"As the U.S. Senate considers the Better Care Reconciliation Act, we are writing to urge you to strike the 'Consumer Freedom Option' from the bill. It is simply unworkable in any form and would undermine protections for those with preexisting medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market."

—Marilyn Tavenner, President and CEO, America's Health Insurance Plans, and Scott P. Serota, President and CEO, Blue Cross Blue Shield Association in a letter to Senate leaders

• Senate Republicans Unveil New Health Bill, but Divisions Remain New York Times by Robert Pear and Thomas Kaplan—Senate Republican leaders on Thursday unveiled a fresh proposal to repeal and replace the Affordable Care Act, revising their bill to help hold down insurance costs for consumers while allowing insurers to sell new low-cost, stripped-down policies. Those changes and others, including a decision to keep a pair of taxes on high-income people and to expand the use of tax-favored health savings accounts, were intended to bridge a vast gap between the Senate's most conservative Republicans, who want less regulation of health insurance, and moderate Republicans concerned about people who would be left uninsured. But Republican leaders will have to battle for votes ahead of a final showdown they hope will come next week. 
  
  
• Senate Health Care Bill: 5 Hurdles Republicans Are Facing to Pass the Bill USA Today by Erin Kelly—Senate Republicans hope their latest proposed bill to replace Obamacare will attract enough votes from the moderate and conservative wings of their party to pass next week. But there are at least five hurdles that could derail efforts to reach consensus.  They include: 1. The bill still makes major cuts to Medicaid. 2. It does not fully repeal Obamacare. 3. It still raises costs for older Americans. 4. It still defunds Planned Parenthood. 5. Two GOP senators are offering a potentially attractive alternative.
  
  
• McConnell: Senate Will Work Through First Two Weeks of August Recess Politico by Seung Min Kim and Burgess Everett—Senate Majority Leader Mitch McConnell will keep the Senate in session the first two weeks of August, the Kentucky Republican announced Tuesday—as the GOP faces a daunting to-do list that includes repealing Obamacare and raising the debt limit. "In order to provide more time to complete action on important legislative items and process nominees that have been stalled by a lack of cooperation from our friends across the aisle, the Senate will delay the start of the August recess until the third week of August," McConnell said.
  
  
• Obamacare 101: Is There a Smaller Fix for the Affordable Care Act? Los Angeles Times by Noam Levey—With Senate Republicans struggling to find votes for sweeping legislation to roll back the Affordable Care Act, several GOP lawmakers have raised the prospect of a more limited bill—passed with help from Democrats—to stabilize health insurance markets around the country. That may be heresy for conservative Republicans who've spent seven years demanding the full repeal of Obamacare, as the law is often called. But most patient advocates, physician groups, hospitals, and even many health insurers say more-targeted fixes to insurance marketplaces make more sense than the kind of far-reaching overhaul of government health programs that Republicans have been discussing.
  
  
• White House Analysis of Health Bill Seeks to Discredit CBO  The Hill by Nathaniel Weixel—The White House on Wednesday released its own internal analysis of the Senate's Obamacare repeal-and-replace bill in an attempt to push back against the Congressional Budget Office's (CBO) findings. In a statement, the White House said the CBO estimates about the Better Care Reconciliation Act's Medicaid impact "should be discounted because of the large errors made by the agency in estimating the toll of the Affordable Care Act." The Council of Economic Advisors' analysis is part of a larger campaign by the White House to discredit the official congressional scorekeeping agency. The administration also released a video, accusing the CBO of using "faulty assumptions and bad numbers" to create scores for the House and Senate GOP Obamacare repeal and replace bills.

• Millions More Uninsured Could Impact Health of Those with Insurance, Too Kaiser Health News by Julie Rovner—Much has been written lately about how individuals' health could suffer if they lose insurance under the health proposals circulating in the U.S. House and Senate. But there is another consequence: creating millions more people without insurance could also adversely affect the health of people who remain insured. "We know that communities with higher rates of uninsurance have worse access to care for those with Medicare or private insurance," said John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan. And if either of the GOP proposals under consideration becomes law, he said, "it's very likely we would go back to some of those same problems we had a decade ago with high rates of uninsurance."

• Despite Doomsday Rhetoric, Obamacare Markets Are Stabilizing Politico by Paul Demko—"Obamacare is dead," President Donald Trump frequently declares. But reports of its demise appear to be premature. For the first time ever this year, insurers selling plans in Obamacare's markets appear to be on a path toward profitability. And despite the drumbeat of headlines about fleeing insurers, only about 25,000 Obamacare customers live in communities facing the prospect of having no insurer next year.  Insurers in the Obamacare marketplaces spent 75 percent of premiums on medical claims in this year's first quarter, an indication the market is stabilizing and insurers are regaining profitability, according to a Kaiser Family Foundation study released this week. By comparison, in the prior two years, insurers spent more than 85 percent of premiums on medical costs during the same period, which translated into huge losses.

• Republicans Say Medicaid Is 'Broken.' Here's How The People It Covers Feel. The Washington Post by Carolyn Y. Johnson—Politicians call the Medicaid program that provides health care for the poor "broken." Academic studies have reported on its limited health benefits or the longer appointment wait times that people with Medicaid face. But as Republicans feverishly work to revise a health-care bill that would trigger deep cuts to the program over time, a massive new survey reveals that people enrolled in Medicaid rate their health care pretty high. On a scale of 0 ("the worst health care possible") to 10 ("the best health care possible"), more than 270,000 people covered by Medicaid in 46 states rated their health care at an average of 7.9, according to an analysis in the journal JAMA Internal Medicine. That's just slightly worse than how Medicare enrollees rated their health care—and not far behind how privately insured patients feel about their coverage.
  
  
• Crippling Medicaid Cuts Could Upend Rural Health Services Kaiser Health News by Virginia Anderson—Republican bills to replace the federal health law would worsen rural areas' financial straits through reductions in Medicaid funding. Patient advocates predict these changes would lead to fewer enrollees, more shutdowns of rural facilities, reduced payments to doctors, and fewer programs for people with health needs or disabilities. In the aggregate, such changes threaten the health of thousands of state residents, especially those in rural areas. "I've seen changes, and I've seen cuts, but I've never seen changes like what's being proposed in this bill," said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. "This is the first time it's been this scary."

• Medicare's Financial Outlook Slightly Improved, Trustees Say Kaiser Health News by Phil Galewitz—The Trump administration said Thursday that the financial outlook for Medicare's hospital insurance trust fund improved in the past year due to health costs rising more slowly than expected and predictions that enrollees will use hospital services less often. The report said that trust fund would last through 2029, one year later than what was projected last year. Two years ago, 2030 was the projected depletion date. Medicare Part B premiums—which cover visits to physicians and other outpatient costs—should remain stable next year, the trustees said. About a quarter of Part B costs are paid for by beneficiary premiums with the rest from the federal budget. 

• What's Actually Wrong With the U.S. Health System:  On the heels of the Senate’s latest attempt at replacing the Affordable Care Act, the Commonwealth Fund has released its latest evaluation of what exactly ails the U.S. health care system. Once again, the researchers found the U.S. medical system performed the worst among 11 similar countries, all while spending more. The United States fared especially badly on measures of affordability, access, health outcomes, and equality between the rich and poor. The United Kingdom ranked first, and the other countries in the comparison were Australia, Switzerland, Sweden, the Netherlands, New Zealand, Norway, Germany, Canada, and France.

Editor: Peter Van Vranken