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.

Read more here:

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

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

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

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)

TRUMPS FIRST 100 DAYS with ABCs RICK KLEIN and VERONICA STRACQUALURSI

Day No. 50

The big story: Here at the halfway point of President Trumps first 100 days, a question looms: Which version of reality to believe? The one where the House is marching toward passing the big new health care plan, with Professor Paul Ryan outlining the way? Or the one where the united force of virtually every conservative policy shop and the House Freedom Caucus kill the bill faster than you can say CBO? Theres another big disconnect: The White House says its still in listening mode, publicly and privately. We're welcoming ideas and thoughts, White House press secretary Sean Spicer said. I didnt hear anything that said its a binary choice at the White House today, said Rep. Mark Meadows, chairman of the Freedom Caucus. But thats not the message from Ryan and company: This is the closest we will ever get to repealing and replacing Obamacare, the speaker said Thursday. For now, theres disagreement on whether this is a real negotiation, not to mention what a compromise from here would even look like.

The sleeper story: Michael Flynn is gone from the Trump administration, but hes not forgotten and with good reason. The disclosure that Flynn was paid more than half a million dollars to lobby on behalf of the government of Turkey work he performed in the run-up and immediate aftermath of the election is a stunner. As his ties to Russian officials continue to be scrutinized, what other foreign lobbying work was he being paid for directly or indirectly as he was about to be tapped to serve as President Trumps national security adviser? Did he disclose any such contracts to the presidents team when his name was under public and private consideration? Moreover, Vice President Mike Pences icy response It is an affirmation of the president's decision to ask Gen. Flynn to resign, he told Fox News Bret Baier on Thursday raises questions about what other aspects of Flynns behavior led to his dismissal. Recall that, after he asked him to go for misleading Pence about his contacts with Russia, the president himself called Flynn a wonderful man who was treated unfairly by the fake media.

The shiny story: EPA chief Scott Pruitt is now on record contradicting his own agency, and surely the vast majority of his employees, in questioning whether carbon dioxide is contributing to global warming. I would not agree that its a primary contributor to the global warming that we see, Pruitt said, falling back on the need to continue the debate and continue the review and the analysis. That may not align fully with what he told Congress at his confirmation hearings. But it should not be the least bit surprising. Pruitt has spent much of his career trying to undermine the core of what he has called the activist agenda of the agency he now leads. The question for career EPA officials as at other agencies that now have radically different leadership is whether they would feel more comfortable staying or going, given the current direction. But no one should truly be shocked by any of this elections, as they say, have consequences.

TLDR: The GOP health care plan has moved through two House panels, but there is a disconnect in the Republican Party of whether itll pass or be killed. And after remaining relatively quiet about the health care bill (except for a tweet yesterday), Trump will be meeting with House Committee chairmen to discuss health care today.

Photo of the day: With rolled-up sleeves and a PowerPoint slideshow, Paul Ryan took on the role of professor instead of House Speaker to explain the GOP plan to repeal and replace Obamacare step-by-step. But what Ryan probably didnt plan for was to fall victim to Photoshop and become a viral meme. (Credit: Dan Amira)

NOTABLES

--FBI Director James Comey meets Congressional leaders on wiretapping, leaks, Russia: FBI Director James Comey traveled to Capitol Hill Thursday to meet with congressional leaders on a number of national security issues, according to senior officials familiar with the situation. Comey was anticipating questions on a range of topics, including the recent WikiLeaks release of purported CIA files, Russian interference in the 2016 presidential election and President Donald Trump's assertion that former President Barack Obama ordered the wiretapping of Trump Tower last year. ABC's PIERRE THOMAS, JACK DATE and BENJAMIN SIEGEL have more: http://abcnews.go.com/Politics/fbi-director-james-comey-meets-congressional-leaders-wiretapping/story?id=46028619

--Inside the Senate GOP resistance to Trumpcare: Just as House Speaker Paul Ryan was rolling up his sleeves to give a presentation on the House Republican Obamacare replacement plan, on the other side of the Capitol, senators offering a full-throated defense of the bill were scarce. The House blueprint, which Ryan referred to as a "three-pronged approach" Thursday, includes some provisions that various Republican factions oppose; most notably, a plan to provide tax credits to individuals, which some critics have said amounts to a new entitlement, and an eventual cap on the amount of Medicaid funding states can receive, which worries some Republicans whose states accepted an Obama-era Medicaid expansion. ABCs ALI ROGIN has more: http://abcnews.go.com/Politics/inside-senate-gop-resistance-trumpcare/story?id=46029688

--The road to repealing and replacing Obamacare: After the House Energy and Commerce Committee and the Ways and Means Committee approved the GOPs health care plan yesterday, ABC's JOHN PARKINSON explains what happens next in the House. While Democrats have worked overtime to frustrate the legislations progress, they appear powerless so far to block its advancement. That privilege will fall to conservatives. http://abcnews.go.com/Politics/road-repealing-replacing-obamacare/story?id=46021299

This Week on This Week: George Stephanopoulos goes one-on-one with White House Office of Management and Budget director Mick Mulvaney, Sunday on This Week. Plus, Sen. Tom Cotton, R-Ark., and House Intelligence Committee ranking member Rep. Adam Schiff, D-Calif., come to This Week. And the Powerhouse Roundtable debates the week in politics, with National Review editor Rich Lowry, Democratic strategist Jamal Simmons, Republican pollster and ABC News contributor Kristen Soltis Anderson, and editor and publisher of The Nation Katrina vanden Heuvel.

Speed read with ABC's ABCs ADAM KELSEY

The 3 key provisions in the GOP health care bill that cause experts concern. Several health care industry experts have expressed serious concerns about three key areas of the Republican health care bill unveiled this week, proposed as a replacement for the Affordable Care Act (ACA), also known as "Obamacare." Some doctors and hospital groups worry that people with lower incomes or who are closer to retirement age would be likely to receive fewer tax credits from the government to help them buy their own insurance than they do through current ACA subsidies, writes ABC's MARYALICE PARKS. http://abcnews.go.com/Politics/key-provisions-gop-healthcare-bill-experts-concern/story?id=45991248

Spicer's rebuke puts spotlight on Congressional budget office amid GOP health care battle. White House press secretary Sean Spicer leveled stinging criticism against the nonpartisan Congressional Budget office Wednesday, assailing its accuracy amid Democratic complaints that the agency would not have an opportunity to review the new health care legislation before a vote. "If you're looking to the CBO for accuracy, you're looking in the wrong place," said Spicer. "They were way, way off last time in every aspect of how they scored and projected Obamacare." ABC's ADAM KELSEY has more: http://abcnews.go.com/Politics/spicers-rebuke-puts-spotlight-congressional-budget-office-amid/story?id=46017070

What the 400 additional US troops in Syria are up to. The addition of 400 Marines and Army Rangers to Syria will increase the number of American troops inside the country to 900, according to U.S. officials. Several hundred Marines have arrived in Syria to provide artillery support to U.S.-backed Syrian rebels preparing to retake Raqqa, ISISs de facto capital in Syria, a U.S. official said Wednesday. Last weekend, a contingent of Army Rangers arrived in Manbij to essentially act as a visible presence to prevent the Turkish military and Kurdish forces from fighting each other in the city retaken from ISIS months ago, explain ABC's LUIS MARTINEZ and ELIZABETH MCLAUGHLIN. http://abcnews.go.com/International/400-additional-us-troops-syria/story?id=46020582

Government ethics office 'concerned' over White House decision not to discipline Kellyanne Conway. The director of the Office of Government Ethics said he is "concerned" over the White House's decision not to discipline Kellyanne Conway for promoting Ivanka Trump's brand in a television appearance. In a letter to White House deputy counsel Stefan Passantino, OGE director Walter Shaub said the White House failed to discipline Conway despite conduct that may have violated a federal ethics rule prohibiting "using one's official position to endorse any product or service," ABC's ALEXANDER MALLIN notes. http://abcnews.go.com/Politics/government-ethics-office-concerned-white-house-decision-discipline/story?id=46026063

ACLU files complaint against Jeff Sessions. The American Civil Liberties Union on Wednesday filed an ethics complaint with the Alabama State Bar against U.S. Attorney General Jeff Sessions for testimony he made about Russian officials during his confirmation hearing, ABCs TOM KUTSCH reports. Mr. Sessions made false statements during sworn testimony on January 10, 2017, and in a subsequent written response to questions on January 17, 2017, the complaint reads. http://abcnews.go.com/Politics/aclu-files-complaint-jeff-sessions-russia-testimony/story?id=46036263

Sessions: Guantanamo Bay 'a very fine place' for terror suspects. During an interview Thursday with conservative radio host Hugh Hewitt, Attorney General Jeff Sessions was asked if either he or President Trump intend to shut down the facility. "Well, I have not favored that," Sessions said. "I've been there a number of times as a Senator, and it's just a very fine place for holding these kind of dangerous criminals. We've spent a lot of money fixing it up. And I'm inclined to the view that it remains a perfectly acceptable place. And I think the fact that a lot of the criticisms have just been totally exaggerated." ABCs DAVID CAPLAN has more: http://abcnews.go.com/Politics/jeff-sessions-guantanamo-bay-nice-place-holding-terror/story?id=46035561

Tillerson steps away from possible pipeline decisions. Secretary of State Rex Tillerson, who previously served as the CEO of oil and gas giant ExxonMobil, has recused himself from any decisions regarding the Keystone XL oil pipeline, according to ABCs CONOR FINNEGAN. In a letter sent to the environmental group Greenpeace Thursday, a State Department deputy legal adviser writes that Tillerson decided to recuse himself in early February...from working on issues related to TransCanada's application for a presidential permit for the proposed Keystone XL pipeline." http://abcnews.go.com/Politics/tillerson-steps-pipeline-decisions/story?id=46030356

Pence: Turkey lobbying 'an affirmation' of decision to fire flynn. Vice President Mike Pence called revelations that former national security adviser Michael Flynn's lobbying efforts may have benefited Turkey an "affirmation" that President Trump was right in firing him. Flynn's lobbying firm, Flynn Intel Group, did lobbying work in the months leading up to his White House appointment that may have benefited the Turkish government, according to a filing made on Tuesday, ABCs KATHERINE FAULDERS and JORDYN PHELPS report. http://abcnews.go.com/Politics/vp-pence-turkey-lobbying-affirmation-decision-fire-flynn/story?id=46029263

WHOS TWEETING?

@markknoller: It's Day 50 of his presidency. He last responded to a few questions from reporters 8 days ago; last interview 11 days ago.

@oliverdarcy: The Marine Corps' nude photo-sharing scandal is even worse than first realized, @PaulSzoldra reports http://www.businessinsider.com/nude-photo-marine-corps-pentagon-scandal-2017-3

@mj_lee: Nobody wants this GOP Obamacare bill named after them. Just asked Kevin Brady what he thinks of the names "Trumpcare" and "Ryancare."

@GlennKesslerWP: @realDonaldTrump has been president for 50 days. In that time, he has made 219 false or misleading statements. https://www.washingtonpost.com/graphics/politics/trump-claims/

@bgittleson: Trump is holding a CAMPAIGN rally in Nashville next Wednesday: https://www.donaldjtrump.com/schedule/

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The Note: Health care disconnect - ABC News

The Republican health care overhaul faces opposition from many in the medical establishment. J. Scott Applewhite/AP hide caption

The Republican health care overhaul faces opposition from many in the medical establishment.

The Republican health care overhaul working its way through the House is opposed by Democrats and by many Republican conservatives. It's none too popular with the people on the front lines of health care, either including doctors, nurses and hospitals.

The chief medical officer of Medicaid, Dr. Andrey Ostrovsky, tweeted out his opposition on Wednesday. "Despite political messaging from others at HHS, I align with the experts ... in opposition to #AHCA," the career staffer said.

Ostrovsky, who has been in his current job since September, has received praise from former Obama administration officials for speaking out.

Former Medicare and Medicaid chief Andy Slavitt called Ostrovsky a "hero."

Trump's Health and Human Services secretary, Tom Price, has been out front with other Republican leaders pitching the new bill. In a press briefing on Wednesday, he said the administration will be looking at Affordable Care Act regulations "and make certain that if they help patients, then we need to continue them. If they harm patients or increase costs, then obviously they need to be addressed."

The organizations Ostrovsky cited in his tweet that have voiced concerns are the American Academy of Family Physicians, the American Academy of Pediatrics and the American Medical Association.

The AMA sent a letter to congressional leaders saying it was unable to support the GOP bill largely due to the "expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations."

Among other things, the AMA cited the proposed rollback of Medicaid expansions that happened under the Affordable Care Act, which the group called "highly successful in providing coverage for lower income individuals"; the proposed repeal of the Prevention and Public Health Fund, also established by Obamacare; and provisions targeting Planned Parenthood.

In a similar letter, the American Nurses Association said the Republican plan "threatens health care affordability, access, and delivery for individuals across the nation." It points to changes the bill would make to Medicaid and says the measure "restricts million of women from access to critical health services." The ANA says the proposed changes "in no way will improve care for the American people."

The American Hospital Association also weighed in, pointing out the Congressional Budget Office has yet to provide a cost estimate for the measure or say how it would change coverage levels. Without such analysis and "needed transparency," the group said, Congress "should wait" before proceeding.

It also points to the proposed restructuring of Medicaid, saying it will "have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care."

The opposition to the GOP plan from health care groups, who say its provisions need to be more generous, puts GOP leaders in a quandary. On the other side of the equation, conservative House members are opposing the measure because they believe it is too generous and doesn't go far enough to repeal subsidies in the Affordable Care Act.

The bill's authors have responded to the criticism. "There's a pretty big the medical-industrial complex in America," Rep. Greg Walden of Oregon, chairman of the House Energy and Commerce Committee, told reporters. "And when you touch it, I've discovered, it touches back."

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Medical, Hospital Groups Oppose GOP Health Care Plan - NPR

Are You Middle Class Enough to Deserve a Health Care Tax Break? New York Times My guess is that a majority of us would agree that health care is a bit more important than retirement savings and I.R.A.s, which in turn are more important than mortgage interest deductions for most people's long-term financial security. Encouraging ... and more »

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Are You Middle Class Enough to Deserve a Health Care Tax Break? - New York Times

New York Times

The Republican Health Care Crackup New York Times Members and staff members on the House Energy and Commerce Committee finishing amendments to their portion of a health care bill on Thursday. Credit Stephen Crowley/The New York Times. The Republican health care bill could represent the moment ... and more »

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The Republican Health Care Crackup - New York Times

What to Know

Get the top headlines of the day in your morning briefing from NBC 4 New York, Monday through Friday. Sign up for our newsletterhere.

GOP Claims Momentum as Health Bill Clears Hurdles

Republican leadersdrove their long-promised legislation to dismantle Barack Obama's health care law over its first big hurdles in the House, claiming fresh momentum despite cries of protest from right, left and center. After grueling sessions, the Energy and Commerce and Ways and Means committees both approved their portions of the bill along party-line votes. The legislation, strongly supported by President Trump, would eliminate the unpopular tax penalties for the uninsured under the Affordable Care Act, replacing Obama's law with a conservative blueprint likely to cover far fewer people but Republicans hope increase choice. "This is the closest we will ever get to repealing and replacing Obamacare," Speaker Paul Ryansaid at a press briefing.

Legal Challenges to Trump's Travel Ban Mount From States

Legal challenges against President Trump'srevised travel banmounted as Washington state said it would renew its request to block the executive order. It came a day after Hawaii launched its own lawsuit, and Washington state Attorney General Bob Ferguson said both Oregon and New York had asked to join his state's legal action. Massachusetts Attorney General Maura Healey said the state is consolidating legal efforts and joining fellow states in challenging the revised travel ban. Trump's revised ban bars new visas for people from six predominantly Muslim countries: Somalia, Iran, Syria, Sudan, Libya and Yemen. It also temporarily shuts down the U.S. refugee program.

2 Die in Protests After South Korean President Ousted

In a unanimous ruling, South Korea's Constitutional Court formally removed impeachedPresident Park Geun-hye, the country's first female leader who rode a wave of lingering conservative nostalgia for her late dictator father to victory in 2012, from office over a corruption scandal that has plunged the country into political turmoil and worsened an already-serious national divide, prompting rowdy protests and celebrations that led to the death of two people. The ruling by the eight-member panel opens her up to possible criminal proceedings and makes her South Korea's first democratically elected leader to be removed from office since democracy replaced dictatorship in the late 1980s.

EPA Chief: CO2 Not Major Contributor to Warming

Environmental Protection Agency AdministratorScott Pruitt saidhe did not believe carbon dioxide was a primary contributor toglobal warming, a view contradicted by NASA and the National Oceanic and Atmospheric Administration, NBC News reported. It is also at odds with Pruitt's own promises during his nomination hearing before the U.S. Senate. But if Pruitt doubts the global scientist consensus that carbon dioxide is causing the Earth to warm, he did pledge during his confirmation hearing to regulate it in accordance with a U.S. Supreme Court ruling and an EPA finding that it was threatening public health.

Can Changing Weather Make You Sick?

Can the weather truly be to blame when you "feel under the weather?" "In a sense, yes,"says Dr. Michael Robinson, a family medicine resident at Louisiana's Lake Charles Memorial Health System. "Thecolder weathercauses people to go inside and be in closer proximity to each other, but as far as just becoming sick, the weather doesn't affect it." That means germs are spreading more indoors when the weather is less inviting outdoors. Still, some viruses replicate more easily in cooler weather, like the agents causing the common cold and influenza that spreads best when the air is cold and dry.

California Wants to Repeal HIV Laws

Exposing a person to HIV is treated more seriously under California law than infecting someone with any other communicable disease, a policy some lawmakers say is a relic of the decades-old AIDS scare that unfairly punishesHIV-positive peoplebased on outdated science. Several lawmakers are promoting a bill that would make it a misdemeanor instead of a felony to intentionally expose someone to HIV, the virus that causes the immune system-weakening disease AIDS. The change would treat HIV like other communicable diseases under California law.

Zuckerberg, Wife Expecting 2nd Girl

Mark Zuckerberg and his wife Priscilla Chan are expecting a second baby girl, theFacebook founderannounced in a post that paid tribute to his and his wife's sisters. In announcing his second daughter, Zuckerbergshared childhood family photosof their families and said what their sisters taught them: "to learn from smart, strong women" in Zuckerberg's case, "the importance of family, caring for others and hard work" in Chan's case.

Nicole Kidman Explains 'Seal Clap' at Oscars

Let's give Nicole Kidman a round of applause. Rather than come up with some excuse for her weird clapping during the 2017 Oscars, the "Lion" actress confirmed her Harry Winston rings were to blame. Kidman, who was nominated for Best Supporting Actress, wore119 caratsworth of Harry Winston diamonds, which included a cluster diamond ring. "It was really awkward!"she saidon "Kyle and Jackie O Show." "I was like, 'Gosh, I want to clap.' I don't want to not be clapping, which would be worse, right? 'Why isn't Nicole clapping?'"

Published 54 minutes ago | Updated 43 minutes ago

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Happening Today: Health Care, South Korea, Travel Ban, EPA, Zuckerberg - NBC New York

New York Times

After Halting Start, Trump Plunges Into Effort to Repeal Health Law New York Times Today marks the beginning of the end of Obamacare, Mr. Scalise declared after House committee votes to advance the Republican's health care bill. Credit Doug Mills/The New York Times. WASHINGTON President Trump, after a halting start, is now ... The Note: Trump in 'sell mode' on health careABC News all 31 news articles »

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After Halting Start, Trump Plunges Into Effort to Repeal Health Law - New York Times