changes in the Senate.

Heres why so many people are against it.

While it is no surprise that Democrats dont like a bill that tears down former Democratic president Barack Obamas legacy, their disgust with its replacement, which will cut $600 billion in taxes on the wealthy while potentially increasing the cost of health insurance for many Americans, has sparked new levels of condemnation of the Trump administration.

Joe Kennedy III, a representative from Massachusetts, berated Paul Ryan in the House just after midnight on March 8 for suggesting the plan was an act of mercy and calling it an act of malice instead. Nearly 8 million people have viewed Kennedys remarks on Facebook so far.

There is no mercy in a systems which makes healthcare a luxury, Kennedy said.

The American Medical Association, a group of nearly 225,000 physicians, issued a letter to Congressional leaders on March 8, saying it cannot support the bill as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations. The letter went on:

As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensiveif not out of reachfor poor and sick Americans.

The group spent $19 million lobbying in 2016, and is a key donor to many regional political campaigns.

Both the American Hospitals Association and The Federation of American Hospitals, which collectively represent over 6,000 hospitals, are concerned about the plans effect on Medicaid. It would reduce enhanced funding levels to Medicaid that 31 states rely on to extend health coverage to the poorest Americans, by banning new enrollments after December 2019, and by capping the amount states can spend on individual Medicaid recipients.

The effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, the AHA said in a letter to Congress.

We want to make sure that whatever comes out of this change really supports particularly those low-income Americans, who frankly dont have the resources to afford coverage, said Chip Kahn, CEO of the Federation of American Hospitals.

Four Republican Senators have already vowed not to support the bill as written. They, too, are worried about the Medicaid reductions.

We are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states, they wrote in a letter to Senate Majority Leader Mitch McConnell.

The American Association of Retired Persons, the USs largest nonprofit with about 38 million members, quickly dubbed the provisions in the bill that give tax credits based on age and not income an age tax.

In a letter to Congress, the nonprofit estimated premiums for current coverage could increase by up to $3,200 for a 64 year old. The AARP spent over $8 million lobbying in 2016.

The white nationalist website Breitbart has dubbed the new healthcare plan Obamacare 2.0 and slammed it for failing to fully repeal Obamacare, while Coulter, the anti-immigrant talk show circuit regular, asked on Twitter What are names of the brain trust that wrote this piece of crap? Coulter did not explain why she thought the bill was so bad, but has espoused free market health care in the past, which seems to mean no government involvement at all.

Tea Party politicians, which hold 48 House seats (and four in the Senate), want exactly the opposite of traditional Republicans: theyre say the plan doesnt get rid of the Medicaid expansion that made Obamacare work fast enough, and they do not support the tax credits included for lower-income Americans.

After a meeting at the White House, at least one Tea Party group sounded an optimistic note, though. We believe we can get to yes on the bill and throw Obamacare into the dustbin of history, said Adam Brandon, president of FreedomWorks, a DC-based libertarian advocacy group.

Despite the opposition, Trump remains upbeat. We have some great results. We have tremendous spirit, Trump said on Friday. And I think its something that is just going to happen very shortly.

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Trump's health care bill is the first true test of his powers as salesman-in-chief - Quartz

It took former President Barack Obama and his Democrats more than a year to pass the Affordable Care Act, a slow and painstaking process that allowed plenty of time for a fierce backlash to ignite, undermining the law from the very start.

Republicans are trying to avoid that pitfall as they attempt to fulfill years' worth of promises to repeal and replace Obama's law.

After going public with their long-sought bill on Monday, House Republicans swiftly pushed it through two key committees. They hope to pass the legislation in the full House during the week of March 20 before sending it to the Senate and then, they hope, to President Donald Trump all before Congress can take a recess that could allow town hall fury to erupt.

Democrats are crying foul, accusing Republicans of rushing the bill through before the public can figure out what it does. Republicans dispute the criticism, arguing that their legislation enshrines elements of a plan House Republicans worked on for months last year and campaigned on under House Speaker Paul Ryan, R-Wis.

"We offered it up in June. We ran on it all through the election. And now we've translated it into legislation," Ryan said.

Yet after seven years of Republican promises to undo Obama's signature health law and without ever uniting behind a plan to achieve that, the fact that they produced a bill at all came as something of a surprise.

And now, after months of confident predictions that Republicans would not be able to get their act together on health care, Democrats find themselves wondering anxiously whether the GOP could actually succeed in wiping away those arduous months of work from the dawn of the Obama administration.

"Nobody believed Republicans had a bill," said the No. 2 House Democrat, Steny Hoyer of Maryland, "until Monday night."

It's a far cry from eight years ago, when Democrats held countless hearings and debated at length, in public and private, how to enact the most significant changes to the nation's health care system in a generation.

While Republicans are not trying for bipartisan support on their repeal bill, Democrats spent arduous months in the Senate with a bipartisan working group of three Republican and three Democratic senators, known as the Gang of Six, trying to agree on a bipartisan bill. That effort ultimately failed.

The GOP legislation is 123 pages long. The Affordable Care Act rang in at more than 900 pages.

"We held hearings and we just spent seemingly endless hours working it over very different from what the Republicans are doing," said Rep. Sander Levin, D-Mich.

To be sure, creating an enormous federal program requires more time and effort than jettisoning some pieces of an existing one while replacing others with new, or in some cases retooled, conservative-friendly solutions.

The GOP legislation would eliminate the current mandate that nearly all people in the United States carry insurance or face fines. It would use tax credits to allow consumers to buy health coverage, expand health savings accounts, phase out an expansion of Medicaid and cap that program for the future, end some requirements for health plans under Obama's law, and scrap a number of taxes.

Republicans have proceeded thus far without official estimates on how much the bill will cost or how many people will be covered, though it's expected to be millions fewer than under Obama's law. The Congressional Budget Office estimates are expected Monday, and that could affect Republicans' chances.

Despite the momentum claimed by GOP leaders and the White House, deep divisions remain in their party. Conservatives argue that the legislation doesn't do enough to uproot the law. Other Republicans express qualms about the impact on Medicaid recipients in their states. Some Republicans accuse Ryan and House GOP leaders of moving too quickly.

"We should have an open process, we should allow all of the members to amend legislation, within reason," said GOP Rep. Justin Amash of Michigan, a perennial leadership foe.

But Democrats paid a price for their lengthy process, and there was second-guessing even then over the length of time Obama allowed the Senate's Gang of Six group to spend in its ultimately fruitless quest. As the months dragged on, public opposition grew. Over Congress' August recess in 2009, that rage overflowed at town halls that spawned the tea party movement, which would take back GOP control of the House the next year.

There's little question that if the GOP process were to drag out for months, especially over a long congressional recess, a similar dynamic could emerge, especially given the consumer and senior groups that have lined up against the legislation and the energized Democratic base already on display at marches and town halls this year.

If Republicans succeed in shoving the bill through this month, such opposition will have less time to make itself known.

Instead, even some congressional Republicans are expressing some amazement at finding themselves, eight years later, undoing the law Democrats forged through those many months of turmoil and debate.

"I'm pleasantly surprised," said GOP Rep. Joe Wilson of South Carolina, who gained notoriety for yelling "You lie!" at Obama during a health care speech to Congress in 2009.

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GOP acts fast on health care, aims to avoid ire Dems faced - ABC News

WASHINGTON As House Republicans prepare to bring their health care proposal to the floor, conservatives are demanding a slate of major changes that they say are necessary to bring them on board and, ultimately, pass the bill.

According to members familiar with negotiations among the House Freedom Caucus, GOP leadership and the White House, conservatives are still demanding that the rollback of the Medicaid expansion begin in 2018, not 2020, as currently written in the Republican bill.

House Republican leaders have been emphatic that they cant move up that date, and White House Press Secretary Sean Spicer said Friday that the 2020 date to begin the Medicaid expansion phaseout was what President Donald Trump supported.

Its not a question of negotiation, Spicer said.

But, based on their own conversations with the White House, conservatives believe it is still a question of negotiation.

We had tremendous conversations with the president a couple of times yesterday, Freedom Caucus Chairman Mark Meadows (R-N.C.) said Friday, and we found him to be not only willing to negotiate, but a desire to really make this bill the very best it can be. His willingness to find common ground shows why The Art of the Deal is not just a distant memory of a previous life.

Meadows was joinedin the White House meetingsThursday by former HFC Chairman Jim Jordan (R-Ohio), who also noted the receptiveness of the president to strike a deal.

Were still working on those changes that we think would make this bill consistent, Jordan told The Huffington Post on Friday, adding that they hadnt settled on any of their negotiations.

But based on conversations with members familiar with the negotiations, in addition to the Medicaid timeline, conservatives also want to allow insurance companies to offer plans that dont meet the coverage standards of the Affordable Care Act, which means plans could have higher deductibles or offer gaps in coverages for lower premiums.

The Republicans legislation already does some of this by repealing the rule mandating that plans cover at least 60% of medical expenses. There is some concern that other provisions on coverage would break the reconciliation status of the bill, which means those provisions would take 60 votes in the Senate to pass, but members want to look for ways to increase the number of insurance mandates and rules that could be repealed while still not violating that so-called Byrd rule.

Freedom Caucus members also want to allow people to use health savings accounts to pay their premiums, instead of just using them for deductibles and other out-of-pocket medical costs. Making that change would introduce an element of a plan by Sen. Rand Paul (R-Ky.) and Rep. Mark Sanford (R-S.C.) to allow tax-free dollars to be used to pay for insurance, which would not quite blow up the entire current GOP bill.

Finally, members want a 20-hour work requirement for able-bodied adults who are on Medicaid. That would further cut some Medicaid costs, but the idea seems based more on stereotypes than on potential savings. Thevast majority of people on Medicaid are ill, in school, already working or looking for work.

Freedom Caucus members still havent given up on overhauling a linchpin of the bill the advance refundable tax credits but some members now acknowledge that major changes to the basis of the replacement language would pretty much amount to Republicans starting over, which doesnt look apt to happen.

Still, one caucus member noted that if Republicans were willing to negotiate on the tax credits, there would be a universe of items that conservatives could give up in exchange, perhaps even lengthening the term of the Medicaid expansion past the 2020 date.

If Republicans actually adopted the changes conservatives are advocating for, however, it would instantly present the House with vote problems from moderates and even more problems in the Senate.

Rep. Charlie Dent (R-Pa.), the chairman of the moderate Tuesday Group, told HuffPost on Friday that if Republicans moved up the Medicaid expansion phaseout, it would be a big problem, and he indicated that a strong majority in the House probably every Democrat and a number of Republicans would oppose that change. If theres that discussion, they should allow an amendment on the floor to resolve the issue.

The problem for House leaders is that even if Republicans agreed to the conservative wish list, there still would be Freedom Caucus members voting against the bill.

HFC member Scott Perry (R-Pa.) noted on Friday that everyone knows there are some conservatives who are going to oppose the bill. But I think some members are more flexible, Perry said, adding that leaders needed to show some good faith and make changes that are meaningful and impactful.

Among the conservatives who appear unwilling to negotiate are Justin Amash (R-Mich.), who is upset with just about every facet of the bill and the process for the legislation, and his non-HFC buddy Thomas Massie (R-Ky.), who has taken to calling the legislation a stinking pile of garbage.

My calls are running 30 to 1 to oppose it, Massie said Thursday night.

Massie went on to ridicule House Speaker Paul Ryans three-pronged approach to repeal and replace, which involves passing this reconciliation bill, letting Health and Human Services Secretary Tom Price handle some aspects administratively and then passing other bills (with a challenging 60-vote threshold in the Senate) to address health care costs.

Theres three baskets: Theres the repeal-and-replace basket, theres the Tom Price basket and the Easter basket, Massie said.

And there are other hard-line right members who look apt to oppose any bill resembling this plan if it maintained the 2020 date for rolling back Medicaid. Rep. Paul Gosar (R-Ariz.) told HuffPost on Friday that Republicans shouldnt agree to any Medicaid expansion whatsoever, and Rep. Scott DesJarlais (R-Tenn.) suggested he couldnt support any measure that didnt address the expansion until after 2018.

Which is all to say, even if Republicans adopted the other changes conservatives wanted, without the most contentious modification, the Medicaid expansion date, there would still be a group of Republicans who would probably oppose the measure. And if Republicans did change the date of the Medicaid expansion, they would face a mutiny from moderates.

Conversely, if House GOP leadership continued to refuse to negotiate, they could probably still pick off a number of Freedom Caucus members, who are not united in their opposition to the bill.

Rep. Ted Poe (R-Texas) told HuffPost this week that the tax credits were a positive step, and his fellow Freedom Caucus Texan, Joe Barton, already supported the most contentious provisions in the Energy and Commerce Committee.

Barton actually had an amendment in committee to shorten the time on the expansion, but he withdrew it when Energy and Commerce Chairman Greg Walden (R-Ore.) asked, though Barton noted Friday he had a green light to offer it for floor consideration.

On the one hand, Freedom Caucus members hope their negotiations lead to floor votes on their demands, but on the other hand, they worry House leadership will rally members against their amendments.

We dont want anybodys thumb on the scale, Perry said this week. We want an honest run at the thing.

If we lose, I guess well have to determine how that factors into our decision. But if we lose an unfair fight, thats going to be problematic.

Jeffrey Young and Jonathan Cohn contributed reporting.

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Conservatives Craft Their Wish List On The GOP Health Care Bill - Huffington Post

If the GOPs proposed American Health Care Actwere to pass, companies with 50 or more employees will no longer have to offer health insurance the most common source of coverage for people under age 65.

Even if this iteration of a so-called replacement for Obamacare goes nowhere in Congress, the employer health care provision could creep back into a final version. This has barely been mentioned so far in the heated conversation about the Republican plan. But its worth examining, because it could cause a sea change in how the nations health care delivery system operates, according to industry experts.

Companies began providing workers with health insurance voluntarily after World War II because of the tax advantages.By the mid-1960s,employer-provided health insurance was pretty much universal. It was an affordable benefit for companies, and a valuable recruitment tool. But as health care costs increased and employees began to switch jobs more regularly, the system eroded.Obamacare put a mandateon the practice, requiring companies with 50 or more full-time workers to offer health care to avoid a tax.

The nonpartisan Congressional Budget Office estimates that in 2016, about 155 million people (or about 57 percent of the population under age 65) got health coverage through their job, or a family members job. Thats an awful lot of us.

Most people just assume that companies dont need to be told to give their workers health insurance they are motivated by tax incentives and a desire to attract the best talent. And, as many point out, employers were offering health benefits voluntarily long before Obamacare made it a mandate. Why would they change just because Republicans remove the requirement?

Because it costs too much.

Those who study corporate benefits say that health insurance as an employee perk has been on the decline for years, with companies shifting more of the cost onto workers. This trend could accelerate by removing Obamacares mandate. The underlying cause is that health care costs have been rising. With higher costs come higher insurance premiums.

The share of Fortunes top companies that still pay for 100 percent of their employee health care dropped to 9 percent in 2016 from 34 percent in 2001. In most cases,employees are covering more of their health insurance premiums than in previous years. Workers with employer-sponsored health plans now contribute an average of 18 percent of the premium for single coverage, and 29 percent for family coverage,according to a study by the Henry J. Kaiser Family Foundation.

Tom Williams via Getty Images

Like most things involving the governments efforts to shape health insurance, theres more than one way to look at employer-sponsored health care. Eliminating the mandate may herald the end of work-based health coverage. Or not. And even if companies opt against providing insurance, that may turn out to be great for workers, if employers replace it with a tax-free stipend that employees can use to shop for benefits on their own.

Here are two ways to look at the future of employer-sponsored health insurance:

Removing the mandate is a very big deal, said Rick Lindquist, co-author of The End of Employer-Provided Health Insuranceand CEO of Zane Benefits, which assists small companies in providing benefits packages to employees. No longer requiring companies to provide insurance would be the beginning of the end of health coverage tethered to our jobs, he told HuffPost.

Before the Affordable Care Actmade it mandatory in 2014, employer-sponsored insurance coverage had been declining anyway, according to the Urban Institute. From 2000 to 2012, coverage rates fell 11 percent, to 69 percent.

Smaller companies that arent required by the ACA to offer insurance those with fewer than 50 employees have also stopped offering health coverage. Coverage rates fell 17 percent, to 52.4 percent during the same period. Its just too expensive, they say. Lindquist said he expects larger companies to follow suit as health care costs continue rising.

Even if the mandate remained, employers find it increasingly enticing to ignore. Its cheaper to pay the fine for not providing coverage than it is to follow the law and provide health benefits, Lindquist said.

He said he envisions a future where employers might provide a fixed amount of tax-free reimbursement for health insurance, and let employees find a plan that best suits them. As long as there are safeguards, like no exclusions for pre-existing conditions or age, workers may end up liking such a system better than what exists now, Lindquist said. Some employees would rather have their compensation be more flexible, and would prefer a raise to comprehensive health coverage, he said.

Ezekiel J. Emanuel, an architect of the Affordable Care Act,shares the view that employer-provided health coverage is doomed. Emanuel,an oncologist, medical ethicist and academic, was a health policy adviser to the Obama administration. He predicted a few years ago that by 2025, fewer than 20 percent of workers in the private sector will receive traditional employer-sponsored health insurance.

Lindquist sees no downside to shifting health insurance away from our jobs. The big losers under such a plan, he said, would be the middlemen insurance brokers who arrange plans for companies.

They dont like it, he said.

The National Association of Health Underwriters the group that represents those brokers notes on its website that the employer-based system is highly efficient at providing American workers and their families with affordable coverage options through group purchasing. Without it, the group says, workers would likely lose a powerful advocate their employer in coverage disputes.

The Kaiser Family Foundationsays employer-sponsored coverage grew to its current dominance because of the tax advantages employers get for providing these plans. That makes providing health coverage cheaper for the company than increasing wages. Plus, a strong health care package is an enticement in recruiting and retaining talent.

But even greater affection for the practice may come from employees. Mercers Inside Employees Minds Surveyin 2015 found that 89 percent of employees regarded health coverage as important as a salary, said Joe Kra,partner and senior health consultant for the global consulting firm.

Employers will continue to respond to cost pressures and look for creative approaches to control cost, Kra said.

That means companies probably will continue to shift more costs onto workers. Even though the Obamacare penalty for not providing coverage was less than the cost of providing it, only 15 percent of employers with up to 499 employees, and just 2 percent of employers with 500 or more workers, said in 2016 that they were likely to terminate coverage within the next five years.

So, if the mandate goes away, Kra said hes not really concerned that employer-provided coverage will end.

Nor is Lydia Frank, vice president at PayScale, a compensation data and software company. She told HuffPost that top companies understand that they need to pay with purpose if they want to keep top-performing employees. Providing health benefits is an important component of the overall package, she said.

With the GOP plan under fire and revisions likely, it behooves those who get health coverage from their jobs to pay attention to what could be waiting for them: a boon or a boogeyman.

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Your Employer-Provided Health Care Could End With The GOP's Plan - Huffington Post

New York Times

Trump Keeps Low Profile After Praising Health Care Overhaul New York Times WASHINGTON President Trump praised House Republican leaders on Friday for their plan to overhaul the Affordable Care Act, but otherwise kept a conspicuously low profile, with a newfound silent treatment of the news media. The president's meeting ... and more »

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Trump Keeps Low Profile After Praising Health Care Overhaul - New York Times

CreditPHOTOGRAPH BY JABIN BOTSFORD / THE WASHINGTON POST VIA GETTY

WASHINGTON (The Borowitz Report)The middle-school student who wrote the Republican health-care bill that was unveiled earlier in the week complained on Friday that he still has not been paid for his work.

Kevin Tenco, a seventh grader from House Speaker Paul Ryans congressional district, in Wisconsin, said that Ryan hired him two weeks ago to write the American Health Care Act with the promise that it wouldnt be too much work and that he would be paid handsomely for his effort.

He said I would get paid, like, five hundred dollars, and I could buy a Nintendo Switch, Tenco said.

Taking Ryan at his word, the thirteen-year-old, from Twin Lakes, Wisconsin, pulled several all-nighters to complete the health-care bill in time for its Monday unveiling.

I basically went to the Wikipedia page for Obamacare, cut and pasted a bunch of stuff and then threw in some tax cuts and whatnot, he said. It doesnt sound like a lot of work, but I was super tired by the end of it.

According to Tenco, Ryans failure to pay him in a timely fashion for writing the American Health Care Act has left him feeling really bad about our government.

I was all set to write an immigration reform bill for Congressman Ryan, but now theres no way, he said.

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Middle-Schooler Who Wrote GOP Health-Care Bill Claims He Has Not Been Paid - The New Yorker (satire)