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Teva Pharmaceutical CEO says health-care is facing ‘huge disruption’

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Teva Pharma CEO on health-care bill and disruption

The global health-care industry faces a “huge disruption” as technology heavyweights jostle for consumers with traditional providers, the chief executive of a major pharmaceutical company said.

Yitzhak Peterburg, interim president and CEO at Teva Pharmaceutical, told CNBC on the sidelines of the World Economic Forum’s annual June meeting in Dalian that digital disruption is an enabler for health-care and pharmaceutical companies to serve today’s customers.

“I am a very great believer that we are now in a huge disruption within the health-care (industry), and I think it will affect our industry,” said Peterburg. “For me, the digital reform, or whatever we see, is a huge enabler.”

Teva Pharmaceutical, headquartered in Israel, calls itself he largest producer of generic medicines. In specialty medicines, Teva has treatment for multiple sclerosis as well as late-stage development programs for other disorders of the central nervous system.

Big technology names have begun looking into ways they can disrupt the health-care sector through big data analytics, artificial intelligence and other technologies.

Earlier this month, CNBC reported that a secretive team within Apple’s growing health unit has been talking to developers, hospitals and other industry groups about bringing clinical data, such as detailed lab results and allergy lists, to the iPhone. Meanwhile, it was reported in May that Amazon was hiring a business lead to figure out how the company can break into the multibillion-dollar pharmacy market.

Peterburg explained that pharmaceutical companies need to think about ways to navigate this changing landscape, where they face increasing competition from non-pharma players. Being good at manufacturing pills and injections is no longer enough for pharma companies, he said. Consumers, he added, have also changed and they expect very different value from pharmaceutical companies and the health care industry as a whole.

An employee collects newly-manufactured pills at the tablet production plant at Teva Pharmaceutical Industries Ltd.'s headquarters in Jerusalem, Israel

“Part of my competitors are not only the Novartis of the world, and the other pharmas, but really the Amazons and Googles,” he said. “Like any company, we need to think about where we invest and how we invest, and what is the right time to jump into the water.”

But the answer to the question is not straightforward, according to Peterburg, because different parts of the health-care industry are not moving at the same pace. “It’s very, very difficult, especially for incumbents, to find the right way and where to move,” he said. “That’s why we have to do it by collaboration maybe with start-ups, with small companies, and try to find the solution.”

Aside from competition from non-traditional players, in some markets, pharma companies also need to navigate regulatory hurdles. For example, in China, Peterburg said Teva has found it challenging to establish a foothold over the last few years.

“China is a challenge,” he said. “Teva was trying in the last — maybe not even few years — to go into China (and) I don’t think we’ve done a great job at this.”

The company has one manufacturing facility in the mainland, according to Peterburg, and it’s speaking with local pharma companies to try and find the right way to succeed in China’s vast market. Regulation is a big hurdle because it takes too long to pass, he said.

“It takes too long, even to register. Now remember, we have the biggest cabinet of drugs in the world. We really are part of the good guys. We are the generic ones. We can bring quality into this market but if the time to register a drug takes two, three, four, five years, it’s too long.”

— CNBC’s Christina Farr contributed to this report.

Geoff Cutmore


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New Perk: A Day Off to Take Care of Your Financial Health

“We were exactly the same as all Americans,” he said in an interview. “It’s hard to think about your 401(k) match if you are worrying about your utility bill.”


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After introducing a financial wellness program to its 24,000 workers, SunTrust acquired the wellness company it initially hired for the job. And now, it plans to offer the program, which is based on eight main financial steps, or “pillars,” to employers across the country.

In a news release Tuesday announcing its plans, SunTrust, which is based in Atlanta, called financial wellness “the next benefit frontier for leading employers.”

Roughly 30 other organizations already offer the SunTrust program, including Home Depot, Delta Air Lines and the company that makes Little Debbie’s snack cakes. Ten others plan to introduce it, the bank said.

SunTrust enters the market at a time when more employers are concerned about their employees’ financial stress and how it could affect their job performance. Nearly one-third of all employees are distracted by personal financial issues while at work, according to a recent study by PwC, the consulting firm, with almost half of them spending three hours or more each week handling personal finances on the job.

A study by Alight, a benefits administrator, found that nearly 60 percent of employers are very likely to expand financial wellness programs this year, almost twice as many as three years ago.

Though employers have said the No. 1 reason they offer the plans is that it is the right thing to do, many rank-and-file workers might argue it is the very least they can do, particularly as pensions fade, wage growth is slow and employees continue to shoulder an ever greater share of medical costs.


Brian Nelson Ford develops SunTrust Banks’ financial wellness program.

Melissa Golden for The New York Times

Home Depot, which has 400,000 employees, started to introduce SunTrust’s “Momentum onUp” program to certain workers in March.

“Stress is brought to work, and that ultimately affects our associates in the store and the customer experience, and it becomes a business issue as well,” said Don Buben, director of benefits at the retailing giant. “It affects everyone from our hourly associates up to the executive level.”


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The SunTrust regimen covers “eight pillars of financial greatness,” which is largely about clarifying a person’s values, then structuring his or her financial lives around what is important. The concept was created by Brian Nelson Ford, who founded the wellness company SunTrust acquired and now works for the bank developing the program.

“A lot of well-intentioned companies focus on the 401(k),” Mr. Ford said, “but I don’t think people are losing sleep and getting divorced over the asset allocation in their 401(k).”

The first pillar asks employees to start an emergency fund, called a “financial confidence account,” for unexpected expenses. Not all companies choose to contribute to the account, but SunTrust will match up to $1,000 once employees automate their own savings plan of $40 a month and meet certain goals like setting up a budget.

Since the beginning of 2015, the bank has paid a total of $9 million in contributions of this type to roughly 15,000 employees.

Beyond the savings accounts, there are pillars dedicated to things like organizing and automating a worker’s financial life, calculating net worth, getting rid of debt, improving credit score, investing and buying a home versus renting. It takes about six hours for an employee to cover all of the content, which can include live instruction and videos.

One of the more unusual aspects of SunTrust’s own program may be its “day of purpose,” something Mr. Rogers, the chief executive, calls a “selfish day” to focus on one’s own finances. For his own — and he takes it — he visited his father and his aunt, who live in the same retirement community, to go over their living expenses, insurance and estate plans. “My aunt had a lot of financial stress,” he said. “I am not sure if we hadn’t had that conversation she would have overcome that.”

Few companies go that far, though the Motley Fool, an investing website, also dedicates a work day to financial health, an idea it picked up from my colleague Ron Lieber, The New York Times’s “Your Money” columnist, who wrote about his own fiscal health day (Check out our guide to your own day here).

So far, SunTrust is pleased with the program’s progress. Most participants are now equipped to handle an unanticipated expense, and they have increased their retirement savings contributions 35 percent, on average.

As for Mr. Moore, the technology manager, he said the classes helped him and his wife of nearly 22 years communicate better about money, a topic they had always struggled with. “We went from, ‘We have been diagnosed with this tumor and literally $100,000 of surgery is about to occur,’ to ‘Oh, we can afford this. We are going to be O.K.’”


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“We finally had the language to communicate with.”

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On Senate Health Bill, Trump Falters in the Closer’s Role

Mr. Trump and his staff played a critical role in persuading House Republicans to pass health care legislation in May, with the president personally calling dozens of wavering House members. But the Trump team’s heavy-handed tactics have been ineffective in the Senate, and White House officials determined that deploying Vice President Mike Pence, a former congressman with deep ties to many in the Senate, was a better bet than unleashing Mr. Trump on the half-dozen Republicans who will determine the fate of the Senate bill to repeal and replace the Affordable Care Act.


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Mr. Trump, who is fond of telling friends he is a “closer,” became more involved over the past few days, reaching out to a few reluctant conservatives like Senators Mike Lee of Utah, Ted Cruz of Texas and Rand Paul of Kentucky, who emerged from an Oval Office meeting on Monday saying he was more optimistic about getting to a yes.

“The White House has been very involved in these discussions,” Mr. McConnell said in announcing that a vote on the bill was postponed until after the Fourth of July recess. “They’re very anxious to help.”

Yet over the past few weeks, the Senate Republican leadership has made it known that it would much rather negotiate with Mr. Pence than a president whose candidacy many did not even take seriously during the 2016 primaries. And some of the White House’s efforts have clearly been counterproductive.

Over the weekend, Mr. McConnell made clear his unhappiness to the White House after a “super PAC” aligned with Mr. Trump started an ad campaign against Senator Dean Heller, Republican of Nevada, after he said last week that he opposed the health care bill.

The majority leader — already rankled by Mr. Trump’s tweets goading him to change Senate rules to scuttle Democratic filibusters — called the White House chief of staff, Reince Priebus, to complain that the attacks were “beyond stupid,” according to two Republicans with knowledge of the tense exchange.

Mr. McConnell, who has been toiling for weeks, mostly in private, to put together a measure that would satisfy hard-liners and moderates, told Mr. Priebus in his call that the assault by the group, America First, not only jeopardized the bill’s prospects but also imperiled Mr. Heller’s already difficult path to re-election.

Mr. McConnell and “several other” Republican senators expressed their irritation about the anti-Heller campaign during the White House meeting, according to two people, one of them a senator, who were present.

The move against Mr. Heller had the blessing of the White House, according to an official with America First, because Mr. Trump’s allies were furious that the senator would side with Nevada’s governor, Brian Sandoval, a Republican who accepted the Medicaid expansion under the health law and opposes the Republican overhaul, in criticizing the bill.


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According to the senator, the president laughed good-naturedly at the complaint and signaled that he had received the message.

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A few hours later, America First announced it was pausing its advertising assault against Mr. Heller, insisting it was doing so because of his willingness to come to the White House meeting with Mr. Trump.

America First was founded by a group of Mr. Trump’s loyalists — many of them with deep connections to Mr. Pence, including Nick Ayers, a Republican consultant who is regarded as the vice president’s top political adviser. The group compared Mr. Heller to Representative Nancy Pelosi, the House Democratic leader, and vowed a seven-figure advertising campaign against him.

Mr. Heller, the only Senate Republican who will face voters next year in a state carried by Hillary Clinton in 2016, is the top target for Democrats facing a Senate map with few opportunities in 2018. And there were already seven groups — a mix of health care advocacy organizations and more partisan Democratic efforts — on the air in Nevada assailing the Republican health care overhaul, according to a Republican ad buyer tracking the ad traffic.

Neither Mr. McConnell’s office nor his top outside political advisers were warned about an impending attack on one of their most endangered incumbents. “They didn’t check in with anybody,” said Josh Holmes, Mr. McConnell’s former chief of staff. “There was no clearing of channels, no heads-up, nothing.”

Republican senators across the ideological spectrum have indicated their unease with the health bill. But Mr. Trump has few ties with the group, and several Republicans who remain on the fence have tangled with Mr. Trump, either during the presidential campaign or since.

Top Trump lieutenants like Stephen K. Bannon, his chief strategist, who lobbied members on the House bill, have been all but sidelined. Mr. Priebus has also played a much diminished role.

Mr. Pence has been far more active in seeking out Republican senators. Seema Verma, Mr. Pence’s former adviser in the Indiana Statehouse and now a top administration health care official, has also been trying to reassure senators that their states will have flexibility on Medicaid under the bill, while Mr. Pence’s former chief of staff, Marc Short, now the White House legislative affairs director, has been quarterbacking the effort from his hideaway in the Capitol.

Until Tuesday’s meeting at the White House, Mr. Trump had spoken with only a few members of the Senate, according to an administration official. The pace was nothing like the dozens of calls he made to help pass the House’s health bill, aides said.


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A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan — and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy, according to an aide who received a detailed readout of the exchange.

Mr. Trump said he planned to tackle tax reform later, ignoring the repeal’s tax implications, the staff member added.

After the meeting, Mr. Trump played the role of cheerleader on Twitter, encouraging his weary Republican allies to keep working.

“I just finished a great meeting with the Republican Senators concerning HealthCare,” he wrote. “They really want to get it right, unlike OCare!”

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Your.MD raises $10M to grow AI-driven health information service and marketplace

Your.MD, an AI-driven health information service delivered via a bot, has raised $10 million in new funding. The round was led by Orkla Ventures, the venture arm of Orkla, a leading supplier of branded consumer goods to the health, pharmacy, and grocery sectors in the Nordics, Baltics and parts of Central Europe. Existing investor Smedvig Capital and other unnamed existing shareholders also participated.

Billed as a AI-based “pre-primary care service,” Your.MD is available for web, iOS, Android, Facebook Messenger, Skype, Slack and Telegram. It is part chatbot, helping users figure out what might be wrong with them via a conversational interface that drills down into your symptoms, and part next-generation search engine to surface detailed and verified information on various medical conditions.

Alongside this, the London-headquartered startup has developed what it calls the “OneStop Health platform,” a marketplace of trusted health service providers and products, some of which it has a commercial partnership. So, for example, if Your.MD helps you determine that you need to speak to a doctor, OneStop would connect you to video telemedicine service Push Doctor. Or if a massage could be the correct remedy, Your.MD would send you Urban Massage‘s way.

There are currently 35 international and local digital health businesses on the platform, and the company says it plans to grow this to over 100 by the end of the year. OneStop is also key to how Your.MD plans to generate revenue, for what it otherwise a free information service.

In a call with Your.MD founder and CEO Matteo Berlucchi, I likened the combination of Your.MD’s next-generation search engine combined with the OneStop Health platform to the way Google’s own search engine captures and then monetises intent. He agreed that the comparison is valid, but with one key difference.

When people search for information on a product or service they typically already know what they’re looking for and what action or intent will follow. With health, there is an extra stage needed before intent can be captured, which is helping you figure out what it is you need first. “When you do a health-related search you don’t want lots of results, you just want the correct one,” notes Berlucchi.

To date, Your.MD has garnered 2.1 million downloads and says it has nearly a million active users per month. Interestingly, 67 per cent of users are male and 33 per cent female. Who said men don’t want to talk about their health? Albeit to an AI-based chatbot.

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When Cutting Access to Health Care, There’s a Price to Pay

And the American deficit has been getting worse. “Each year, other high-income countries are improving their health at a much faster rate than the United States, and the United States currently ranks lowest on a variety of health measures,” the report by the Institute of Medicine and the National Research Council noted.


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I bring this up, senators, because you are considering a bill that would drive a stake through the Affordable Care Act. As you mull the legislation over your holiday recess, think about the consequences of cutting access to care for millions of mostly poorer, sicker and older Americans.

Of course, the dismal health situation is not all the fault of the health care system — which, until the passage of the Affordable Care Act, was the only one in the developed world that routinely barred access or limited care for millions of people of modest means.That is because violence accounts for a large share of Americans’ excessive mortality, and accidents take a disproportionate toll. Nor is the health care system entirely to blame for the nation’s elevated obesity rate — a leading cause of problems like diabetes.

The High Cost of Avoiding Health Care

Americans die from noncommunicable diseases at higher rates than citizens of many other advanced countries. And many people here have at times been reluctant to see a doctor because of the cost.

Mortality rate from noncommunicable diseases

Age-standardized deaths per 100,000 people,

selected countries, 2008







United States

















Percentage who say they have

skipped seeing a doctor because of cost

Among respondents to the 2016 Commonwealth

Fund International Health Policy Survey






United States




New Zealand









By The New York Times

What’s more, the United States’ higher tolerance of poverty undoubtedly contributes to higher rates of sickness and death. Americans at all socioeconomic levels are less healthy than people in some other rich countries. But the disparity is greatest among low-income groups.

Still, senators, you are not off the hook. Limited access to health care may not entirely account for the poor health and the early deaths of so many of your fellow Americans. But it accounts for a good chunk.

A study about equity in access to health care for 21 countries in 2000 revealed that the United States had the highest degree of inequity in doctor use, even higher than Mexico — which is both poorer and generally more inequitable.

And as noted in a 2003 study by the Institute of Medicine, insurance status, more than any other demographic or economic factor, determines the timeliness and quality of health care, if it is received at all.

It doesn’t require an advanced degree to figure out what limited access to a doctor can do to people’s health. A review of studies published this week in Annals of Internal Medicine reported that health insurance substantially raises people’s chances of survival. It improves the diagnosis and treatment of high blood pressure, significantly cutting mortality rates. It reduces death rates from breast cancer and trauma. Over all, the review concluded that health insurance reduces the chance of dying among adults 18 to 64 years old by between 3 and 29 percent.

Another assessment, published last week in The New England Journal of Medicine, found that access to health insurance increases screenings for cholesterol and cancer, raises the number of patients taking needed diabetes medication, reduces depression, and raises the number of low-income Americans who get timely surgery for colon cancer.


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It said that expansions in three states of Medicaid, the federal health insurance for the poor whose rolls Republicans are prepared to trim by 15 million over a decade, were found to reduce mortality by 6 percent over five years, mostly by increasing low-income Americans’ access to treatment for things like H.I.V., heart disease, cancer and infections.


Annals of Internal Medicine reported that health insurance improves the diagnosis and treatment of high blood pressure, and reduces death rates from breast cancer and trauma.

Whitten Sabbatini for The New York Times

I understand, senators, that this sort of analysis may not sway all of you. I’m aware of the view on the rightmost end of the political spectrum that ensuring people’s well-being, which I assume includes their health, is a matter of personal responsibility and not the government’s job.

Yet there is a solid economic argument for protecting your fellow citizens’ access to health care that does not rely on arguments from empathy, charity or the like. A sickly, poorly insured population can be expensive.

As noted by a study from the Joint Center for Political and Economic Studies, poor health and limited access to health care not only raise the cost of providing such care but also reduce productivity, eat into wages, increase absenteeism, weigh on tax revenues and generally lower the nation’s quality of life.

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The study, which focused on the disadvantages of African-Americans, Latinos and Asians, added up the costs of inequalities in health and premature death between 2003 and 2006 and came up with a price tag of $1.24 trillion.

The good news, senators, is that solving these inequities needn’t be particularly expensive. The analysis relayed in The New England Journal of Medicine suggested that each additional life saved by expanding Medicaid costs $327,000 to $867,000. That is much cheaper than other public interventions, such as workplace safety and environmental regulations, which achieve a similar reduction in mortality for each $7.6 million spent on compliance.

Even better: Instead of taking away the health insurance of more than 20 million Americans, what if you could offer nearly universal access and still make that work within your broader agenda?

In 2015, according to the Organization for Economic Cooperation and Development, the United States government spent 8.4 percent of its gross domestic product to pay for health care for about half of all Americans, including Medicare, Medicaid and subsidies under the Affordable Care Act. That year, Britain spent 7.7 percent to cover virtually all of its citizens. Finland, Canada and Italy spent even less.

I understand, senators, that these places have what is known as single-payer systems — which tend to stick in the craws of some of you. But think about it. If your primary motivation to repeal the Affordable Care Act is to provide a large tax cut for high-income Americans, think what you could do with a full percentage point of G.D.P. It could even be worth the effort to provide health care for all.

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Senate Health Bill in Peril as CBO Predicts 22 Million More Uninsured

But the budget office put Republicans in an untenable position. It found that next year, 15 million more people would be uninsured compared with current law. Premiums and out-of-pocket expenses could shoot skyward for some low-income people and for people nearing retirement, it said.


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The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

Mr. McConnell, the chief author of the bill, wanted the Senate to approve it before a planned recess for the Fourth of July, but that looks increasingly doubtful. Misgivings in the Republican conference extend beyond just a few of the most moderate and conservative members, and Mr. McConnell can lose only two Republicans.

Where Senators Stand on the Health Care Bill

A real-time count of every senator’s position.

At least some of Ms. Collins’s concerns could be shared by Senators Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia, whose rural states would face effects similar to those in Maine.

“If you were on the fence, you were looking at this as a political vote, this C.B.O. score didn’t help you,” said Senator Lindsey Graham, Republican of South Carolina. “So I think it’s going to be harder to get to 50, not easier.”

He added, “I don’t know, if you delayed it for six weeks, if anything changes.”

Under the bill, the budget office said, subsidies to help people buy health insurance would be “substantially smaller than under current law.” And deductibles would, in many cases, be higher. Starting in 2020, the budget office said, premiums and deductibles would be so onerous that “few low-income people would purchase any plan.”

Moreover, the report said, premiums for older people would be much higher under the Senate bill than under current law. As an example, it said, for a typical 64-year-old with an annual income of $26,500, the net premium in 2026 for a midlevel silver plan, after subsidies, would average $6,500, compared with $1,700 under the Affordable Care Act. And the insurance would cover less of the consumer’s medical costs.

Likewise, the report said, for a 64-year-old with an annual income of $56,800, the premium in 2026 would average $20,500 a year, or three times the amount expected under the Affordable Care Act.

The budget office report was a major setback to Senate Republican leaders, but it was too early to declare the legislation dead, and turmoil in health insurance markets could still induce Congress to take action this year. Many people thought the House repeal bill was dead after Speaker Paul D. Ryan pulled it from the floor on March 24, but a slightly revised version was narrowly approved by the House six weeks later.


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Senator John Thune of South Dakota, a member of the Republican leadership, suggested that leaders would press forward with the Senate bill. He said that an argument could be made for delaying it “if you thought you were going to get a better policy,” but that that was not the case.

“This is the best we can do to try and satisfy all the different perspectives in our conference,” Mr. Thune said, adding that he did not think the politics would improve by waiting. “It’s time to fish or cut bait.”


Fact Check: The Senate Health Care Plan

Does the health care bill in the Senate live up to Republicans’ promises? We checked the facts.

By DAVE HORN and NATALIE RENEAU on Publish Date June 26, 2017.

Photo by Doug Mills/The New York Times.

Watch in Times Video »

The White House discounted the report, saying the budget office had “consistently proven it cannot accurately predict how health care legislation will impact insurance coverage.”

The Trump administration says the Senate Republican bill would not cut Medicaid because spending would still grow from year to year. But the Congressional Budget Office said that the bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million lower than under current law.

In 2026, it said, Medicaid spending would be 26 percent lower than under current law, and enrollment of people under 65 would be 16 percent lower. Beyond 2026, Medicaid enrollment would keep declining compared with what would happen under current law.

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The Senate bill would make it much easier for states to obtain waivers exempting them from certain federal insurance standards, like those that require insurers to provide a minimum set of health benefits. The budget office said that nearly half of all Americans could be affected by these cutbacks in “essential benefits,” and that as a result, coverage for maternity care, mental health care, rehabilitation services and certain very expensive drugs “could be at risk.”

Before the budget office released its report, the American Medical Association had announced its opposition to the bill, and the National Governors Association had cautioned the Senate against moving too quickly.

The budget office’s findings immediately gave fodder to Democrats, who were already assailing the bill as cruel. Senator Chuck Schumer of New York, the Democratic leader, said Senate Republicans had been saying for weeks that their bill would be an improvement over the House bill, which President Trump had described as “mean.”

The budget office had found that under the House bill, the number of people without health insurance would increase by 23 million by 2026 — only slightly more than the 22 million projected for the Senate bill.


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“C.B.O.’s report today makes clear that this bill is every bit as mean as the House bill,” Mr. Schumer said. “This C.B.O. report should be the end of the road for Trumpcare. Republicans would be wise to read it like a giant stop sign, urging them to turn back from this path that would be disastrous for the country, for middle-class Americans and for their party.”


The C.B.O. Did the Math. These Are the Key Takeaways From the Senate Health Care Bill.

A look at four big numbers in the C.B.O. report.

The criticism was not confined to the Democratic caucus. Mr. Johnson, one of five Senate Republicans who said last week that they could not support the bill as drafted, told a radio host that Senate leaders were “trying to jam this thing through.” He, too, suggested he would not vote even to begin debating the bill.

“I have a hard time believing I’ll have enough information for me to support a motion to proceed this week,” Mr. Johnson said later on Monday.

Beyond the number of Americans without insurance, the Senate bill’s $321 billion in deficit reduction is larger than the $119 billion that the budget office found for the bill that passed the House.

Earlier Monday afternoon, Senate Republican leaders altered their bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the previous year.

The waiting period was meant to address a notable omission in the Senate’s bill: The measure would end the Affordable Care Act’s mandate that most Americans have health insurance, but also require insurers to accept anyone who applied. The proposal is supposed to prevent people from waiting until they get sick to buy a health plan. Insurers need large numbers of healthy people, whose premiums help defray the cost of care for those who are sick.

Under one of the most unpopular provisions of the Affordable Care Act, the government can impose tax penalties on people who go without health coverage. Republicans have denounced this as government coercion.

The repeal bill passed by the House last month has a different kind of incentive. It would impose a 30 percent surcharge on premiums for people who have gone without insurance.

Mr. Trump wrote on Twitter on Monday that Republican senators were “working very hard to get there” but were not getting any help from Democrats.


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“Not easy! Perhaps just let OCare crash burn!” Mr. Trump wrote, reiterating his assertion that the Affordable Care Act would be doomed if Congress did not come to its rescue.

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‘Trumpcare’ would send her to Mexico for birth control

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

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Untangling politics of health care, Russian interference

HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR: For more analysis of the health care debate, “NewsHour Weekend” special correspondent Jeff Greenfield joins us from Santa Barbara, California.

Jeff, here we are, a sixth of the U.S. economy depends on healthcare and we have a piece of legislation that could be decided by maybe two, three votes, it’s coming down to this?

JEFF GREEENFIELD, PBS NEWSHOUR WEEKEND SPECIAL CORRESPONDENT: Yes, and it’s remarkable. You know, in the old days, big social legislation like Social Security and Medicare used to pass by overwhelming margins. But for the last 25 years, we’ve seen this down to the wire kind of situation. Clinton got his tax bill through with a one or two-vote margin. President George W. Bush got his prescription drug plan through the House with one vote to spare. Obama’s stimulus and his healthcare bill needed 60 votes in the Senate to overcome a filibuster. That’s exactly what’s he got.

So, that’s what has happened and that reflects I think, in part, political polarization. But there’s also something to remember, all those bills passed because members of the president’s party in Congress are very reluctant to see the president fail.

SREENIVASAN: This idea of party versus country and what you should put first, how does it play out in this vote?

GREENFIELD: I think you can see it dramatically with Senator Dean Heller of Nevada, who is the most endangered Republican senator next year in the midterms. With the prodding of the Republican governor, he has said he’s no on this bill because of Medicaid. So, what’s happening, a pro-Trump PAC is going to launch a seven-figure media buy against him. And what happens now is for him and for the other Republicans who expressed reluctance. What it comes down to is Mitch McConnell looking for ways to pacify them with concessions at the last minute and the problem, of course, is that any time you concede to the moderates, the conservatives don’t like it and vice versa.

SREENIVASAN: All right. From politics to policy, when you look into the meat of it, whether it’s the House version or the Senate version, you have these huge constituencies that are going to be hurt by it — the poor, the elderly. Who wins going forward or is this just a calculation of figuring out the bare minimum to get it over the line?

GREENFIELD: Look, I think what you — every independent analysis says this is big distribution away from middle class and the poor toward the affluent, who got hit in the Obama plan because their taxes were increased to pay for the subsidies.

But two things to remember: first, the tax cuts kick in immediately. The bites with Medicaid expansion later and reduced subsidies and higher premiums, they don’t begin to kick in until after the 2018 midterms. I think that’s a very critical point.

The second thing I’d say is that for a lot of Republican base, repealing Obamacare, whatever that means, has become the be all and the end all. It’s like Vince Lombardi once said, winning this and everything, it’s the only thing. Anything they can call Obama repeal, they want, because not to do it betrays the central promise they made to the Republican base.

SREENIVASAN: Shifting gears a little bit, the president back on Twitter. In a couple of tweets, he seems to acknowledge the Russian interference in the context of blaming the Obama administration for not doing anything about it, which is a different tactic than what the White House and the administration and President Trump has been pushing with the past few months.

GREENFIELD: So, for months, Donald Trump was saying there is nothing to the story of hacking. Maybe it’s the Chinese. Maybe it’s some guy in his parents’ basement. Now, he seems to be he’s saying, of course, there was hacking, and the reason the Obama administration didn’t talk about it much was to help Hillary by not talking about it.

That makes no sense. Had they exposed Russian effort to push the electorate away from Hillary, that would have helped her politically. And one of the reasons they didn’t do it, according to the intelligence chiefs that served Obama was, had they raised that issue, they would have been accused of politicizing the story in an effort to help Hillary Clinton.

I think it’s an illustration also, more broadly, of how Trump uses social media, to convince his millions of followers that his version of reality is right and, by definition, anyone pushing back against that story is a product of fake news. And I think that’s just become a kind of running theme of this administration. There’s no reason to think it’s going to stop.

SREENIVASAN: All right. Jeff Greenfield joining us from California — thanks so much.

GREENFIELD: Thank you.

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Revised Senate health-care bill penalizes consumers who have gaps in coverage

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U.S. Senate Majority Leader Mitch McConnell (R-KY).

U.S. Senate Republicans on Monday released changes to their healthcare bill, including a six-month waiting period for people who have let their insurance coverage lapse for over 63 days — about two months — and want to get insured again.

The change appeared aimed at deterring people from dropping health insurance to begin with, a concern that arose in part because the bill cancels the monetary penalty for being uninsured under the current law, known commonly as Obamacare.

Senate leaders want to hold a vote on the bill before the July 4 recess that starts at the end of this week.

The nonpartisan Congressional Budget Office said in a statement that it will release a report estimating the bill’s effects on Monday afternoon.

A spokesman for Senate Majority Leader Mitch McConnell would not comment on whether votes on whatever bill is finally crafted would be held in the full Senate on Thursday, as originally anticipated.

At least four conservative Republicans have expressed opposition to the draft legislation, saying it does not go far enough in repealing former President Barack Obama’s health-care law known as Obamacare.

Meanwhile, some moderate Republicans have either withheld judgment or expressed doubts about replacing Obamacare with legislation that is similar to a health care measure narrowly passed by the House of Representatives last month.

That measure initially was supported by President Donald Trump, who later was reported to have described it as “mean.”

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Medicaid Cuts May Force Retirees Out of Nursing Homes

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.


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“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, stay-at-home parents and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle class but turned to Medicaid, which was once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.

A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, the president of the American Health Care Association, a national nursing home industry group.

With more than 70 million people enrolled in Medicaid, the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office.

Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.

“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”


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While most Medicaid enrollees are children, pregnant women and nonelderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.


Ms. Jacobs in her room at Dogwood Village. Her fellow residents include former teachers, farmers, doctors, lawyers and health aides.

Khue Bui for The New York Times

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group representing state agencies that manage programs for these populations or advocate on their behalf. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the nursing home after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.

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“You have patients who have spent their life savings, and they come here,” said Kristen Smith, the admissions coordinator. Ms. Smith said patients now are older and sicker than they used to be, frequently arriving directly from a hospital.

“It used to be hips and knee” surgeries, she said. “And now a lot of those patients are going home. What we’re seeing is more complex, sicker patients.”

With cinder-block walls brightened by pictures of horses that evoke this equestrian county, the nursing home offers crafts, bingo and other activities.

Mary Ann Mohrmann is 85, the average age of Dogwood Village residents. An elementary schoolteacher for 25 years, she has Charcot-Marie-Tooth disease, a neurological disorder that has weakened her legs, feet and thumbs and compromised her fine motor skills.


Mary Ann Mohrmann, 85, was an elementary school teacher for 25 years. She now has a neurological disorder that weakens her legs, feet and thumbs and limits her fine motor skills.

Jeff Poole/Orange County Review

Two of her children have it, too, she said. None of them can take care of her at home. “I’ve been here years,” she said. “I don’t know how many.”


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Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 65, who has been here for four years and regards herself as “a medical disaster.”

She listed her ailments: spinal cancer in remission, restless leg syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that one day she will be able to leave her wheelchair and use a walker.

Ms. Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.

Major Medicaid cuts would compel Dogwood Village to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.

If that does not save enough money, the nursing home might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.

Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.

They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.

“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”

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