• Health Care Bill Teeters, GOP Adds Money to Woo Dissidents Associated Press by Alan Fram — Top Republicans are adding money to their staggering effort to repeal the Obama health care law and say they’re pushing toward a climactic Senate face-off this week. Yet their path to succeeding in their last-gasp effort has grown narrower, perhaps impossible. GOP senator's’ opposition to their party’s drive to scrap President Barack Obama’s Affordable Care Act swelled to lethal numbers Sunday. Moderate Sen. Susan Collins all but closed the door on supporting the teetering bill and conservative Sen. Ted Cruz said that “right now” he doesn’t back it.…But the Congressional Budget Office, which is lawmakers’ nonpartisan fiscal analyst, has said that it doesn’t have time to determine the bill’s impact on coverage and premiums, major factors for some lawmakers deciding their votes. Instead, the office is expected to only detail its estimates of the measure’s effect on federal deficits. A vote must occur this week for Republicans to have any chance of prevailing with their narrow Senate majority. Next Sunday, protections expire against a Democratic filibuster, bill-killing delays that Republicans lack the votes to overcome.
  
  

• GOP Health Bill All but Dead; McCain Again Deals the Blow Associated Press by Erica Werner and Alan Fram — Sen. John McCain declared his opposition Friday to the GOP's last-ditch effort to repeal and replace "Obamacare," dealing a likely death blow to the legislation and, perhaps, to the Republican Party's years of vows to kill the program. "I cannot in good conscience vote for the Graham-Cassidy proposal," McCain said in a statement, referring to the bill by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. His opposition likely leaves the bill at least one vote short of the support needed for passage. "I believe we could do better working together, Republicans and Democrats, and have not yet really tried," McCain said. "Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."
  
  
• Latest Obamacare Repeal Effort is Most Far-Reaching The New York Times by Kate Zernike, Reed Abelson and Abby Goodnough — For decades, Republicans have dreamed of taking some of the vast sums the federal government spends on health care entitlements and handing the money over to states to use as they saw best. Now, in an 11th-hour effort to repeal the Affordable Care Act, the party has come up with a way to repackage the funding for the law it loathes into a trillion-dollar pot of state grants. The plan is at the core of the bill that Senate Republican leaders have vowed to bring to a vote next week. It was initially seen as a long-shot effort by Senators Lindsey Graham and Bill Cassidy. But for all its ad hoc, last-minute feel, it has evolved into the most far-reaching repeal proposal of all. It dismantles the Medicaid expansion and the system of subsidies to help people afford insurance. It gives the states the right to waive many of the consumer protections under President Obama's landmark health law. And it removes the guaranteed safety net that has insured the country's poorest citizens for more than half a century.
  
  
• Obamacare States May Lose $180 Billion Under Senate Bill Bloomberg by Anna Edney — States that expanded Medicaid under Obamacare would be hard-hit by spending cuts called for in Republican senators' latest bill to repeal and replace the health law, while states that didn't expand the program stand to benefit. The 32 states that increased their Medicaid coverage for low-income people would lose $180 billion in federal funding, but states that didn't would gain $73 billion from 2020 to 2026, according to a study by the Kaiser Family Foundation. The state-by-state breakdown covers a wide range, with New York at one extreme seeing a cut of 35 percent and Mississippi at the other with a 148 percent boost.
  
  
• Did Democrats Jump the Gun with Single-Payer Splash? Politico by Elana Schor — There's second-guessing inside the party about Bernie Sanders' timing as Republicans take aim again at Obamacare. Last week, a group of Senate Democrats rallied behind single-payer health care at a splashy news conference. This week, the same group is scrambling to beat back the GOP's latest Obamacare repeal blitz. The contrast shows the chasm between the two parties' approach to health care: Republicans claim that Bernie Sanders' "Medicare for All" pitch fueled their revived repeal effort, an argument that even Democratic single-payer foes dismiss as untrue. Yet some Democrats wish more attention had been paid to protecting the Affordable Care Act before some of the party's biggest names turned to single payer.

• Top Doctor, Hospital, and Insurance Groups Release Joint Statement Urging the Senate to Reject Graham-Cassidy Bill Business Insider by Michelle Mark — A group of six major doctor, hospital, and insurance groups released a joint statement on Saturday condemning the latest GOP effort to repeal and replace the Affordable Care Act, urging the Senate to reject the Graham-Cassidy bill. "While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all," the statement said. "The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it."
  
  

• Here’s a List of Medical Groups Opposing the Cassidy-Graham Health Care Bill The Washington Post by Christopher Ingraham — One factor in the bill's apparent (although not yet certain) demise: Cassidy-Graham has mobilized nearly the entire American health care community in opposition. Dozens of national advocacy groups representing patients, doctors, insurers and hospitals have issued strongly worded condemnations of the proposal. The American Medical Association warns it violates doctors' oath to "first do no harm." Kaiser Permanente says that any changes to health care law should "increase access to high-quality, affordable care and coverage for as many people as possible" and that "the Cassidy-Graham bill does not meet any of those tests." In the view of the American Hospital Association, "this proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term." The American Heart Association, March of Dimes, and 14 other patient and provider groups urged the Senate to "oppose this legislation." Strikingly, The Washington Post was unable to identify any medical associations that support the measure. 

• Sen. Lamar Alexander Pulls Plug on Bipartisan Obamacare Fix The Tennessean by Michael Collins and Holly Fletcher — Sen. Lamar Alexander pulled the plug Tuesday on his push for a bipartisan bill to stabilize the individual health insurance market, saying he and a key Democrat had been unable to reach a deal that could pass. Alexander, a Tennessee Republican, said he and Democratic Sen. Patty Murray of Washington “had hoped to agree early this week on a limited, bipartisan plan to stabilize 2018 premiums in the individual health insurance market that we could take to Senate leaders by the end of the month.”  
  
  “During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” said Alexander, chairman of the Senate Health, Education, Labor, and Pensions Committee. Murray, the committee’s top Democrat, said the negotiations with Alexander had taken place in “good faith.”
  
  

• Trump to Make Obamacare Payments for September The Hill by Rachel Roubein — The Trump administration will make key Obamacare payments to insurers in September, though a final decision hasn't been made about future payments, a White House spokesman said Tuesday. Insurers have been seeking long-term certainty that they'll continue to receive the disbursements, known as cost-sharing reduction payments.

• While Premiums Soar Under Obamacare, Costs of Employer-Based Plans Are Stable The New York Times by Reed Abelson — In sharp contrast to the soaring health insurance premiums in many Affordable Care Act marketplaces, the cost of coverage for the vast numbers of people who get insurance through their jobs rose relatively little this year, continuing a period of remarkable stability in the employer market, according to a national survey released Tuesday. The annual premium for family coverage rose an average of 3 percent to $18,764 this year, according the Kaiser Family Foundation, a nonprofit group, which conducted the annual survey of employers. That is the sixth straight year that employer-provided policies have increased by well under 5 percent, according to the survey. Employers paid the bulk of the costs, the survey found, with workers shouldering an average of $5,714, a year for a family policy.

• A Battle for Children's Health Coverage on Two Fronts Modern Healthcare by Shelby Livingston  — As Sept. 30 approaches, pediatric providers are grappling with the potential loss of funding for two programs responsible for huge gains in the health insurance coverage for children. Combined, the Children's Health Insurance Program (CHIP) and Medicaid, both of which provide health coverage to uninsured children in families that can't afford it elsewhere, cover an estimated 46 million children. Federal funding for CHIP expires at the end of the month, the same time that Republican Senators run out of time to pass an Affordable Care Act repeal-and-replace by a simple majority. Nonpartisan organizations expect that repeal bill to gut Medicaid funds to states by billions. Provider organizations are scrambling to fight for funding on both fronts. "We can do all this work to get CHIP reauthorized…but all that work will be for naught if the Graham-Cassidy bill passes," said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, which represents 62 not-for-profit clinics who see mostly Medicaid patients.

• CMS Champions Innovation and Competition While Buoying Value-Based Care Modern Healthcare by Maria Castellucci — The Centers for Medicare and Medicaid Services (CMS) issued a "request for information" Wednesday from providers and patient advocacy groups on new ideas to bring to the Center for Medicare and Medicaid Innovation, which is responsible for creating new payment models. The notice came after CMS Administrator Seema Verma wrote in a Wall Street Journal op-ed Tuesday evening that the Innovation Center's old policies led to consolidation that has been widely blamed for growing overall healthcare costs. She also said the policies burdened providers. "Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements," she wrote.

Editor: Peter Van Vranken