"As long as we are fundamentally changing Medicaid and taking some $700 billion out of the program, I do not see myself voting for a bill that does that. And to do that without holding a single hearing on what the implications would be for some of our most vulnerable citizens, for our rural hospitals and our nursing homes, is not an approach that I can endorse."

—Senator Susan Collins (R-ME)

• GOP Leaders Plan Tuesday Health Vote, It's An Uphill Climb Associated Press by Alan Fram — Republican leaders pushed toward a Senate vote next Tuesday on resurrecting their nearly flat-lined health care bill. Their uphill drive was further complicated by ailing GOP Sen. John McCain's potential absence and a dreary report envisioning that the number of uninsured Americans would soar. The White House and GOP leaders fished Thursday for ways to win over recalcitrant senators, including an administration proposal to let states use Medicaid funds to help people buy their own private health insurance. But there were no indications they'd ensured the votes needed to even start debating the party's legislative keystone, a bill scuttling and supplanting President Barack Obama's health care law.
  
  
• Senate Leaders Press for Health Care Vote, but on Which Bill?  New York Times by Thomas Kaplan and Robert Pear — Senate Republicans ended a demoralizing week on Thursday with their leaders determined to press ahead with a vote to begin debating health care next week, but with little progress on securing the votes and no agreement even on which bill to take up. With President Trump urging them to move forward on their seven-year quest to erase the Affordable Care Act, Republican senators on Thursday still had not decided whether to revive a proposal to replace former President Barack Obama's health care law with one of their own, or to simply repeal it and work on a replacement later. The choice is unpalatable.
  
  
• These Americans Hated the Health Law. Until the Idea of Repeal Sank in  New York Times by Kate Zernike and Abby Goodnough —  When President Trump was elected, his party's long-cherished goal of dismantling the Affordable Care Act seemed all but assured. But eight months later, Republicans seem to have done what the Democrats who passed the law never could: make it popular among a majority of Americans. Support for the Affordable Care Act has risen since the election — in some polls, sharply — with more people now viewing the law favorably than unfavorably. Voters have besieged their representatives with emotional telephone calls and rallies, urging them not to repeal, one big reason Republicans have had surprising trouble in fulfilling their promise despite controlling both Congress and the White House.
  
  
• Senate Republicans Still at Impasse After Late-Night Health Care Meeting Politico by Burgess Everett , Seung Min Kim, and Jennifer Haberkorn — A key group of Senate Republicans met late into the night Wednesday to try to salvage their health care bill but emerged without any breakthroughs and still appeared far from finding the votes to repeal Obamacare. Still, as senators left the nearly three-hour meeting at the Capitol, they professed optimism. At least 20 Republicans, including leadership allies, moderates and conservatives, worked through the party's myriad disagreements over Medicaid, coverage numbers, lowering premiums and cutting regulations.
  
  
• 'Repeal Now, Replace Later' Has Immediate Consumer Impact Associated Press by Ricardo Alonso-Zaldivar — Consumers would feel the impact immediately if Republicans repeal "Obamacare" with no replacement. Problems could start this fall for customers buying individual health policies, say independent experts, with more insurers likely to exit state markets around the country, and those remaining seeking higher rates. Low-income people who qualified for expanded Medicaid expansion under the Affordable Care Act, or ACA, might be shielded for a year or two. But then federal funding for their coverage would stop and states would have to decide whether to keep those able-bodied adults on the rolls.
  
  
• Trump Administration Pulls Health Law Help in 18 Cities Associated Press by Carla K. Johnson — President Donald Trump's administration has ended Affordable Care Act contracts that brought assistance into libraries, businesses, and urban neighborhoods in 18 cities, meaning shoppers on the insurance exchanges will have fewer places to turn for help signing up for coverage. Community groups say the move, announced to them by contractors last week, will make it even more difficult to enroll the uninsured and help people already covered re-enroll or shop for a new policy. That's already a concern because of consumer confusion stemming from the political wrangling in Washington and a shorter enrollment period.  "There's a clear pattern of the administration trying to undermine and sabotage the Affordable Care Act," said Elizabeth Hagan, associate director of coverage initiatives for the liberal advocacy group Families USA. "It's not letting the law fail, it's making the law fail."

• Collapse Of Obamacare Repeal Campaign Ups Pressure on Republicans to Work with Democrats Los Angeles Times by Noam Levey and Lisa Mascaro —  Congressional Republicans, their campaign to repeal and replace the Affordable Care Act in shambles, face mounting pressure to work with Democrats to make fixes to the 2010 healthcare law rather than roll it back. But it remains unclear whether the White House and GOP leaders are prepared to reach across the aisle to stabilize insurance markets and shield Americans from rising healthcare costs, especially if that also means being seen as betraying their years-long promise to repeal Obamacare.

• Senate 'Repeal Only' Bill Would Leave 32 Million More Uninsured, CBO Says Politico by Adam Cancryn — A revived bill that would dismantle large parts of Obamacare without an immediate replacement would leave 32 million more people uninsured and double premiums over a decade, the Congressional Budget Office said in a report Wednesday. The nonpartisan scorekeeper's report projects that 17 million people would lose insurance in the first year after a partial repeal that includes ending Obamacare's Medicaid expansion and repealing most of the taxes tied to the law. Premiums would jump 25 percent over that same period as insurers grapple with the effective elimination of Obamacare's requirement that everyone purchase coverage.
  
  
• Revised GOP Healthcare Bill Would Still Leave Millions Without Insurance, New Report Concludes Los Angeles Times by Noam Levey — The GOP plan analyzed by the budget office — one of multiple versions now being considered -- would still nearly double the number of people without health coverage over the next decade, pushing up the ranks of the uninsured by 22 million. And it would increase costs for millions of sick and elderly Americans, the budget office estimates. Those costs could soar even further under another provision of the bill that would allow insurers to offer slimmed down health plans that don't offer the basic set of health benefits currently mandated by Obamacare, such as prescription drugs, maternity care, and mental health services.

• Medicaid Shows Its Political Clout  Politico by Rachana Pradhan — Medicaid may be the next "third rail" in American politics. Resistance to cutting the health care program for the poor has emerged as a big stumbling block to Obamacare repeal, and Republicans touch it at their political peril. "If they'd gone ahead ... clearly I would think we'd be seeing a transfer of power in a year and a half," said John Weaver, a GOP strategist for Ohio Gov. John Kasich, who has called the Medicaid overhaul proposals of his fellow Republicans "unacceptable." Medicaid may not be quite as untouchable as Medicare and Social Security — the traditional "third rails" of politics that drive voter behavior. But "it's become even more of a national safety net," Rowland said. "And more people's lives have been touched by it."

• Obamacare Payments to Continue The Hill by Nathaniel Weixel - Key Obamacare subsidies to insurers will be paid this month, the White House confirmed to The Hill on Wednesday, one day before the deadline to make July's cost-sharing reduction (CSR) payments. The administration has not made a commitment beyond this month. The payments help low-income people afford the co-pays, deductibles and other out-of-pocket costs associated with health insurance policies. Insurers have called the payments critical, saying that without them, they would have to massively increase premiums or exit the individual market.

• Trump Officials Say a New Plan Will Cut Drug Prices. It's Not That Simple Stat by Erin Mershon — When the Trump administration unveiled a new Medicare proposal this week to cut payments to hospitals as part of a drug reimbursement program, Health and Human Services Secretary Tom Price called the plan a "significant step toward fulfilling President Trump's promise to address rising drug prices." It may not be that simple. The proposal takes aim at a controversial drug discount program, known as the 340B program, which is designed to boost revenues for hospitals that primarily serve low-income patients. The program requires drug makers to offer those hospitals sizable discounts on certain drugs. The hospital can then bill Medicare and other insurers at regular reimbursement rates when patients take the drugs, banking the extra savings to spend elsewhere.
  
  
• The Myth Of Drug Expiration Dates ProPublica by Marshall Allen — ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We've documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country's health care spending.  What if the system is destroying drugs that are technically "expired" but could still be safely used?

• Why Health Care Drives Presidents Insane Politico Magazine by Jeff Greenfield — I can't prove this happened, but it wouldn't surprise me at all if Bill Clinton and Barack Obama placed a conference call to President Donald Trump, where they began by proclaiming: "Welcome to the club!" Once again, a new American president has received a significant shock by daring to touch what is now the reigning third rail of American politics: health care. Do I exaggerate? Let's take a trip down memory lane."

Editor: Peter Van Vranken