• Senate Republicans Head Back to Work with No Health Care Deal The Washington Post by David Weigel—Senate Republicans returned to Washington from a holiday recess with new and deepening disagreements about their health-care bill, with key Republicans differing Sunday not merely on how to amend the bill, but also on whether a bill could pass at all. "I would probably put that as 50-50," Sen. Bill Cassidy (R-La.) said in a "Fox News Sunday" interview.
  
  
• Senate Republicans Say They're Weeks Away From Healthcare Vote The Hill by Peter Sullivan—Republican senators are downplaying the chances of a quick vote next week on their Obamacare replacement bill amid divisions in the party over what the legislation should look like. "We're still several weeks away from a vote, I think," Sen. Pat Toomey (R-Pa.) said at an event Wednesday.  Likewise, Sen. Ted Cruz (R-Texas) said in a radio interview on Wednesday that a vote could happen "in the next several weeks." Senate Republicans had originally planned to vote on the bill last week, before the July Fourth recess, but leaders delayed action when it became clear the measure would fail to clear a procedural hurdle. Senate Majority Leader Mitch McConnell (R-Ky.) said after announcing the delay last week the vote on the bill would occur in a "couple weeks."
  
  
• Senator McConnell: If GOP Health Bill Dies, Bipartisan Fix Will Be Needed USA Today by Eliza Collins—If Senate Republicans can't get the 50 votes required to get an Obamacare repeal and replacement over the finish line, they may have to work with Democrats to repair the existing marketplace, Majority Leader Mitch McConnell, R-Ky., said Thursday. "If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur," McConnell said in Glasgow, Ky. Thursday according to the Associated Press. McConnell made the comment after he was asked about bipartisan cooperation. "No action is not an alternative," McConnell said. "We've got the insurance markets imploding all over the country, including in this state." Minority Leader Chuck Schumer, D-N.Y., jumped on the Republican leader's comments, saying McConnell "opened the door to bipartisan solutions."
  
  
• GOP Promises Lower Health Premiums But Ignores All That's Driving Them Politico by Joanne Kenen—Even if the party fulfills its vow to repeal Obamacare and reins in premiums, the nation's mounting costs are almost sure to pop out in other places.  Republicans promise to bring down the cost of health insurance for millions of Americans by repealing Obamacare. But in the race to make insurance premiums cheaper, they ignore a more ominous number—the $3.2 trillion-plus the U.S. spends annually on health care overall. Republicans are betting it's smart politics to zoom in on the pocketbook issues affecting individual consumers and families. But by ignoring the mounting expenses of prescription drugs, doctor visits, and hospital stays, they allow the health care system to continue on its dangerous upward trajectory. That means that even if they fulfill their seven-year vow to repeal Obamacare and rein in premiums for some people, the nation's increasing health care costs are almost sure to pop out in other places—including fresh efforts by insurers and employers to push more expenses onto consumers through bigger out-of-pocket costs and narrower benefits.
  
  
• If Republicans Reach a Health Care Deal, It Must Survive This Obscure Senate Rule Vox by Dylan Scott—Let's talk about the Byrd Rule. The fate of the Republican drive to repeal and replace Obamacare—and of the millions of Americans who could be left uninsured if it succeeds—could come down to a complex and obscure Senate rule. That rule will determine what provisions Republicans can include in the bill, how much of Obamacare they can repeal, and perhaps whether the most conservative GOP senators will vote for it. It could be the roadblock to a policy that conservatives see as their biggest demand before they support a bill they have serious reservations about. But the first domino to fall in such a scenario would be a conservative win on insurance regulations. 

• BCRA Spells Trouble for Providers Modern Healthcare by Alex Kacik—If the Senate bill becomes law, providers could be faced with ballooning uncompensated care that forces service cutbacks, potential staffing reductions or hospital closures, health experts said. As patients lose access, more will turn to high-cost emergency rooms for care, increasing uncompensated care, and squeezing providers' margins.  In other words, providers would be forced to regress.
  
  
• Senate Obamacare Repeal Could Cut 78,000 Florida Jobs, $8 Billion From State Economy Miami New Times by Jerry Iannelli—In addition to being moral abominations, experts say the measures are also just really bad for the economy. Last month, analysts at the nonprofit Commonwealth Fund warned the House plan—called the American Health Care Act (AHCA)—would cut more than 83,000 jobs and $8.6 billion from the Florida economy. Now, the Fund, along with George Washington University's Miliken Institute of Public Health, published a similar analysis of the Senate's new plan. Guess what? It would take a nearly identical, devastating chunk out of the Sunshine State's job market. According to the Commonwealth Fund's new data, the Senate deal would cut 78,000 jobs from Florida by 2026, including 52,000 jobs from the health care sector due to Medicaid cuts. Likewise, Florida's Gross State Output would shrink by $7.9 billion.
  
  
• Kentucky Would Lose 32,000 Jobs Under Senate bill to Replace Obamacare, Study Says Lexington Herald Leader by Bill Estep—Kentucky would lose 32,100 jobs in health care and other fields by 2026 under the U.S. Senate bill to replace Obamacare, a study released Thursday estimated. A separate study estimated the average premium under the law would be 49 percent higher in Kentucky for a benchmark insurance plan for marketplace customers than under Obamacare, officially known as the Affordable Care Act. The studies dovetail with others that have estimated significant impacts in Kentucky under the Senate bill, including a big increase in the number of people without insurance. For example, the Urban Institute projected that the number of uninsured people in Kentucky would increase from 6.3 percent of the population to 21 percent under the Senate bill.

• John Kasich Scores Another Victory over GOP on Medicaid Expansion Cincinnati Enquirer by Jessie Balmert—Republican lawmakers failed to vote to override Gov. John Kasich's latest major veto, keeping Medicaid intact for 500,000 lower-income Ohioans and giving the governor another victory over his own party. After Kasich rejected lawmakers' proposal to halt future enrollment in Medicaid expansion, GOP lawmakers vigorously debated whether to override that veto. In the end, on Thursday, they didn't try. The Ohio House's 66-member GOP caucus lacked the 60 votes it needed to send Kasich a message on Obamacare's Medicaid expansion, lawmakers said. 
  
  
• Kentucky Seeks Stricter Medicaid Work Requirements The Hill by Nathaniel Weixel—Kentucky is asking the Trump administration for permission to impose stricter work requirements for Medicaid beneficiaries than originally requested, according to an updated plan to overhaul the state's Medicaid program. Gov. Matt Bevin (R) this week submitted an amended plan that would eliminate the phase-in period for a controversial work requirement. The waiver would require able-bodied adults without dependents to work at least 20 hours a week to qualify for coverage.  The 20-hour requirement would start as soon as the waiver is approved. The initial proposal would have started the requirement at five hours a week, gradually increasing to 20 hours after a year.

• Opioid Prescriptions Fall After 2010 Peak, CDC Report Finds The New York Times by Abby Goodnough—The amount of opioid painkillers prescribed in the United States peaked in 2010, a new federal analysis has found, with prescriptions for higher, more dangerous doses dropping most sharply—by 41 percent—since then. But the analysis, by the federal Centers for Disease Control and Prevention (CDC), also found that the prescribing rate in 2015 remained three times as high as in 1999, when the nation's problem with opioid addiction was just getting started. And there is still tremendous regional variation in how many opioids doctors dole out, with far more prescribed per capita in parts of Maine, Nevada, and Tennessee, for example, than in most of Iowa, Minnesota, and Texas.

• Drug and Device Makers Pay Providers $8 Billion in 2016 Modern Healthcare by Virgil Dickson—Payments from drug and device companies to physicians and teaching hospitals hit more than $8 billion in 2016.  The CMS released the third full year of open payments data on Friday. The disclosure is required by the Sunshine Act, a provision of the Affordable Care Act, as an effort to help the public learn about payments received by doctors from industry groups and how those payments could affect clinical care. All told, nearly 631,000 physicians and approximately 1,146 teaching hospitals received $8.18 billion in payments and ownership and investment interests in 2016, according to tallies compiled by the CMS. Last year's total was $7.52 billion.

Editor: Peter Van Vranken