Aetna To Donate Anti-Overdose Drug To 4 Kentucky Counties Tuesday, Aug 22 2017 

Over 700 doses of Narcan will be distributed to first responder agencies in four Northern Kentucky counties. Gov. Matt Bevin and officials from insurance company Aetna will make the official announcement Wednesday morning at the Boone County Sherriff’s Training Center.

Aetna is donating the overdose antidote to first responders in Boone, Campbell, Grant and Kenton counties. Narcan is often sold under the generic name naloxone.

Chief Medical Officer Harold Paz says the donation is part of the work the insurance provider is doing to aid in the opioid epidemic. He says the company hopes to reduce the amount of opioids prescribed to its members by 50 percent over the next five years.

“We’ve seen a reduction in opioid prescriptions, with almost a 12 percent decrease with opioid prescriptions in 2017 compared to 2016 based on the data we have now,” Paz says.

But non-prescription opioids, like heroin, are a growing problem. The drug is increasingly mixed with fentanyl, which is sometimes used as an elephant tranquilizer.

According to the Kentucky Office of Drug Control Policy, nearly half of the state’s overdose deaths last year were attributed to fentanyl — either alone or mixed with heroin.

KentuckyOne narrows suitors for Jewish Hospital, enters ‘due diligence phase’ Thursday, Aug 3 2017 

KentuckyOne Health has narrowed the list of suitors for Jewish Hospital and other assets it wants to sell and expects to lead executives of interested parties on facility tours later this summer, the organization’s interim CEO said. Chuck Neumann, who also serves as the health system’s president, said that KentuckyOne, with the help of its […]

Breathe Easier: New Smartphone App Could Help COPD Patients Friday, Jul 28 2017 

Kentucky has the nation’s highest rate of people with chronic obstructive pulmonary disease, or COPD. But managing the disease and interpreting symptoms is often a challenge for people who suffer from the lung disease.

Enter a new smartphone app that aims to use technology to help COPD sufferers to recognize emergencies, and avoid unnecessary doctors’ or ER visits. The app made its debut earlier today, screening people at the Family Community Clinic in Butchertown.

One of the first testers was Barry. When he walked through the door at the clinic, he had already been diagnosed with COPD. We’re only using his first name to protect his privacy.

Barry is 62-years-old. He said he started smoking at age 25, and later took a job in Rubbertown making paper bags where he inhaled chemicals daily. He blames the combination of smoking and industrial work for his health problems.

“Working with chemicals, breathing it in, yea, you get [COPD],” Barry said.

All that exposure has caused Barry’s lungs to slowly harden and tighten. Sometimes, it’s very hard for him to breathe, especially on certain days.

“Days like this: rainy days, cloudy days, hot days [are not good], but a good sunny day, you’ll be all right,” Barry said.

A Chronic Problem For Kentuckians

COPD is prevalent in Kentucky. In 2011, almost ten percent of people in the commonwealth had COPD – the highest rate in the nation, followed by Alabama. And in 2015, almost a quarter of Kentuckians with COPD reported visiting the emergency room because of that condition and related emphysema.

Ted Smith is the CEO of Revon Systems, a tech company based in East Louisville, and the developer of the “Smart COPD” app. The app is designed on a simple premise: that some of those emergency room visits could have been prevented if people were able to track their symptoms.

“The focus of the app is helping you keep track of whether your systems are starting to deteriorate so that you don’t have to get to a point where you have to go to the hospital for emergency care” Smith said.

When you open the app, it poses a series of questions: “Shortness of breath?” “Cough?” and “Running nose or feeling like you have a cold?” It also asks for temperature, and for users to punch in the readings from a separate device that measures oxygen saturation and heart rate.

Finally, the app evaluates the information and tells the user whether they need to head to the ER, call their doctor, check back in a few days or that no medical attention is needed.

It’s simple, and requires only a cell phone and a cheap finger oxygen and heart rate monitor.

‘Not designer technology for rich people’

Family Community Clinic Executive Director Becky Montague said she can see the app working for her patients. The clinic is one of the only places in the region that doesn’t charge anything for medical care, so they end up caring for the approximately 80,000 people in the Louisville Metro Area that don’t have health insurance. She said the majority of her patients have a cell phone.

“People have telephones, they’re our life line. So putting a self-management tool on a cell phone is just a genius idea,” Montague said.

Smith said the clinic’s patients are the ones he wants to reach the most.

“The majority of digital health technologies have been created for those that are commercially insured, typically these are expensive,” Smith said. “[Smart COPD] is not designer technology for rich people, it’s good technology for everybody.”

Barry–like many low-income Americans–has a cell phone obtained through Medicaid. Smith said these phones don’t come with health-related apps already downloaded, but they could. He sees that as a possible opportunity for Smart COPD to reach more people with low-incomes.

“If there’s one thing I wish for, it’s that we take advantage of something we’re already paying for as a society and turn it into health care,” Smith said.

On Friday, six people were screened at the Family Community Clinic. They’ll be part of a pilot study, and the clinic will follow up with them to measure the outcome of using the Smart COPD app.

Barry, in the meantime, manages with a daily inhaler and routine check-ups at the clinic. He’s interested in the Smart COPD app, and he left the clinic with information on how to use and download it. His cell phone doesn’t work very well, but even so, he has access to people who can download the app if he needs it.

“That’s where my nieces come in,” Barry said. “They got smart phones and if I need information, they can pull it up for me.”

Interested? Search for ‘Revon Systems’ in your App store and look for the “Smart COPD” app.

This story has been updated.

McCain Votes No, Dealing Potential Death Blow To Republican Health Care Efforts Friday, Jul 28 2017 

In a moment of unexpected high drama, Republicans were stymied once again in their effort to repeal Obamacare — and they have John McCain to thank for it.

The senator who earned the nickname “Maverick” over his long tenure showed why in the early morning hours Friday.

McCain, who was diagnosed with brain cancer and returned to Washington to advance the health care bill, turned around and bucked his party’s leadership — and President Trump — by joining two moderate Republicans and every Democrat in voting against the so-called “skinny repeal” of the Affordable Care Act.

McCain’s office released a statement from the senator on his reasoning:

“From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker’s statement that the House would be ‘willing’ to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.”

McCain continued, calling for lawmakers to “return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people.”

The Senate voted 51 to 49 against the legislation aimed at dismantling the Affordable Care Act.

“This is clearly a disappointing moment,” Republican Senate leader Mitch McConnell of Kentucky said immediately after the bill failed. He added, “I regret that our efforts simply were not enough this time.”

McConnell, who seemed to exhaust every trick in the procedural playbook to get to this point, seemed surprised and undercut by the result.

The defeat ends — for now — the health care debate in Congress. The chamber adjourned following the defeat and there are no further Senate votes this week. In the short-term, the Senate intends to move on to defense legislation and the nomination of Christopher Wray to be the next FBI Director.

In a written statement from McConnell’s office after the vote, he seemed to indicate a GOP-only effort on health care may be dead.

“We look forward to our colleagues on the other side suggesting what they have in mind,” McConnell said in the statement.

Republican senators said there was no consensus and no plan for what comes next on health care. Sen. Ted Cruz, R-Texas, warned of potentially severe political consequences for Republicans for failing to deliver on what has been the GOP’s unifying campaign pledge for the previous three elections.

“I sadly feel a great many Americans will feel betrayed,” Cruz told reporters, “that they were lied to, and that sentiment will not be unjustified.”

The “skinny repeal” was a pared down version of Republican proposals to undo Obamacare with no plan for what to replace it with. It would have eliminated the individual and employer mandate and key taxes, defunded Planned Parenthood for a year and eliminated key protections of health benefits that were required under Obamacare.

The bill was deeply unpopular, but GOP leaders worked to assure members it would never become law. Instead, they wanted the Senate to pass it in order to advance the legislation to a third round of negotiations with the House to try to craft a final bill both chambers could pass.

McCain was not moved by these assurances, including a private meeting with House Speaker Paul Ryan on Thursday prior to the House vote. After the vote, McCain quickly left the Capitol and declined to comment to reporters.

Something seemed afoot before the vote. It was delayed; McCain was seen huddling with Democrats; Vice President Pence, who had come to the Capitol expecting to be the tie-breaking vote, personally — and unsuccessfully — lobbied McCain on the floor to try to win his vote.

With McCain’s vote apparently gone, Republicans were seen trying to persuade Alaska’s Lisa Murkowski to vote for the bill — to no avail. She eventually also voted no (as originally expected) along with Maine’s Susan Collins.

Some GOP senators worried the measure would go back to the House, where leaders would put it on the floor, pass it and send it to President Trump — who has said he would sign whatever lands on his desk when it comes to Republican-passed health care legislation.

Before the vote, at 10:43 p.m. ET, Trump was rooting them on:

Afterward, it was a different story, with the president tweeting at 2:25 a.m. ET:

It’s somewhat ironic that McCain was the one to derail what seemed like a sure Trump victory (even if only a short-term one). After all, Trump’s comments about the former prisoner of war were among the earliest to land him in controversy.

“He’s not a war hero,” Trump said in 2015 of McCain. “He was a war hero, because he was captured. I like people who weren’t captured. He’s been losing so long he doesn’t know how to win anymore.”

That was likely never lost on McCain.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

States Have Already Tried Versions Of ‘Skinny Repeal.’ It Didn’t Go Well Thursday, Jul 27 2017 

Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a “skinny repeal” that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.

Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act’s “individual mandate,” which assesses a tax on Americans who don’t have insurance. The bill would also eliminate the ACA’s penalties for some businesses – those that have 50 or more workers and fail to offer their employees health coverage.

Details aren’t clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.

In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that “we just heard from the nonpartisan Congressional Budget Office that under such a plan … 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.” The CBO posted its evaluation of the GOP’s proposed plan Wednesday evening.

Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.

“We need an outcome, and if a so-called skinny repeal is the first step, that’s a good first step,” said Sen. Thom Tillis, R-N.C.

Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to published reports. It is, at least for now, being viewed as a step along the way to Republican health reform.

“I think that most people would understand that what you’re really voting on is trying to keep the conversation alive,” said Sen. Bob Corker, R-Tenn. “It’s not the policy itself … it’s about trying to create a bigger discussion about repeal between the House and Senate.”

But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States’ experiences with insurance market reforms and rollbacks highlight the possible trouble spots.

Considering the parallels

By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they’d previously put on the individual market were lifted. “Things went badly,” said Mark Hall, director of the health law and policy program at Wake Forest University.

Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don’t get it through their jobs) with fewer choices and higher prices.

That’s because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn’t include mandates that consumers carry coverage.

That goes to a basic concept about any kind insurance: People who don’t file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.

Bottom line: Insurers end up “less willing to participate in the market,” said Hall.

It’s not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.

During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be “strong incentives for people to obtain health insurance and keep it year-round.”

Individual mandate is still unpopular in voter polls

About 6.5 million Americans reported owing penalties for not having coverage in 2015.

Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult poll said they want the Senate to keep eight, rejecting only the individual mandate.

Even though the mandate’s penalty is often criticized as not strong enough, removing it would still affect the individual market.

“Insurers would react conservatively and increase rates substantially to cover their risk,” said insurance industry consultant Robert Laszewski.

That’s what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state’s insurance commissioner. By 1998, the state’s largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, “precipitating a sense of crisis,” according to a study published in 2000 in the Journal of Health Politics, Policy and Law.

“When one pulled out, the others followed,” said current Washington Insurance Commissioner Mike Kreidler, who was then a regional director in the federal department of Health and Human Services.

The state’s individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.

Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.

“Few markets can go bad on you as fast as a health insurance market,” said Kreidler.

As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said Joseph Antos, a health care economist and resident scholar at the American Enterprise Institute.

That’s because the requirement under the ACA meant that some smaller firms didn’t hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.

The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.

However, the individual market could be roiled by other factors, Antos said.

“The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges [— the state and federal markets through which insurance is offered —] work more poorly.”

Kaiser Health News is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter @Julie_Appleby Congressional reporter Rachel Bluth also contributed to this report.

Copyright 2017 Kaiser Health News. To see more, visit Kaiser Health News.

Kindred shares plunge on feds’ plan to lower reimbursement rates Wednesday, Jul 26 2017 

Shares of Kindred Healthcare fell sharply Wednesday after a federal agency said that it planned to reduce its payments to home health care providers next year by $80 million, with even bigger cuts to come. The Centers for Medicare & Medicaid Services proposed that payments to providers be cut 0.4 percent for fiscal year 2018. […]

Anti-Abortion Conference Begins With Tame Protests At Louisville Clinic Saturday, Jul 22 2017 

It was surprisingly quiet outside of the EMW Women’s Surgical Center in downtown Louisville Saturday.

Hundreds of anti-abortion activists were expected in front of Kentucky’s last remaining abortion clinic Saturday as far-right fundamentalist Christian group Operation Save America began its weeklong conference with the stated goal of shutting down the clinic. U.S. District Judge David Hale granted a temporary restraining order on Friday establishing a buffer zone around the clinic to keep protesters from blocking its entrance.

The order affects 10 individuals associated with Operation Save who were arrested at the EMW clinic after protesting in May, as well as any of their associates.

Lisa Gillespie | wfpl.org

Buffer zone outside EMW clinic in Louisville.

The buffer zone isn’t a large area — 15-feet by 7.5 feet — and the only breach of the boundary by anti-abortion protesters was to walk from one side of the clinic to the other. Protesters were set up in front of the buffer zone to the street.

Sarah Dugan, a volunteer who helps escort women between their cars and the entrance of the clinic, said the unusually quiet day was due to increased law enforcement presence. Eight U.S. Marshalls and 15 Louisville Police officers were stationed outside.

“Today was quieter than most Saturdays,” Dugan said. “With the police presence there, everyone was way more cognizant about behavior that could be seen as escalating.”

On a typical Saturday morning, Dugan said there’s at least one Louisville police officer who observes from a parked car across the street from the clinic. She said with more officers on site today, the process was smoother for patients approaching the clinic.

“The police were telling people to ‘move, move, get out of the way,’ when people — some people were trying to get through and there was blocking happening,” Dugan said. “Which is amazing. It’s a luxury for us because typically we don’t have that sort presence at all, and the sidewalk gets very congested and very blocked.”

Jonese Franklin

Law enforcement officials keep the peace as anti-abortion activists protest at the EMW clinic.

Brian Parrish, the chief deputy of the U.S. Marshalls Western Kentucky district, said marshalls will be posted there as long as the temporary restraining order — which created the buffer zone — remains in place.

“We’ve had no issues,” Parrish said. “We’re here to make sure everyone’s rights are preserved, and maintain the integrity of the court order.”

In May, 10 people associated with Operation Save America — formerly Operation Rescue — were arrested for blocking the door to the clinic. The group changed its name to Operation Save America after reports of violence against abortion providers and at clinics were tied to the organization.

Ante Pavkovic, an organizer with Operation Save America, drove from Charlotte, North Carolina to attend the weeklong conference that kicks off Saturday night. He said the buffer zone isn’t necessary because his group and other local anti-abortion protesters will still approach women walking toward the clinic to stop them from going in.

“Our weapons are prayer, speaking, and just being out there where things are happening,” he said. “It’s persuasion and that’s as far as it can go.”

Some protesters just pray, others silently hold signs. Some hand out pamphlets and talk at the patients walking toward the clinic. But Sarah Dugan, the clinic escort, said anti-abortion protesters commonly try to intimidate her and the other volunteers.

Pavkovic acknowledged he does this as well.

Lisa Gillespie | wfpl.org

An anti-abortion protester holds a sign outside the EMW clinic in Louisville.

“Yes, there’s rebukes,” he said. “I preach against this sin. I hate abortion. So the preaching is often fiery, but if babies are actually being killed, it should be.”

About 15 minutes before the clinic opened and patients walked the block toward the clinic, Pavkovic approached a clinic escort wearing a purple vest, standing on the same corner.

“You shouldn’t be working here,” he said to the escort. “Take that dumb purple thing off or better yet, join us. Don’t you care about babies? Do you at least know what abortion really is? And do you actually support murdering and dismembering little babies?”

Most Operation Save conference attendees were due to arrive on Saturday and Sunday, according to Pavkovic. And Dugen said the clinic escorts expect next Saturday to be the most active day of protests.

Ahead Of Anti-Abortion Conference, Louisville Clinic Beefs Up Security Thursday, Jul 20 2017 

The founder of Kentucky’s last abortion clinic said the facility is increasing security ahead of anti-abortion protests that will start Saturday.

EMW Women’s Surgical Center founder Dr. Ernest Marshall said he and other staff have been in close contact with the Louisville Metro Police Department and the U.S. Marshall Service. In a conference call Thursday, Marshall described the difficulty surrounding the choice women make to have an abortion. This, he said, is coupled with the logistical problems for some in getting transportation to the clinic, which in many cases is hours away from their homes.

“After overcoming so much to come to our clinic, our patients are forced to face a final obstacle: the excessive bullying and harassment outside the clinic,” Marshall said. “They come to us already made their decision, and it’s awful that they’re then subjected to the surveillance and humiliation outside our doors.”

Far-right religious group Operation Save America will hold its annual conference in Louisville beginning Saturday, and is organizing protests outside the clinic July 22 and 29.

Anti-abortion group Created Equal also has a permit to play footage of a “live” abortion on a large “JumboTron” screen outside City Hall on July 26, according to the group’s Facebook page.

Vicki Saporta with the National Abortion Federation said it will be critical that police enforce the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits people from blocking access to the EMW Center.

“They’re trying to shut down this clinic and I think they’ll go to whatever extremes they think they need to [and] that they think they can get away with,” Saporta said.

While the FACE Act will technically apply no matter what, currently there’s no buffer zone restriction to limit protesters from filling the public sidewalks in front of the clinic.

In a motion pending in U.S. District Court, U.S. Attorney John Kuhn asked a judge to grant a temporary restraining order under the FACE Act. If the judge grants the motion, it would implement a buffer zone and would mean any violation of the buffer zone would carry with it stricter federal penalties.

A similar measure has been informally discussed in Louisville’s Metro Council, though no official ordinance has been proposed. At a committee meeting Wednesday, members were told LMPD is not planning on using extra police or barriers outside the clinic.

Meg Sasse Stern, an escort who aids women in entering the clinic, said 2,658 patients entering the clinic in the past year took surveys asking for their reactions to the protests outside. Eighty-six percent of patients said they were “disturbed,” in some way, including being blocked, intimidated, shoved or touched. Half felt threatened, unsafe or scared. A third of respondents reported considering confronting anti-abortion protesters.

“Anti-abortion extremists emboldened by the prospect of ending legal abortion in Kentucky are marshalling to stage a massive disruptive action that could threaten patient access to the clinic,” Stern said.

Abortion appointments will go on both Saturdays as planned, despite the protests, according to Ernest Marshall.

In May, 10 people associated with Operation Save America were arrested for blocking the door to the clinic. A Louisville Metro Police Department officer told Metro council members Wednesday that besides those arrests and some property damage last week, there haven’t been any recent incidents at the abortion clinic.

Trump’s Big Repealing Deal: 8 Takeaways On The Senate’s Health Care Meltdown Moment Wednesday, Jul 19 2017 

President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a post mortem.

The Senate still reportedly plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.

So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?

1. The president was AWOL

Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.

Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: “Nobody knew health care could be so complicated.” He then praised the House bill at a self-congratulatory ceremony only to trash it later as “mean” while speaking with GOP senators.

When the bill came to the Senate, Trump tweeted his hope that it would be “beautiful,” (that comment was made about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.

2. The president wasn’t the problem

Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.

Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say especially among Republicans.

3. Health care politics are explosively dangerous

People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them fear those things might happen.

Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far larger number of people and still no guarantee that the insurance will cost less or cover as much. That’s why polls show the country prefers Obamacare to the GOP repeal bills by 2-1. This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.

4. The Senate sorcerer’s hat has been knocked off

Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.

In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.

At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.

5. Obamacare in some form is here to stay

Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.

This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.

6. Opposition is easy; governing is hard

The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.

Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.

7. The health care issue will not go away

For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care, and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.

8. Surprise: The idea of “single-payer” is gaining ground

Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.

But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.

Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. Biden’s salty choice of words is more politely repeated by the initials “BFD.” But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

Anti-Abortion Group To Protest Metro Council Meeting On Buffer Zone Wednesday, Jul 19 2017 

Kentucky’s last abortion clinic — EMW Women’s Surgical Center in downtown Louisville — is at the center of protests and public hearings that begin this week. Operation Save America, a far-right religious group, is coming to Louisville this weekend to kickoff a week-long conference.

In preparation, the city is holding a hearing Wednesday on creating a buffer zone that would limit anti-abortion protesters from coming into close contact with people going into the clinic.

Some cities such as Chicago, Portland and San Francisco have enacted buffer zones —usually an 8-15-foot zone that protesters are barred from entering. Chicago and Oakland, and the state of Colorado have enacted “bubble zones” around abortion clinics, barring protesters from several feet around a clinic patient, provider or escort.

In May, ten protesters from Operation Save America — formerly Operation Rescue — were arrested for blocking the doors to the EMW clinic. The group changed its name following reports that violence against abortion providers and at clinics was tied to the organization.

Members from Operation Save America are planning a news conference prior to the Metro Council’s Wednesday meeting. In a letter to Metro Council members, National Director Rusty Thomas told members the issue isn’t about safety.

“Supporters of a ‘safety zone’ have crafted the issue before you to appear as a ‘public safety issue,’” Thomas wrote. “In reality, it’s a religious/freedom issue.”

Thomas said if the city moves forward with enacting an abortion buffer zone, the group will sue.

“Louisville will be sued for violating our duty before God and by denying our constitutional rights,” he wrote.

Although Thomas said the group does not promote violence, last year at its annual conference in Kansas, Operation Save America hosted Matthew Trewhella as keynote speaker. He is founder of a subgroup called Missionaries to the Preborn and was one of the first anti-abortion leaders to call for militias.

Trewhella was also part of an anti-abortion and anti-government group that cited abortion as a key reason “to spring immediately and effectively to arms,” according to the Southern Poverty Law Center, which monitors extremist groups.

Operation Save America is planning a large protest at the EMW Women’s Surgical Center in downtown Louisville on Saturday, July 29.

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