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KKR Strikes Deal To Buy Health Information Giant WebMD For $2.8B And A Former Partner Scores

The WebMD application is demonstrated on an Apple Inc. iPad Air. Photographer: Andrew Harrer/Bloomberg

Private equity giant KKR is betting big on healthy living. In separate announcements on Monday morning, KKR said it will buy both internet health information giant WebMD Holdings for $2.8 billion and The Nature’s Bounty Co., a company that sells supplements ranging from fish oil and Vitamin D pills to protein bars and fiber tablets.

KKR’s headline deal was its planned purchase for WebMD for $66.50 a share, or an enterprise value of about $2.8 billion. WebMD, speculated as a takeover target for years, agreed to be sold for a 30% premium to its stock price on Feb. 15, the day before it told shareholders it would run a process to consider a sale of the company. In March, activist fund Blue Harbour Group, run by former KKR partner Clifton Robbins, disclosed a near 9% stake in WebMD and its interest in discussing strategic alternatives with the company.

Blue Harbour’s stake, built in the low $50s, means Monday’s deal will provide a nice windfall for the fund after a half-year long sale process. The hedge fund’s position was made under the auspices of its unique strategy to blends corporate activism with a focus on environmental, social and governance issues.

Similarly, KKR is positioning its WebMD purchase inside a larger investment on internet-based health information, as ordinary Americans take to the web to better understand their health and wellness.

WebMD will be rolled into a KKR-built company called Internet Brands, which already boasts an extensive footprint in the web-health market. The company’s businesses serve 50,000 health practices and boast a big footprint in cloud web hosting geared towards practitioners such as dentists, chiropractors, veterinarians, eye doctors and therapists. Its operating businesses include Demandforce, Officite, Sesame Communications, and web properties such as,,, and

WebMD, which also owns properties geared to clinicians like, will help KKR build its scale in the health information market.

“WebMD and Medscape are the market leaders in online health with unparalleled reach to consumers and healthcare professionals,” said Bob Brisco, CEO of Internet Brands. “Since its founding, WebMD has established itself as a trusted resource for health information. We look forward to delivering that resource to even more users, by leveraging our combined resources and presence in online healthcare to catalyze WebMD’s future growth.”

Added Herald Chen, head of KKR’s technology industry team, “KKR and Internet Brands are pleased to be investing behind the experienced WebMD management team and trusted WebMD platforms. The combined portfolio of leading vertical internet assets will be a powerful one.”

WebMD’s chairman Martin Wygod said Monday’s deal was the culmination of a sale process that reached 100 possible buyers as is seen as the best possible premium for shareholders. Though Monday’s deal is struck at a substantial premium to WebMD’s beginning-of-year share price it is roughly the same price as the company’s May 2016 highs. Over the past three and five years, WebMD has returned 15% and 190% respectively, indicating the company’s volatile run on public stock markets as a midcap web health brand.

KKR’s other acquisition, the purchase of a controlling stake in The Nature’s Bounty Co. was negotiated with another private equity giant. KKR will be taking control of the company from Carlyle Group for an undisclosed price. It appears Carlyle will hold onto a minority stake after the close of the purchase, expected in the coming months.

“While we close one chapter in our ownership of Nature’s Bounty, we are pleased to remain part of its future. We’ve supported significant investments in new management talent and functional capabilities, strengthened the branded portfolio and optimized the operations, creating a strong foundation for future growth,” said Elliot Wagner, a managing director at Carlyle. “We look forward to our partnership with KKR as we continue to build Nature’s Bounty as a global leader in wellness products,” he added.

Recently, Nature’s Bounty’s struck a deal to its UK-based Holland Barrett retail chain to L1 Retail, the retail investment arm of LetterOne. KKR will be acquiring a majority stake in the remaining business of Nature’s Bounty.

KKR expects to grow the presence of Nature’s Bounty products, signaling the firm sees its investment as a platform in the supplements market, where consumers purchase wares at specialty retailers and online via e-commerce giants such as Amazon.

“Nature’s Bounty is a unique consumer health and wellness platform that has built an outstanding reputation for developing distinctive brands and high quality products,” said Nate Taylor, head of consumer retail at KKR. “We are excited to partner with the management team to grow Nature’s Bounty’s global franchise.”

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The 5 health-care terms every millennial should know

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Personal Finance

Health-care plans are confusing enough but the industry-specific jargon often used to describe them can make their details even more difficult to decipher.

If you get confused about your options and end up making the wrong health-care choice, you could find yourself with some serious financial stress. Health-care bills are the most common type of debt in collection and represent about 38 percent of total debt collected in the U.S., according to Eligible, a developer of health-care Application Programming Interfaces (APIs).

A scene from the TV show Greys Anatomy.

To avoid calling their parents every time they make a health-care decision, millennials should learn five key terms, said Eligible CEO Katelyn Gleason.

1. Premium

Your premium is the amount of money you pay each month for health insurance. With company-provided health insurance, the employer contributes a percentage of the premium (usually most of it) and employees pay the remaining amount, usually through a payroll deduction. On average, employers paid 83 percent of a premium and cover 72 percent of a family plan.

When choosing a medical plan, you must look at both the cost of the premium and the deductible, Gleason advised.

2. Co-pay

A co-pay should be outlined in your health-care plan as a predetermined amount of money you would pay when you receive medical care. However, the co-pay varies depending on what type of doctor you visit, Gleason said.

Usually, there is a small co-pay for visiting a primary care physician, and a higher co-pay for an emergency room visit, she said.

3. Deductible

A deductible is a specified amount of money that the insured person must pay before an insurance company will pay a claim. Health-care-related payments, such as a co-pay, usually count towards your deductible, but you should always clarify that with your provider, Gleason said.

Usually, plans with lower monthly premiums have higher deductibles, and plans with higher monthly premiums have lower deductibles, according to The average deductible for a single worker in the U.S. is $1,478, according to a 2016 survey by the Kaiser Family Foundation.

If you rarely need medical attention, you usually won’t hit your deductible, Gleason said. However, if you do encounter a serious medical issue, that deductible number becomes important, because the higher the deductible, the more medical costs you will have to cover yourself.

Health care plans: How to control high costs

4. Co-insurance

Co-insurance is a type of insurance in which the insured pays a share of the payment made against a claim. Basically, you would pay a percentage of the costs of a covered health-care service after you’ve paid your deductible. Gleason explained. For example, if your co-insurance is 20 percent and you receive a medical bill of $1,000 after you hit your deductible, you would pay $200 and your insurer would pay $800. You typically pay co-insurance after meeting your annual deductible.

5. Out-of-pocket

Your out-of-pocket costs are your expenses for medical care that are not reimbursed by insurance. Out-of-pocket costs include deductibles, co-insurance and co-payments for covered services plus all costs for services that aren’t covered.

Let’s say you develop a serious medical issue and the costs add up to $100,000 for that year. If your out-of-pocket maximum is $10,000, then after you hit $10,000, generally through deductibles, co-payments and co-insurance, your insurer is responsible for the other $90,000.

Usually, plans with lower monthly premiums have higher out-of-pocket maximums, and plans with higher premiums have lower out-of-pocket maximums, according to


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Democratic 3rd Congressional District candidate supports taxpayer-funded health care for all

SALT LAKE CITY — Kathie Allen, the Democratic candidate in the special 3rd Congressional District race, said she supports what most people would call a single-payer government health care system.

“I don’t like that term,” the 64-year-old doctor recently told the Deseret News and KSL editorial boards. “I would describe it as a taxpayer-funded system for everyone. But how you decide to implement it needs to be customized for our country.”

It’s a proposal she believes has support in the district that had been represented since 2009 by a conservative Republican, Jason Chaffetz, until he stepped down June 30 and became a Fox News contributor.

“I’m not an outlier. I can’t emphasize enough that if I had this discussion five years ago, I would be called a socialist. And that’s probably what you’re all thinking right now,” the Cottonwood Heights resident said.

What’s changed, Allen said, is that President Donald Trump and many of his fellow Republicans in Congress are trying to dismantle the Affordable Care Act, better known as Obamacare, “without a reasonable replacement.”

That, along with internal polling that shows health care is the No. 1 issue in the district, has convinced Allen that most Utahns agree with her, she said. Allen’s campaign declined to share any details about the polling.

“I think my message resonates with people,” she said. “I think they want the truth.”

Allen said that means treating voters just as she does her patients when there’s bad news.

“Most patients I talk to say, ‘Dr. Allen, tell it to me straight. Don’t sugarcoat it,’” she said. “They realize they can’t get proper treatment without a diagnosis.”

Unlike the three Republicans competing in the upcoming Aug. 15 primary — Provo Mayor John Curtis, former state lawmaker Chris Herrod and Alpine lawyer Tanner Ainge — Allen has already secured her party’s nomination.

The political newcomer has a big lead in fundraising, collecting nearly $729,000 since entering the race earlier this year, according to her most recent Federal Election Commission filing.

Allen initially was running against Chaffetz, who would have been up for re-election in 2018. Her campaign got a big boost in March after Chaffetz said rather than buying a “new iPhone that they just love,” Americans should invest in health care.

Comedian Rosie O’Donnell and other celebrities helped Allen raise record amounts through her campaign’s crowdfunding effort after she’d tweeted in response, “Cell phone vs. health ins. People have to make a choice. Yes they do, Jason!”

Chaffetz, already under fire from some constituents who saw him as too soft on Trump, announced a month later he would not run in 2018, and then that he was resigning his office to spend more time with his family.

The former chairman of the House Oversight and Government Reform Committee said Allen had nothing to do with his decision, and to suggest otherwise “is delusional.”

Democrats hoping to represent the 3rd District can expect to fight an uphill battle, and Allen is no exception, said Chris Karpowitz, co-director of the BYU Center for the Study of Elections and Democracy.

The district includes portions of Salt Lake and Utah counties, as well as Carbon, Emery, Grand, San Juan and Wasatch counties, and is considered one of the most Republican in the nation.

“Any Democratic candidate who is going to be successful in the 3rd District is going to have to position himself or herself as a pragmatic centrist,” Karpowitz said. “Otherwise, I think it’s going to be extremely difficult.”

Allen’s call for the government to provide health care for everyone isn’t likely to help, he said.

“She’s taken a position on an issue that allows her to draw a sharp contrast with what’s going on in Washington, D.C.,” Karpowitz said, adding that Allen has the financial resources to make her case.

But, the political science professor said, voters in the district have “not been particularly friendly toward arguments for more government involvement in health care or anything else.”

And Democrats have to appeal to moderate Republicans and independent voters, as well as members of their own party, if they want to win an election in a GOP-dominated district.

“If the first thing out of the gate is, ‘I want single-payer health insurance,’ that’s likely to be a hard sell,” Karpowitz said. “It’s a bit of a minefield for a Democratic candidate.”

For Allen, a family physician for 30 years who recently sold her practice, her position on health care is the core of her campaign.

“I personally do feel that it’s an ethical and moral issue. I feel that everyone deserves health care,” she said, decrying what she called “the profit motive in medicine.”

Competition isn’t something that patients typically benefit from, she said.

“The free-market system has never worked in health care, and it doesn’t work for a variety of reasons,” Allen said. “You can’t plan when you’re going to be sick.”

Entitlement is another term she rejects when it comes to health care.

“When you see somebody who’s really a spoiled brat or a TV star that thinks the world owes them something, you say they’re entitled,” Allen said. “The way a lot of people use it is you don’t deserve it because it’s your fault you’re sick. It’s your fault that you’re poor. I don’t agree with that.”

A plan that would extend Medicare-style coverage to all Americans must be put together “slowly and thoughtfully,” she said, and that means higher taxes, at least for the wealthy.

Allen said she doesn’t like the term single payer because people see that as federally controlled, when she would like to see states given at least some control over the administration of a new system.

“Something like that would probably work a lot better in the United States, where we like to have states’ rights and have our states have a say over things,” Allen said, citing as a model some foreign countries with universal health care.

Not surprisingly, the Republicans running in the 3rd District do not back such a system of health care.

“I think it’s the opposite direction from where I want to go. I want more choice, competition and free-market forces in our health care system,” Ainge said, including a larger role for health savings accounts.

Herrod said “there will be very stark differences that come out in the general election” on health care. He also wants to see more reliance on health savings accounts, as well as catastrophic insurance plans.

Curtis warned that a “drastic change to single-payer health care takes us in the wrong direction” and called for Republicans “to slow down, be transparent and get to work on a free-market, patient-centered replacement” for Obamacare.

Allen said she currently has insurance purchased through former President Barack Obama’s signature health care system, and for her, a tax increase to cover a universal government plan would likely result in savings.

Trump has undermined the current health care system, she said.

“The one thing he’s ever said that I agree with is health care is complicated. It’s very complicated,” Allen said. “There’s not going to be any instant fix.”

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Pence calls on GOP to ‘step up to the plate’ on health care bill

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Health care follies in the Senate

A long time ago, in a galaxy not all that far away, the opposition party in Congress killed a White House-hatched health care plan. The president was Bill Clinton, although the complex blueprint was midwifed by first lady Hillary Rodham Clinton, as she liked to be called.

The Republican effort to put a stake through the heart of Hillarycare was aided by a $20 million insurance industry-sponsored ad campaign remembered as the “Harry and Louise” ads. A middle-aged couple pore over piles of government-mandated paperwork and lament the spiraling costs and diminishing options that come with the new bureaucratic requirements, before delivering their signature line: “There’s got to be a better way.”

Two-and-a-half decades later, Sen. Pat Roberts, a Kansas Republican, sought to divert attention from his own party’s troubled health care legislation by invoking another distraught woman named Louise.

“It’s a lot like being in the back seat of a convertible with Thelma and Louise,” Roberts said, referring to 1991 film starring Susan Sarandon and Geena Davis. It’s a grim reference, given that the title characters drive that convertible off a cliff to their deaths. Asked to elaborate, Roberts said, “I don’t want to drive the car off the cliff. I want to prevent the car that’s going off the cliff from going there, or if it has to go over the cliff with regards to what the Democrats want, then get out of the car.”

This murky metaphor put me in mind of another buddy movie, “Butch Cassidy and the Sundance Kid,” in which the protagonists also go out with guns blazing. The scene I’m thinking of is when Butch and Sundance are hired as mining company payroll guards in South America by a colorful U.S. expat named Percy Garris. “Morons!” Percy exclaims. “I’ve got morons on my team.”

That must be how Senate Majority Leader Mitch McConnell felt when Sen. Jerry Moran, Roberts’ Sunflower State sidekick, acted in concert with Utah Republican Sen. Mike Lee to undercut McConnell’s Obamacare alternative.

“We should not put our stamp of approval on bad policy,” Moran explained. Amen to that, but Jerry Moran was the first member of Congress who formally sought to repeal the Affordable Care Act. As his hometown paper noted matter-of-factly, Moran on Monday “became a major player in keeping the 7-year-old law alive.”

All week, political commentators across the ideological spectrum explained that the Republicans’ difficulties on health care underscored how much harder it is to govern than campaign. True, but it hardly suffices as an excuse. The Republican-controlled House voted to repeal Obamacare more than 50 times. Over in the Senate, the Republicans finally did it in December 2015, on a 52-47 vote, with both Lee and Moran voting with McConnell. They also shut the government down over Obamacare funding.

So, what’s the problem now, when a Republican president means that a vote to rescind Obamacare can’t be vetoed by its namesake — when repeal would actually mean repeal? For starters, Republicans lost two Senate seats in 2016, meaning that the GOP margin is thinner than before. Too thin, as it happens. Still, why can’t McConnell marshal the troops? Let’s examine the pockets of resistance and other hurdles:

The Donald Factor: President Trump has been all over the map, making it that much more difficult for GOP senators to take a hard vote. He’s variously endorsed repealing Obamacare without a replacement, repeal-and-replace, or just letting Obamacare fail on its own — all in just the past week.

The War Hero: Eighty-year-old John McCain, a former GOP presidential nominee and current Trump frenemy, was supporting McConnell’s repeal-and-replace legislation, but was suddenly hospitalized with brain cancer. His illness cast a pall over Washington and left Senate Republican leaders with only 51 votes.

The Mountaineers: In 2015 Shelley Moore Capito, the first female senator in West Virginia’s history, voted to repeal the ACA, but since then, the epidemic of heroin overdoses and other opiate-related deaths has devastated her state. Medicaid money is being used to fight this scourge, funding she fears will dry up under the GOP plans. “I did not come to Washington to hurt people,” she said. This issue also figures in the thinking of Alaska Sen. Lisa Murkowski, another wavering Republican.

The Cautious Caucus: Critics say some of these senators are hedging because the polling on Obamacare has shifted since the days when conservatives were blistering Democrats at town-hall meetings during the Obama years. Now it’s the other way around. Certainly, that criticism has been leveled at Jerry Moran.

The Independent: Officially, the U.S. Senate has two independents, Bernie Sanders of Vermont and Susan Collins’ Maine compadre, Angus King. Sanders doesn’t count — he’s to the left of the Democrats; on health care, King doesn’t count, either — he’s with the Dems. On the GOP side, that leaves Susan Collins. In 2015, she was one of two moderates (Mark Kirk of Illinois was the other) to vote against Obamacare repeal. Kirk is gone, but Collins isn’t. She still believes the best thing to do about Obamacare is fix what’s wrong with it. She doesn’t want to repeal the whole thing and vote for a plan she thinks will disadvantage rural residents of her state. On this issue, she may well be the most consistent and intellectually honest person on Capitol Hill. The problem for McConnell is that meeting her concerns takes him in the opposite direction of appeasing …

The Tea Party: Mike Lee doesn’t fit the media’s stereotype of a knuckle-dragging right-winger. He’s friendly, handsome, courteous — and smart as hell. He’s also very conservative. Republicans ran on defunding or repealing Obamacare, and Lee doesn’t see why keeping a promise he made to voters makes him a bad guy. “I’m not being an absolutist,” he said Thursday of his opposition to the current bill. “I’m a little frustrated by some who are eager and willing to call me out for saying this doesn’t go far enough in doing what we promised to do for seven years.”

Lee is a problem for McConnell, but not an unforeseen one: Lee came to Washington in 2010 after mounting a Tea Party-backed primary challenge to a veteran Republican incumbent who until then was considered plenty conservative.

The Libertarian: Rand Paul is another no vote on the Republican alternative to the ACA. This isn’t a surprise, either. Like Collins, the Kentucky senator doesn’t really have a party. Although closer on most issues to Republicans than Democrats, Paul is really a Libertarian. But in our bipolar political system, he must choose one or the other. Although he picked the GOP, when it comes to federal regulation, Paul makes Mike Lee look like FDR. He was never going to be an easy vote for anything other than straight repeal, and it’s almost impossible to construct health care legislation that he and Collins would both support.

The “morons” line in “Butch Cassidy” was uttered by talented character actor Strother Martin. The line he is best known for comes from “Cool Hand Luke,” and when it comes to senators such as Mike Lee and Rand Paul, it is probably more apropos.

“What we have here is failure to communicate,” Martin’s character said. “Some men you just can’t reach.”

Carl M. Cannon is executive editor and Washington Bureau chief of RealClearPolitics.

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Here’s a health-care fix that’s small but powerful

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A nurse listens to a client's chest at the Spanish Catholic Center agency of the Diocese of Washington Catholic Charities.

Comprehensive health-care reform is dead for now. But the problems facing the nation’s beleaguered health system live on.

Lawmakers must now come together to make bipartisan reforms on the margin to shore it up. They should start by addressing Medicaid, which isn’t working for doctors, patients, or taxpayers. Expanding charity care can help.

Medicaid was conceived to provide care for the poor and the disabled, but was expanded under the Affordable Care Act to cover able-bodied men and women earning above the poverty line. As a result, it now covers nearly one-quarter of all Americans.

This enrollment surge has blown a hole in state budgets and will only grow as the federal government shifts costs for new enrollees to the states. According to the Congressional Budget Office, which has consistently underestimated future Medicaid enrollment, Medicaid spending between 2014 and 2022 is projected be over three-quarters of the program’s total historical spending before 2014. This will further crowd out other state priorities such as schools, roads, and middle-class tax cuts.

“Small yet beneficial reforms are now the best hope to improve American health care.”

The program also isn’t working for doctors. The reimbursement rate is roughly half that of private insurance, according to research by the Kaiser Family Foundation. Participation requires reams of paperwork, approvals, and delays in reimbursements. Patients, as a result, increasingly cannot find a doctor to treat them. Over half of doctors no longer accept new Medicaid patients, according to the Department of Health and Human Services, and stories of patients trying dozens of times in vain to get an appointment are not uncommon.

Expanding charity care can relieve some of the Medicaid burden. Perhaps even more importantly, such an uncontroversial reform could achieve the bipartisan support necessary to become law.

Charity health care, where doctors volunteer a certain number of hours a week and donations cover variable costs, has a long history in the United States. There are currently over 1,200 charitable clinics nationwide, largely operating outside and parallel to the Medicaid system.

One major advantage of charity care is that doctors can have their medical insurance costs covered by the federal government under the Federal Tort Claims Act when working in a charity clinic that meets federal government requirements. This allows them to provide good care, but not excessive or defensive medicine, worried that their good deed may go punished.

Charity care could be expanded further if state governments, which have the most to gain from its implementation, cover the private practice liability insurance costs of any physician who volunteers a certain number of hours per week in a free clinic.

Such a trade would be a bargain for both doctors and state governments. The average primary doctors would save roughly $12,000 in annual malpractice insurance premium costs. Specialists would save even more. In return, by keeping Medicaid, uninsured, and undocumented patients out of expensive and overburdened emergency rooms, the state would save hundreds of thousands of dollars per doctor. As an added bonus, defensible and costly malpractice lawsuits would likely be reduced because of the bigger burden associated with suing the government instead of the individual physician.

Dr. Alieta Eck, who runs the Zarephath Health Center, a charity clinic in Somerset, New Jersey, shows how this model can work in practice. By relying on donated physician time and cutting out the burdensome Medicaid bureaucracy, the cost to provide care comes to $15 per patient visit (covered by donations). This is compared to the roughly $1,000 it would ultimately cost the taxpayer if the patient ended up at the ER.

She’s spearheaded a New Jersey bill, S239, that calls on the state to provide liability coverage for the private practices of physicians who donate at least four hours per week in a charity clinic. Similar proposals are alive in several states across the country.

While trial lawyers may object, opposing charity care expansion is a dim prospect for even the most hardened partisan legislator. Such small yet beneficial reforms are now the best hope to improve American health care.

Commentary by Joel L. Strom a Beverly Hills dentist and a fellow at the Unruh Institute of Politics at the University of Southern California.

For more insight from CNBC contributors, follow @CNBCopinion on Twitter.

Senate Parliamentarian Challenges Key Provisions of Health Bill

And Democrats made clear they would seize on the findings. “The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off of health insurance is a disaster,” said Senator Bernie Sanders, independent of Vermont.

Mr. Sanders, the ranking member of the Senate Budget Committee, disclosed the preliminary decisions by the parliamentarian.

The waiting period provision is fundamental to the working of the bill. Because the legislation would end the Affordable Care Act’s mandate that most Americans have health insurance, the waiting period was designed to ensure that people could not simply wait to get sick before they purchased a policy.

Senate Republican leaders plan to begin debate next week on repealing the Affordable Care Act, President Barack Obama’s signature domestic achievement, which has provided health insurance to roughly 20 million Americans.

At the moment, Republican leaders lack the votes to ensure passage of their bill to repeal and replace the law, and they are still modifying it in hopes of gaining support from uncommitted Republican senators. All Democrats are expected to oppose the repeal bill.

Under the procedure that Republicans are using to speed passage of the health care bill, senators can object to a provision if it does not change federal spending or revenue or if the budgetary effects are “merely incidental” to some policy objective. The parliamentarian serves as a sort of referee, determining whether specific provisions of the bill comply with Senate rules.

Don Stewart, a spokesman for the Senate majority leader, Mitch McConnell, Republican of Kentucky, emphasized that “this is guidance, not a ruling.” The parliamentarian “provided guidance,” and that guidance will help inform subsequent drafts of the legislation, he said, suggesting that the bill could be revised to answer her questions.


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The Senate’s presiding officer usually follows advice from the parliamentarian. But the full Senate can vote to overturn those decisions.

The parliamentarian also objected to a narrowly written provision that would shift Medicaid costs from New York’s counties to its state government. This provision, tagged by opponents as the “Buffalo Bailout,” was included in a repeal bill passed by the House in May to secure the votes of Republican House members from upstate New York.

The Senate Democratic leader, Chuck Schumer of New York, suggested that other provisions written specifically for different states could also be at risk.


“I have said all along that we need to both repeal and replace Obamacare, and I’m not giving up on that goal,” Senator Shelley Moore Capito of West Virginia said in a video message on Friday.

Doug Mills/The New York Times

“This will greatly tie the majority leader’s hands as he tries to win over reluctant Republicans with state-specific provisions,” Mr. Schumer said. “We will challenge every one of them.”

Even before the parliamentarian’s blow, Trump administration officials and Republican leaders were struggling to win over moderate Republicans with a new infusion of money to help people who would lose Medicaid under the Senate health care bill.

Senators are set to return to the Capitol on Monday, and Republican leaders are eager to begin debate in the Senate on health care, perhaps as early as Tuesday. It is unclear they have the votes needed to start the debate, let alone to ensure passage of a bill to repeal and replace the health care law.

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In their latest bid for agreement on a plan to undo the health care law, Senate Republicans are weighing a proposal to add funds, perhaps $200 billion, to the bill to help low-income people transition from Medicaid to private insurance. But Republican leaders must balance the interests of senators from states that expanded Medicaid under the Affordable Care Act with the goals of fiscal conservatives, who see the repeal bill as a once-in-a-generation opportunity to rein in the growth of one of the nation’s largest entitlement programs.

“You can only go so far, and then you lose votes on one side where we want to make reforms within Medicaid,” Senator Michael Rounds, Republican of South Dakota, said after a lengthy meeting this week with administration officials and other Republican senators. “And if you don’t go far enough, then you’ve got folks that are concerned that we’re making the changes too quick. So it’s that balancing act of trying to keep everybody on board and feeling comfortable.”

The Congressional Budget Office says the Senate repeal bill would cut projected federal Medicaid spending by more than $750 billion in the coming decade, leaving 15 million fewer people on Medicaid in 2026, compared with the enrollment expected under current law.


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Those cuts have caused deep concern to Republican senators from states that expanded Medicaid under the Affordable Care Act, including Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska.

“I would like to do more to help people at the low end of the income scale afford private health insurance,” Mr. Portman said, noting that more than 700,000 people in his state had gained coverage through the expansion of Medicaid under the Affordable Care Act.

Ms. Capito, in a video message on Friday, said that many of her constituents had been hurt by the Affordable Care Act, but that “many West Virginians have benefited from our state’s decision to expand Medicaid” under the health law.

“I have said all along that we need to both repeal and replace Obamacare, and I’m not giving up on that goal,” she said. But, she added, “We aren’t there yet.”

Opponents of repeal, including consumer advocates and health care providers in every state, are keeping up the pressure on Republican senators.

AARP called on senators to vote against the procedural motion to begin debate, while the American Medical Association panned the repeal measure and an alternate Senate bill that would repeal the health law without providing a replacement.

“Recent revisions do not correct core elements that will lead to millions of Americans losing health insurance coverage with a resulting decline in both health status and outcomes,” Dr. James L. Madara, the association’s chief executive, wrote to Senate leaders on Friday. The Senate legislation, he said, would undermine state Medicaid programs and weaken the individual insurance market.

Save My Care, a group that is fighting the repeal effort, is targeting Ms. Capito, Ms. Murkowski and Senator Dean Heller, Republican of Nevada, with new television commercials urging them to vote against repealing the health law.


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“Senator Capito promised to protect our health care,” one of the ads says. “Now Washington insiders are pressuring her to back down.”

On the flip side, Republican senators risk angering conservative supporters — as well as President Trump — if they stand in the way of the repeal effort, perhaps by opposing the procedural motion to begin debate that is planned for next week.

“I don’t know how you face the people who elected you when you don’t even vote to take up the bill,” Senator Ted Cruz, Republican of Texas, said on Fox News.

Continue reading the main story

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Sen. Mike Lee spends past week in eye of health care storm

SALT LAKE CITY — Sen. Mike Lee’s stand against Senate Republicans’ health care bill landed him in the spotlight for much of the past week.

Utah’s junior senator explained his position to various media outlets amid criticism from President Donald Trump, Sen. Orrin Hatch, R-Utah, and others over his holdout on the latest proposal. Some in the GOP establishment tagged him with being the Republican who stopped the Obamacare repeal.

“He was the key man this past week,” said Chris Karpowitz, co-director of BYU’s Center for the Study of Elections and Democracy.

Trump expressed dismay about several conservative senators — Lee among them — opposing the last version of the health care proposal. Hatch jumped on board, saying the Senate “blinked” and those senators would have to explain themselves to folks back home why they didn’t repeal Obamacare when they had the chance.

“I’m not being an absolutist,” Lee said in a Politico article, adding that he didn’t need 100 percent of the law to be repealed. “I’m a little frustrated by some who are eager and willing to call me out for saying this doesn’t go far enough in doing what we promised to do for seven years.”

Lee even mixed it up with Hatch in a testy exchange in the article.

“I don’t see him looking for a path to yes. It seems like he’s against everything right now,” Hatch said. “That’s the way it looks to me.”

Lee bristled at Hatch’s comments.

“I am stunned by that suggestion,” Lee told Politico. “I am surprised that he would purport to know what my thoughts and intents were, what I was thinking or intending. He could not be more wrong.”

Hatch and Lee have taken decidedly different approaches to health care reform and to the Trump presidency in general. But to have it play out publicly is “quite striking and quite unusual,” Karpowitz said.

It’s hard to give much credit to those saying Lee somehow favors Obamacare when he was an ardent opponent from the beginning, Karpowitz said. Lee, he said, is in a difficult spot when it comes to sticking to his conservative principles and getting to yes on a health care bill.

“He’s not a wheeler-dealer. He’s not someone who is deeply engaged in horse trading over votes,” Karpowitz said. “Instead, he tries to move forward without betraying those core principles he holds dearly.”

Lee told Fox News he could vote for the bill if it included his Consumer Freedom Amendment allowing insurance companies to sell any health coverage plan they want as long as they provide a plan that satisfies Obamacare mandates.

It’s time to offer people the chance to connect with willing insurers to buy the policy that’s right for them, he said.

“All things being equal, if they could get that, I could get to yes. Now, I speak only for myself. I control only my vote. But what I’m saying is, all things being equal, if they added that with those protections, the protections of the dual pool, the fully loaded Consumer Freedom Amendment, I could get to yes,” Lee said.

Karpowitz said trying to deregulate insurance markets in a way that will bring premiums down is complex. And when moderate Republicans are coming from a different perspective than Lee, it’s hard to find the sweet spot that gets everyone on board, he said.

On Wednesday, Trump hammered senators who opposed the health care bill and demanded the Senate pass legislation before recessing in August.

“Any senator who votes against starting debate is really telling America that you’re fine with Obamacare,” Trump said.

Earlier in the week, the president said the best option was to let Obamacare fail.

White House leadership on the issue has been inconsistent at best, Karpowitz said. Trump, he said, hasn’t shown a clear understanding of the policy choices, nor has he articulated guiding principles, and that sometimes leaves individual senators exposed.

“He seems to want to win more than he cares about the substance of the bill,” Karpowitz said.

Agree or disagree with him, Lee’s approach isn’t about winning but how to get the things he believes into the legislation, Karpowitz said.

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Health research dollars don’t just save lives, they create jobs

American investment in global health research actually helps the US economy and creates jobs, returning $33 billion to the American economy and generating 200,000 jobs from 2007 to 2015, according to a new report from the Global Health Technologies Coalition. The report comes as President Donald Trump has proposed a budget that would cut $2.2 billion in global health spending.

From 2007 to 2015, the government invested nearly $14 billion in research and development for global health. This money was crucial to developing over 40 new drugs for diseases like AIDS, malaria, and tuberculosis. Trump’s new budget is unlikely to be fully implemented, but if his suggestions do go into effect, at least a million people will die of AIDS as a result of the lost funding.

Global health research investment has been stagnant or falling since 2009, excluding the billions in emergency funding set aside during the Ebola outbreak. Global health research spending from the US government usually goes to agencies such as the National Institutes of Health and the Centers for Disease Control and Prevention, as well as more indirectly to universities doing research.

President Trump’s proposed 2018 budget includes deep cuts to both the NIH and CDC, which are key agencies that work on global health. Trump ran on an “America first” platform and prioritizes the economy and boosting American jobs over helping out abroad. But according to the report, 89 cents of every dollar invested in global health research in 2015 was invested within the US. This is an increase from 2012, when 64 cents of every dollar invested in global health research was invested domestically. Today’s finding suggests that the Trump administration — which campaigned on creating jobs, not destroying them — could bolster the American economy by simply investing in American research.

“Congress deliberating over funding for USAID and NIH and CDC, so this is just illustrating that all even relatively small amounts can produce so much,” says GHTC Director Jamie Bay Nishi. “Often with global health, the perception is that money is going overseas or into a black hole, and now we have some real data about how this does support the US.”

Nishi says it’s hard to give a total number of lives saved by the funding, but says one of the biggest successes is Coartem Dispersible, a malaria drug designed especially for children that has saved about 750,000 lives so far. Similarly, a 50-cent vaccine called MenAfriVac has already prevented about 378,000 deaths from meningitis, which is a dangerous swelling of the brain and spinal cord. It’s now on track to save $9 billion in treatment costs by 2020. This last part is key because investing money now can save millions later, as in the case of Ebola. The government spent about $3 billion during the outbreak, but could have spent much less if they’ve invested more earlier to help develop a vaccine, says Nishi.

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These Americans Hated the Health Law. Until the Idea of Repeal Sank In.

“I can’t even remember why I opposed it,” said Patrick Murphy, who owns Bagel Barrel, on a quaint and bustling street near Mr. Brahin’s law office here in Doylestown.


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He thought Democrats “jammed it down our throats,” and like Mr. Brahin, he worried about the growing deficit. But, he said, he has provided insurance for his own dozen or so employees since 1993.

“Everybody needs some sort of health insurance,” Mr. Murphy said. “They’re trying to repeal Obamacare but they don’t have anything in place.”

Five years ago, people here could barely turn on their televisions without seeing negative ads warning that the Affordable Care Act would lead to rationed care and bloated bureaucracy. The law’s supporters, meanwhile, including the president whose name is attached to it, were not making much of a case.

To win support, Democrats were emphasizing that little would change for people who already had coverage; President Barack Obama famously promised that you could keep your plan and your doctor, even as a few million people’s noncompliant plans that did not offer all the law’s required benefits were canceled as the law was rolled out.

“The best way to get something passed was to argue it was small change,” said Stanley Greenberg, a veteran Democratic pollster. “It was only when Republicans got control that people then on their own discovered that this is what the benefits are.”


Patrick Murphy, 50, owner of Bagel Barrel, in Doylestown on Thursday. “I can’t even remember why I opposed” the Affordable Care Act, he said.

Jessica Kourkounis for The New York Times

Jennifer Bell, sitting outside Mr. Murphy’s bagel shop with a friend, was raised a Democrat and always supported the health care law. But it was only after she was injured in a serious car accident in 2013 that she thought to advocate for it. She used to get health insurance through her job as a teacher. Now disabled with extensive neurological damage, and working part-time in a record store, she qualifies for Medicaid, and without it, she said, could not afford her ongoing treatment.

“It’s very, very scary to think about not having health insurance,” she said.

“If the condition doesn’t kill you, the stress of having it does, in this country,” she added. “The fact that people do without health insurance is a sin, in my opinion.”

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Ms. Bell, 35, joined about 2,000 others for a women’s march in Doylestown after the inauguration, and now makes calls to Representative Brian Fitzpatrick and Senator Patrick J. Toomey, both Republicans, urging them to protect the Affordable Care Act. She is working to elect a Democrat challenging Mr. Fitzpatrick, who voted against the House bill to replace the law, saying he worried about people losing coverage.


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More vigorous support among the law’s natural constituents since Mr. Trump’s election has helped lift public opinion. The Kaiser Family Foundation polls tracking monthly support for the law have shown the greatest gains among Democrats and independents, with an increase of 10 to 12 points among each group over the last year, while Republicans’ opinion has remained as unfavorable as ever.

“When something is threatened to be taken away, people start to rally around it,” said Liz Hamel, the director of public opinion and survey research for Kaiser, a nonpartisan group.

There has been an increase in the percentage of Republicans and Democrats saying that Medicaid is important for them and their families; between February and July the percentage of Republicans saying so had increased 10 points, to 53 percent.


Obamacare Included Republican Ideas, but the G.O.P. Health Plan Has Left Democrats Out

How much input did the opposing party have in shaping the Affordable Care Act versus the Republican health care plan?

The law still faces hurdles even beyond the debate in Congress. Five years ago, Cindy McMahon, who works at the store on the vegetable farm her family has owned for nearly a century, was not intending to buy health insurance, despite the law’s requirement that people have it or pay a tax penalty. She remains uninsured (and the Trump administration has suggested it may not enforce the penalty).

“If I had to pay a penalty, it’s still less than I have to pay for having health care all year,” Ms. McMahon said. At 52, she has diabetes and says the strips to test her blood sugar are so expensive that sometimes she tests once a month rather than daily. She has not looked into whether she might qualify for the Medicaid expansion; she was not aware Pennsylvania had expanded the program.

Frank Newport, the editor in chief of Gallup, said that the area of biggest agreement in polls is that Americans want the law changed. In the most recent poll, 44 percent of Americans said Congress should keep the law but make “significant changes.” That compares with 23 percent who want to keep it as it is, and 30 percent who support the Republicans’ plan to repeal and replace it.

Mr. Greenberg said the growing belief that the government should make sure people have health coverage was less an outbreak of compassion than a matter of affordability. In focus groups he conducted, Trump voters said they wanted the president and Congress to lower their health insurance premiums; they did not want to lose the Affordable Care Act’s protections against insurers charging more to people with pre-existing conditions, or denying coverage of basic health benefits.

Mark Goracy, an insurance consultant in Langhorne, near Doylestown, calls the coverage he and his wife get through the individual market “a joke.” Their premium is $1,415 a month, with combined deductibles of more than $12,000.


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Still, Mr. Goracy, 62, said he nonetheless wants the law’s mandate blocking insurers from charging people more because of pre-existing conditions to survive.

While he once wished for “root-and-branch” repeal of the Affordable Care Act, he is not disappointed about the Republican failure to repeal it.

“Unlike when Democrats passed A.C.A. with not one Republican vote, what the Republicans need to do is get together with 20 or 25 Democrats and pass some kind of reform,” he said. “That, to me, is how legislation is supposed to proceed.”

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