Posts Tagged ‘healthcare’

Bernie Sanders to push for government-funded healthcare and abolition of private insurance

August 14, 2017

The issue has the potential to split the Democratic party

By Alexandra Wilts Washington DC

The Independent

Senator Bernie Sanders is relaunching his push for a government-funded healthcare system, but the move could further divide Democrats on a key issue as the party seeks to regain its footing at the state and national levels.

While defending Obamacare – which Republicans unsuccessfully tried to dismantle in July – the Vermont independent declared that the way forward in the long-term was a “Medicare-for-all” single-payer system, a federally administered programme that would abolish the role of private insurers in basic healthcare coverage.

Single-payer healthcare is a system in which the government, generally through taxes, covers basic healthcare costs for all residents regardless of income, occupation or health status.

“Medicare-for-all …will be saving middle-class families substantial sums of money, and it will be guaranteeing health care to every man, woman, and child in this country,” Mr Sanders, who caucuses with the Democrats, told CNN.

Mr Sanders will soon be introducing a bill in the Senate that would create this system, a major plank of his 2016 presidential campaign, even if he knows it is unlikely to pass in the current political climate.

An Urban Institute study of Mr Sanders’ single-payer proposal during the campaign said implementing the plan would increase federal expenditures by $32 trillion over 10 years. 

“Look, I have no illusions that under a Republican Senate and a very right-wing House and an extremely right-wing president of the United States, that suddenly we’re going to see a Medicare-for-all, single-payer passed,” Mr Sanders recently told NPR. “You’re not going to see it. That’s obvious.”

But he said the point of the bill is to force conversation about the idea.

“Senator Sanders has always believed that health care must be recognized as a right, not a privilege,” office spokesperson Daniel McLean told the Independent. “Like every other major country on Earth, every man, woman and child in our country should be able to access the health care they need regardless of their income.” 

The concept of a single-payer system is becoming increasingly popular in the Democratic party – senators including Cory Booker, Kirsten Gillibrand and Kamala Harris have expressed some support, and, for the first time, a majority of Democrats in the House of Representatives have now signed on to the single-payer bill that Congressman John Conyers has been introducing regularly for more than 10 years.

However, experts fear that supporting a single-payer programme could become a litmus test for Democrats, meaning members either support the bill or progressive political action committees, or PACs, try to prevent them from getting reelected.

“Any Democrat worth their salt that doesn’t unequivocally say Medicare-for-all is the way to go? To me, there’s something wrong with them,” Nina Turner, president of Mr Sanders’ Our Revolution PAC, told Politico. “We’re not going to accept no more hemming and hawing.”

While the progressive, and arguably most energetic, wing of the party has gotten behind the single-payer idea, it still remains a divisive issue for moderate Democrats. The proposal was notably excluded from Democratic leaders’ new economic agenda that was unveiled last month.

The party has been desperate to regain its mojo following its defeat last November, when it failed to win a majority in the Senate and Mr Trump triumphed over Democratic nominee Hillary Clinton.

It will be a challenge for the Democrats to retake a majority in both the House of Representatives and the Senate during the 2018 midterm elections. The party needs a net gain of 24 to have a majority in the 435-member House. And while they only need a net gain of three seats in the 100-member Senate, they are also defending 25 seats – 10 of which are in states that Mr Trump won.

“Single-payer healthcare as an issue is a worthy debate for the Democrats to be having,” said Jim Kessler, the senior vice president for policy for Third Way, a centrist think tank. “But it’s a huge mistake to make it a litmus test for Democrats at this point.”

Instead of pushing for a healthcare system overhaul in the US that Donald Trump will reject, some of suggested, all efforts should be focused on improving Obamacare – otherwise known as the Affordable Care Act – which still remains under attack by the President.

At the end of July, one vote prevented the Senate’s Republican leadership from passing a bill that would have repealed major provisions of former President Barack Obama’s healthcare law.

“We are one lousy election in November 2018 away from losing Obamacare,” Mr Kessler said.

“The stronger that Obamacare is, the great likelihood it will survive the next assault.”

Republican members of Congress, as well as Mr Trump, campaigned for years on repealing and replacing Obamacare, which they say has driven up premiums and forced consumers to buy insurance they do not want or cannot afford.

In June, when asked why Democrats aren’t countering Republicans with a single-payer plan, House Democratic Leader Nancy Pelosi said “it isn’t helpful to tinkle all over the Affordable Care Act right now.”

“The path to public option, single payer is in the Affordable Care Act,” she said. “It is not in distracting us from the focus of stopping what (Republicans) are doing to let people die..with their bill.”

http://www.independent.co.uk/news/world/americas/us-politics/bernie-sanders-healthcare-medicare-for-all-government-funded-abolish-private-insurance-a7891611.html

Democrats fear Russia probe blowback

August 5, 2017

‘We need to talk about what people think about when they wake up in the morning, and it’s not Russia,’ said one strategist.

POLITICO

08/05/2017 07:34 AM EDT

Gavin Newsom is pictured. | Willy Sanjuan/Invision/AP
The Russia investigation “doesn’t do anything for Democrats at all,” said California Lt. Gov. Gavin Newsom, who’s running for governor, in a recent appearance on MSNBC’s “Morning Joe.” “It’s a loser.” | Willy Sanjuan/Invision/AP

ALISO VIEJO, Calif. — Democrats are increasingly conflicted about how forcefully to press the issue of possible collusion between the Trump campaign and Russia.

Fearful of alienating voters who appear more concerned about the economy and health care, Democrats campaigning in districts across the country are de-emphasizing Russia in their rhetoric — and some are warning that a persistent focus on the Russia investigation could backfire.

“In the races where I’m working, I think voters think that Russia is important and that the questions need to get answered,” Bill Burton, a veteran Democratic consultant, said at a political convention this past weekend. “But they’re mostly sick of hearing about it, and they want to hear politicians talk about things that are more directly important in their lives.”

In a state that is critical to the party’s efforts to retake the House, Darry Sragow, a Democratic strategist whose California Target Book handicaps races in California, called Russia a “distraction” and said Democrats “are going to be in deep, deep trouble if they don’t start talking about what voters care about.”

“We need to talk about what people think about when they wake up in the morning, and it’s not Russia,” Sragow said. “The more we talk about stuff that voters don’t truly care about in their daily lives … it confirms that the Democratic Party’s brain has been eaten by the elites in Washington who have been sitting fat and happy for a lot of years while working Americans have lost their jobs and lost confidence in the future.”

Public polling suggests the electorate is deeply suspicious of Trump’s ties to Russia — but also tired of the months-long inquiry into possible collusion between the president’s campaign and Russia. According to a Quinnipiac University Poll released this week, 63 percent of American voters believe Moscow interfered in the 2016 election, and in a POLITICO/Morning Consult poll last month, more than half of voters said it was inappropriate for Donald Trump Jr. to meet with an attorney linked to the Russian government.

But a plurality of voters in the POLITICO/Morning Consult poll said Congress should not seek to impeach Trump. An earlier Harvard-Harris Poll found nearly two-thirds of American voters say investigations into Trump and Russia are hurting the country.

In that polling, wary Democrats see shades of 1998, when Republicans were widely believed to have overreached on the Monica Lewinsky scandal, losing five House seats in the midterm elections.

“Obviously, you don’t know how everything’s going to come out and what cycles we’re going to go through with the independent counsel and the report,” said Mark Penn, the Harvard-Harris Poll’s co-director and former adviser to Bill and Hillary Clinton. “But if you were to ask me as of today, Democrats are doing a lot better on health care than they’re doing on Russia … There’s a risk that they repeat ‘98, that the Republicans create a campaign on issues and [Democrats] get tagged too much with only being about negative arguments.”

The Russia investigation has proved alluring to Democrats for both the seriousness of the allegations and for the angry response it has provoked from Trump. And for Democrats bidding to unseat Republican incumbents — even those who have generally supported the investigation — the various probes have provided a platform on which to yoke Republican House members to Trump.

Brian Flynn, one of several Democrats challenging Rep. John Faso in New York, said, “The effect of Russia isn’t people think John Faso is involved in Russia … What it is doing is showing the betrayal of the people who put them in office, and that is how we’re using it.”

Still, Flynn said, “I don’t talk a lot about it … We’re not going to win on an anti-Trump, anti-corruption approach.”

Hans Keirstead, one of several Democrats challenging Rep. Dana Rohrabacher in California, said Russia “is not the story … it’s an opener.” Running against Rohrabacher, a fierce defender of Russia on Capitol Hill, Keirstead said, “Russia just shows he is paying attention to things that are not district-focused.”

Even so, the Russia issue and it’s near-constant stream of developments remain a staple for many Democrats. On Thursday night, critics of Rep. Michael Burgess confronted the Republican lawmaker on Trump’s Russia ties at a town hall in Texas, while in California, Democrat Doug Applegate took to Twitter to mock GOP Rep. Darrell Issa as “Trump’s lapdog.”

Earlier this week at a gymnasium in Rohrabacher’s Orange County district, several hundred activists joined in a game of “Who said it? Dana or Putin?”

In a room off the gym floor, Rep. Ted Lieu said, “I think it depends what happens with this special counsel investigation … No one knows. It could be issue No. 8 in voters’ minds, or it could be No. 1 if they find collusion or people start getting indicted.”

Later, at the podium, Lieu told the crowd, “Here is a fun fact for you: the first article of impeachment for Nixon was obstruction of justice.”

Scott Simpson, a Democratic consultant who works on races throughout the country, doubted focusing attention on the Russia investigation would alienate voters or hurt Democrats in the midterm elections. But he said voters are “not attuned” to Russia and that health care is “just so much more top of mind.”

California Lt. Gov. Gavin Newsom, who’s running for governor, was even more direct in a recent appearance on MSNBC’s “Morning Joe.” The Russia investigation, he said, “doesn’t do anything for Democrats at all … It’s a loser.”

It’s not just the complicated nature of the Russia probes and their distance from many voters’ immediate concerns, that are leading Democrats to question the value of the issue on the campaign trail. Most voters who consider Russia a significant issue will tie the controversy to Trump, not members of Congress, said Colin Rogero, a Washington-based Democratic media consultant.

And unlike on health care, Republican House members believe they have little cause for concern on Russia, with many echoing Trump’s charge that the investigation is “fake news.”

“Democrats have forgotten one of the edicts of one of the wise men of their party, Tip O’Neill, who said ‘all politics is local,’” said Dave Gilliard, a strategist for four of California’s targeted Republicans — Reps. Jeff Denham, Mimi Walters, Issa and Ed Royce. “Russia is the furthest thing from those voters’ minds … If you went out on the street right now and asked 100 people what the most important issue right now is, I would be shocked if one said ‘Russia.’”

Kentucky Sen. Rand Paul last month called the Russia investigation a “witch hunt,” and House Intelligence Committee Chairman Devin Nunes has said Washington should “stop chasing Russian ghosts around the closet.”

Even Rohrabacher, who would appear to be the most susceptible House member to any anti-Russia sentiment, dismisses any concern. After audio leaked of House Majority Leader Kevin McCarthy saying, supposedly in jest, that he suspected the Russian president of paying then-candidate Trump and Rohrabacher, the congressman said he posed for a photograph with McCarthy at a fundraiser last month — both of them holding drinks known as Moscow mules.

“I think that health care and tax reform will determine who controls the House of Representatives and who controls the Senate,” Rohrabacher said. “Republicans made a serious error when they started yakking away about ‘Within 100 days we’re going to do this and that,’ which was totally unrealistic.”

As for Russia, Rohrabacher said, “This is not an issue that voters are concerned about — not in my area, and certainly I don’t think throughout the country.”

Rohrabacher was heading to the beach for a meeting about shark detection technology, which he said has promising implications for swimmers along the coast.

“That’s the type of thing that I think impresses voters more than telling people that the Russians are just as evil and threatening as they were during the Cold War,” Rohrabacher said. “I’m confident about this election, and it’s not going to be about Russia.”

http://www.politico.com/story/2017/08/05/democrats-trump-russia-blowback-241346

Healthcare: Some Insurers Seek ACA Premium Increases of 30% and Higher — Senate Republicans Rebuff Donald Trump’s Health-Care Push

August 2, 2017

Companies say they are struggling to make decisions as Congress and White House wrangle over health care

Harland Stanley of Louisville, Ky. has an Anthem health-insurance plan, and Anthem has proposed an average rate increase of about 30%.
Harland Stanley of Louisville, Ky. has an Anthem health-insurance plan, and Anthem has proposed an average rate increase of about 30%. PHOTO: JESSICA EBELHAR FOR THE WALL STREET JOURNAL
.

Aug. 1, 2017 8:19 p.m. ET

Major health insurers in some states are seeking increases as high as 30% or more for premiums on 2018 Affordable Care Act plans, according to new federal data that provide the broadest view so far of the turmoil across exchanges as companies try to anticipate Trump administration policies.

Big insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to raise premiums by averages close to 30% or more, according to preliminary rate requests published Tuesday by the U.S. Department of Health and Human Services. Major marketplace players in New Mexico, Tennessee, North Dakota and Hawaii indicated they were looking for average increases of 20% or more.

In other cases, insurers are looking for more limited premium increases for the suites of products they offer in individual states, reflecting the variety of situations in different markets. Health Care Service Corp., a huge exchange player in five states, filed for average increases including 8.3% in Oklahoma, 23.6% in Texas, and 16% in Illinois.

Together the filings show the uncertainty in the health-insurance marketplaces as insurers around the U.S. try to make decisions about rates and participation for next year amid open questions about changes that could come from the Trump administration and Congress.

Insurers face a mid-August deadline for completing their rates. The companies have until late September to sign federal agreements to offer plans in 2018. In some cases, insurers warn, the figures revealed by federal regulators may not reflect their up-to-date thinking.

The insurers’ decisions will be closely dependent on moves by the Trump administration and Congress. Most important is whether the federal government continues making payments that reduce health-care costs for low-income exchange enrollees, which insurers say are vital and President Donald Trump has threatened to halt.

Insurers are also concerned about whether the Trump administration will enforce the requirement for most people to have insurance coverage, which industry officials say helps hold down rates by prodding young, healthy people to sign up for plans.

In Montana, Health Care Service linked 17 percentage points of its 23% rate increase request to concerns about the cost-sharing payments and enforcement of the mandate that requires everyone to purchase insurance. Kurt Kossen, a senior vice president at Health Care Service, said the company’s rate requests are driven by causes including growing health costs and “uncertainty and the associated risks that exist within this marketplace, including uncertainty around issues like the continued funding of [cost-sharing payments] and mechanisms that encourage broad and continuous coverage.”

Sen. Lamar Alexander (R., Tenn.), who chairs the Senate committee that oversees health policy, said Tuesday that he had told Mr. Trump directly that the government should continue making the payments to insurance companies

The effect of the rate increases will be blunted for many exchange enrollees, because lower-income people receive federal subsidies that cover much of their premiums.

But increases could be tough to stomach for those who aren’t eligible for the help, like Harland Stanley, 53, of Louisville, Ky. Mr. Stanley, who owns his own research business, pays about $400 a month for a plan from Anthem Inc., which is seeking an average increase of 34% in the state, though Mr. Stanley’s own premiums might rise by less or more than that.

“It’s going to hurt,” said Mr. Stanley, who said his monthly premium this year is about $120 more than he paid in 2016. “I worry about, what if it keeps going? When is this going to stop?”

Anthem, which is seeking rate average increases of 30% or more in states including Colorado, Kentucky, Nevada and Virginia, has said it would refile for bigger hikes and may pull back its exchange offerings more if uncertainty continues around issues including the cost-sharing payments.

Centene Corp.’s requests ranged from less than 1% in New Hampshire to 21% in Texas and 12.49% in Georgia. Those rate proposals generally assume the current rules surrounding ACA plans continue, the company said.

Within the marketplaces, “there is relative stability,” said Chief Executive Michael F. Neidorff. “The uncertainty is driven by these policies on the ACA.”

CareSource, a nonprofit insurer that offers exchange plans in four states, has prepared alternate rate filings for different scenarios, and one of its state regulators Monday asked it to refile with proposed rates that assume no cost-sharing payments.

“It’s challenging; you learn to be very fluid,” said Steve Ringel, president of the Ohio market for CareSource. According to actuarial firm Milliman Inc., at least seven states have made similar requests in the past week, while others had earlier asked for two versions of rate filings.

“Resolution of the [cost-sharing payments] is an urgent issue,” said Bill Wehrle, a vice president at Kaiser Permanente, which offers exchange plans in a number of states. “We’re coming up at a point that’s fairly soon, where the pricing decisions we make are set for all of next year.”

The impact of potentially losing the cost-sharing payments was also clear in the rates requested by Blue Cross of Idaho, which average 28%. That would probably be in the lower teens if the payments were guaranteed, said Dave Jeppesen, a senior vice president. “It’s a big swing,” he said. “There’s a lot of risk associated with the uncertainty in Congress right now, and we are pricing appropriately for that risk.”

A recent Kaiser Family Foundation analysis found insurers’ financial results on exchange plans improved in the first quarter of this year, a sign of potentially emerging stability in the business. That is reflected in a number of states where rate-increase requests are limited. The exchange in California said Tuesday that insurers there were seeking an overall average increase of 12.5%—but there would be an additional 12.4% boost layered onto middle-tier “silver” plans if the cost-sharing subsidies aren’t paid.

However, in a number of cases, insurers’ rate requests are well above 20% because of market factors not directly tied to the federal uncertainty. Anthem has warned that it may need to add 18% to 20% to its existing rate requests if the cost-sharing payments aren’t locked in, and it may pull back in more states beyond the five exchanges where it has disclosed plans to leave or sharply reduce its footprint. An Anthem spokeswoman declined to comment on the company’s rate filings.

In Iowa, Medica said its rate increase request was 43.5%, driven by the dynamics of the local market, including the departure of other insurers and the fact that Medica itself has been losing money because enrollees’ health costs ran higher than expected. “You have some element of catching up to what the claims experience is,” says Geoff Bartsh, a Medica vice president.

Medica’s requests in other states have been far lower, he said, a sign of increased steadiness in those markets. But, he said, if the cost-sharing payments go away, Medica estimates it will need to add around 13% to 19% to its rate requests.

Write to Anna Wilde Mathews at anna.mathews@wsj.com

Appeared in the August 2, 2017, print edition as ‘Insurers Seek Hike In ACA Premiums.’

 

.
*********************************************
.
Senate Republicans Rebuff Donald Trump’s Health-Care Push
Lawmakers say they want to focus on a tax overhaul and critical fiscal legislation

President Donald Trump waves to the crowd while attending a small-business event in the East Room of the White House in Washington, D.C., on Tuesday.
President Donald Trump waves to the crowd while attending a small-business event in the East Room of the White House in Washington, D.C., on Tuesday. PHOTO: MARK WILSON/GETTY IMAGES

WASHINGTON—Senate Republicans made clear on Tuesday that they want to chart their own course to focus on a tax overhaul and critical fiscal legislation, bypassing requests from President Donald Trump and White House officials to keep health care their top legislative priority.

In his first press conference since a GOP health bill collapsed in the Senate, Majority Leader Mitch McConnell (R., Ky.) on Tuesday left health legislation off the list of items to be voted on before the chamber leaves for recess later this month, despite Mr. Trump’s calls for the Senate to dive back in.

Mr. McConnell, who has said he prefers to keep disagreements with the president private, also disclosed that he had told Mr. Trump that most senators don’t support changing the chamber’s rules to allow bills to pass on a simple majority vote, as the president urged on Twitter several times in the past week.

“There are not the votes in the Senate, as I’ve said repeatedly to the president and all of you, to change the rules of the Senate,” Mr. McConnell said.

Mr. McConnell was one of several senators in recent days who have resisted White House entreaties on health care, often expressed in language that is frank for leaders of the same party.

Sen. John Cornyn (R., Texas) took a shot at White House Budget Director Mick Mulvaney, who said Sunday that Congress should continue to work on health care rather than move on to other issues.

“I don’t think he’s got much experience in the Senate, as I recall,” Mr. Cornyn told reporters on Monday night about Mr. Mulvaney, who served three terms in the House. “He’s got a big job. He ought to do that job and let us do our job.”

A spokesman for the Office of Management and Budget said Mr. Mulvaney was merely conveying Mr. Trump’s view. “Health care is a priority for most Americans,” the spokesman said. “It should be for Congress as well.”

In an effort to keep the health-care effort front and center, Mr. Trump has threatened to take away government contributions toward the cost of lawmakers’ health care and to stop government payments to insurers that reduce copayments and deductibles for some of the poorest customers under the 2010 health law. Mr. Trump also has ousted White House staffers most closely linked to the Republican National Committee and the House leadership—former Chief of Staff Reince Priebus and spokesman Sean Spicer —as part of a staff shake-up.

Potentially rebuffing Mr. Trump’s plans, Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R., Tenn.) said Tuesday that his committee would begin drafting legislation this week to stabilize the Affordable Care Act’s fragile insurance markets, where people who don’t get health coverage through work purchase insurance. He said the committee aims to pass short-term legislation in mid-September.

For its part, the White House on Tuesday rejected a suggestion made at the White House press briefing that Mr. Trump’s agenda was suffering because he was losing credibility on Capitol Hill.

“What’s hurting the legislative agenda is Congress’s inability to get things passed,” White House spokeswoman Sarah Huckabee Sanders said.

Next on the Senate Republicans’ agenda is a tax overhaul. “We began to discuss today at lunch tax reform,” Sen. Bob Corker (R., Tenn.) said Tuesday. “That’s our next agenda item, and it’s something that regardless of who’s president we would want to be pursuing at this time.”

Senate and House Republicans plan to advance the issue in September after their recess and have been working with administration officials on a coordinated plan. But Senate Republicans also dismissed White House suggestions they take input from Democrats.

“I don’t think this is going to be 1986, when you had a bipartisan effort to scrub the code,” Mr. McConnell said.

Mr. Trump retains some support in Congress, despite the differences over legislative priorities in the Senate.

“He doubted Congress could repeal and replace Obamacare with no Democrat help,” said Rep. Chris Collins (R., N.Y.), one of Mr. Trump’s earliest supporters. “He was right, so Donald Trump’s not wearing this at all.”

Texas Sen. Ted Cruz, Mr. Trump’s rival for the 2016 GOP presidential nomination, agrees with his call to end the cost-sharing payments to insurers. “The answer is not simply to pass a bailout for insurance companies,” Mr. Cruz said. “That would be a mistake. It’s what the Democrats want.”

Congress also must pass legislation to fund the government beyond Sept. 30, when the current spending law expires, and it needs to raise the borrowing limit by the end of September.

The Treasury has been resorting to cash-management techniques in order to keep paying its bills, but its cash balance is expected to drop to near $25 billion in September, a precariously low level.

Some conservative Republicans have in the past demanded budget concessions in return for voting to raise the debt ceiling. Treasury Secretary Steven Mnuchin met early Tuesday with Mr. McConnell and Sen. Chuck Schumer (D., N.Y.), the top Senate Democrat, to urge Congress to raise the debt ceiling with no strings attached, according to aides. Mr. McConnell told reporters he was committed to raising the borrowing limit  “to make sure America continues to never, ever default.”

Democrats are holding back on entering negotiations on the debt ceiling until Republicans take a position on whether they will to attach conditions on an increase.

“They’ve got to make some decisions themselves about how they’re going to handle it,” Sen. Ron Wyden, an Oregon Democrat, said. “The leader, of course, is the executive branch.”

Write to Siobhan Hughes at siobhan.hughes@wsj.com, Natalie Andrews at Natalie.Andrews@wsj.com and Janet Hook at janet.hook@wsj.com

Appeared in the August 2, 2017, print edition as ‘Senate GOP Rebuffs Trump Health Push.’

https://www.wsj.com/articles/senate-republicans-rebuff-donald-trumps-health-care-push-1501630741?mod=e2fb

John Kelly — President Donald Trump’s new chief of staff — Is in The West Wing — What Some Experts Expect

July 31, 2017

By CATHERINE LUCEY

July 31, 2017

 

 WASHINGTON (AP) — President Donald Trump’s new chief of staff is entering a West Wing battered by crisis.

Retired Gen. John Kelly, previously the Homeland Security secretary, takes over Monday from the ousted Reince Priebus. Trump hopes Kelly can bring some military order to an administration weighed down by a stalled legislative agenda, a cabal of infighting West Wing aides and a stack of investigations.

Still, Kelly’s success in a chaotic White House will depend on how much authority he is granted and whether Trump’s dueling aides will put aside their rivalries to work together. Also unclear is whether a new chief of staff will have any influence over the president’s social media histrionics.


Image may contain: 2 people, closeup
Former Trump campaign manager Cory Lewandowski, who was ousted from the campaign in June 2016, said on NBC’s “Meet the Press” that he expected Kelly would “restore order to the staff” but also stressed that Trump was unlikely to change his style.
“I say you have to let Trump be Trump. That is what has made him successful over the last 30 years. That is what the American people voted for,” Lewandowski said. “And anybody who thinks they’re going to change Donald Trump doesn’t know Donald Trump.”

Kelly’s start follows a tumultuous week, marked by a profane tirade from the new communications director, Trump’s continued attacks on his attorney general and the failed effort by Senate Republicans to overhaul the nation’s health care law.

In addition to strain in the West Wing and with Congress, Kelly starts his new job as tensions escalate with North Korea. The United States flew two supersonic bombers over the Korean Peninsula on Sunday in a show of force against North Korea, following the country’s latest intercontinental ballistic missile test. The U.S. also said it conducted a successful test of a missile defense system located in Alaska.

Sen. Dianne Feinstein, D-Calif., said on CBS’ “Face the Nation” that she hopes Kelly can “be effective,” and “begin some very serious negotiation with the North and stop this program.”

Another diplomatic fissure opened Sunday when Russian President Vladimir Putin said the U.S. would have to cut its embassy and consulate staff in Russia by several hundred under new sanctions from Moscow. In a television interview, Putin indicated the cutback was retaliation for new sanctions in a bill passed by Congress and sent to Trump.

Trump plans to sign the measure into law, the White House has said. After Putin’s remarks, the State Department deemed the cutbacks “a regrettable and uncalled for act” and said officials would assess the impact and how to respond to it.

While Trump is trying to refresh his team, he signaled that he does not want to give up the fight on health care. On Twitter Sunday, he said: “Don’t give up Republican Senators, the World is watching: Repeal & Replace.”

The protracted health care fight has slowed Trump’s other policy goals, including a tax overhaul and infrastructure investment. But Trump aides made clear that the president still wanted to see action on health care. White House budget director Mick Mulvaney said on CNN’s “State of the Union,” that senators “need to stay, they need to work, they need to pass something.”

Asked if nothing should be voted on in Congress until the Senate votes again on health care, Mulvaney said: “well, think — yes. And I think what you’re seeing there is the president simply reflecting the mood of the people.”

On Saturday, Trump threatened to end required payments to insurance companies unless lawmakers repeal and replace the Obama-era health care law. He tweeted that if “a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

The payments reduce deductibles and co-payments for consumers with modest incomes. Trump has guaranteed the payments through July, but has not made a commitment going forward.

White House counselor Kellyanne Conway said on “Fox News Sunday” that Trump would make a decision on the payments this week.

Sen. Susan Collins, R-Maine, who opposed the efforts to move a health bill forward this week, said on CNN that cutting the payments would “be detrimental to some of the most vulnerable citizens” and that the threat has “contributed to the instability in the insurance market.”

The House has begun a five-week recess, while the Senate is scheduled to work two more weeks before a summer break.

The doctors’ dilemma: Cases of the bottom line or medical ethics are on the rise

July 30, 2017

By 
Channel News Asia

Some doctors remain in a dilemma following new medical ethical guidelines which came into force this month. And this could mean patients’ medical benefits may no longer be accepted at certain clinics.

Image may contain: one or more people and people sitting

Patients waiting to see the doctor at a clinic in Singapore. (File photo: TODAY)

SINGAPORE: Covered by a medical benefits scheme? You may have to fork out your medical fees in cash, if your doctor was among those who recently suspended or terminated their contracts with third-party administrators (TPA) who provide medical benefits such as co-payment for a visit to a GP.

This is in response to the Singapore Medical Council’s (SMC) new ethical guidelines which came into effect this month. The new guidelines prohibit doctors from paying TPA fees that are calculated as a percentage of the patient’s total bill.

Doctors have been left scrambling to work out whether they should continue to accept patients who are on benefit schemes – and potentially fall foul of the new guidelines – or withdraw from the process altogether, leaving some patients either paying full fees or looking for treatment elsewhere.

“We’re stuck between a rock and a hard place,” said Dr Tan Tze Lee, a general practitioner at the Edinburgh Clinic in Choa Chu Kang who has dropped out.

“The professional bodies have given us their advisories … but at the end of the day I am the one who has to make the decision whether or not to sign,” he said. “I am risk-averse, and because everything is due to interpretation, I decided, better not.”

NEW GUIDELINES DESIGNED TO REFLECT “FAIR WORK”

SMC’s new ethical code came into effect on Jan 1, but it gave doctors six months – until Jul 1 – to ensure their contracts with TPAs meet the new guidelines. Since the guidelines came into effect, a number of doctors have terminated or temporarily suspended their contracts with TPAs.

Paying TPA percentage fees may be construed as a form of “fee splitting” between doctors and TPAs, said SMC in an advisory to doctors issued in December 2016. It pointed out that the work done by third parties in handling claims does not vary depending on the fees doctors charge patients. Hence, the fees paid to TPAs must likewise reflect the “fair work done” in processing the claims.

In a second advisory to doctors dated Jun 23, SMC said that should it receive any complaint or information that a doctor has breached the guidelines, “it will refer such complaint or information to the chairman of the Complaint Panel, and a Complaints Committee will inquire into the complaint or information.”

It added that the onus is on doctors, rather than third parties, to ensure that the fees they pay are in compliance with the new guidelines.

CHANGES BY THIRD-PARTY ADMINISTRATORS MAY NOT BE IN COMPLIANCE WITH NEW GUIDELINES

Since the guidelines were first announced last year, TPAs have made changes to their fee structures to ensure that they comply with the SMC guidelines.

However, in its Jun 23 advisory, SMC noted that some revised fee structures it has seen based on information provided by the TPAs still do not comply with the new guidelines. It said some of the revised fee structures appear to be tiered and primarily based on “the fee payable to the doctor, the amount claimable by the patient (which is in turn based on the fee payable to the doctor), and/or for surgical procedures, the Ministry of Health Table of Surgical Procedures”.

It clarified that while the new guidelines do not prohibit tiered fixed fee structures as such, the payment of a fee to third parties “cannot be based primarily on the services the doctors provide or the fees that doctors collect”.

In response to queries from Channel NewsAsia, the SMC said it is aware that following its Jun 23 advisory, some third parties have amended their fee structures or explained and elaborated further on the basis for their fees. “However, in general, if two cases that a doctor is seeing are within the same tier of complexity of work done by the third party but are charged different fees, such a fee structure may not be adequately justified as reflecting the work of the third party,” it said.

Benefits administrator MHC said it used to charge doctors a percentage fee of 10 to 15 per cent. Its CEO Low Lee Yong told Channel NewsAsia that it has revised its payment structure to a fixed fee model, and stressed that its new model does not breach the revised ethical guidelines.

As for Parkway Shenton, it said that its “flat fee model” remained unchanged for the past eight years before the review of the SMC guideline. “Prior to 1 July, we have had numerous discussions with both MOH and SMC to understand their viewpoints and concerns,” said Parkway Shenton’s CEO Adrian Lee. “With SMC’s clarifications and legal counsel, we made iterations to our fee schedule to ensure that it is in strict adherence to SMC guidelines.”

Parkway Shenton declined to give more details to the changes it made, but said it does not intend to make further changes. MHC, on the other hand, “may review the fee structure to ensure our changes are fair, transparent and reflective of the work done.”

DISRUPTION TO PATIENTS “NEGLIGIBLE”: THIRD-PARTY ADMINISTRATORS

Both TPAs said the majority of their doctors have chosen to stay on with them, with MHC’s Dr Low noting that the drop out rate is “negligible”.

“The handful of doctors who have dropped out have since requested to be put back in the panel,” he said. The disruption to patients, he added, is also negligible.

“We continue to be in conversation with doctors who have opted out of the panel and those who have taken a wait-and-see approach, and will accept them back into the scheme when they are more comfortable with the programme,” said Parkway Shenton’s Mr Lee.

“Since Jul 1, we have been working with our corporate partners and clients to keep everyone apprised of the daily change of panel doctors,” he added. “To date, we have not received any adverse feedback from our clients or their members.”

But one patient was left reeling from an S$80 medical bill when his regular family doctor abruptly terminated its contract with the TPAs. The final-year university student, who wished to be known only as Casper, said he got a “rude shock” when he visited the clinic on Jul 1. His school’s student insurance coverage allows for cashless payment at the school’s clinic or at about 200 GPs around the island.

“When I gave them my student card, the lady at the counter pointed to a notice which said the clinic no longer accepted patients under TPA schemes,” he added. “It was frustrating because I knew I needed antibiotics and that would cost me a lot.

“But because it was already so late (in the evening) and I was travelling soon, I just decided to pay in full.”

“I’ve been seeing this doctor for close to seven years and it was so convenient that my school was partnering with this clinic,” he said. “Besides being close to my house, the doctor also has my past records.”

THE DOCTORS’ DILEMMA

But as the onus is on doctors, rather than TPAs, to make the call, some doctors Channel NewsAsia spoke to remain in a dilemma: falling foul of the SMC if they stayed on with the TPAs, or losing business from patients on the TPA schemes.

“There are GPs where more than 70 per cent of their patient load comes from TPAs,” said one GP who runs a clinic in the east. “How are they going to survive if they terminate their agreement with TPAs?”

He explained that TPAs provide doctors with a ready pool of patients to tap on, particularly when they are new. “When I first started out, I was in a mature estate with many established GP clinics. It was hard starting out then, and why would patients with regular GPs come to see me instead?”

“Yet, we’re not allowed to market ourselves,” he said. “So the TPAs offer the potential for new patients.”

But as patients on the TPA scheme made up only 5 to 6 per cent of his clinic’s collections, the GP, who declined to be named, decided it was not worth it to stay on. His last remaining contract with a TPA ended on Jun 30.

“Even on the modified terms, it’s still considered fee splitting to me,” he said. “My wife and I talked it over and decided that it was not worth it to continue.

“I lost a few long-term patients because of this, and of course it’s a bit sad,” he added. “But I don’t blame them since they have to pay out of their own pockets if they wanted to see me henceforth.”

Medical director of the Central 24-hour clinic chain Lye Tong Fong said they have chosen to stay on with the “five or six” TPAs they have contracts with. About 50 per cent of their patients are on the TPA schemes.

“Some of them are our long-term chronic patients, and I don’t think it’s fair to leave patients’ interests out and leave them in the lurch regarding their payment,” he said. “It’s also not easy to jump from one doctor to another, especially if you have a chronic disease.”

“Of course, I would expect certain changes and rectifications to come along the way if any need should arise, and on our end, we will make sure the charging is based on one fixed fee,” he added. “If any contention arises, we will reject to work with the TPA from then onwards.”

Dr Lye said it is good that the SMC “put out such guidelines so everyone can fall in line”. But he noted that TPAs should also be regulated. “Millions of dollars flow to them, and patients’ interests are at stake here, because whether their problems can be clearly sorted out depends on the payers themselves,” he said.

But in the meantime, rather than collecting administrative fees from doctors, TPAs should collect them from companies instead, according to the GP who runs a clinic in the east. “Why should the TPA take a cut of the GP’s fees and affect his earnings when rightfully it’s the employers that should be shouldering the administrative costs? Maybe when this is the case I would reconsider re-joining.”

“If the companies want their medical expenditure to be controlled, the company can subscribe to a co-payment or cap scheme,” he added.

“At the end of the day I just want to focus on doing the best I can for my patients. Leave the money out of it.”

Source: CNA/lc
Read more at http://www.channelnewsasia.com/news/singapore/the-doctors-dilemma-sacrifice-the-bottom-line-or-fall-foul-of-9067386

Couple jump to their deaths because they ‘can’t afford’ health care

July 28, 2017
 Image may contain: car and outdoor

Manhattan parents struggling to pay their doctor’s bills jumped to their deaths early Friday – leaving double suicide notes pleading that their two kids be cared for, a law enforcement source told The Post.

The suicide note recovered by police.

The bodies of the man, 53, and woman, 50, — who claimed they had a “wonderful life” — were found in the middle of the street on 33rd Street between Park and Madison avenues in Murray Hill after the pair jumped from the 9th floor window of a 17-story corner office building on Madison Avenue at about 5:45 a.m., police said.

The woman had a suicide note in her pocket that read, “in sum and substance, ‘Our kids are upstairs, please take care of them,’” the source said.

The man had a typed note in his pocket that began with “WE HAD A WONDERFUL LIFE.”

“Patricia and I had everything in life,” the note read as it touched on the couple’s “financial spiral” and how “we can not live with” the “financial reality.”

The source added that a line of the note contained words to the effect: “’We both have medical issues, we just can’t afford the health care.’”

The victims’ identities were not immediately released.

Area workers who witnessed the aftermath of the tragic incident were stunned.

“When I got here at 6:05 a.m. I walked by dead bodies on the ground,” said a woman who would only identify herself as Kazi who works at the nearby 7-Eleven store.

“I was scared. I’ve never seen dead bodies before,” she said.

Seth Gottfried

Another man who works at the building next door said when he heard police sirens he looked out the window and saw the two bodies.

“Insane,” the man, who identified himself as Harry, said.

The couple’s tragic deaths come at a time of national debate on healthcare reform.

Additional reporting by Larry Celona and Yaron Steinbuch

McCain, battling cancer, returns to Senate and casts critical health care vote in “another heroic moment”

July 26, 2017

Senator John McCain thanked his fellow senators for their support after he was diagnosed with cancer, and says he plans to return after treating his illness.

 

WASHINGTON — Sen. John McCain returned to the U.S. Capitol on Tuesday afternoon to cast a critical vote in favor of health care legislation less than a week after undergoing surgery and revealing he has brain cancer.

And then, in typical McCain fashion, he took to the floor and blasted both the Senate’s draft health care bill and the process that produced it.

“All we’ve managed to do is make more popular a policy that wasn’t very popular when we started trying to get rid of it,” he said of Obamacare.

McCain’s vote was pivotal as Republicans, who hold a 52-seat majority, scrambled to round up 50 votes on a motion to advance legislation to repeal Obamacare.

McCain did not announce in advance whether he would support Tuesday’s “motion to proceed,” but he marched onto the floor to a standing ovation from his colleagues and voted “aye.” Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted no, requiring Vice President Pence to cast the tie-breaking vote in favor.

But that was only a vote to begin debate. “I will not vote for this bill as it is today,” McCain said, and if it fails, “which seems likely,” the Senate should go back to the drawing board, with hearings, markups and consultation with Democrats — all things that have thus far been lacking.

Standing in the well of the Senate with the surgical scar over his left eyebrow clearly visible, McCain urged his colleagues to “stop listening to the bombastic loudmouths” on radio, television and the Internet who rail against compromise. “To hell with them!” McCain said.

Democrats, including Senate Minority Leader Chuck Schumer of New York, were seen smiling during McCain’s speech as he railed against Republicans crafting legislation behind closed doors and trying to convince skeptical members that it’s better than nothing.

“Let’s trust each other,” McCain said. “We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle.”

McCain left the Capitol with his wife, Cindy, after his speech, canceling a scheduled news conference.

His announcement Monday that he would return for the vote added momentum to Republican efforts in the Senate following House Republicans’ passage of their bill in May.

“We all know Sen. McCain is a fighter,” said Majority Leader Mitch McConnell of Kentucky during a Senate floor speech Tuesday. “That’s evidenced by his remarkable life of public service, just as it’s again evidenced by his quick return to the Senate this afternoon.”

McCain, 80, a decorated Vietnam War veteran and six-term senator, is battling glioblastoma, an aggressive type of brain cancer that is difficult to treat. The cancer was discovered during surgery to treat a blood clot above his eye. He is reviewing treatment options, which may include chemotherapy and radiation, with his care team at the Mayo Clinic.

On the Senate floor, he hugged his colleagues and joked about his well-wishers.

“I’ve had so many people say such nice things about me recently that I think some of you must have me confused with someone else,” he said.

President Trump, who has criticized McCain in the past, tweeted his thanks early Tuesday morning and then again after the vote.

“.@SenJohnMcCain-Thank you for coming to D.C. for such a vital vote. Congrats to all Rep. We can now deliver grt healthcare to all Americans!” he wrote.

.@SenJohnMcCain-Thank you for coming to D.C. for such a vital vote. Congrats to all Rep. We can now deliver grt healthcare to all Americans!

Others blasted McCain on Twitter for leaving taxpayer-supported treatment to help pass legislation that —according to a Congressional Budget Office analysis — would lead to more than 20 million fewer people having insurance by 2026.

“After brain surgery paid for by taxpayers,@SenJohnMcCain will vote to take away healthcare from 22 million Americans,” tweeted Jon Cooper, chairman of the Democratic Coalition, which describes itself as an anti-Trump organization.

After brain surgery paid for by taxpayers,@SenJohnMcCain will vote to take away healthcare from 22 million Americans https://amp.cnn.com/cnn/2017/07/24/politics/john-mccain-returns-health-care-vote/index.html 

Photo published for John McCain to return to Senate Tuesday for health care vote

John McCain to return to Senate Tuesday for health care vote

Sen. John McCain, recently diagnosed with an aggressive form of brain cancer, will make a dramatic return to the Senate Tuesday to cast a critical vote on…

amp.cnn.com

McCain, who chairs the Senate Armed Services Committee, said he will stay in D.C. “for a few days” and plans to return to work on the National Defense Authorization Act, among other issues.

“After that, I’m going home for a while to treat my illness,” he said. “I have every intention of returning here and giving many of you cause to regret all the nice things you said about me.”

Contributing: Ronald J. Hansen, The Arizona Republic, and Eliza Collins, USA TODAY.

Includes video:

https://www.usatoday.com/story/news/politics/2017/07/25/mccain-battling-cancer-returns-senate-critical-health-care-vote/508685001/

GOP Senate Leader Mitch McConnell Abandons Health-Care Bill

July 18, 2017

Majority leader says “it is now apparent” Republican effort to repeal and replace Obamacare won’t be successful

Senate Majority Leader Mitch McConnell withdrew the GOP’s health-bill overhaul late Monday night.
Senate Majority Leader Mitch McConnell withdrew the GOP’s health-bill overhaul late Monday night. PHOTO: REUTERS

WASHINGTON—Senate GOP leaders gave up their effort to dismantle and simultaneously replace much of the Affordable Care Act, after the defections of two more Republican senators left the party short of the votes needed to pass President Donald Trump’s top legislative priority of his first seven months in office.

In a stinging defection for party leadership, GOP Sens. Mike Lee of Utah and Jerry Moran of Kansas on Monday night became the third and fourth Republicans to oppose the latest version of the GOP bill, which would roll back and replace much of the Affordable Care Act.

Senate Republicans had already lost two GOP votes, from Sens. Rand Paul of Kentucky and Susan Collins of Maine, and the new opposition from Messrs. Lee and Moran meant Senate leaders didn’t have enough support to advance the bill in a procedural vote.

Senate Majority Leader Mitch McConnell (R, Ky.) acknowledged the defeat. “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” he said in a statement.

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!

In a strategy facing long odds, the majority leader said the Senate would instead vote in coming days on a bill the chamber passed in late 2015 to unravel most of the ACA, which former President Barack Obama vetoed in January 2016.

Conservatives in both chambers and Mr. Trump have pressed to repeat the vote on the 2015 bill, which Mr. McConnell said would come as an amendment to the health-care bill passed by the House in May and would allow for a two-year transition.

“Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!” Mr. Trump tweeted shortly before Mr. McConnell’s statement.

Mr. Trump had embraced the idea earlier in July when it was proposed by Republican Sen. Ben Sasse, who noted that 49 sitting GOP senators had voted for a sweeping repeal bill earlier.

But many Republican senators have balked at this strategy, saying they wouldn’t feel comfortable rolling back the ACA without being able to tell their constituents what would supplant it.

Mr. McConnell’s latest tactic applies new pressure to conservatives who have so far blocked a bill they have said falls short of ACA repeal by offering them the chance to vote on exactly that. And while it is unlikely to become law, it also offers a way to move on from a bruising fight.

With 52 Republicans in the Senate, Mr. McConnell needed to secure at least 50 GOP votes, with Vice President Mike Pence casting a tiebreaking vote. No Democrats were expected to support the bill. The opposition from Messrs. Lee and Moran ended a frenzied period of negotiations aimed at shoring up faltering GOP support.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle-class families; nor does it create enough free space from the most costly Obamacare regulations,” Mr. Lee, one of the Senate’s most conservative Republicans, said in a statement Monday night.

Mr. Moran said he objected to the process used to craft the Senate GOP health-care bill, which he said “fails to repeal the Affordable Care Act or address health care’s rising costs.”

Messrs. Lee and Moran are likely to face backlash from Mr. Trump and his supporters, who were eager to see Republicans keep their seven-year promise to repeal the 2010 health law.

Their move comes as a surprise to many in Washington, since Mr. Moran rarely breaks with GOP leaders and Mr. Lee has often voted in step with Republican Sen. Ted Cruz (R., Texas), who introduced a key measure that GOP leaders incorporated into the bill last week.

On Monday night, the White House issued a statement that repeated a stance the president’s officials have taken in recent days—that GOP senators have no choice but to act.

“Insurance markets continue to collapse, premiums continue to rise, and Obamacare remains a failure. Inaction is not an option,” a spokesman said. “We look forward to Congress continuing to work toward a bill the president can sign to end the Obamacare nightmare and restore quality care at affordable prices.”

Republicans’ struggle to pass a health-care bill has exposed divisions within the party that could imperil other key items on their legislative agenda, including their yearslong push to overhaul the tax code.

Many had expected the next defection to come from the more centrist GOP senators, who have wavered over the latest version of the health-care bill, including Sens. Dean Heller of Nevada, who is up for re-election next year, and Republicans concerned about the bill’s cuts to federal Medicaid funding, such as Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

Democrats said it was time for Republicans to begin to work with them on strengthening the health-care system.

“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Senate Minority Leader Chuck Schumer (D., N.Y.) said Monday night. “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long term stability to the markets and improves our health-care system.”

The downfall of the bill is a tough blow for Mr. Trump, who has made it clear that undoing the 2010 law is a priority and has leaned heavily on fellow Republicans to make it happen. Mr. Trump said recently he would be very angry if the repeal legislation didn’t make it to his desk, and he was meeting Monday night with a handful of Republican senators to discuss the legislation.

Earlier Monday, the president promised Republicans would replace the law with “something that is going to be outstanding” and “far, far better than failing Obamacare.”

“We’re going to get that done,” he said, “and I think we’re going to surprise a lot of people.”

Health and Human Services Secretary Tom Price has already encouraged states to apply for waivers giving them more flexibility in enforcing the law and structuring their Medicaid programs. The waivers allow states to require many people to work to obtain their Medicaid benefits, among other changes.

Insurers will immediately be looking for assurances that the cost-sharing subsidies will be paid, said Larry Levitt, a senior vice president at the Kaiser Family Foundation. The drop-dead date for insurers will be mid to late September, when they have to sign contracts for 2018.

The individual insurance market has been stabilizing in most of the country and could continue just fine, Mr. Levitt said, but insurers will be reading the tea leaves for whether the Trump administration will make the subsidy payments they are expecting and enforce the individual mandate.

There are still some fragile markets, especially in rural areas, and they will likely require some shoring up to make sure insurers are participating and premiums are affordable, he said.

Write to Kristina Peterson at kristina.peterson@wsj.com and Stephanie Armour at stephanie.armour@wsj.com

Appeared in the July 18, 2017, print edition as ‘GOP Abandons Senate Health Bill.’

https://www.wsj.com/articles/gop-senate-leader-mcconnell-abandons-health-care-bill-1500348064

Related:

GOP effort to repeal and replace “Obamacare” fatally wounded in the Senate as two more Republican senators announced their opposition

July 18, 2017

The Associated Press

 (AP) — The latest GOP effort to repeal and replace “Obamacare” was fatally wounded in the Senate Monday night when two more Republican senators announced their opposition to legislation strongly backed by President Donald Trump.

The announcements from Sens. Mike Lee of Utah and Jerry Moran of Kansas left the Republican Party’s long-promised efforts to get rid of President Barack Obama’s health care legislation reeling. Next steps, if any, were not immediately clear.

Lee and Moran both said they could not support Majority Leader Mitch McConnell’s legislation in its current form. They joined GOP Sens. Susan Collins of Maine and Rand Paul of Kentucky, both of whom announced their opposition right after McConnell released the bill last Thursday.

McConnell is now at least two votes short in the closely divided Senate and may have to go back to the drawing board or even begin to negotiate with Democrats, a prospect he’s threatened but resisted so far.

McConnell’s bill “fails to repeal the Affordable Care Act or address healthcare’s rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one,” said Moran.

It was the second straight failure for McConnell, who had to cancel a vote on an earlier version of the bill last month when defeat became inevitable.

Trump had kept his distance from the Senate process, but Monday night’s development was a major blow for him, too, as the president failed to rally support for what has been the GOP’s trademark issue for seven years — ever since Obama and the Democrats passed the Affordable Care Act in the first place.

The Senate bill eliminated mandates and taxes under Obamacare, and unraveled a Medicaid expansion. But for conservatives like Lee and Paul it didn’t go far enough in delivering on Republican Party promises to undo Obama’s law, while moderates like Collins viewed the bill as too extreme in yanking insurance coverage from millions.

Senate Healthcare Bill — Unexpected McCain surgery delay gives more time for criticism — “The Votes Aren’t There”

July 17, 2017

Delay in long-promised vote after unexpected McCain surgery

(Reuters)

A Republican push to pass a sweeping health-care law experienced another setback as Senate leaders said they would delay a vote set for this week, sparking fresh doubts about whether congressional leaders can muster support for a marquee GOP policy priority.

Updated July 16, 2017 7:05 p.m. ET

President Donald Trump and party leaders in Congress were hoping the Senate would vote this week on a plan to overturn parts of the 2010 Affordable Care Act and make other changes to the health system. But Senate leaders announced a delay after Sen. John McCain said he would recover in Arizona from surgery removing a blood clot above his left eye, leaving supporters short of the votes needed to move ahead with the bill.

The delay prolongs the uncertainty over the bill’s prospects. GOP leaders have pursued a fast-paced timeline, as health-policy changes are often controversial. Sen. John Cornyn, a member of Senate GOP leadership, told reporters last month that passing the bill is “not going to get any easier” with time. Another GOP senator, Lindsey Graham of South Carolina, said the bill “is not like fine wine; it doesn’t get better with age.”

Meantime, insurance companies, state governors and congressional critics continued to line up against the bill, with their objections running the ideological gamut. Governors, including some Republicans, have said they are concerned about its proposed cuts to the growth of Medicaid spending, while two top insurance industry groups objected to a change to the GOP bill proposed by Sen. Ted Cruz of Texas as “unworkable.”

Senate Majority Leader Mitch McConnell (R., Ky.), who can’t afford more than two defections among the 52 GOP senators, has been balancing demands by more-centrist lawmakers for additional money for Medicaid and consumer subsidies with a push by conservatives to pare back requirements on insurers in order to lower premiums for younger, healthier people.

One centrist and one conservative GOP senator who have bucked their party before, Susan Collins of Maine and Rand Paul of Kentucky, have said they can’t support the bill, for different reasons. But others have yet to commit, and one more defection would derail the legislation. Mr. McCain’s absence means GOP leaders are short of the votes this week for a procedural motion to consider the bill.

Ms. Collins, speaking on Sunday on ABC, said that eight to 10 Republicans had “deep concerns” about the bill, even after a new version was unveiled last week to address issues raised by some GOP senators. “I think it would be extremely close,” she said when asked whether Mr. McConnell had the votes for passage.

Senate GOP leaders, spurred on by the White House, had been building toward a deadline of this week that had been intended to isolate and spotlight holdouts, warning them that they would pay a price for bucking their party and undermining its collective legislative goal of the past seven years. They have emphasized insurance-market woes under the ACA in some states as proof of the urgency of the cause.

Mr. McConnell had hoped to finish the health debate this week so the Senate could turn to the annual defense-policy bill, confirmation of more of Mr. Trump’s nominees and raising the debt limit before adjourning in mid-August.

The McCain absence gives Mr. McConnell and the White House a chance to continue working on holdout senators without having to back down from a vote this week. But it also creates a window for the 2010 health law’s supporters to continue a fight they believe is more likely to be successful the longer they wage it.

“A key factor is time: The longer the bill languishes, the less likely it will pass,” said Greg Valliere, chief global strategist at Horizon Investments. “And there won’t be much time left after Labor Day, as Congress shifts its focus to budget and tax issues. So, while McCain’s absence complicates the health debate, it already was in deep trouble, even when he was healthy.”

Prime targets for both sides are the remaining senators who had opposed an earlier version of the Senate bill but haven’t taken a public stance on its latest iteration. Sen. Dean Heller (R., Nev.), up for re-election next year, is likely under the most pressure, due in part to concerns about the bill from the GOP governor of his state. Other Republicans from states that expanded Medicaid, including Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia, will be in the limelight this week.

The extra time also allows for more scrutiny of a measure from Mr. Cruz that would allow insurers to offer cheaper plans with less comprehensive coverage than required under the ACA, if they also offer plans that meet ACA coverage requirements. The proposal has alarmed insurers and centrist Republicans who say it would cause premiums to surge for sicker people, who would more likely buy more-comprehensive plans without the costs being offset by policies that younger and healthier people buy.

Senate leaders said they are confident they could hold the procedural vote to advance the bill as soon as Mr. McCain was back in the Senate. The White House declined to comment at length on the setback Sunday. “We wish Sen. McCain a speedy recovery,” said spokeswoman Helen Aguirre Ferré.

The Trump administration has previously said a quick timeline on a health vote was best, particularly as Democrats and liberal organizers have stepped up their advocacy of preserving the ACA, which they see as former President Barack Obama’s signature domestic achievement.

“The left, I think, has been more organized in their messaging on this than collectively Republicans have as far as advocating for the benefits of the bill,” said Marc Short, the White House director of legislative affairs, last week.

The difficulty for many Republicans is that supporting the bill or opposing it both carry political risk. On the one hand, the party has for years vowed a full repeal of the ACA, known as Obamacare. “I think not being able to deliver on that promise would do serious and long-lasting damage to the credibility of Republicans,” Mr. Cruz said in an interview.

Others are weighing the fallout over health policy and how its changes would affect some states, particularly rural ones. “This bill would make sweeping and deep cuts to the Medicaid program….It would also jeopardize the very existence of our rural hospitals and our nursing homes,” Ms. Collins said on ABC. Conservative lawmakers say the financing for Medicaid as now configured is unsustainable.

Rep. Mark Amodei, a Republican representing a competitive district in Nevada, opposed an early draft of the House health bill but voted for the final version in May. He said that ultimately, he would expect GOP voters to be frustrated if Congress doesn’t repeal the ACA, or large swaths of it, but he recognizes the political peril either way.

“If somebody’s looking for safe harbor and no hard votes, this is going to be an awful year for them, because I think it’s going to be hard vote after hard vote after hard vote,” he said.

Jennifer Levitz contributed to this article

Write to Byron Tau at byron.tau@wsj.com, Louise Radnofsky at louise.radnofsky@wsj.com and Kristina Peterson at kristina.peterson@wsj.com

https://www.wsj.com/articles/trump-push-to-pass-health-care-law-faces-new-setback-1500219899