In McConnell’s Own State, Fear and Confusion Over Health Care Bill – New York Times

WHITESBURG, Ky. — Dewey Gorman, a 59-year-old banker who has struggled with opioid addiction, had just gotten out of the hospital in this tiny central Appalachian city when he heard the word from Washington: His fellow Kentuckian, Senator Mitch McConnell, had delayed a vote to repeal the Affordable Care Act. He felt torn about that.

“It’s broken. It’s broken very badly,” Mr. Gorman said of former President Barack Obama’s signature health care law. “But if they want to take away insurance from 22 million people — a lot of them would come from these mountains. That would be devastating to our area.”

Perhaps nowhere has health care law had as powerful an impact as in Kentucky, where nearly one in three people now receive coverage through Medicaid, expanded under the legislation. Perhaps no region in Kentucky has benefited as much as Appalachia, the impoverished eastern part of the state, where in some counties more than 60 percent of people are covered by Medicaid.

And in few places are the political complexities of health care more glaring than in this poor state with crushing medical needs, substantially alleviated by the Affordable Care Act, but where Republican opposition to the law remains almost an article of faith. While some Senate moderates say the Republican bill is too harsh, Rand Paul, Kentucky’s other Republican senator, is among Senate Republicans who say they are opposed to the current bill for a different reason: They believe it does not go far enough to reduce costs.

Mr. McConnell, who was re-elected handily in 2014, seems committed to his party’s pledge to repeal the Affordable Care Act even if it might hurt some constituents back home. A study last year by the Kaiser Family Foundation found that the percentage of uninsured in Kentucky dropped from 18.8 percent in 2013, the year the health law was put in place, to 6.8 percent — one of the sharpest reductions in the country.

Here in Whitesburg, a city of roughly 2,000 people at the base of Pine Mountain, Mr. Gorman’s sentiment seems to be the prevailing one. In nearly two dozen interviews with health care workers and patients, at the hospital and at a nonprofit clinic run by the Mountain Comprehensive Health Corporation, Kentuckians sounded both fearful and flummoxed by the health care drama on Capitol Hill.

“It makes me very nervous,” said Brittany Hunsaker, 29, a clinic social worker who counsels pregnant women addicted to opioids. “Some of the most vulnerable people that we serve, we may not be seeing any more.”

Several clear themes emerged. Most people said they want everyone covered, and were appalled, as was Mr. Gorman, when they learned the Congressional Budget Office had estimated the Republican plan would leave 22 million more people uninsured over a 10-year period. They are happy that lawmakers are trying to fix Mr. Obama’s health law — rising premiums are a worry for many — but fear that Republicans, in their haste, will make a bad situation worse.

Sorting out the way forward is agonizingly complex. Kentucky’s Medicaid expansion and successes under the Affordable Care Act are largely the result of former Gov. Steve Beshear, a Democrat who is out of office now. Meanwhile, Gov. Matt Bevin, a Republican elected in 2015, is pushing for a Medicaid waiver from the federal government that includes requirements for many beneficiaries to work or participate in job training.

Dr. Van Breeding, the clinic’s director of medical affairs, lamented that the Republican bill in the Senate had gotten mixed up in “party politics,” while patients had been forgotten. He summed up the situation this way: “Senator Paul is worried about the financial aspect of it. Senator McConnell is worried about the political aspect of it. And I’m worried about patients not having access to basic health care.”

Kathy Collins, 50, who suffers from lupus, an autoimmune disease — and who was uninsured until she got Medicaid coverage through the law’s expansion — is among Dr. Breeding’s patients. Sitting in her hospital bed here Tuesday morning, she said she was surprised to hear that Mr. McConnell, whom she had voted for previously, was leading the charge to roll it back.

“He is?” she asked. “Well, then, he’s no good for Kentucky.”

Health care is a growing part of this region’s economy, and people here are also deeply concerned that the repeal will bring job losses to a region already decimated by unemployment from the coal industry downturn.

Dr. Breeding says the number of uninsured patients at the clinic dropped from 19 percent to 4 percent as a result of the health care law. He said Mountain Comprehensive was “barely getting by” financially before the law was passed; business is much better now. Mountain Comprehensive has hired more people and now offers extended weekend hours and an optometry clinic — services that have been financed by revenue brought in from the health law, Dr. Breeding said.

And those services mean more health care jobs.

“If they do what they say they are going to do, then we may lose our jobs,” said Vicki Roland, a surgical nurse. “I think what we have works pretty good for the people. If they revamp it, I’m not sure what’s going to happen.”

Mr. McConnell’s office did not respond to a request for an interview. But Mr. McConnell did make his case for why the bill would help Kentucky on the Senate floor last week, and in an opinion piece in The Cincinnati Enquirer on Sunday, in which he argued that the legislation would stabilize markets and “deliver flexibility” to state officials to address problems like the opioid crisis.

Despite his constituents’ concerns, Mr. McConnell has little reason to worry about a political backlash; he is widely credited with building the Republican Party in this state, and after three decades in the Senate, his seat is secure. In 2014, he clobbered his Democratic opponent, Secretary of State Alison Lundergan Grimes, winning by more than 15 percentage points.

“He ran on a clear platform to repeal and replace Obamacare, as did Matt Bevin, the governor, as did Rand Paul, the other senator, as did Donald Trump,” said Scott Jennings, a Kentucky Republican strategist with close ties to Mr. McConnell. “And they all have one thing in common: They have overwhelmingly won their elections in Kentucky.”

Still, there has been pushback. On Monday, nearly 100 opponents of the repeal protested outside Mr. McConnell’s northern Kentucky office. On Tuesday, more than a dozen organizations representing health care providers signed an open letter to Mr. McConnell, published in his hometown paper, The Courier-Journal of Louisville, imploring him to “STOP the mad rush to pass this bill” and instead seek advice from health care experts.

“You said you have a ‘responsibility to act,’” the letter said. “We believe you have a duty to act responsively. Kentuckians deserve better.”

The local newspaper here in Whitesburg, The Mountain Eagle, published an editorial assailing Mr. McConnell for putting the bill together behind closed doors. “Why the secrecy, Sen. McConnell?” its headline read.

Dr. Breeding, recently named Country Doctor of the Year by Staff Care, a Dallas-based health care company, shares these sentiments. His message to Mr. McConnell: “Don’t rush it. Bring in the experts. Let’s hammer it out.”

To spend a day with Dr. Breeding is to get a glimpse of his patients’ challenges. His weekday mornings begin at 4:30 a.m., when he arrives at the hospital in Whitesburg. Dressed in his workout gear, he makes rounds, visiting patients whose ailments run the gamut: pneumonia, respiratory failure, colon cancer, lupus, black lung disease, dementia, heart attack, kidney infection and multiple myeloma, a bone cancer.

By 8:30 a.m., after a break for a brisk walk through town, he arrives at the clinic, where his nurse practitioner, Heather Yates, says she sees the health care debate from both sides.

Like her colleagues, Ms. Yates, 35, worries that undoing the Affordable Care Act will hurt patients. But she has had to cope with the high cost of premiums; when her husband was out of work, they qualified for subsidies under the Affordable Care Act but still paid $400 a month for an insurance policy with a deductible of as much as $1,500. Now the couple pays $1,000 a month, with a $6,000 deductible, for a plan that covers all expenses once the deductible is met.

“I’ve got a mix of emotions,” she said. “I do want everybody to have insurance, but I understand what it’s like to pay for it too.”

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DHS announces enhanced security measures for all flights to US but won’t expand laptop ban – Washington Post

By ,

U.S. officials on Wednesday announced enhanced security and screening measures for all commercial flights to the United States, but backed away from a proposal to expand a ban on laptops and other electronic devices — unless airlines and airports refuse to comply with the new rules.

“The good news is we found a way to raise the bar worldwide, but at same time not inconvenience the traveling public,” said U.S. Secretary of Homeland Security John Kelly.

DHS officials said that the changes will be “seen and unseen” and could include additional screening for travelers and their laptops, e-readers and tablets as well as the expansion of Preclearance, a program in which U.S. Customer and Border Protection officers conduct screening at international airports.

Since March, passengers on flights to the U.S. from certain mostly Middle Eastern countries, have been prohibited from bringing electronic devices larger than a cellphone on board with them. But those restrictions could be lifted if the affected airlines and airports adopt the new security protocols, officials said.

In a briefing with reporters, senior DHS officials said the new requirements will “raise the baseline” on aviation security worldwide. The directives are focused on preventing terrorists from circumventing aviation security.

Ultimately, the senior DHS officials said the secretary concluded that the threats could be handled without an expansion of the laptop ban.

[Britain, U.S. ban most electronic devices in cabins on flights from some Muslim countries]

“Since adopting the large [personal electronic device] prohibition, DHS has been in constant contact with our interagency, industry and foreign partners to address evolving threats with a minimum of disruption to the traveling public,” according to a fact sheet outlining the changes. “DHS developed these new enhanced security measures to effectively mitigate threats to aviation with minimum passenger inconvenience.”

However, airlines and airports that do not comply with the new requirements could face repercussions, including a full ban on all personal electronic on board flights, even in cargo, fines and possible loss of their permission to fly to the U.S.

It is not clear when the enhanced measures would be put into place, but DHS officials said travelers may start to see changes as early as this summer. The officials said that not all measures will be visible to the public, though people may notice more bomb sniffing dogs, more thorough screening of their carry-on bags and swabbing of devices for traces of explosions.

Wednesday’s announcement comes after months of debate over whether the U.S. should expand the ban on laptops and other electronic devices that it put into place in March for travelers from 10 airports in mostly Middle Eastern countries.

The ban was prompted by growing concerns that terrorists could conceal bombs in laptops and other similar devices.

In May, U.S. officials suggested the ban might be expanded to include direct flights to the U.S. from Europe. Later that month, in an appearance on “Fox News Sunday,” Homeland Security Secretary John Kelly suggested he might go even further extending the ban to all international flights in and out of the U.S.

[E.U., U.S. officials meet to discuss possible expansion of the laptop ban]

European officials raised concerns about potential new restrictions and sought more information about the threats that prompted talk about an expansion.

European Union officials characterized a meeting last month in Brussels with top U.S. Homeland Security officials as productive but also urged officials to consider other ways to address the potential threat.

Industry groups both in the U.S. and abroad said they were concerned about the economic implications of expanding the ban as well as the impact it could have on worker productivity.

In May, the head of the International Air Transport Association (IATA), which represents more than 270 international carriers, expressed serious concerns about the ban and urged leaders to consider other enhanced screening methods as an alternative.

Expanding the ban could cost $1.1 billion a year in lost productivity, travel time and “passenger well-being,” Alexandre de Juniac, director general and chief executive of the group, which represents 265 airlines, wrote in a letter to Violeta Bulc, the E.U.’s top transportation official and Kelly.

In all, 280 airports in 105 countries will be required to meet the heightened security standards, DHS officials said. Roughly 325,000 daily passengers on 2,100 flights could be affected.

DHS officials also said one visible enhancement could be the expansion of CBP’s Preclerance program, which is currently in place at airports in six countries: Aruba, the Bahamas, Bermuda, Canada and the United Arab Emirates.

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Why one man keeps ramming his car into Ten Commandments statues on government property – Washington Post

Authorities identified Michael Tate Reed as the driver who rammed into a newly installed Ten Commandments monument less than 24 hours after it was placed on the Arkansas State Capitol grounds. (AP)

In the video, the Arkansas Capitol dome can be seen lit against the night sky as the Dodge Dart accelerates to 10, then 20 mph.

“Oh my goodness,” a man says as he flicks on the car’s lights. “Freedom!”

The vehicle speeds up the hill, and the last thing that comes into view before a crash is a large, newly installed monument.

Authorities say the man in the video is Michael Tate Reed, an alleged serial destroyer of Ten Commandments monuments.

He was arrested by state capitol police officers at the scene early Wednesday, according to Chris Powell, a spokesman for the Arkansas secretary of state. Reed is charged with criminal trespass, first-degree criminal mischief and defacing objects of public interest.

That object of public interest was a three-ton granite monument that had been installed less than 24 hours before its violent, pre-dawn demise on the southwest lawn of the state capitol in Little Rock.

Crews had cleaned up the crash site by late Wednesday morning and taken the broken pieces to storage, Powell said. Jason Rapert, an Arkansas state senator who led the movement to put up the monument, said a replacement has already been ordered, according to the Arkansas Democrat-Gazette.

“This law will be fulfilled, and we will raise the funds to make sure it’s put back where it should be,” he told the newspaper.

We will rebuild. In fact, we should build the monument bigger and higher to show that will not be intimidated #arpx#arleg#ARNewshttps://t.co/SJBEzXGIzW

— Senator Trent Garner (@Garner4Senate) June 28, 2017

Reed could not be reached for comment. Powell told The Washington Post he wasn’t sure whether Reed had been released from jail.

According to the Associated Press, a 2015 law required Arkansas to allow the Ten Commandments display near the capitol. But groups who argue for a strong separation of church and state have criticized the placement of a biblical statue on the grounds of the seat of the state’s government.

After plans for the Ten Commandments monument were announced, the satanic temple pushed for a competing statue of Baphomet, a goat-headed, angel-winged creature accompanied by two children smiling at it, the AP reported.

Other states have grappled with similar Ten Commandments controversies, including Oklahoma, which installed a 4,800-pound monument on its capitol grounds in 2012.

In 2014, Reed rammed a car into that monument, Powell said. But it was replaced and stood on the capitol grounds until the state Supreme Court ruled it had to be removed, according to The Washington Post’s Abby Phillip.

[Oklahoma’s Ten Commandments statue must be removed, state Supreme Court says]

According to the Tulsa World, a judge ordered Reed to receive mental health treatment after that incident. He was diagnosed with schizoaffective disorder and released under an agreement that required him to continue treatment.

He sent a rambling letter to the newspaper apologizing and describing the voices in his head and his attempts to recover from mental health issues.

He also detailed one incident where voices told him to crash his car into other vehicles, but instead he wrecked on a highway median. In the past, he’s walked into federal buildings to spit on portraits, made threats against former president Barack Obama and set money on fire, according to the World.

Reed appears to allude to the Oklahoma toppling incident in a Facebook post before the Arkansas statue was rammed.

“I’m a firm believer that for our salvation we not only have faith in Jesus Christ, but we also obey the commands of God and that we confess Jesus as Lord,” he says in the post. “But one thing I do not support is the violation of our constitutional right to have the freedom that’s guaranteed to us, that guarantees us the separation of church and state, because no one religion should the government represent.”

Later, he says he’s “back at it again,” and asks for people to donate money to help repair his car.

Read more: 

Texas mayor blasted after she says lack of faith in God causes poverty

A mother’s response to the health-care debate: Her 3-year-old son’s $231,000 hospital bill

Video shows woman demanding ‘white doctor’ for her son in waiting-room rant

An airline tried to get a musician to check her 17th-century violin. A ‘wrestling match’ ensued.

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The Health 202: There will be dead bodies whichever way the Senate swings on health care – Washington Post

THE PROGNOSIS

A casket in Yokohama, Japan. Photographer: Shiho Fukada/Bloomberg

Let’s put it this way: There will be dead bodies one way or another, regardless of which way the Senate swings on its health-care bill.

The Senate GOP quest to pass a measure replacing big parts of the Affordable Care Act and enacting steep Medicaid spending cuts suffered a spectacular meltdown yesterday as senators kept jumping ship, forcing Majority Leader Mitch McConnell (R-Ky.) to suspend his plans for a vote this week and virtually guaranteeing health-care will remain front-and-center on Capitol Hill throughout July.

There were glimmers of harmony after the Republicans huddled at the White House yesterday afternoon with President Trump, but it was clear the legislation would still need changes to secure enough votes and that a vote this week is still unlikely.

“The president got an opportunity to learn all the various positions on things that we’ve been discussing,” McConnell said after the gathering. “We all agreed that, because the markets are imploding, we need to reach an agreement among ourselves here as soon as possible and then move to the floor after the recess.”

There’s a widespread expectation that McConnell will ultimately bring some version of his health-care bill to the floor sometime in the 13 legislative days before August recess — even if he knows it will fail. It’s not enough for him to tell the GOP base it couldn’t get done, not after seven years of promising otherwise. He’s got to show them with dead bodies on the floor — a morbid, insider way of describing a measure that can’t get enough votes to pass.

“It’s now or never,” Rodney Whitlock, a former longtime health staffer for Sen. Charles E. Grassley (R-Iowa), told The Health 202.

On the other hand, if Republicans do pass their health-care bill, it could cause 22 million fewer Americans to have health coverage a decade from now. Some of those people will voluntarily choose to forgo insurance. But others facing serious illnesses will find plans less affordable than under the ACA, fueling dramatic charges by Democrats that more people will die under the GOP approach.

A tweet by Sen. Bernie Sanders (I-Vt.):

Let us be clear and this is not trying to be overly dramatic: Thousands of people will die if the Republican health care bill becomes law.

— Bernie Sanders (@BernieSanders) June 23, 2017

From Senate Finance Committee ranking member Ron Wyden (D-Ore.):

GOP health plan is heartless. It is brainless. It is cruel. It means more Americans will suffer or die without access to care. #Trumpcare

— Ron Wyden (@RonWyden) June 22, 2017

Rep. Jackie Speier (D-Calif.) said the GOP bill “will guarantee that people will die” 

“Will guarantee that people will die.” Dem @RepSpeier on the Senate GOP healthcare bill.https://t.co/o8f6EJPHzD

— Kate Bolduan (@KateBolduan) June 27, 2017

Hillary Clinton called Republicans “the death party” if they pass their health-care measure:

Forget death panels. If Republicans pass this bill, they’re the death party. https://t.co/jCStfOaBjy

— Hillary Clinton (@HillaryClinton) June 23, 2017

Democrats are clearly blowing up the “death” line to score political points. The available evidence suggests there will be a human toll from an increase in the number of uninsured – but that number is hard to pin down, my colleague Philip Bump writes.

“One key reason is obvious: There are serious ethical questions about running an experiment in which people are denied insurance in an effort to determine how much more quickly they might die,” Philip writes. “We’re left with a number of studies that try to approximate the answer to the question by using inadvertent experiments along those lines.”

The studies we do have suggest that health insurance does save some lives; the Annals of Internal Medicine published a meta-analysis this month concluding that the odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

Regardless, the steep coverage declines projected for the Senate GOP bill are such bad optics for the party’s moderates that McConnell may ultimately fail to bring them on board. The month of July will be a defining time for Republicans as it becomes clear whether they’ll be able to fulfill their long-standing promise of repealing much of the ACA. If the Senate passes a bill, it would then be the House’s turn to approve it or reconcile it with their own version passed in May. Only at that point could it get a signature from President Trump and become law.

Health 202 would do anything to be a fly on the wall in McConnell’s office. The majority leader appears determined to hold a health-care vote but he’s given little indication of the path he sees forward for a bill filled with unpopular Medicaid cuts and less-generous insurance subsidies. Yet he’s widely-regarded as one of D.C.’s most able political operatives and he may have some tricks left in his back pocket, observers say.

“He’s a political person and he’ll figure out whatever moves cause the least political damage,” Tom Miller, a health care policy fellow at the conservative American Enterprise Institute, told me.

As senators are back in their home states over the July 4th recess, negotiations will be going on in the background. There’s a strong possibility that McConnell will try to ease some of the bill’s Medicaid cuts, perhaps forgoing its slower Medicaid growth rate in 2026 or even pulling back more slowly on extra federal funding for expanded Medicaid programs. Any moves of that nature would be aimed at Sens. Dean Heller (Nev.) and Susan Collins (Maine) who are opposing the bill in its current form.

McConnell could also add in more funding to combat opioid addiction to attract Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va)., who declared they were opposing the bill only after the vote was delayed yesterday. Portman and Capito had asked for $45 billion in funding but got only $2 billion in the measure.

It’s less clear how McConnell could tweak existing policy to get Sens. Rand Paul (Ky.), Ted Cruz (Tex.), and Mike Lee (Utah) and other conservatives on board. They want more of Obamacare repealed, but that could be hard under budget reconciliation rules governing the whole process.

But this much is clear: To get to 50 votes over the next few weeks, Senate Republican leaders will have to have heart-to-hearts with a dozen or so deeply skeptical senators, winning them over one by one.

“He has to do it on a retail basis,” said Julius Hobson, a former lobbyist for the American Medical Association. “It’s senator by senator, and that’s tough.”

AHH, OOF and OUCH

McConnell waits for Trump to arrive for a meeting with Republican senators about health care yesterday. (Photo by Jabin Botsford/The Washington Post)

AHH: Replacing Obamacare used to be the GOP’s great unifier. Now it has become their albatross, the Post’s Dan Balz writes

“In a worst-of-all-worlds environment, Republicans continue to struggle with what they’re selling, beyond the stated goal of repealing or revising the Affordable Care Act,” Dan writes. “Whatever overarching arguments they hope to make on behalf of their legislation have been lost in a welter of competing claims and demands among senators with different priorities and dissimilar ideological viewpoints.”

“The Republicans’ major selling point is that Obamacare is collapsing,” he continues. “Even Democrats acknowledge weaknesses with the current law, though some Democrats have accused Trump and Republicans of deliberately trying to make those problems worse. McConnell said Tuesday that a Republican solution will be superior to the status quo. Exactly how, Senate Republicans haven’t been able to say. But in terms of corralling the votes, McConnell should not be underestimated.”

Sen. Dean Heller (R-Nev), and Sen. Susan Collins (R-Maine) talk before President Trump arrives for a meeting with Republican senators about health care. (Photo by Jabin Botsford/The Washington Post)

OOF: Maybe don’t attack your own if you’re trying to build support for a health-care bill. Heller, one of the moderates skeptical of the Senate bill who is facing a tough reelection next year, reportedly complained to Trump yesterday about attack ads coming from America First Policies, a nonprofit run by a former White House aide and Trump campaign veterans. The group targeted Heller over the weekend with a TV and radio ad campaign for denouncing the Senate plan as written, pressuring him to vote for it and even roping him to House Minority Leader Nancy Pelosi (D-Calif.)

Why did @SenDeanHeller lie to voters about #RepealAndReplace? He’s now with @NancyPelosi. NOT GOOD! #HellerVotesYes

— AmericaFirstPolicies (@AmericaFirstPol) June 24, 2017

“McConnell told White House Chief of Staff Reince Priebus over the weekend that the group’s attacks were ‘beyond stupid,’ according to a Republican with knowledge of the exchange,” the AP reports. “McConnell allies argued that the approach alienated Heller and other Republicans rather than making it easier to get their votes.”

Shortly after Heller himself complained about the ads in the White House meeting yesterday, America First Policies said it decided to take down its Heller ads because “he has decided to come back to the table to negotiate with his colleagues on the Senate bill,” spokeswoman Erin Montgomery said.

But America First Policies didn’t apologize for its aggressive strategy. And one of its leaders, former Trump campaign spokesman Katrina Pierson, tweeted that it’s not the group’s task to preserve GOP seats in Congress:

It’s not @AmericaFirstPol job to protect R seats. It’s to support/promote #AmericaFIRST policies. If you don’t we’ll let your voters know.🇺🇸 https://t.co/W4otDhnrCD

— Katrina Pierson (@KatrinaPierson) June 27, 2017

OUCH: Members of Congress are skilled at giving answers that really aren’t answers at all, as my colleague Sean Sullivan noted yesterday. His conversation with Sen. Patrick J. Toomey (R-Pa.) on whether delaying the health-care vote until July is good or bad:

Me: “Is more time a good thing right now?”
Toomey: “It might be.”
M: “Could it be a bad thing?”
T: “It could be good and it could be bad.”

— Sean Sullivan (@WaPoSean) June 27, 2017

TRUMP TEMPERATURE

Trump met with Republican senators about health care in the White House yesterday. (Photo by Jabin Botsford/The Washington Post)

–Trump attempted a heart-to-heart with the entire Senate Republican Conference at the White House yesterday afternoon, where senators got a chance to air their grievances about the health-care bill and the whole closed-door process of writing it,Sean Sullivan, Juliet Eilperin and Kelsey Snell report.

The president sat between two of the bill’s holdouts — Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) — and said Republicans are “getting very close” to securing the votes they need even as he acknowledged that they might fail. He told the room we have “no choice but to solve this situation” because Obamacare is a “total disaster.”

“This will be great if we get it done,” Trump said. “And if we don’t get it done, it’s just going to be something that we’re not going to like — and that’s okay. I understand that very well.”

Collins described the meeting as productive, and said Trump was “really in listening mode.” “He was taking in all of the comments. There were many senators who raised issues, and, as you can imagine, the issues really run the ideological gamut,” she added.

McConnell also emerged from the meeting praising Trump’s interventions, according to my colleague Ed O’Keefe:

Trump is “fully engaged and being helpful in every way that he can,” McConnell says.

— Ed O’Keefe (@edatpost) June 27, 2017

McConnell: “The president’s been very involved over the last week, talking to members individually.”

— Ed O’Keefe (@edatpost) June 27, 2017

Now speaking to reporters, McConnell says he’ll keep working “to get 50 people to a comfortable place.” #HealthcareBill

— Ed O’Keefe (@edatpost) June 27, 2017

A telling photo of Collins and Heller (the two moderates who have said they won’t vote for the health-care bill unless it’s changed). From former Hillary Clinton press secretary Tim Hogan:

Best picture from the Trump health care meeting? pic.twitter.com/zAIiJv5qRW

— Tim Hogan (@timjhogan) June 27, 2017

Another visual of the meeting tweeted by the New York Times’ Doug Mills: 

.@realDonaldTrump meets with GOP members of the Senate to discuss healthcare. #HealthcareBillpic.twitter.com/MHBvsMLS0D

— Doug Mills (@dougmillsnyt) June 27, 2017

Nevada Independent editor Jon Ralston poked fun:

“Republicans and Democrats should sit down together.” — Heller

And the farmer and the cowboy should be friends!

— Jon Ralston (@RalstonReports) June 28, 2017

–But does Trump have enough clout with congressional Republicans? Maybe not. “Republican fixtures in Washington are beginning to conclude that Trump may be neither, despite his mix of bravado, threats and efforts to schmooze with GOP lawmakers,” the Post’s Philip Rucker, Ashley Parker and Robert Costa write.

Case in point: Trump got on the phone Monday with conservative Sen. Mike Lee (R-Utah) and urged him to back the measure, but a day later Lee said he would vote against the bill.

“Trump had hoped for a swift and easy win on health care this week. Instead he got a delay and a return to the negotiating table — the latest reminder of the limits of his power to shape outcomes at the opposite end of Pennsylvania Avenue,” Ashley, Robert and Philip report. “History suggests that presidents who have governed successfully have been both revered and feared…The president is the leader of his party, yet Trump has struggled to get Republican lawmakers moving in lockstep on health care and other major issues, leaving no signature legislation in his first five months in office. The confirmation of Supreme Court Justice Neil M. Gorsuch is his most-cited achievement to date.”

A Post video about the White House meeting:

–Unlike most congressional leaders, McConnell has managed so far to escape Trump’s wrath, my colleagues Robert Costa and Sean Sullivan report. “He’s never, as far as I can tell, gotten angry at me — in my presence, anyway,” McConnell said of the president last month.

President Trump shakes hands with McConnell. (AP Photo/Pablo Martinez Monsivais)

“That fragile peace between a taciturn insider and a brash newcomer has helped both men pursue Republican priorities, but it faces an uncertain future this week as a major rewrite of the nation’s health-care laws falters in the Senate. McConnell and Trump are both hungry for a win,” Robert and Sean write. “Their understanding, built to score legislative victories, does neither of them any good if victories remain out of reach.”

“On its surface, the health-care effort is about fulfilling a GOP pledge,” they continue. “But Republicans said it is also a test of whether McConnell and Trump can stitch together winning coalitions on any big-ticket item this year — and reassure business leaders and activists eager for action.”

REPRODUCTIVE WARS

–Hundreds of activists protesting the Senate health-care bill hooted and cheered from their stakeout in the “Senate swamp” as the news broke yesterday that the Senate was delaying a vote on its health-care bill. “Hundreds of activists from Planned Parenthood, AFSCME, and smaller progressive groups were hooting and cheering their latest mini-victory,” the Post’s Dave Weigel reports.

“For some Democrats, it was the fifth or six protest of the Better Care Reconciliation Act in 24 hours,” Dave writes. “Some of the protesters had done even more, with the progressive group Ultraviolet tailing Republican senators as they left their offices, the most aggressive of dozens of tactics to slow down or stop BCRA. More had been cycling in and out of Capitol office rooms for news conferences, where Democrats sat back and let Medicaid beneficiaries take over the microphone.”

–Among the protesters were dozens of women dressed in “The Handmaid’s Tale”-like costumes to protest the bill’s restriction on Medicaid dollars for Planned Parenthood clinics. “It would be the worst bill for women in generations and decimate women’s healthcare,” said Planned Parenthood spokeswoman Fern Whyland, according to the Hill. “It’s a healthcare bill with no healthcare.” 

From The Hill’s Taylor Lorenz:

Currently outside the Capitol pic.twitter.com/fn3KGfaljA

— Taylor Lorenz (@TaylorLorenz) June 27, 2017

MALPRACTICE

McConnell had polio as a child. (Photo by Bill O’Leary/The Washington Post)

–A meme about how McConnell received his polio treatment as a child has been shared hundreds of thousands of times on the Internet by activists opposing the Obamacare overhaul he’s shepherding through the Senate.

“As a kid, Mitch McConnell had polio, and the government paid for ALL of his care and rehabilitation,” says a text below an apparent picture of a young McConnell, adding that McConnell wants to take away the government-funded care that once helped him. The meme was originally posted to Facebook by the group Occupy Democrats.

The problem is, that story is false, the Post’s Kristine Phillips reports.

Dr. Jonas Salk administers a trial polio vaccine to David Rosenbloom of Pittsburgh in this 1954 photo from the National Foundation March of Dimes. (AP Photo/National Foundation March of Dimes)

The facts: After McConnell was struck with polio at the age of 2 in 1944, he received treatment at the polio treatment center that President Franklin D. Roosevelt founded in Warm Springs, Ga. The funds for the treatment center were raised by the National Foundation for Infantile Paralysis, a nonprofit that collected private donations — not government funding.

“Shortly after the foundation was created in 1937, comedian Eddie Cantor spearheaded a fundraising campaign that he called March of Dimes,” Kristine writes. “Its goal was simple: Use radio and the president’s Birthday Ball to encourage people to donate at least one dime to the cause of fighting polio…The result was an ‘avalanche of donations’ in the form of 80,000 letters containing dimes and dollars that inundated the White House mail room, according to the March of Dimes website.”

“It’s likely that the stories by Occupy Democrats and others relied on a misunderstanding of what public money is and falsely concluded that dollars donated by members of the public to a private organization are the same as taxpayer dollars that fund government programs,” Kristine continues. “McConnell’s staff did not respond to a request for comment. Colin Taylor, who wrote the Occupy Democrat story, also did not respond.”

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DAYBOOK

A Philadelphia Police officer shows a package of the overdose reversal agent Naloxone Hydrochloride. (AFP PHOTO / DOMINICK REUTERDOMINICK REUTER/AFP/Getty Images)

Today

  • The Bipartisan Policy Center will hold an event  on cybersecurity and medical devices.
  • The Cato Institute will hold a briefing  on Capitol Hill on how the federal government should address the opioid crisis.

Coming Up

  • The Bipartisan Policy Center will hold an event on Thursday on balancing Medicaid cost and coverage.
  • American Enterprise Institute will hold an event on Thursday on the government’s role in medical innovation.

SUGAR RUSH

Here’s what happened after Senate leaders postponed the health-care vote:

Senate Minority Leader Charles E. Schumer (D-N.Y.) on health care: ‘We’re going to fight the bill tooth and nail’

Sen. Ted Cruz (R-Tex.) on health-care bill: ‘We still got a way to go’:

Sen. Jeanne Shaheen (D-N.H.) said she wants Republican and Democratic senators to “work together” to “improve on the Affordable Care Act.”: 

House Speaker Paul D. Ryan (R-Wis.) weighs in on the health-care bill: 

White House deputy press secretary Sarah Huckabee Sanders says Trump remains ‘optimistic’ on health care and criticizes CBO report:

A mother’s response to the health-care debate: Her 3-year-old son’s $231,000 hospital bill:

And Stephen Colbert says “‘Repeal And Replace’ Is Being ‘Delayed And Postponed'”:

 

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Emboldened industry lobbyists try to scale back Medicaid cuts – Politico

Hospitals, doctors and nursing homes have one last chance to shape a Republican bill to repeal and replace Obamacare they say will hurt millions of old, poor and sick Americans — and their own bottom lines.

After being on the sidelines for much of the repeal debate, the groups see an opening in the meltdown of the Senate health care bill. They’re particularly worried about the legislation’s proposed deep cuts to Medicaid, the country’s largest insurance program, which covers 74 million people.

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Medicaid “was established to prevent our country’s most vulnerable citizens from being left behind, and it’s truly become a lifeline for millions of Americans,” said Rick Pollack, CEO of the American Hospital Association, during a call with reporters on Tuesday. “Even Republican senators are sounding alarm bells over the harm these deep cuts would cause for vulnerable patients in their states.”

A coalition of the nation’s largest provider groups is airing ads across 12 states this week linking the Senate bill to worse care for millions, including children, the disabled and the elderly. Health care lobbyists are targeting shaky senators both in D.C. and in their home states, hammering home the idea that Medicaid cuts could skyrocket charity care and force hundreds of small and rural hospitals out of business. And on Monday, the trade group representing nearly 14,000 nursing homes broke its silence to deliver a scorching indictment of Senate Republicans’ bid to remake Medicaid.

“We genuinely believe that if the senators had any idea of the extent of the impact on each building in the country that they’d never be proposing this,” American Health Care Association President Mark Parkinson said. “If they adopt this bill, the future of long-term care as we know it will be very different.”

The uncertainty is likely to further embolden industry lobbyists. Even before Tuesday’s announcement, they were expressing confidence that they could prevail on key expansion-state senators in Alaska, Arizona, West Virginia and Ohio.

“This is not fine wine,” said one lobbyist, describing the unhappiness with the bill among Republicans senators. “It does not get better with age.”

Hospital groups are working closely with expansion-state governors, including Ohio’s John Kasich, Arizona’s Doug Ducey and Nevada’s Brian Sandoval, to exert pressure on senators.

The CBO score projecting coverage losses and deficit savings gave the industry groups some sense of how much they can ask for.

“Having the Senate bill provides a level of clarity we didn’t have before,” said Tom Nickels, AHA’s executive vice president for government relations and public policy. Nickels described the industry as being in “purgatory” between hammering the House bill and trying to anticipate the Senate bill.

The Senate plan notably went further than the House bill in curbing future Medicaid spending. The upper chamber would have eventually limited Medicaid spending growth per beneficiary to the consumer price index, which is far below the current growth rate.