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As the House of Representatives prepares to vote Thursday on an Obamacare replacement plan, there is still enough Republican opposition in Congress to kill the bill. Assuming no Democrats support the measure, Republicans can lose two votes in the Senate and 21 votes in the House. (Phillips, 3/21)

The GOP health care bill appears poised for failure with at least 19 Republicans committed to voting “no,” absent additional substantial changes, and several more likely to join them in opposition. This reality seems to be sinking in with GOP leaders, as they have started discussions with the House Freedom Caucus that accounts for most of the current opposition to the bill. However, neither leadership, nor the Freedom Caucus would say serious negotiations about changes were underway Tuesday night. (McPherson and Rahman, 3/22)

House GOP leaders are trying to navigate the concerns of competing factions to win enough support for their ­ObamaCare repeal-and-replace measure ahead of a crucial Thursday vote...The conservative House Freedom Caucus remains the chief obstacle to passage of the bill. Freedom Caucus Chairman Mark Meadows (R-N.C.) said after the group met Tuesday afternoon that there are “without a doubt” still not enough votes to pass the healthcare legislation. (Sullivan, Hellmann and Hagen, 3/21)

A familiar group of conservative rebels stands between House Speaker Paul Ryan and his goal of passing an Obamacare repeal measure on Thursday: the House Freedom Caucus. The group said Tuesday it has enough votes to block the measure, arguing that it’s not a complete enough repeal of the health-care law, and Thursday’s vote could be the first sign of whether the caucus will be able to enforce its conservative principles in the age of Donald Trump. (John and House, 3/21)

The GOP health care debate has quickly become a battle of wills between the House Freedom Caucus and Republican leadership in the House and White House. And if the vote proceeds as planned on Thursday without changes to the bill, it will be a battle over reputations. Absent a compromise between the conservative caucus and House leadership and/or the President Donald Trump and his administration, one of the two sides will emerge from Thursday’s vote significantly scathed. “Without a doubt; it would be disingenuous to suggest otherwise,” Freedom Caucus Chairman Mark Meadows said when asked if the caucus’ hand would be weakened in future negotiations if the bill passes without conservatives’ concerns being heard. (McPherson, 3/22)

Heritage Action will negatively score votes in favor of the House's ObamaCare repeal bill, the conservative group said Tuesday. The House is set to vote on the GOP health plan Thursday. The measure is opposed by many conservatives because it does not repeal ObamaCare's regulations and insurer requirements. (Hellmann, 3/21)

NPR and dozens of member stations have been collecting public statements from members of Congress to help the public understand where lawmakers stand on this issue. (Neely, 3/10)

Less than two days before they are scheduled to vote, a handful of California’s 14 Republican members of Congress say they are still weighing how to vote on the GOP plan to undo and replace parts of the Affordable Care Act. California’s 38 House Democrats have lined up pretty firmly against the bill, as have most of the chamber’s Democrats, so Republicans are on their own to pass the bill. House Republicans can afford to lose up to 20 members and still pass it with a simple majority. (Wire, 3/21)

Suspense was the word of the day outside of the U.S. House chamber Tuesday, as Republicans scrambled to figure out which members of their caucus opposed the plan to overhaul former President Obama's health care law that Speaker Paul Ryan and President Donald Trump aim to put to a vote on Thursday. Republicans across the board are bracing for, as one Texas delegation staffer put it, a "squeaker" of a vote margin — if the bill even makes it to the floor. With Democrats uniformly opposed to the proposed legislation, Ryan and his lieutenants — including some Texans — have little wiggle room to negotiate policy differences between the GOP's hardliners and moderates. (Livingston, 3/21)

Senate Republican Ron Johnson of Wisconsin expressed deep skepticism Tuesday about the Obamacare replacement bill his party is struggling to pass in the U.S. House this week... Johnson’s qualms about a plan championed by House Speaker Paul Ryan, his fellow Wisconsin Republican, underscore the challenges Republicans face in getting a health care measure to President Donald Trump’s desk, despite their control of both chambers. (Gilbert, 3/21)

U.S. Rep. Martha McSally signaled support for the revised Republican health care bill Monday, but the plan's passage remained uncertain as it headed toward a key vote Thursday in the House or Representatives. In a statement Monday night, McSally, a two-term Arizona Republican, said the bill backed by House Speaker Paul Ryan "is not perfect and I still have concerns," but she indicated she was working to strengthen that plan. (Hansen, 3/21)

Iowa Republican Representative Rod Blum said Tuesday he will not support the House GOP’s health care plan in its current form. The 1st District congressman tweeted that the American Health Care Act “doesn’t do enough to lower premiums for hardworking Americans.” (Sostaric, 3/21)

Sen. Mike Lee (R-Utah) is urging House Republicans to cancel the vote slated for Thursday to pass their healthcare plan, saying the proposal won't pass in its current form. “I am strongly, strongly persuaded that it is not going to pass. I think they should cancel the vote because they don't have the votes,” Lee said during an interview with Fox News host Martha MacCallum. (Beavers, 3/21)

To witness the political tug-of-war in Congress over repealing the Affordable Care Act, tune into the TV or the radio, or go online, in Miami-Dade County. Ads for and against — but mostly against — House Republicans’ health plan have gone up over the past week, with two new campaigns launched Tuesday. (Mazzei, 3/21)

North Florida Congressman Neil Dunn hosted a nearly four hour town hall meeting in Panama City this weekend. Dominating the conversation: Dunn’s view on Congress’ plan to repeal and replace the Affordable Care Act. The conversation between Dunn and his constituents was at times emotional.(Hatter, 3/21)

House Republicans are expected to clear the way Wednesday for a Thursday vote on the GOP’s Obamacare overhaul. “This is our chance and this is our moment,” House Speaker Paul Ryan, R-Wis., said Tuesday after President Trump made a personal pitch to GOP lawmakers to pass the bill. “I think our members are beginning to appreciate just what kind of a rendezvous with destiny we have right here.” (Groppe, 3/22)

Each weekday morning, groggy aides pile into House Majority Leader Kevin McCarthy’s conference room and suit up for battle. No pastries. Bring your own coffee. The niceties are limited. (Mascaro, 3/21)

House Republican leaders have changed their healthcare reform bill to please both conservative and moderate members of their party. (Meyer, 3/21)

Lawmakers in both parties clashed Tuesday over a new proposal aimed at helping older people pay for health coverage under the House GOP bill to repeal and replace Obamacare. Republicans say lowering the amount individuals can deduct from their taxes for medical expenses could provide $75 billion. But Democrats dubbed it a "slush fund" that may never provide funding for its intended use. Ways and Means Chairman Kevin Brady, R-Texas, said a new provision in the manager’s amendment for the bill (HR 1628) that would repeal and replace parts of the 2010 health care overhaul (PL 111-148, PL 111-152) would provide fiscal flexibility needed to build consensus in the House and increase prospects for advancement in the Senate. (Ota, 3/21)

Some conservatives in Washington were fuming on Tuesday after an Obamacare rollback bill was tweaked by Republican leaders to delete a provision meant to crack down on illegal immigrants getting federal healthcare insurance coverage. (Ainsley and Abutaleb, 3/21)

The Republican National Committee (RNC) is committing almost $250,000 to a series of digital ads meant to pressure vulnerable Democratic senators into agreeing to an "up-or-down vote" on President Trump's Supreme Court nominee and to gin up support for the GOP healthcare plan working its way through Congress. The ad buy, provided exclusively to The Hill, is made up of three separate ads — two on healthcare and one on Judge Neil Gorsuch's confirmation — that will run on social media. The buy shows a coordinated effort by the party to support two of the key priorities shared by the White House. (Kamisar, 3/21)

President Trump on Tuesday turned up the pressure on recalcitrant Republicans to support a sweeping bill to overhaul the health care system, threatening wavering lawmakers in his party with political payback if they failed to get behind a measure that has become an early test of his negotiating power. (Davis, Kaplan and Pear, 3/21)

The president told lawmakers a failed vote would be embarrassing to the party and could result in members facing primary challengers and Republicans losing the House, sources said. (Wong, 3/21)

There was laughter and applause inside as the President cajoled reluctant Republicans to get on board. “Look, the guy is very personable,” said Rep. Markwayne Mullin (R-OK). “He speaks bluntly.” (Dupree, 3/21)

[Trump] singled out Rep. Mark Meadows (R-N.C.), the chairman of the House Freedom Caucus, which has led the right-wing opposition to the bill. “I’m gonna come after you, but I know I won’t have to, because I know you’ll vote ‘yes,’ ” Trump said, according to several lawmakers who attended the meeting. “Honestly, a loss is not acceptable, folks.” Trump’s remarks — which Meadows said he took as good-natured ribbing — reflected his mounting urgency to secure a major legislative victory in the early months of his presidency and fulfill a central campaign promise by repealing the signature domestic achievement of President Barack Obama. (DeBonis, Snell and Costa, 3/21)

"If we fail to get it done, fail to (meet) the promises made by all of us, including the president, then it could have a very detrimental effect to Republicans in '18 who are running for re-election," said Rep. Mike Conaway, R-Texas. "If it fails, then there will be a lot of people looking for work in 2018. "Trump's message to Republicans: "If you don't pass the bill there could be political costs," said Rep. Walter Jones, R-N.C. (3/21)

Mr. Meadows, whose bloc claims it has enough votes to defeat the bill, said he wasn’t convinced by Mr. Trump—a sign GOP leaders have more work to do to secure the votes needed to pass the bill. “It won’t lower premiums, and until it does, I’m going to be a ‘no,’ even if it sends me home,” Mr. Meadows said of the legislation after the president addressed lawmakers. “As a person, I love him,” said Rep. Rod Blum (R., Iowa), after the president’s presentation. Hearing from Mr. Trump “was a lot of fun. But it didn’t change me at all.” (Armour, Peterson and Hughes, 3/21)

Hours after being singled out by Trump over his opposition to the Republican health care plan, Freedom Caucus Chairman Mark Meadows said his group of conservatives still has the votes to block the bill. Freedom Caucus insiders say the group has 27 members who are firmly against it or leaning "no." (Bade, Bresnahan and Cheney, 3/21)

"I serve at the pleasure of the people of western North Carolina, and when you serve at their pleasure, it's only those 750,000 people that can send you home," Meadows told reporters Tuesday. (Hellmann, 3/21)

Meadows and other conservatives want the legislation to more aggressively scale back the health care law regulations that spell out what insurance plans must cover. GOP leaders have said those changes can't clear Senate rules on reconciliation bills. And the amendments that some Republicans are seeking, lawmakers warned, might not even have a majority support in the Senate. (Mershon and Williams, 3/21)

The morning strategy session at the Capitol was the first time in his two months as president that Trump met with almost the full House Republican Conference that was elected with him in November. The membership reflects the disparate coalition of Republicans who aligned to make him their standard-bearer last year. The question for the party now is whether that ideologically diverse group can govern. (Memoli and Mascaro, 3/21)

At the White House daily press briefing on Tuesday afternoon, press secretary Sean Spicer said that Trump "continues to meet with members and walk away with a very, very optimistic view of where the bill is headed." Spicer also said he didn't want to "rule anything out" with regard to further changes to the bill. (Davis and Keith, 3/21)

President Donald Trump may be hands off when it comes to health policy, but the task of corralling Republicans is right up his alley. His work to close the deal on the GOP bill to repeal Obamacare harks back to his days as a developer who mixed hyperbole with weighty-sounding promises and/or threats to get what he wanted. (Bettelheim and Millman, 3/21)

For a president with a penchant for vengeance — who named “an eye for an eye” as his favorite biblical passage, who banned media outlets from campaign events when he didn’t approve of their coverage, who after the election ousted a GOP state chairman whom he viewed as disloyal, who just last week reminded a GOP governor who hadn’t endorsed him that “I never forget” — the roll-call vote on the Republican health care plan, expected Thursday, will be the first accounting of who’s with him and who’s against him on Capitol Hill. (Goldmacher, 3/21)

President Donald Trump tried to rally Republican lawmakers behind a plan to dismantle Obamacare on Tuesday as U.S. stock markets showed their worst one-day performance since the November election. (Cornwell and Abutaleb, 3/21)

Quorum Health Corp. and other hospital chains fell Tuesday as President Donald Trump went to Capitol Hill to drum up support for a Republican health bill that would repeal parts of Obamacare and add to the number of people who can’t pay their medical bills. Quorum plunged 11 percent to $6.64 at 1:41 p.m. in New York trading, while Community Health Systems Inc. dropped 7.5 percent to $8.23 and Tenet Healthcare Corp. slid 5 percent to $16.65. HCA Holdings Inc., the biggest U.S. hospital chain, fell 1.3 percent to $82.79. (Greifeld, 3/21)

President Trump is like a broken record of Pinocchios, incessantly repeating false and misleading claims that have been debunked. As Congress debates the Republican replacement bill for the Affordable Care Act, Trump has been on a greatest-hits tour of his favorite, and questionable, claims about Obamacare. We compiled a round-up of his most notable claims from the past week. (Lee and Kessler, 3/22)

Making the case for a Republican repeal and replacement of his predecessor's health care law, President Donald Trump reached for a dire-sounding argument that's unsupported by the data. "Many of our best and brightest are leaving the medical profession entirely because of Obamacare," Trump told his audience at a Monday night rally in Louisville, Kentucky. In fact, the number of doctors in the U.S. actively caring for patients grew from 799,501 in 2010, when the Affordable Care Act was signed into law, to 860,939 in 2015, according to the Association of American Medical Colleges. (Drinkard, 3/22)

The vote on the Republican health care bill is a defining moment for House Speaker Paul Ryan that could boost his aggressive agenda to overhaul the tax code and remake the federal government. Or send it off the rails. If he fails? "It will be very hard to manage this," the Wisconsin Republican told reporters ahead of Thursday's likely vote. (3/22)

The test for Mr. Ryan is whether he can make the leap from serving as the architect of conservative policy, a role he played for years as the party’s leading budget author, to the more difficult role of guiding legislation into law. The task is much tougher now than when Republicans passed bills with the knowledge that a Democratic president would veto them. “Everybody understands that we’re dealing with live ammo now,” said Sen. Pat Toomey (R., Pa.), a roommate of Mr. Ryan when they served together in the House. (Peterson, 3/21)

The fate of the GOP health-care plan depends largely on whether divided Republicans can decide just how far they want to go in torpedoing the central underpinnings of Affordable Care Act. Conservative Republicans are pressing to swiftly gut most of the law while more moderate GOP members want the federal government to play more of a central role in helping people obtain coverage. (Armour, 3/21)

Forget the House GOP's troubles passing a health care bill. The party's bigger problem looms in the Senate. Mitch McConnell is being tasked with fixing what GOP senators and House members say is a flawed Obamacare repeal proposal — one with little to no chance of passing in that chamber in its current form — in a week’s time. (Everett and Haberkorn, 3/22)

Top Senate Republicans said Tuesday that they want to pass legislation to repeal and replace ObamaCare next week, despite deep divisions over the House bill.  "We will reach a conclusion on healthcare next week because we're going to Judge Gorsuch the week after that," Majority Leader Mitch McConnell (R-Ky.) told reporters, asked if he thought the current timeline is realistic. "We'll try to move it across the floor next week."  (Carney, 3/21)

The Senate is moving forward with an aggressive timeline to pass legislation repealing the 2010 health care law next week, Majority Leader Mitch McConnell of Kentucky insisted Tuesday, despite concerns within his party over the measure. His chamber would take up the legislation if the House advances it Thursday, McConnell said. Senate Republicans would aim to pass an amended version, teeing up a House vote on a final package during the first week of April. “We’re not slowing down,” McConnell said at his weekly news conference. (Mershon, 3/21)

House Republicans chasing the final votes to repeal much of Obamacare are promising hard-liners they'll fix the rest of the health care system with another batch of conservative bills down the road. The hitch is those bills would almost certainly die in the Senate — as several of them have done before. (Demko, 3/21)

House Democrats have a new plan to tank Paul Ryan’s Obamacare repeal: Get out of the way. Democratic leaders in the House know they’re powerless to stop the GOP’s health care bill. So instead, with a repeal vote looming Thursday, they’re executing a strategic retreat. (Caygle and Schor, 3/22)

Senate Democrats up for re-election in Republican-leaning states are united in opposition to the GOP health care plan. For them, overhauling the health care system is not just about policy. It’s a matter of right and wrong. ... 10 Senate Democrats [are] running for re-election in 2018 in states President Donald Trump won in November. But those Democrats are not rushing to join Republicans seeking to dismantle President Barack Obama’s signature 2010 health care law. Instead, they say the GOP bill, known as the American Health Care Act, is a disaster. (Bowman, 3/22)

With the House vote on the Republican health care bill looming on Thursday, Democrats are unified in their opposition. Lawmakers have echoed the same talking points, exaggerating the bill’s effect on insurance pools, employment and income inequality. Here is an assessment of their claims. (Qiu, 3/21)

Top Republicans are warning their fellow party members that failing to repeal Obamacare could imperil the goal of a massive tax cut -- and perhaps more of President Donald Trump’s legislative agenda. As a health-care replacement bill backed by House Speaker Paul Ryan struggles to gain support from House conservatives and Senate Republicans, some GOP lawmakers argue that a once-in-a-generation opportunity to overhaul the U.S. tax code with stout cuts in tax rates for businesses and individuals depends on the outcome. (Kapur, 3/21)

Top Republicans are emphasizing the strategic importance of cutting taxes in the bill to repeal and replace parts of the 2010 health care overhaul as the first step towards cementing a broader tax overhaul later this year. Amendments released late Monday would add items sought by critics of the health care bill (HR 1628) including tax cuts beginning in 2017 and not in 2018 and lowering the threshold for deductible health care expenses. The changes would also open the door for the Senate to funnel more resources to low-income people aged 50 to 64 that would help pay  for health insurance premiums. (Ota, 3/21)

The lawmaker guiding the Senate’s work to renew the Food and Drug Administration’s ability to collect fees from industry wants to move quickly, he said at a hearing Tuesday. Yet any push to rapidly advance FDA user fee legislation may be slowed by the Republican push to repeal the 2010 health care law (PL 111-148, PL 111-152). At a hearing of the Health, Education, Labor and Pensions Committee on Tuesday, panel Democrats were uniformly critical of the decision to not hold any hearings on the House GOP health care law replacement bill (HR 1628) that could soon be before the Senate. (Siddons, 3/21)

Over the last four years, [Denver] has quietly transformed how it cares for its poorest residents. As hundreds of thousands of Coloradans gained health insurance through the Affordable Care Act, known as or Obamacare, Denver built an extensive new system to keep patients healthy, hiring dozens of mental health specialists and nurses, expanding dental clinics and launching efforts to help patients manage debilitating illnesses, such as diabetes and heart disease. (Levey, 3/22)

Rick Snyder, Michigan’s Republican governor, is warning congressmen in his state that a bill repealing Obamacare could harm some of their most vulnerable constituents. Snyder sent personal letters to each member of Michigan’s House and Senate delegation on Monday, saying that the American Health Care Act would limit federal funding, and detailing potential harms. Snyder had earlier said he opposes the AHCA, which repeals and replaces portions of the Affordable Care Act, sometimes called Obamacare. (Tracer and Edney, 3/321)

Gov. Rick Snyder, reaching out to Republican members of Michigan's congressional delegation on Tuesday, never specifically asked them to reject a GOP plan to replace the Affordable Care Act, but he reminded them individually — with statistics specific to their districts — of the tens of thousands of Michiganders who could lose coverage if they support it...But even as Snyder warned members of the consequences of passing the legislation —  including changes that may gut funding for Healthy Michigan, the state's Medicaid expansion program that has insured some 650,000 lower-income Michiganders, and cut support for the traditional Medicaid program as well — many of the state's Republican members of the U.S. House continued to voice their support for the plan. (Spangler, 3/21)

Governor Charlie Baker warned Tuesday that the GOP plan to repeal the federal health care law could put a half-million Massachusetts residents at risk of losing coverage, blow a $2 billion hole in the state budget, and threaten the state’s first-in-the-nation commitment to universal health care coverage. In a letter from Baker and in subsequent testimony from his health chief, the Republican administration stepped further into the caustic national debate over President Trump’s effort to repeal his predecessor’s health care law. (Miller, 3/21)

If the American Health Care Act (AHCA) becomes law, it would cost Massachusetts $1 billion by 2020, nearly $2 billion just two years later, and the losses would "likely have a greater annual impact in the years that follow," wrote Gov. Charlie Baker, a Republican, in a letter to the state's all-Democratic congressional delegation. ... And Baker says the state would lose another $425 million to $475 million a year if new Medicaid rules in the AHCA put specific payments in the state's Medicaid waiver at risk. (Bebinger, 3/21)

Older Louisianians who buy their own health insurance are likely to pay more under the Republican plan to replace the Affordable Care Act, according to a Times-Picayune analysis of data collected by The Associated Press.  Given that the state voted overwhelmingly for Donald Trump in the 2016 election, many voters who helped put Trump in office could see their tax credits for health insurance drop under the GOP proposal. (Lipinski, 3/21)

A series of changes to the GOP’s Obamacare replacement plan -- aimed at winning over hard-line conservatives -- could provide more financial aid to older Americans to help buy them insurance. The move announced Monday night could bolster tax credits for people ages 50 to 64, many of them working class who voted for Donald Trump. The tax credits are aimed at helping people who don’t have insurance through an employer buy their own coverage. (Williams, 3/21)

Subsidies from “Trumpcare” will be higher for households in Atlanta and most Georgia cities than the subsidies under Obamacare, according to an analysis by WalletHub. The calculation does not in any way reckon with the number of people who will not have insurance, but it shows how relatively affluent cities may -- on average -- do better than less affluent, less citified areas. (Kanell, 3/21)

Older Americans who have not yet reached Medicare age are among the groups hardest hit by the Republican plan to replace the Affordable Care Act. An analysis by The Associated Press shows that many of those who buy their own health insurance stand to pay thousands of dollars more. That is especially true for the nearly 3.4 million older Americans who have enrolled through the government marketplaces, many of whom receive generous federal subsidies through the health care law enacted under former President Barack Obama. (Aboraya, 3/21)

As Republicans in Congress work to repeal and replace the Affordable Care Act, state and tribal leaders in Montana are concerned Native Americans might lose improved access and care created under the law. Led by former U.S. Sen. Max Baucus of Montana, Congress in 2009 peppered the ACA with several health insurance reforms specific to Native Americans. They expanded access to care, brought more local control and funding to Indian Health Service facilities, and ultimately provided guarantees that the federal budget will pay the full cost for most Native users of state-managed Medicaid expansions. (Frazier, 3/22)

If the Republican plan to replace the Affordable Care Act becomes law, Montana could end its Medicaid expansion program, which has opened up coverage options for many Native Americans. ... In Hardin at Bighorn Valley Health Center, Dr. David Mark said that would have a negative effect. Medicaid expansion was “really a game-changer in terms of connecting so many people in our community and in our region for the first time ever have really been connected to access to health care now,” Mark said. “It’s really allowed people to access care in a whole new way.” (Michels, 3/22)

A soon-to-be father whose wife is getting prenatal care through the Affordable Care Act. A woman whose mother would have been bankrupted by her cancer diagnosis had she not had ACA coverage. An older self-employed couple, insured under the law, who for “the first time in our lives” can afford to see doctors and buy medicines. This month, they and nearly 1,200 other people responded when The Washington Post asked readers how they thought the health-care debate on Capitol Hill would affect them: “Do you or someone you know have health insurance through the Affordable Care Act? What do you think of the proposed changes by Congress? Are you concerned about a specific part of the plan? Share your story.” (Somashekhar, 3/22)

Many millennials have their hands full as they launch into adulthood — jobs, homes and partners. But Ford Inbody, 33, already thinks about a time when he won’t be able to work. He has Parkinson’s disease. Every night after work, he and his wife, Cortney, walk their two dogs through their Overland Park, Kan., neighborhood. For now, going out for an evening’s stroll is easy. But many of their evening conversations revolve around a time they know is coming — when these walks will prove difficult. (Smith, 3/22)

State lawmakers hashing out a $152 billion budget are contending with a possible complication as Congress weighs a proposal that would shift some health-care costs from New York’s counties to its state government. (Vilensky, 3/21)

The governor likened it to an act of war. A Democratic congresswoman called it a brazen case of theft. And a Republican legislative leader suggested it could be a crisis on the level of 9/11. Even as Congress debated a massive and divisive overhaul of the nation’s health care system, a late amendment to the bill seemingly singling out New York’s state government for new financial responsibilities under Medicaid set off a separate political firestorm in the president’s home state, again pitting its Democratic governor against Mr. Trump and his Republican surrogates. (McKinley, 3/21)

Governor Andrew Cuomo accused two New York Republicans in the U.S. House of selling out their constituents and risking the state’s economy with a plan to win votes for a bill to replace Obamacare by exempting most counties from paying for Medicaid. The proposal crafted Monday by U.S. Representatives Chris Collins of Lancaster, near Buffalo, and John Faso of Kinderhook, near Albany, would force the state to absorb the $2.2 billion of Medicaid costs paid by counties outside New York City. (Goldman and House, 3/21)

If you're poor and you want to keep your health insurance, you may have to go to work. That's the message from Republican lawmakers who Monday night released a series of changes to their plan to overhaul the Affordable Care Act.A key change, designed to help attract votes from conservative Republicans, would let state governors require people to work to qualify for health insurance under Medicaid. (Kodjak, 3/21)

On Thursday night, the House is expected to vote on a bill to repeal Obamacare. The only hurdle is Republicans themselves. House leaders are desperate to get enough conservatives on board to get the bill to the Senate, so last night they made some changes to it. One sweetener: letting states add work requirements to Medicaid eligibility rules. (Gorenstein, 3/21)

The Republican plan to repeal and replace Obamacare is drawing strong opposition just ahead of a crucial House floor vote expected on Thursday, driven by the bill’s cuts to the Medicaid health program for the poor. A group representing major Medicaid insurers said on Tuesday that it has “serious concerns” about the GOP bill, estimated to slash $880 billion from Medicaid. Governors, including some Republicans, are also warning that it could blow holes in their budgets and harm constituents. (Tracer, 3/21)

Connie Dotts is a big fan of her insurance. "I like that we can choose our own doctors," says the 60-year-old resident of Mesa, Ariz. "They also have extensive mental health coverage." Dotts isn't on some pricey plan, either. She's among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2013. (Stone, 3/22)

A Republican proposal to replace the Affordable Care Act would effectively block states’ ability to expand Medicaid, thwarting a new attempt by Kansas to expand its own privatized version of the program. Congressional Republicans have continued to push forward with the GOP’s American Health Care Act, which would repeal and replace the 2010 Affordable Care Act, widely known as “Obamacare.” The Republican bill has struggled to find widespread support, even in the Republican-controlled Congress. (Woodall and Wise, 3/21)

The Affordable Care Act, commonly called Obamacare, includes no “Health Choices Commissioner.” Another bill introduced in Congress in 2009 did include such a position, but the bill died — and besides, the job as outlined in that legislation didn’t have the powers [Louisiana Sen. Bill] Cassidy ascribed to it. As the debate to repeal the law heats up in Congress, constituents are flooding their representatives with notes of support or concern, and the lawmakers are responding, sometimes with form letters that are misleading. (Ornstein, 3/22)

In letter after letter, Republican lawmakers have reminded their constituents: Obamacare cut Medicare. Implied, and sometimes stated outright, was that the GOP’s own plan should instead bolster the program. “Any reforms must protect Medicare,” Congressman Ted Poe, a Texas Republican who represents a district in the Houston area, wrote in a letter last month to one of his constituents about the Affordable Care Act’s failures and his party’s own plans. ... But the bill now working its way through Congress does not reverse those cuts. (Scott, 3/22)

Americans paid more than $6.6 billion over eight years to care for victims of gun violence, according to a new tally of hospital bills. And U.S. taxpayers picked up at least 41% of that tab. That’s just the tip of the iceberg, say the authors of a study published this week in the American Journal of Public Health. Their sum does not include the initial — and very costly — bill for gunshot victims’ care in emergency rooms. Nor does it include hospital readmissions to treat complications or provide follow-up care. The cost of rehabilitation, or of ongoing disability, is not included either. (Healy, 3/22)

A rare cancer first linked to breast implants in 2011 has now been associated with nine deaths, the Food and Drug Administration said Tuesday. As of Feb. 1, the agency had received a total of 359 reports of the cancer associated with the implants. The deaths were not caused by breast cancer, the agency said, but by a rare malignancy in the immune system, anaplastic large-cell lymphoma. (Grady, 3/21)

[Dr. Rajeev] Kumar explained that Lewy body dementia is caused by the accumulation of the protein, alpha-synuclein, in the brain. The abnormally processed protein clumps together and impacts patients’ cognitive functions including the ability to plan and process information, ability to pay attention and ability to get rapid eye movement, or REM, sleep. Patients are known to physically act out their dreams, sometimes violently. The disorder is also linked to Parkinsonism — stiffness, tremors, slowness that come with the disease’s better-known related disorder, Parkinson’s disease. Behavior and mood problems including depression and anxiety and even hallucinations and delusions may develop. (Rubino, 3/21)

Some research has suggested that vitamin E and selenium supplements might lower the risk for Alzheimer’s disease, but a new long-term trial has found no evidence that they will. (Bakalar, 3/21)

U.S. regulators have approved the first new drug in a decade for Parkinson’s disease, a chronic neurological disorder that causes tremors and movement difficulties. The Food and Drug Administration said Tuesday that it has approved Xadago for use when a patient’s regular medicines aren’t working well. The pill was tested in two six-month studies that included about 1,200 patients taking a standard treatment, levodopa. (Johnson, 3/21)

Every year cigarette smoking contributes to about 1 in 5 deaths in the United States. A group of prominent health leaders called for the immediate implementation of  national action to reduce the number of smokers in the country by 15 million in a report published last week. (Naqvi, 3/21)

How far should scientists be allowed to go in creating things that resemble primitive human brains, hearts, and even human embryos? That's the question being asked by a group of Harvard scientists who are doing exactly that in their labs. They're using stem cells, genetics and other new biological engineering techniques to create tissues, primitive organs and other living structures that mimic parts of the human body. Their concern is that they and others doing this type of "synthetic biology" research might be treading into disturbing territory. (Stein, 3/21)

A state-run survey of 37,000 middle and high school students in Washington state finds that marijuana legalization there has had no effect on youngsters' propensity to use the drug. The Washington State Healthy Youth Survey found that the 2016 rate of marijuana use was basically unchanged since 2012, when the state voted to legalize marijuana for recreational use. In the survey, researchers used the measure of “monthly use,” asking students across all grade levels whether they'd used the drug within the past month. (Ingraham, 3/21)

A Southern California cardiologist’s study of indigenous South Americans found that an extremely healthy lifestyle appears to prevent coronary artery disease, a leading cause of death in the U.S. Dr. Gregory Thomas, medical director of the Heart and Vascular Institute at Long Beach Memorial, helped lead the research project that was published Friday, March 17, in the British journal The Lancet. Researchers took CT scans of the hearts of 705 Tsimane adults who live in the Bolivian Amazon. (Perkes, 3/21)

Hantavirus Pulmonary Syndrome (HPS) is the severe respiratory disease in humans caused by infection with hantavirus. Anyone who comes into contact with rodents that carry hantavirus is at risk, according to the CDC. Rodent infestation in and around the home remains the primary risk for hantavirus exposure. There are no reported cases of hantavirus in the U.S. in which the disease was transmitted from one person to another, according to the CDC. (Young, 3/21)

Officially, as a scientist in the state Experiment Station’s insect inquiry office, Gale Ridge’s job is to help the public with many-legged creatures that actually exist. She has an “open-door policy”: Anyone can walk in, ring the service bell, and benefit from her expertise...But her most difficult cases haven’t involved spiders or bedbugs or chiggers or mites. Instead, the hardest bugs she has to deal with are the ones that aren’t really there. She labels these cases DP, short for delusional parasitosis. Some entomologists prefer Ekbom syndrome, because it carries less stigma. In the Diagnostic and Statistical Manual of Mental Disorders, which most psychiatrists use, the condition is listed as one kind of delusional disorder, defined as an unshakeable belief that you are being attacked by bugs or parasites even when there is no evidence of infestation. (Boodman, 3/22)

The maker of the pain medication OxyContin has asked a federal judge in Seattle to throw out a Washington city’s lawsuit that seeks to hold the drugmaker responsible for allowing its pills to flood the black market and into Everett. (Le, 3/21)

In a motion filed in federal court in Seattle, attorneys for Purdue Pharma wrote that the suit by Everett, Wash., suffered from “multiple, independent legal failings” — including statute of limitations problems and a failure to demonstrate a close connection between the company’s conduct and the criminal acts of drug dealers and addicts. (Ryan, 3/21)

Gov. Chris Sununu has nominated Gordon MacDonald, a well-known Manchester attorney, to serve as Attorney General. MacDonald's clients include a major opioid maker being investigated by the state. (Rodolico, 3/21)

No matter how hard he looked, a frustrated Dan Baker couldn't find the answer. Knowing it could help save lives, though, he refused to give up. His tenacity was rewarded when Baker, chief toxicologist in the Franklin County coroner's office, developed a new test to detect even minute quantities of carfentanil, a little-known, man-made opioid used to tranquilize elephants, polar bears, moose and other large animals. Baker's test helped officials across Ohio and the country determine that the "heroin" that was causing a frightening increase in overdoses and deaths last summer was much more. (Perry, 3/22)

The four children woke up and were about to start getting ready for school when they found their parents, Brian and Courtney Halye, unresponsive and cold in their bedroom. The children, ages 9 to 13, dialed 911. “My mom's on the floor and my stepdad's basically pale and they're not waking up,” Courtney Halye's daughter told an emergency dispatcher through tears. (Bever, 3/21)

Only one exchange site exists in Northern Kentucky, two years after a state law was changed to allow such programs, and it's outside the population centers of Boone, Campbell and Kenton counties. In Southwest Ohio, the only needle exchange program is limping along with spotty funding and little government support. Needle exchange is lagging locally although the national Centers for Disease Control and Prevention supports such exchanges to prevent the spread of infectious diseases, including hepatitis B and C and HIV. (DeMio, 3/21)

Old health advice often dies hard. This is particularly true — perhaps dangerously so — of historic advice for pregnant women, according to a new Viewpoint published Tuesday in the Journal of the American Medical Association. Most adults remember the traditional guidelines for expectant mothers. Get as much rest as possible during your pregnancy, even prolonged bed rest if complications arise. At the same time, “eat for two” — you and your developing child. According to the new report, however, “these misguided recommendations” have “evolved into a major contributor to the worldwide obesity epidemic.” (Burfoot, 3/21)

A group of researchers want women to know that when it comes to exercise, there is a strong consensus of benefit for both the mother and developing fetus. "Within reason, with adequate cautions, it's important for [everyone] to get over this fear," says Alejandro Lucia, a professor of exercise physiology at the European University of Madrid, an author of the viewpoint published Tuesday in JAMA, the journal of the American Medical Association. (Hobson, 3/21)

Researchers have some bad news for moms who used DHA supplements while they were pregnant in hopes of boosting their baby’s brains: It didn’t work. At age 7, kids whose mothers took DHA scored no higher on an IQ test than kids whose moms swallowed capsules that were DHA-free. (Kaplan, 3/21)

Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions. That may be one reason vasectomy rates are low: Five percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The CDC’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive. (Dembosky, 3/21)

The conservative Family Foundation of Virginia says it plans to file a legal challenge over the way the state did away with restrictive regulations for abortion centers. The group says it notified Gov. Terry McAuliffe’s administration Tuesday of its intention to file an administrative appeal over the health and safety regulations, which were updated in October.Foundation President Victoria Cobb says the administration violated state law in its “quest to water down” the standards. (3/21)

A group that includes some members of the Virginia Board of Health intends to file an appeal alleging that the board violated state law last year during the regulatory process it used to change abortion clinic standards. Victoria Cobb, president of the anti-abortion Family Foundation of Virginia, said Tuesday the lawsuit will be filed within 30 days in Henrico County Circuit Court. The appeal takes issue with the way the Board of Health last year enacted changes to the state’s code overseeing clinics that provide abortions. (Demeria, 3/21)

Planned Parenthood pressed a federal judge Tuesday to block abortion-restricting Missouri rules similar to Texas ones struck down last year by the U.S. Supreme Court, while an attorney for Missouri countered that undoing the Missouri regulations could endanger women. U.S. District Judge Howard F. Sachs deferred a ruling until at least next month after hearing arguments over the preliminary injunction request by Planned Parenthood affiliates with Missouri health centers. (Suhr, 3/21)

The Texas Senate has given final approval to a so-called “wrongful birth” bill seeking to prevent parents from suing doctors for malpractice after their child is born with severe disabilities. Tuesday’s vote sends Republican Sen. Brandon Creighton’s proposal to the House. (3/21)

The House is advancing a measure making it easier for patients to access hospice care. Florida confines hospice services to the final six months of a person’s life.  But Rep. Gayle Harrell (R-Stuart) wants to ensure terminal patients can receive access to pain relief more quickly. (Evans, 3/21)

The Arizona Legislature has given final approval to a controversial bill that would protect a health-care provider who refuses for religious or moral reasons to participate in medical care that may lead to a patient's death. The bill passed 32-24, with Republicans supporting it and Democrats opposing it. Four members were absent. (Beard Rau, 3/21)

Georgia’s ranking on a health system scorecard has improved from 46th in the nation to 41st. The Commonwealth Fund’s 2017 scorecard ranked the 50 states and the District of Columbia on the most recent data available in five areas: health care access, quality, avoidable hospital use and costs, health outcomes, and health care equity. (Miller, 3/21)

U.S. Stem Cell Clinic is in the spotlight after three patients reportedly lost their eyesight following procedures here. The Sunrise facility offers stem cell treatments for a range of diseases and chronic disorders and yet it has no medical facility license. Here’s what you might not know: It doesn’t need one. (Lade, 3/21)

Advocate Children's Hospital surgeons have successfully operated on a baby from Africa born with two spines and an extra set of legs protruding from her neck. The Park Ridge hospital announced Tuesday that 10-month-old Dominique from Ivory Coast, or Cote d'Ivoire, in West Africa, is recovering well from the March 8 surgery. The baby already has started sitting up again, and doctors expect she'll be able to live a normal, fully functional life. (Schencker, 3/21)

Eastern Missouri has four full time police officers dedicated to investigating human trafficking cases, but convictions are rare... To improve awareness, Webster University will hold a training session this weekend for law students and the general public. Attendees will hear how people are forced into sex work and other trades, and how to identify warning signs. (Bouscaren, 3/22)

Monsanto is facing more pressure to compensate farmers and farm workers who allege that its leading pesticide product caused them to develop cancer. A Los Angeles-based law firm on Friday filed 136 new cases against the company in St. Louis County Circuit Court. The lawsuits allege that exposure to glyphosate, the active ingredient in Roundup, caused the plaintiffs to develop non-Hodgkin's lymphoma. (Chen, 3/21)

“The Jungle Book” may be one of Disney’s most beloved animated movies, but a consumer health watchdog group is warning parents to lay-off feeding their kids Walgreens’ Disney Jungle Book whole grain animal crackers, featuring the storybook characters Mowgli and Baloo on the package. Turns out the bare necessities involved in making that version of the crackers requires higher baking temperatures, which produces excessive levels of a cancer-causing chemical called acrylamide, said Charles Margulis of the Oakland-based Center for Environmental Health. (Seipel, 3/21)

Florida's new medical marijuana market will start to take shape today as a panel of senators workshops five proposals to put the voter-approved constitutional amendment legalizing the drug into place. The Senate Health Policy committee, chaired by Tampa Republican Sen. Dana Young, will consider issues related to the five proposed bills and hear public comment, the first step toward passing legislation and the first time members of the public will hear what key senators think about how medical marijuana should be implemented. (Auslen, 3/22)

Florida senators will begin hashing out possible medical marijuana laws this week. There are five competing bills just in the Florida Senate on how the state should implement a medical marijuana amendment. The Florida Senate’s Health Policy Committee under Senator Dana Young will start the medical marijuana debate. (Aboraya, 3/21)

As far as many patient groups are concerned, the theme song for the pharmaceutical industry should be Joan Jett’s “Bad Reputation.” For all the criticism that drug makers have endured in recent years, a new survey finds that they are faring worse than ever. Just 38 percent of patient groups thought the pharmaceutical industry had an “excellent” or “good” reputation last year, down from almost 45 percent in 2015, according to PatientView, a research firm that canvassed more than 1,400 patient groups from 105 countries. (Silverman, 3/21)

Biopharma, a high-flying industry for most of the past decade, may be coming down to earth. The backlash against steep drug prices has become a rare subject of bipartisan agreement in Washington, D.C. Leading the charge is President Trump, who promised last week that his administration is “going to get drug prices so far lower than they are now your head will spin.” (Weisman, 3/19)

The four most recent Food and Drug Administration commissioners are warning Congress that legalizing the importation of drugs from other countries — an idea that has drawn support from both Bernie Sanders and Donald Trump — is a risky approach that would endanger consumers by exposing them to fake, substandard and contaminated drugs. (McGinley, 3/17)

Scrutiny of high drug prices constitutes a major investment risk for big pharma. The industry’s transparency push can help. Eli Lilly released a report Monday that shows the growth of its gross and net prices across its U.S. drug portfolio. They are the third major drug company to release such data this year after Merck & Co. and Johnson & Johnson. The data show that Lilly has raised average gross prices by more than 11% in each of the past five calendar years. (Grant, 3/20)

Abill that would allow the Maryland attorney general to take legal action against generic drug makers for price gouging cleared a significant hurdle on Monday night when the Maryland House of Delegates overwhelming voted to approve the measure. The legislation, which was approved by a vote of 137-to-4, now goes to the state Senate. Specifically, the bill would require the Maryland Medical Assistance Program to notify the attorney general when an “essential” generic drug rises in price by 50 percent or more within the preceding two-year period. (Silverman, 3/21)

David Higginbotham contracted hepatitis C more than 35 years ago. He'd like to rid his body of the virus, but Colorado's Medicaid program says he's not sick enough to justify the cost. And he's not alone. (Kodjak, 3/17)

Acholesterol-cutting drug from Amgen succeeded in lowering patients’ risk of cardiovascular trouble in a huge clinical trial — but the results, announced Friday, may not be good enough to prompt insurers to cover the expensive drug for millions of patients. Amgen’s treatment, called Repatha, met its goals in a two-year trial on more than 27,000 patients with heart disease who were already taking a maximum dose of statins like Lipitor and yet still had stubbornly high cholesterol. Those who got Amgen’s drug were 15 percent less likely to suffer a bad outcome, defined as heart attack, stroke, hospitalization for chest pain, placement of a stent, or death. (Garde, 3/17)

Biogen scored another intellectual property win for its investors Tuesday, but growth concerns remain. The U.S. Patent Trial and Appeal Board upheld a key piece of intellectual property on Biogen’s multiple sclerosis drug Tecfidera, following a hedge fund’s challenge to its validity. Biogen shares rose Tuesday morning, even as most biotech stocks sold off sharply. (Grant, 3/21)

With prescription drug prices soaring and President Donald Trump vowing to take action, an old idea is gaining fresh traction: allowing Americans to buy medicines from foreign pharmacies at far lower prices. A new bill in Congress to allow the practice would modify previous safety standards and remove a barrier that proved insurmountable in past attempts to enable progress. (Bluth, 3/22)

Hoping to deflect criticism of its pricing, Eli Lilly released data showing that rebates and discounts paid to middlemen are increasingly reducing the list prices charged for its drugs. (Silverman, 3/20)

Rising drug prices are one of the biggest challenges in health care in the United States. More people are using prescription drugs on a regular basis, and the costs of specialty drugs are rising faster than inflation. President Donald Trump has promised over and over again to drive down drug prices. ... But Trump already has a weapon he could deploy to cut the prices of at least some expensive medications. (Kodjak, 3/16)

How do insurance companies decide what medicines to pay for and when to pay for them? Insurers and other payers look first at how well the drug works — not its cost — when they decide whether to cover the latest treatments, according to the nation’s largest pharmacy benefits manager, Express Scripts. The price patients eventually pay gets determined later, when an insurance company or pharmacy benefits manager decides where a drug fits on a list of covered treatments called a formulary. (Murphy, 3/17)

Laura Ries was moved to action when she saw a TV commercial that portrayed a woman enjoying time with her grandchildren after taking Lyrica, a prescription medication for diabetic nerve pain. Ries’ elderly mother suffered from just that problem. “The ad showed someone who was enjoying life again,” said Ries, president of a marketing strategy firm in Atlanta, who then researched the drug and spoke with her mother’s doctor. “This … was very relatable to what my mom was experiencing.” (Horovitz and Appleby, 3/20)

Sanofi SA expects its drug sales in China to grow at least 10% this year, helped by its push outside cities and efforts to tailor medicines to suit local needs, senior executives said. Sales in China last year exceeded €2 billion ($2.15 billion), making it the French company’s third-largest market after the U.S. and France. Drugs accounted for €1.8 billion, with the rest from vaccines and consumer health products. (Rana, 3/21)

When Tami Haught was diagnosed with HIV, she was one day shy of her 25th birthday. The diagnosis did not come as a shock since doctors had determined her fiancé was dying of AIDS several weeks earlier. In the two decades since, Haught, 48, has turned to expensive prescription drugs to keep the deadly infection in check. In 2005, she began receiving help purchasing her medications through the AIDS Drug Assistance Program (ADAP), a federally funded network of programs in each state that assist low-income HIV and AIDS patients. Since the Affordable Care Act was implemented, ADAP instead has helped her buy an insurance policy to cover a wide assortment of her health care needs. (Heredia Rodriguez, 3/21)

In response to anger from drug makers, the Food and Drug Administration delayed implementing a final rule until next year that would give the agency greater leeway to police off-label marketing. The move comes three weeks after the pharmaceutical industry filed a petition urging the agency to postpone the rule over concerns it would harm public health and chill “valuable scientific speech.” As we noted previously, the rule says drug makers must update product labeling if there is evidence indicating a company intended its medicine to be used off-label, or for an unapproved use. (Silverman, 3/17)

The Senate will soon begin the process of considering President Trump’s nomination of Dr. Scott Gottlieb, who has close professional and financial ties with the pharmaceutical and biotechnology industries, for commissioner of the Food and Drug Administration. A trial that began in a federal courtroom in Boston in January is a timely reminder of how the laissez-faire regulatory posture that Gottlieb is expected to promote can harm the public’s health. (Renee M. Landers, 3/16)

President Trump is neither a fan of regulation nor high drug prices. So it is no surprise that his nominee to head the Food and Drug Administration, Scott Gottlieb, is a candidate sent straight from central casting. Gottlieb, who is himself a doctor, American Enterprise Institute scholar, and former deputy commissioner of the FDA under President George W. Bush, has long been on record as a critic of the FDA’s overly risk-averse approach to approving new drugs and generic forms of existing ones. (Mytheos Holt, 3/17)

My 4-year-old daughter, Elle, is in the fight of her life. Her older sister, Milla, lost her fight last November. Their opponent? Batten disease, a rare, fast-moving, and fatal condition that destroys the central nervous system’s ability to function. Elle has a chance to help manage, or maybe even beat, her disease that Milla didn’t have: a clinical trial in which an investigational protein is infused directly into Elle’s brain every 14 days. (Frazer Gieselmann, 3/17)

Next month, the Food and Drug Administration is likely to miss another target date for implementing a rule to improve generic drug safety. If that happens, the American public will lose. The rule is important because it addresses a maddening quirk in the law. Right now, brand-name drug makers can change product labels after learning about potentially harmful side effects. But generic companies cannot do the same thing — unless such a change has already been made to the corresponding brand-name drug. (Ed Silverman, 3/20)

The February news that Amgen Inc.'s cholesterol-lowering drug Repatha helped prevent heart attacks was one of the most exciting biotech events of the year, renewing faith in the drug's blockbuster potential. But the full trial results behind that headline, which Amgen released on Friday, disappointed investors, sinking the company's shares more than 6 percent.  (Max Nisen, 3/20)

It's generally considered good sense to give wasps' nests a wide berth. But PTC Therapeutics Inc. just paid $140 million in cash and stock for the pleasure of sticking its face in one.  PTC on Thursday bought the Duchenne Muscular Dystrophy (DMD) drug Emflaza from Marathon Pharmaceuticals. The drug is an old steroid widely and cheaply available in other countries. Marathon got FDA approval for it last month and proceeded to price it at a hefty $89,000 per year. (Max Nisen, 3/16)

I'm about to violate my own HIPAA protections to illustrate the illogical nature of health-care costs. I have toenail fungus on one toe. Right foot, middle toe. Gross, I know. I never did anything about it until a routine visit to the dermatologist last year. When she saw that nasty dawg, she told me there were meds that could fix it. (Michael Smerconish, 3/19)

The drug-pricing debate focuses too much on President Donald Trump's Twitter account, and too little on the fact that price hikes don't work that well any more. According to a report it released Monday, Eli Lilly & Co. had a 50-percent-off sale on its drugs in the U.S. in 2016, giving half the list price of its medicines back to insurers and pharmacy benefit managers, on average. It raised list prices by 14 percent, but only received 2.4 percent of that increase. (Max Nisen, 3/20)

Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care. The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it's because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose. (Jill Lawrence, 3/21)

The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters. (3/21)

Although this week got off to a crackling start with high-profile hearings on Judge Neil Gorsuch’s Supreme Court nomination and potential Russian interference in the 2016 presidential election, the event with the largest consequences for the Trump administration and the Republican congressional majority occurs on Thursday. That’s when the full House takes up legislation to repeal and replace the Affordable Care Act. (William A. Galston, 3/21)

Next comes the House Republican plan, which Trump enthusiastically supports, to repeal the Affordable Care Act and replace it with a system that will cause 14 million Americans to lose their health insurance next year, and 24 million by 2026, according to the Congressional Budget Office. How does Trump justify this human hardship? The plan barely makes a dent in the national debt. It cuts the federal budget deficit by only $337 billion over the next 10 years — a small fraction of the national debt. (Robert Reich, 3/21)

The poor can be safely ignored largely because they allow themselves to be split along tribal lines of creed and color and kept at one another’s throats. Then they are nickled and dimed and robbed damn near blind by monied interests and their political henchmen. The new health care bill is a prime example. (Leonard Pitts, 3/22)

Exactly seven years ago Thursday, after decades of effort to make health care available to all Americans, the Affordable Care Act was signed into law. Now, in what House Speaker Paul Ryan calls “an act of mercy,” the House is planning an anniversary vote to repeal it and, in addition, to radically alter the Medicaid program that has been a staple of the national safety net since the 1960s. For members of Congress, this is one of the most consequential votes they might ever face. (Andy Slavitt, 3/22)

The House GOP leadership has aligned itself so closely with President Trump on healthcare, it’s borrowing his signature sales tactic as it tries to ram through a bill this week to “repeal and replace” Obamacare: the bold but empty promise. Specifically, it’s promising House Republicans a solution to their concerns about drastically increasing insurance premiums for millions of older Americans, but leaving the Senate to figure out how to deliver it. (Jon Healey, 3/21)

No great political acumen or psychology degree is necessary to conclude that President Trump is highly susceptible to flattery. It’s little wonder then that House Speaker Paul D. Ryan (R-Wis.), desperate to pass GOP health-care reform or at least not be blamed if it fails, keeps talking about what a terrific “closer” Trump is. (Jennifer Rubin, 3/21)

What do we lose when social insurance unravels? It is startling to realize just how much the social safety net expanded during Barack Obama’s presidency. In 2016, means-tested entitlements like Medicaid and food stamps absorbed 3.8 percent of the nation’s gross domestic product, almost a full percentage point more than in 2008. (Eduardo Porter, 3/21)

The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place. That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance. (Margot Sanger-Katz, 3/21)

Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans. (Drew Altman, 3/22)

Republican leaders in the House have been huddling over the last few days in a frantic search for enough votes to win passage of their proposed revision of Obamacare, in the process making an already flawed bill even worse. One measure of their desperation was a cynical last-minute provision that would shift Medicaid costs from New York’s rural and suburban counties to the state government, pleasing upstate Republicans who represent those counties but reducing coverage provided by the state. (3/21)

Per capita caps on Medicaid beneficiaries? Block-granting Medicaid? Do these wonky and innocuous-sounding proposals really make any difference? They do. The American Health Care Act – the Republicans replacement for Obamacare – is scheduled for a vote this week in the U.S. House. You will hear much discussion about the individual insurance marketplace, tax credits, and promotion of health savings accounts. However, the changes in Medicaid are the most profound in the AHCA. (Jessica Schorr Saxe, 3/21)

"America spends more on health care than other rich nations, but has lower life expectancy." If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system. (Megan McArdle, 3/21)

Last week I was in London to participate in a scientific symposium. During coffee breaks, many British colleagues asked me and other American visitors to explain the bewildering news that President Trump had announced his intention to cut the budget for the National Institutes of Health by 18.3 percent, about $5.8 billion. (Harold Varmus, 3/22)

Judge Neil M. Gorsuch has written little about abortion, and we do not know whether he would vote to overturn Roe v. Wade, the 1973 Supreme Court decision that established abortion as a fundamental right. But he has expressed a position on two related subjects, assisted suicide and euthanasia. In his Oxford dissertation and a later book, he defended the inviolability of human life. He rejected the role of states in granting the terminally ill a right to die and offered a legal framework that could be applied to abortion. (Corey Brettschneider, 3/21)

Democratic senators questioning Supreme Court nominee Neil Gorsuch appear quite preoccupied with how often he has ruled for “the little guy.” That seems an odd way to measure the independence and acuity of a judge; presumably, little guys can be wrong now and again. But in his opinion in the controversial Hobby Lobby case, Gorsuch did rule for the little guy. And in doing so, he has given us some clues about the kind of justice he would be. (Melinda Henneberger, 3/21)

First things first: Neil Gorsuch is qualified to be a justice of the U.S. Supreme Court, and he should be confirmed by the Senate. That said, even qualified judges can make bad decisions. And Gorsuch and others on the federal appeals bench were deeply wrong when they decided Americans can opt out of laws for religious reasons. (Dave Helling, 3/21)

Lahren, the 24-year-old conservative internet provocateur, angered many of her followers Friday when she said this during an interview on ABC's "The View": "I'm pro-choice and here's why. I'm a constitutional — you know, someone that loves the Constitution. I am someone that's for limited government. And so I can't sit here and be a hypocrite and say I'm for limited government but I think that the government should decide what women do with their bodies. I can sit here and say that, as a Republican, and I can say, you know what, I'm for limited government, so stay out of my guns, and you can stay out of my body as well." This did not go over well with her bosses at The Blaze, a conservative media site founded by Glenn Beck. (Eric Zorn, 3/21)

Michael Yeaman’s lab on the Harbor-UCLA Medical Center campus in Torrance is loaded with bacteria, and it’s been that way for a quarter of a century. Yeaman is a bug detective. To be more technical, he’s a medical science investigator. You should not talk to him if you’re a hypochondriac, because you’ll crawl into a bubble and zip it shut. (Steve Lopez, 3/22)

We’re in the midst of a rampant opioid epidemic that has surged in three successive waves. The first involved prescription opioids. The second saw increased usage of heroin as many of those addicted to prescription opioids sought a different source of pain relief, for various reasons. The third wave has been fentanyl. The drug that killed Prince has been linked to a soaring amount of overdoses and deaths across the country. (Rep. Tim Murphy (R-Pa.), 3/21)

This was the proposal: Deliberately infect a small group of consenting adults with the Zika virus to learn about the disease and speed up the search for a vaccine... What might go wrong and what might go right with such an experiment? Perhaps no institution can handle those questions better than the National Institutes of Health. (Paul McLean, 3/21)