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GOP health law repeal thwarted, but ‘Trumpcare’ already under way

  • Janella Williams watches television for news on the healthcare vote while receiving treatment at Lawrence Memorial Hospital in Lawrence, Kan., Friday, March 24, 2017. The 45-year-old graphic designer receives medication from an intravenous drip for a neurological disorder, getting the drugs that she says allow her to walk. Under her Affordable Care Act plan, she pays $480 a month for coverage and has an out-of-pocket maximum of $3,500 a year. If she were to lose it, she wouldnít be able to afford the $13,000-a-year out-of-pocket maximum under her husbandís insurance. Her treatments cost about $90,000 every seven weeks. (AP Photo/Orlin Wagner) Photo: Orlin Wagner, Associated Press



Janella Williams watches television for news on the healthcare vote while receiving treatment at Lawrence Memorial Hospital in Lawrence, Kan., Friday, March 24, 2017. The 45-year-old graphic designer receives medication from an intravenous drip for a neurological disorder, getting the drugs that she says allow her to walk. Under her Affordable Care Act plan, she pays $480 a month for coverage and has an out-of-pocket maximum of $3,500 a year. If she were to lose it, she wouldnít be able to afford the $13,000-a-year out-of-pocket maximum under her husbandís insurance. Her treatments cost about $90,000 every seven weeks. (AP Photo/Orlin Wagner) less

Photo: Orlin Wagner, Associated Press

House Republicans’ failure to advance legislation to replace the Affordable Care Act means that President Barack Obama’s health care law — which has led to millions more Americans receiving health insurance — lives another day.

But the status quo could be short-lived, as the Trump administration has signaled that it is willing to loosen regulations enacted by the Affordable Care Act.

Health experts say too much change could undermine the delicate balancing act of the law, which sought to broaden coverage to people who would not otherwise buy insurance.

President Trump signed an executive order his first day in office pledging to ease the “regulatory burden” of enforcing the law, which it also believes has failed to contain health care costs. And some changes are already under way.

Most notably, the Internal Revenue Service has relaxed its enforcement of the requirement to buy insurance, known as the individual mandate. Republicans largely oppose the requirement as onerous, but Democrats view it as a vital to the law’s effectiveness, because it means people who are healthy — not just those who are sick — must buy insurance. That spreads the risk of incurring high health costs across more people.

Another change came in late January, during the final days of open enrollment, when the U.S. Department of Health and Human Services pulled $5 million in advertising that was meant to remind consumers to sign up for plans on the insurance exchanges, or marketplaces, before open enrollment ended. The administration said it did not want to put additional money toward a health care policy that was already failing. It may have led to fewer people signing up for the exchanges that the Affordable Care Act had established.

“We’re already living with Trumpcare because the administration has and is making substantial changes to the enforcement of the law,” said Micah Weinberg, president of the Bay Area Council Economic Institute, a think tank. “That will have far-reaching ramifications in spite of health care reform being put on hold indefinitely” in Congress.

Immediately after House Speaker Paul Ryan’s announcement to withdraw the legislation, Trump reiterated his long-held assertion that the Affordable Care Act is unraveling and will eventually “explode.” Democrats, who opposed the House legislation, will own the resulting problem, he said.

The failure to pass legislation to replace the Affordable Care Act may not quell the uncertainty felt by insurance companies, many of which are debating whether to continue selling plans on the exchanges after 2017.

“Although the AHCA is off the table for now, we are currently unable to make an informed decision about whether to participate in 2018 in the individual marketplace without additional clarity on a couple of key issues,” said Dr. Mario Molina, CEO of Molina Health.

Larry Levitt, a senior vice president at the Kaiser Family Foundation said: “Insurers still face a lot of uncertainty, it’s just a different uncertainty now.”

Covered California, the insurance exchange where millions of Californians buy health coverage, is relatively stable: Eleven insurers, more than in most states, offer coverage. Five states have only one insurer on the exchange, leaving consumers with limited options for plans and pricing. But California too has been affected by uncertainty and a rocky rollout of the Affordable Care Act. Last year, United Healthcare, one of the nation’s biggest insurers, withdrew from exchanges nationally, including California, citing high health costs.

Of particular concern to insurers is the fate of what’s called “cost-sharing subsidies,” which are now in the hands of the Trump administration.

These subsidies were created under the ACA to help poorer Americans pay for high deductibles and some prescription costs. They are separate from the subsidies the federal government provides consumers to help pay for insurance premiums. Currently, about $7 billion in cost-sharing subsidies go to 7 million people, including 800,000 in California.

The House has sought for years to end these subsidies. In 2014, the body sued the Obama administration, arguing that the Department of Health and Human Services did not have the authority to implement them. A federal judge ruled in the House’s favor, but the Obama administration appealed the decision. After Trump took office in January, his administration asked the appeals court to hold off on the case while the legislative effort to repeal the Affordable Care Act was under way. The failed House legislation had attempted to eliminate the subsidies. Now the department could simply drop the legal appeal, which would end the subsidies — just one of the ways the Trump administration could impact the law.

“The ACA is here to stay,” Levitt said. “The Trump administration really does face a choice ahead about whether to make the law work or undermine it.”

Catherine Ho is a San Francisco Chronicle staff writer. Email: Twitter: @Cat_Ho

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Essential Health Benefits and why they matter

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Trump the Dealmaker Projects Bravado, but Behind the Scenes, Faces Rare Self-Doubt

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Trump Tells GOP It’s Now or Never, Demanding House Vote on Health Bill

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Drinkers who have vodka Red Bulls at high risk of injury | Daily Mail …

  • A review of 13 medical reports reveals high rate of injury in people who mix alcohol with highly-caffeinated drinks like vodka Red Bull
  • The researchers put it down to an excess of energy, compared to other drunks 

Mia De Graaf For



For years, doctors have warned against the popular trend of mixing alcohol with highly-caffeinated energy drinks like Red Bull, since it sends your heart rate pumping dangerously fast.

But now, there may be a new reason for concern. 

Researchers in Canada have found a high rate of injuries among people who drink vodka with Red Bull or something similar.

They believe the increased risk of injury boils down to the person’s excessive energy, which drives them to be reckless.   

A review of 13 medical reports reveals high rate of injury in people who mix alcohol with highly-caffeinated drinks like vodka Red Bull

A review of 13 medical reports reveals high rate of injury in people who mix alcohol with highly-caffeinated drinks like vodka Red Bull

To investigate, researchers at the University of Victoria’s Centre for Addictions Research of British Columbia analyzed 13 peer-reviewed studies published between 1981 and 2016.

Ten of those studies found a link between the use of alcohol mixed with energy drinks and an increased risk of injury, compared to just drinking alcohol.

The injuries ranged from unintentional falls or motor vehicle accidents, to intentional fights and outbursts.

‘The stimulant effects of caffeine mask the result that most people get when they drink,’ says lead study author Audra Roemer.

‘Usually when you’re drinking alcohol, you get tired and yo u go home. Energy drinks mask that, so people may underestimate how intoxicated they are, end up staying out later, consume more alcohol, and engage in risky behavior and more hazardous drinking practices.’ 

Roemer explained that she starting investigating this particular cocktail after researching how cocaine affects injury rates. 

‘Cocaine is obviously a strong stimulant, and I was curious about lower level stimulants that are more socially acceptable,’ she says. ‘I wondered if they were having a similar impact but to a lesser degree.’ 

There was a wide variability in the studies that made it difficult to compare results. 

Consequently, the researchers were not able to statistically determine the exact risk associated with drinking vodka Red Bull.

‘At the end of the day, we looked at all of the studies, but more research is need to confirm our findings,’ says Roemer.

Roemer says the current study is the first of three planned articles that they hope to publish on the link between caffeinated alcohol drinks and the risk of injury.

‘We’re currently running a controlled emergency department study to look at the relationship a little more closely,’ she says. 

‘Hopefully that will bring more answers. The research we’ve done so far points to an increased risk of injuries with the use of these drinks that could be a serious public health concern.

‘Our hope is to conduct and facilitate future research in order to identify limitations and get a closer look at the topic to see what’s really going on.’

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Trump Warns House Republicans: Repeal Health Law or Lose Your Seats

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Trumpcare’s Medicaid Work Requirements Add To Health Costs, Insurers Say

A work requirement for Medicaid recipients would add to health plan administrative costs and therefore hit taxpayers, say health insurers that administer benefits for millions of poor Americans.

Medicaid Health Plans of America (MHPA), which represents insurers like Aetna, Centene, Cigna and UnitedHealth Group, came out in opposition Wednesday to the Republican-led American Health Care Act. In a letter to leaders in the House of Representatives, MHPA took issue with everything from block grants to the quick rollback of Medicaid benefits that would “create unmanageable problems for the most disadvantaged Americans and the plans that provide access to their care.”

President Donald Trump (L) and HHS Secretary Tom Price leave a Republican closed party conference March 21, 2017 in Washington, DC. where Trump urged House Republicans to support his American Health Care Act. (Photo by Mark Wilson/Getty Images)

A vote on the AHCA is expected Thursday in the U.S. House of Representatives following a week of intense lobbying by President Donald Trump and Republican leaders who made changes to win over conservative House members that would allow states to impose work requirements on certain Medicaid recipients.

But health plans say a work requirement would add to administrative costs and take away from patient care.

“Work requirements in Medicaid aren’t wrong in principle, but we have concerns because it becomes our health plans’ responsibility to ensure they’re working, which is an administrative burden,” Jeff Myers , president and CEO of Medicaid Health Plans of America, said in a statement accompanying a letter opposing the GOP House legislation. “Plans would rather spend their time and resources actually caring for their members.”

Most Americans on Medicaid want to work or are working. “Only 13 percent of adults covered by Medicaid’s expansion are able-bodied and not working, in school, or seeking work,” Health Affairs blog said earlier this month, citing the 2015 National Health Interview Survey in its report.

Health plans say it’s common for poor Americans to work periodically so kicking them off when they lose a job could potentially lead to poor health outcomes. And that, in turn, can lead to higher costs when medical care is not coordinated.

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Trump Talks Changes to Health Bill to Win Over Conservatives

The White House is talking with House conservatives about last-minute changes to the embattled GOP health-care bill aimed at wooing enough holdouts to secure House passage.

Lawmakers and Trump administration officials are discussing revisions to “essential benefits” requirements in Obamacare, according to members of Congress and a White House official familiar with the discussions. The negotiations dragged late into Wednesday night, and Republicans postponed until Thursday a key procedural step before the bill gets to the floor.

Holdouts in the House Freedom Caucus also pushed for changes in Obamacare’s requirements that insurers cover people with pre-existing conditions, but the White House gave them a hard no, according to a White House official.

QuickTake Why It’s GOP Versus GOP on Obamacare Replacement

UBS Wealth Management’s Geoffrey Yu discusses the impact of U.S. healthcare legislation on the markets.

Mark Meadows of North Carolina, who chairs the House Freedom Caucus, disputed that. “Addressing pre-existing conditions has always been a requirement for any replacement plan that HFC would support,” he said late Wednesday.

Meadows said that there was no deal yet with the White House, and that it was too early to tell if one would be reached Thursday. Members of the Freedom Caucus are scheduled to go to the White House Thursday morning, the same day the House is scheduled to vote on the measure. But House Republicans leaders delayed a conference meeting scheduled for Thursday morning.

“We know the areas that have to be addressed and are still working to find consensus,” Meadows said Thursday morning in an email. “We do not have a deal, but remain optimistic that all parties are working in good faith for the benefit of the people we serve. It would be premature to suggest that there are enough votes to get it passed in the House.”

Last Procedural Step

The House Rules Committee, which will make final changes to the bill before it gets a floor vote, postponed a session that lasted for more than 12 hours on Wednesday as the talks with the conservatives dragged on. The committee plans to reconvene Thursday, finalize changes to the bill and set the rules for how it will be debated in the full House.

President Donald Trump and House Speaker Paul Ryan have been working to win over conservative rebels who stand in the way of their Obamacare replacement measure. Early Thursday, Meadows said there are signs of movement.

Mark Meadows

Losing Moderates?

Yet as Trump and Ryan pick up conservative members with some of the potential changes, they risk losing moderates. Republican Representative Charlie Dent of Pennsylvania, leader of the moderate Tuesday Group in the House, reiterated Thursday morning that he would oppose the bill.

“I just feel this bill misses the mark,” Dent told MSNBC in an interview. Dent issued a statement Wednesday saying he believes the bill “will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”

Meadows and other conservative Freedom Caucus members have been demanding changes to the “essential benefits” portion of the Affordable Care Act, which requires insurers to cover 10 categories of services. Those services include hospitalization, ambulance services, maternity care, pediatric services, mental health and substance abuse treatment, prescription drugs, rehabilitative care and laboratory services.

The goal of limiting the required essential health benefits would be to bring down health insurance premiums. Freedom Caucus founder Representative Jim Jordan, the Ohio Republican, told Fox News Thursday that members haven’t been shown any amendments or agreements in writing yet. “We want to see the language first” and make sure “it does what needs to be done.”

Senate Rules

It’s unclear whether changes to these requirements could survive procedural challenges in the Senate.

“What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” Matt House, a spokesman for Senate Democratic leader Chuck Schumer, said in a statement late Wednesday. “It will require 60 votes to repeal these protections, and the votes just aren’t there in the Senate.”

Earlier Wednesday, Alyssa Farah, a spokeswoman for the Freedom Caucus, wrote on Twitter that more than 25 members of the group remain opposed — enough to defeat the bill — and that GOP leaders should “start over.”

Trump met with nearly a dozen Republican lawmakers Wednesday morning who still have concerns about the legislation. Separately, about 26 Republicans met with senior White House officials, including Vice President Mike Pence.

‘To the Closer’

“We’re bringing them to the closer,” Representative Patrick McHenry, a senior member of the House GOP vote-counting team, told reporters at the White House, referring to Trump.

White House Press Secretary Sean Spicer noted that at least two lawmakers who had expressed reservations as recently as Tuesday are now backing the bill.

“I think the trajectory is going very well for us,” he told reporters. “This is the only way that we will repeal and replace Obamacare.”

But the Freedom Caucus has said that the current bill is not a complete enough repeal of the health-care law. The floor vote scheduled for Thursday could be the first sign of whether the caucus will be able to enforce its conservative principles in the age of Trump.

“How can you talk about repealing the ACA, Obamacare, without repealing the essential benefits and the guaranteed issue?” Representative Scott Perry of Pennsylvania said, referring to the required benefit packages under the Affordable Care Act and the law’s preexisting condition rules.

Freedom Caucus members said White House officials made the pitch that conservatives should pass the bill so that the Senate can amend it and address their concerns, but several lawmakers said they weren’t buying it.

“Pence made a play for more support for the bill based on the Senate being able to change it,” Representative Randy Weber said in an interview, adding that he’s still a no. “That’s a hard row to hoe.”

“Because we’d like for it to be as strong as possible going over to the Senate,” he added.

Do It Now

Weber said many Republicans were elected to Congress because of Obamacare, and said they can’t wait years for costs to come down. “In 10 years none of us will be here,” he said. “Probably at this rate, in two years none of us will be here.”

If the Freedom Caucus is unable to win major changes — or block the measure — it could mark a double victory for Ryan by diminishing the influence of a group that led the ouster of his predecessor, John Boehner.

Indeed, a Republican aide said that House leaders see the prospect of damaging the clout of the Freedom Caucus as a satisfying byproduct of passing the health-care measure.

Last Holdouts

So far, about a dozen members of the Freedom Caucus have come around to embrace the bill. The group claims to have roughly 40 members, but doesn’t publish an official roster.

Whether any of the Freedom Caucus’s remaining holdouts will drop their opposition to the health-care measure before Thursday’s vote will determine the outcome. Those holdouts are being cheered on by several Senate conservatives, including Rand Paul of Kentucky and Mike Lee of Utah.

Meadows was singled out as a holdout by Trump during a closed-door meeting with House Republicans Tuesday morning. 

Representative Richard Hudson, a Republican from North Carolina, said the Freedom Caucus will damage itself if it ends up blocking the measure, though he predicts most members eventually will come on board.

“How can they go back and face their constituents if they’re the reason we didn’t get the most significant entitlement reform in a generation, if they’re the reason we didn’t keep our promise of repealing Obamacare,” Hudson said. “It defies me to understand where they’re coming from.”

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‘Hypnosis put me off heavy drinking for good’: Former UB40 singer Ali Campbell answers our health quiz


Yes. I’m on the road a lot doing two-hour shows so I’m active. I’ve got a stationary bike that I do 20km on several times a week. 

I’m a couch potato by nature and I love watching telly, so at least if I’m on my bike at the same time I don’t feel so guilty.

Ali Campbell, pictured at The Pride of Birmingham Awards in 2014. He says he is a couch potato by nature and loves watching telly, but keeps fit on his exercise bike

Ali Campbell, pictured at The Pride of Birmingham Awards in 2014. He says he is a couch potato by nature and loves watching telly, but keeps fit on his exercise bike


I do try. I’ve had type 2 diabetes for a few years, so eating healthily is important. 

I was quite heavily into juicing, having a couple of pints of something like carrot, apple and ginger a day, thinking I was being super-healthy. 

But I was having so much fruit sugar that it made my diabetes worse, so I scaled it back.


Chocolate, especially Maltesers.


I’ve always worried about my weight, partly because I used to be a heavy drinker. 

I was hypnotised 15 years ago and had aversion therapy, where I had to visualise a giant ten-pint glass getting more and more disgusting. 

I haven’t drunk clear beer since, but I still have the occasional Guinness. I’m 5ft 8in and about 14½ stone.

UB40 performing in Switzerland, 1984, with Ali (right) on guitar and Robin Campbell on drums

UB40 performing in Switzerland, 1984, with Ali (right) on guitar and Robin Campbell on drums


Type 2 diabetes. My mum’s got it too.


My diabetes, because I’ve never had any symptoms (it was diagnosed by a random blood test), and I’m never really sure if I’m managing it right.


On my 17th birthday I got caught in the middle of a fight and was hit with a glass — I had 90 stitches on the left side of my face. 

I used my criminal injuries compensation to start UB40.

The singer is still on the road a lot, and says his two-hour shows keep him active. 'My only fear is going on stage and everyone ignoring me,' he says.

The singer is still on the road a lot, and says his two-hour shows keep him active. ‘My only fear is going on stage and everyone ignoring me,’ he says.


At the moment, I’m drinking fresh or powdered turmeric in hot water every morning. A friend in California swears by it. 

I’ve also heard it can help type 2 diabetes by reducing blood sugar levels.


No. I don’t want to look the same as everyone else.


I’m pretty positive but I used to get SAD (Seasonal Affective Disorder). 

Even as a child, I’d get very depressed because of the dark winters and horrid yellow lighting inside. 

Ali (middle), pictured with band members Mickey Virtue (left) and Astro (right) atttending the iHeart80s party in California this year

Ali (middle), pictured with band members Mickey Virtue (left) and Astro (right) atttending the iHeart80s party in California this year

It’s part of the reason I moved to Jamaica for 17 years in the Eighties. It made a huge difference. 

I live in Christchurch, Dorset, by the sea now. I still get SAD but it’s nowhere near as bad as it was.


Nothing, I sleep like a brick.


My only fear is going on stage and everyone ignoring me.


God, no.

UB40 featuring Ali Campbell, Astro and Mickey have a new album, Unplugged + Greatest Hits, out now on Universal, price £9.99. 


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Trump tells Louisville rally GOP health bill is chance to end ‘ObamaCare catastrophe’

President Trump again went outside Washington to whip up support for House Republicans’ health care bill Monday, telling a rally in Louisville, Ky. that the legislation “is our chance to end ObamaCare and the ObamaCare catastrophe.”

“This is our long-awaited chance to finally get rid of Obamacare.” Trump told the crowd at the city’s Freedom Hall. “It’s a long-awaited chance. We’re going to do it.”

In a speech peppered with shout-outs to Kentucky’s congressional delegation — “Hey, Mitch,” Trump asked Senate Majority Leader Mitch McConnell at one point, “we gonna be OK? … That health care’s looking good?” — the president warned the crowd that if the health bill did not pass, “the alternative is what you have [and] what you have is nothing.”

Trump also attempted conciliation toward Sen. Rand Paul, R-Ky., one of the bill’s most outspoken opponents, saying, “I look forward to working with him so we can get this bill passed — in some form.”

Echoing House Speaker Paul Ryan, R-Wis., Trump told supporters that the GOP health bill was a necessary step before enacting sweeping tax reform, another cornerstone of his agenda.

“We’ve got to get this done before we can do the other,” Trump told the crowd. “In other words, we have to know what this is before we can do the big tax cuts. We’ve got to get it done for a lot of reasons, but that’s one of them.”

Trump’s speech capped a day of meetings and phone calls aimed at helping the much-criticized legislation through the House ahead of a floor vote Thursday. The president was to meet with House Republicans on Capitol Hill Tuesday morning in what could be a major test of his deal-making abilities. 

At the White House on Monday, the president met with Ryan, Health and Human Services Secretary Tom Price and Dr. Ezekiel Emanuel, an architect of Obama’s health care law and the brother of Obama’s White House chief of staff, Chicago Mayor Rahm Emanuel.

On Capitol Hill, Counselor to the President Kellyanne Conway met with the House Republican whip team, responsible for ensuring that the health bill has the requisite 218 votes on Thursday. 

Sources told Fox News that members implored Conway to persuade Trump to endorse revisions to the bill that are expected to be laid out in a so-called “manager’s amendment” ahead of the floor vote this week.

Trump’s aides and congressional Republicans spent the weekend trying to woo conservatives and moderate House members who have questioned the health care plan. Rep. Steve Scalise, R-La., the House’s No. 3 Republican and the leader responsible for rounding up votes, wrote Sunday night to his whip team that the “next few days could define us for years to come.”

“There’s no such thing as ‘perfect.’ Each of us has our own ideal plan, but if we want to advance our principles and fulfill our promises, this bold approach achieves our objectives,” Scalise wrote.

Many hard-line conservatives have pushed for a more complete repeal of Obama’s law, including its requirement that policies cover a long list of services, which they say drives up premiums. They also complain that the GOP bill’s tax credits create an overly generous benefit the federal government cannot afford.

“We need substantive changes,” said Rep. Jim Jordan, R-Ohio, a member of the conservative House Freedom Caucus, said late Monday. “There’s gotta be fundamental change.”

Rep. Justin Amash, R-Mich., wrote on Twitter that fellow Freedom Caucus members had suggested several changes but had been rebuffed.

Moderate Republicans, meanwhile, have said the tax credits are too limited and would hurt low earners and older patients. They also worry the plan would leave too many people uninsured, pointing to a nonpartisan Congressional Budget Office analysis that estimated 24 million people would lose coverage over 10 years.

The White House and House Republicans have agreed that the bill will be amended to let states impose work requirements on some healthy Medicaid recipients. States will also be allowed to alter the entire federal-state program for poorer people so states would receive a lump sum federal payment to cover some costs — not an amount that’s pegged to the number of beneficiaries in the state, as the current bill provides.

Fox News’ Chad Pergram and the Associated Press contributed to this report.

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