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Mental Health Problems Rising Among College Students

Amy Ebeling struggled with anxiety and depression throughout college, as her moods swung from high to low, but she resisted help until all came crashing down senior year.

“At my high points I was working several jobs and internships — I could take on the world,” said Ebeling, 24, who graduated from Ramapo College of New Jersey last December.

“But then I would have extreme downs and want to do nothing,” she told NBC News. “All I wanted to do was sleep. I screwed up in school and at work, I was crying and feeling suicidal.”

More than 75 percent of all mental health conditions begin before the age of 24, according to the National Alliance on Mental Illness, which is why college is such a critical time.

Ebeling resisted getting therapy, but eventually got a diagnosis of bipolar II disorder from a psychiatrist associated with Ramapo’s counseling office.

“Then everything fell into place,” said Ebeling, who is doing well on medication today.

RELATED: Young Adults and Mental Health: A Guide for Parents

College counselors are seeing a record number of students like Ebeling, who are dealing with a variety of mental health problems, from depression and anxiety, to more serious psychiatric disorders.

“What has increased over the past five years is threat-to-self characteristics, including serious suicidal thoughts and self-injurious behaviors,” said Ashley Stauffer, project manager for the Center for Collegiate Mental Health at Penn State University.

According to its data, collected from 139 institutions, 26 percent of students who sought help said they had intentionally hurt themselves; 33.2 percent had considered suicide, numbers higher than the previous year.

And according to the 2016 UCLA Higher Education Research Institute survey of freshmen, nearly 12 percent say they are “frequently” depressed.

At Ramapo College, counselors are seeing everything from transition adjustment to more serious psychiatric disorders, according to Judith Green, director of the campus’ Center for Health Counseling Services.

Being away from home for the first time, access to alcohol and drugs and the rigorous demands of academic life can all lead to anxiety and depression.

Millennials, in particular, have been more vulnerable to the stressors of college life, Green told NBC News.

“This generation has grown up with instant access via the internet to everything,” she said. “This has led to challenges with frustration tolerance and delaying gratification.”

Millennials tend to hold on to negative emotions, which can lead to self-injury, she said. It’s also the first generation that will not likely do as well financially as their parents.

“Students are working so much more to contribute and pay for college,” said Green. “Seniors don’t have jobs lined up yet.”

‘I dragged myself to the counseling center’

Like Ebeling, many students often experience mental illness breaks in college.

She had been in grief counseling after the death of her father at age 8, and even had therapy — but refused medication — during her teen years.

“I thought that it was weakness — ‘why can’t I just snap out of it?’” she said. “It became apparent it just wasn’t that easy.”

She hit a deep low her senior year.

“I was a crazy over-achiever,” she said. “I got involved in all the clubs and extracurricular activities.” But when her mood dropped, she said, “I couldn’t do anything, but had all those responsibilities.”

“In one class I panicked so much, I freaked out,” said Ebeling. “I dragged myself to the counseling center.”

The resources are available, according to Green, who first counseled Ebeling.

Ramapo reaches out to freshman and their parents at orientation and reinforces the availability of mental health resources throughout the year. The college also maintains an online anonymous psychological screening tool so students can see if therapy might be helpful.

RELATED: Meditation May Help Students Combat High Levels of Stress, Depression

“Students are electronically savvy, so we meet them where they are,” said Green.

They also sponsor wellness fairs so students learn about nutrition, exercise and even financial well-being — “the whole gamut to keep themselves well,” she said.

As for Ebeling, she took her experience and devoted her senior capstone project to learn more about mental illness. “It was therapeutic.”

“Kids going to college need to realize it’s not a weakness,” she said. “They shouldn’t be afraid to get help. ”

“I try to be open and talk about it with friends and family,” said Ebeling. “Don’t shy away from it. It needs to be addressed. Let go of the stigma.”

Ebeling had good communication with her mother regarding her mental health diagnosis, but said other students should consider sharing their medical information if they “feel they have a good support system.”

“I have friends who tried to discuss mental health issues with family members and completely got brushed off, which can be crushing and damaging,” she said.

“I think both students and parents need to keep an open mind, but at the end the of the day, those who are seeking help need to realize that they are doing this for themselves and no one else, and they need to put themselves first and foremost no matter what.”

Tips for Parents from the National Association of Mental Illness:

  • Let your child know that mental health conditions are common — one in five college students — so they don’t feel alone.
  • Emphasize the importance of exercise, sleep and diet.
  • Know the warning signs of mental stress and when and how to seek help. Check out the college’s resources.
  • And because of privacy laws, come up with a plan in advance for which information about mental health can be shared with the parent.

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This GOP Health Bill Proposes New Limits To Medical Malpractice Awards

Calls for tort reform in regards to medical malpractice are popular on the campaign trail. But research shows that costs from medical liability make up just 2 to 2.5 percent of total health care spending in the U.S.

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Calls for tort reform in regards to medical malpractice are popular on the campaign trail. But research shows that costs from medical liability make up just 2 to 2.5 percent of total health care spending in the U.S.

FangXiaNuo/Getty Images/iStockphoto

Last week, a jury awarded a Pennsylvania man $620,000 for pain and suffering in a medical malpractice lawsuit he filed against a surgeon who mistakenly removed his healthy testicle, leaving the painful, atrophied one intact.

However, if a bill before the House of Representatives passes, the maximum he would be able to receive for such “non-economic” damages would be $250,000.

Doctor Confesses: I Lied To Protect Colleague In Malpractice Suit

Non-economic damages cover losses that are hard to put a dollar amount on — such as suffering, loss of a limb, pain, and loss of companionship. In addition, medical malpractice awards may include monetary damages to cover medical costs and loss of future wages. Sometimes punitive damages may be awarded as well, as punishment for reckless or other harmful behavior.

The bill H.R. 1215 is part of a package of proposed reforms that supplement the American Health Care Act, the House measure to replace the Affordable Care Act that was narrowly approved in May. The Trump administration has pledged to support the tort reform legislation.

Still, passage is far from certain; groups across the political spectrum oppose the measure. Advocates for patients say such legislation would be unfair to people seriously injured by medical negligence, whose lives are changed forever. Many conservatives don’t embrace it either because it would impose federal standards on tort law, an area where states have traditionally determined the rules.

The Congressional Budget Office estimates that the bill would lower health care costs by reducing the premiums of medical liability insurance and the use of health care services by providers worried about being sued. This would lead to lower spending on federal health care programs. The likely overall result, the CBO says, would be to reduce deficits by nearly $50 billion over 10 years.

Supporters of the bill say caps on medical malpractice awards discourage frivolous lawsuits and reduce the cost of health care because providers no longer need to practice defensive medicine.

A Few Doctors Account For Outsize Share Of Malpractice Claims

Yet research shows that costs from medical liability make up just 2 to 2.5 percent of total health care spending.

About half of states have a cap of some sort on non-economic damages in medical malpractice cases, according to Joanne Doroshow, executive director of the Center for Justice and Democracy, a consumer advocacy organization for civil justice issues.

Under the House bill, states that already have caps on non-economic damage awards could keep those limits in place. In states without such caps, even if the state constitution prohibits them or state courts have struck them down, the federal $250,000 cap would apply.

The case of the Pennsylvania man’s surgery is a “never event” — one of list of around 30 types of serious medical events that experts on patient safety say should never occur. Since Pennsylvania doesn’t have its own cap on non-economic damages, if the House bill had been in effect, it would have limited the $620,000 the jury awarded the patient to $250,000. In this case, the patient, Steven Hanes, also was awarded an additional $250,000 in punitive damages.

Hanes declined to be interviewed, but his attorney, Braden Lepisto, said in an email that his client was shocked to learn of the proposed cap.

The 2 Things That Rarely Happen After A Medical Mistake

“He felt that the $250,000 cap was ridiculous,” Lepisto said of his client, “because that amount would not compensate him for what he has gone through and will go through moving forward.”

He added, “The reality is that there are many individuals who are injured from medical negligence who do not have ‘economic loss’ as defined by the law. Nonetheless, their lives are altered from the pain and suffering, loss of life’s pleasures, and the emotional effects of the injuries.”

The House bill would also come into play in Florida, where earlier this month the state Supreme Court struck down caps on non-economic damages in medical negligence cases because the court ruled they violate the equal protection clause of the state constitution. The House bill would supersede the state court decision and impose the cap in Florida cases.

Although the damages cap is noteworthy, other elements of the House bill also trouble consumer advocates. For example, it would establish a three-year statute of limitations for consumers to bring a lawsuit after an injury, or a one-year limit from the date that the consumer discovers or should have discovered the injury.

“Because it’s [worded as] whichever comes first, for all intents and purposes it’s one year,” said Doroshow. “That is a drastic change. Almost no state has a statute of limitations that severe.”

The bill would also set limits on the amounts that lawyers can recover in contingency fees from legal judgements in consumer cases. This seemingly consumer-friendly provision could actually harm patients, said Doroshow.

Having Loved And Lost, One Man Takes On Medical Malpractice In India

Medical malpractice cases are complex and expensive to bring, she noted. “If you have a law that caps the ability of the attorney to recover from the judgment, they’ll think twice before taking a case,” Doroshow said. “It hurts the patient’s ability to have a competent attorney or any attorney at all.”

Meanwhile, some supporters of tort reform say the House bill goes about it the wrong way.

“The federal government doesn’t really have a legitimate role to play here,” said Dr. Jeffrey Singer, a general surgeon in Phoenix who is also an adjunct scholar at the libertarian Cato Institute, located in Washington, D.C.

Conservatives might be relying too much on the idea of tort reform to bring down the costs of health care, Singer said.

“It’s become almost a part of the canon of people who align themselves with the market-oriented conservative reforms school,” he said. “But it should be done at the state level, and we’re fooling ourselves if we think that it’ll be the magic bullet.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Follow Michelle Andrews on Twitter @mandrews110.

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Senate health care plan: What happens now?

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Good Health Never Lasts

Many critics have fixated on how cruel it is to draft a bill that squeezes sick people and old people out of the insurance market, and understandably so.

But there are pragmatic concerns, too. Like the fact that populations of people who tend to need health-care services the most—the poor, the elderly, the very ill—are in constant flux. The 5 percent of Americans who account for 50 percent of the country’s healthcare costs isn’t a static group, as Helaine Olen recently wrote for this magazine. “A chronic illness can land someone in this category but, given the increasing prevalence of high-deductible plans, so can something as simple as a broken bone or an emergency appendectomy. Although some people will be in this group year after year, many will cycle in and out, and nearly everyone will be in it for some brief period.”

Nearly everyone means me, and you, and all the people we love. Because, if we’re lucky, we’ll all eventually become very old indeed, and the likelihood that we’ll need expensive health-care along the way is quite high. (An enormous part of this is preventative care in high-risk populations, which can drive down costs—but only for those who have consistent, affordable access to care.)

Many Americans cannot afford to pay for insurance hikes under the Affordable Care Act—the cost of the most popular Obamacare plan is going up 22 percent this year. Senator Mitch McConnell, the majority leader and author of the legislation, has argued he simply wants Americans to be free to make “the best health care decisions for their families on what types of plans they want and can afford.” But who can afford a serious illness? How can anyone plan for such a thing?

“There are no ‘healthy’ and ‘sick’ people,” wrote Ken Norton, a partner at Google Ventures, in a Twitter essay about the death of his 11-year-old son from a congenital heart defect in 2014. “Healthy people can turn into sick people really fucking suddenly… I’m here to tell you that there is no ‘us’ and ‘them,’ no responsible taxpayers and irresponsible moochers, we are them and they are us.”

The men who bristle at the idea of paying for insurance that covers women’s prenatal care would do well to remember that they themselves are former fetuses. And healthy people need to remember that they are future sick people, too.

The question of how to fix the Affordable Care Act—which, indeed, needs attention—isn’t just a question for poor people, or the elderly, or the middle class, or people with pre-existing conditions, or people who don’t have jobs, or the tens of millions more Americans who will be uninsured in a decade if the GOP’s repeal-and-replace plan passes. It is a question for all Americans, because all of us are vulnerable to a change in fortune.

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Delaying the Senate health care vote likely won’t solve the problem

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Vote Delayed as Republicans Struggle to Marshal Support for Health Care Bill

That delay does not guarantee the senators will come together. Opposition groups will mount pressure campaigns on lawmakers in their home states, and policy divisions are deep.


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“It’s hard to see how tinkering is going to satisfy my personal concerns,” Ms. Collins told reporters.

Negotiations on Tuesday that leaders hoped would move senators toward yes only exposed the fissures in the Republican Party. Conservatives were demanding that states be allowed to waive the Affordable Care Act’s prohibition on insurance companies charging sick people more for coverage and are asking for a more expansive waiver system for state regulators. They also wanted more money for tax-free health savings accounts to help people pay for private insurance.

Senators from states that expanded the Medicaid program — and Senator Susan Collins, Republican of Maine — would not brook many of those changes, especially the measure to severely undermine protections for people with pre-existing medical conditions. They wanted more money for mental health benefits for people addicted to opioids and money for states to cover people left behind by the rollback of the Medicaid program in both the House and Senate versions.

Three Republican senators — Ms. Collins, Rand Paul of Kentucky and Ron Johnson of Wisconsin — had announced they would vote against the motion to begin debate that had been scheduled to hit the Senate floor on Wednesday, joining Senator Dean Heller of Nevada, who made the same pledge on Friday.

Where Senators Stand on the Health Care Bill

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

A bevy of other senators from both flanks of the party seemed headed in the same direction if they did not see changes made to the Senate health care bill, leaving the measure in deep peril, since Republicans can only lose two votes from their own party.

The release of a Congressional Budget Office evaluation on Monday did little to help leaders roll up votes from either side of the fence. The budget office said the Senate bill would leave 22 million more uninsured after 10 years, while sending out-of-pocket medical expenses skyrocketing for the working poor and those nearing retirement.

The budget office did not provide conservatives with support for their demands either. The state waivers already in the Senate bill “would probably cause market instability in some areas” and “would have little effect on the number of people insured” by 2026, the analysis concluded. Adding still more waivers, including one that could allow insurers to price the sick out of the health care market, could deprive even more people of health care.

Even before Mr. McConnell’s decision, White House officials had braced for the likelihood that the procedural vote would fail and that they would have to revisit the measure after the Fourth of July recess — when they hoped to be able to woo Mr. Johnson, who has been a surprisingly fierce critic of the bill from the right. The senator has repeatedly warned that this week is too soon to vote on the health care measure, as Republican senate leaders have insisted they need to do.


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Vice President Mike Pence, attended the Senate Republican lunch on Tuesday and then broke off for private meetings with Mr. Heller, a seemingly firm “no” and the first moderate Republican to break with Mr. McConnell over the bill, and Rob Portman of Ohio, who is feeling pressure from his state’s governor, John R. Kasich, to oppose the bill and defend Ohio’s Medicaid expansion.

Mr. Portman was the subject of a spirited evaluation of his open criticism of the bill by Mr. McConnell, who was frustrated with the expansion-state senators who showed their hand early to other wavering colleagues, dooming the bill for now. Mr. McConnell was unhappy that Mr. Portman seemed to be abandoning his previous stance on fiscal rectitude by opposing Medicaid cuts in the bill.

But the Ohio senator was getting it from both sides. Mr. Kasich appeared in Washington on Tuesday to sharply criticize the Senate bill. The governor said he was deeply concerned about millions of people losing coverage under the bill.

“Who would lose this coverage?” Mr. Kasich said. “The mentally ill, the drug addicted, the chronically ill. I believe these are people that need to have coverage.”

At the same news conference, Colorado’s Democratic governor, John W. Hickenlooper, said his state’s Republican senator, Cory Gardner, “understands the hardships and the difficulties in rural life.”

“This bill would punish people in rural Colorado,” Mr. Hickenlooper said, raising the pressure.

Doctors, hospitals and other health care provider groups came out strongly against the Senate bill, as did patient advocacy groups like the American Heart Association. But business groups were ramping up their support. In a letter on Tuesday, the U.S. Chamber of Commerce endorsed the Senate bill and urged senators to vote for it.

The Senate bill “will repeal the most egregious taxes and mandates” of the Affordable Care Act, allowing employers to create more jobs, said Jack Howard, a senior vice president of the group. The bill, he noted, would repeal a tax on medical devices and eliminate penalties on large employers that do not offer coverage to employees.

A separate letter expressing general support for the Senate’s efforts was sent by a coalition of 28 business and employer groups including the National Association of Home Builders, the National Restaurant Association and the National Retail Federation.


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But Senate conservatives found themselves squeezed between business sentiment and their conservative base. Club for Growth, an ardently conservative political action committee, came out strongly against the Senate measure on Tuesday.

“The Club for Growth and the American people took Republicans in Congress at their word when they promised to repeal every word – ‘root and branch’ – of Obamacare and replace it with a patient-centered approach to health care,” the group’s president, David McIntosh, said in a statement. “Only in Washington does repeal translate to restore. Because that’s exactly what the Senate GOP healthcare bill does: it restores Obamacare.”

Even the Trump administration is divided over what comes next, especially on the payment of subsidies to health insurance companies to compensate for reducing out-of-pocket costs for low-income people.

Mr. Trump has threatened to withhold the monthly payments as a way to induce Democrats to bargain with him over the future of the Affordable Care Act. Administration officials said Mr. Trump did not want to make the payments if the Senate did not pass a health care bill this week. But they said Tom Price, the secretary of health and human services, had urged the White House not to cut off the payments abruptly.

A federal judge has ruled that the payments are illegal because Congress never appropriated money for them, but that ruling is being appealed. Any interruption of the payments could have a dire destabilizing effect on markets, insurers say. Blue Cross Blue Shield of North Carolina recently blamed the Trump administration’s mixed signals on the subsidy for most of its proposed 23 percent spike in premiums next year.

Sean Spicer, the White House press secretary, defended the administration’s position at his briefing on Friday.

“If the president were to hypothetically say that he’s going to make the payments in perpetuity or for a year, I think that continues to prop up a failed system,” Mr. Spicer said. “It continues to do wrong by the American taxpayer. And it also doesn’t lend itself to the expediency that I think we want to — help get a new health care system in place.”

Robert Pear and Emmarie Huetteman contributed to this report.

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More Health Problems Reported With Hair And Skin Care Products

Problems with hair care products are among the most common in the FDA’s database.

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Problems with hair care products are among the most common in the FDA’s database.

RuslanDashinsky/Getty Images

We rub, pour, sprinkle and spray them all over our bodies, so you’d hope cosmetics would undergo serious safety oversight before they get into our hands. But in fact, the cosmetics industry is largely self-regulated, with no requirements for approval before going on the market. And once on the market, there are few systems in place by to monitor the safety of personal care products.

“You can start making a cosmetic and start selling it the next day without any kind of permission from the FDA,” says Steve Xu, a resident physician in dermatology at the McGaw Medical Center of Northwestern University and author of a study on problems with personal care products published Monday.

If you suspect that a product has resulted in an “adverse event,” such as a rash, nausea, stress, or even death, you can report it to the manufacturer or tell the Food and Drug Administration. And while that might get you an apology and some coupons, there is no guarantee that your case will be investigated, or that a manufacturer will report it to the FDA.

Last December the FDA for the first time publicly released data collected by its Center for Food Safety and Applied Nutrition on adverse events related to food and cosmetics since 2004. Before, someone would have had to file a Freedom of Information Act request with the agency to gain access to reports of safety problems.

Hair care products, skin care products and tattoos were most commonly reported as the source of problems, according to the analysis by Xu and colleagues at Northwestern, which was in JAMA Internal Medicine.

The most common complaints, according to Xu, were hair loss or breakage and local skin irritation. Baby products, personal cleanliness products, and hair care and coloring products were found to have the highest proportion of serious adverse events, including serious injuries, hospitalization and death.

Problems After Using Hair Conditioner Prompt An FDA Warning

From 2015 to 2016, the number of reported adverse events more than doubled. This leap, Xu says, was driven largely by complaints of hair loss and skin irritation associated with WEN by Chaz Dean Cleansing Conditioners. In 2014, the FDA announced that they were investigating WEN products.

Although the FDA had only received 127 complaints about these products by that time, the manufacturer had received about 21,000 complaints. Unfortunately, manufactures have no legal obligation to report adverse events to the FDA. So the FDA has asked the public to submit complaints about WEN conditioners directly to the agency. Many of the 2016 complaints, says Xu, were a direct result of that call to action. The agency also welcomes reports on problems with other personal care products through its online MedWatch system.

In an editorial also published in JAMA Internal Medicine, former FDA Commissioner Robert M. Califf and his co-authors say there needs to be better premarket assessment and postmarket surveillance of cosmetic products. Substantial improvements to cosmetics regulations, they say, would require more support for the “chronically underfunded” FDA, mandatory registration of cosmetic products, and modernization of cosmetics oversight, based on systems the FDA already has in place for drug and device monitoring. With these changes, they write, “we can achieve the high levels of safety people in the United States have a right to expect.”

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The Note: Can Republicans stanch the bleeding on health bill?


  • Next steps for President Trump‘s travel ban could be decided today. It’s the end of the Supreme Court‘s term today and the court is expected to decide on whether to take up Trump’s travel ban when it returns in the fall or let the circuit court decisions stand.
  • Brace for another Supreme Court pick battle? Washington is on alert for a possible retirement announcement that would change the court in a “YUGE” way. There’s high speculation that it could be swing-vote Justice Anthony Kennedy.
  • A crucial week for health care. The Congressional Budget Office score is expected early this week. Some GOP senators are waiting for the formal analysis before making their final decision on the bill.
  • Are we rushing things? Senate GOP leadership wants a vote on the health care bill by Friday, before Congress takes off to celebrate July Fourth.
  • THE TAKE with ABC News’ Rick Klein

    “Forget about votes; this has nothing to do with votes,” President Trump declared in one of his recent Fox News interviews. The president is right but also very wrong. Of course, it’s all about the votes in the Senate, with Majority Leader Mitch McConnell trying to orchestrate a kabuki dance with a limited number of moves. When it comes to the president’s involvement, “We’re trying to hold him back a little bit,” Majority Whip John Cornyn told reporters, with a smile, on Sunday. (Maybe that’s because the president is calling the House bill he once celebrated “mean,” even while his super PAC allies go to war with one of the “very fine senators” who might say the same about the current bill.) Yet as the focus turns to deal-making, this is not really about handouts or kickbacks. This bill is deadly serious policy; it could be law by the end of the week, with the House poised to capitalize on any Senate momentum. This is where political muscle is measured, in influencing this week on actual votes, not at vague points in the run-up to 2018. The human consequences will jostle for attention with the political ones in the coming quite interesting days.


    Sen. Ben Sasse, R-Neb., would not commit to voting one way or another on the health care bill over the weekend. He called the legislation less “repeal-and-replace” and more Medicaid reform. Under the Senate bill, funding for those covered under the Obamacare Medicaid expansion would dry up in 2024, depending on the state. Those are people who earn between $12,000 and $16,000 a year (slightly more if pregnant or in a nursing home), and after that the government would increase Medicaid funding at rates significantly lower than the actual growth rate of medical costs. The U.S. population is aging rapidly and already, under current law, the program covers over 6 million low-income elders. Almost 2 million Americans rely on Medicaid for nursing home or other long-term care costs. About 35 million children depend on the program as well. If the federal government stops providing funds, cash-strapped states will either have to cut folks off their Medicaid rolls or fix their balance sheets another way. Republican lawmakers have talked for decades about shrinking and adjusting programs like Medicaid but they are finding even Republican governors pushing back, having come to rely on the federal dollars to cover the poorest in their states, ABC News’ MaryAlice Parks writes.


    President Trump hosts India’s Prime Minister Narendra Modi at the White House today and the two will give a joint statement tonight.


    These are not cuts to Medicaid, George. This slows the rate for the future and it allows governors more flexibility with Medicaid dollars because they’re closest to the people in need,” Trump counselor Kellyanne Conway on the Senate health care bill on ABC News’ “This Week”

    NEED TO READ with ABC News’ Adam Kelsey

    Trump: “I think we are going to get there” on health care. As five Republicans have come out in opposition to the current GOP health care bill, President Trump, in an interview with Fox News Sunday, expressed optimism that the Senate will pass the plan to repeal and replace Obamacare. “I don’t think they’re that far off — you know, famous last words — but I think we are going to get there,” the president said.

    WH “paying very close attention” to SCOTUS’ last decisions of term: Conway. Amid speculation that Supreme Court Justice Anthony Kennedy may announce his retirement, presidential counselor Kellyanne Conway declined to say whether President Trump or the White House has heard from the justice about his plans. “I will never reveal a conversation between a sitting justice and the president or the White House,” Conway told ABC News’ George Stephanopoulos on “This Week” Sunday.

    GOP Sens. Susan Collins, Rand Paul express doubts about Senate health care bill. Sen. Rand Paul, one of the key Republican senators in the ongoing health care battle, said Sunday that his party has “promised too much” in trying to fix the health care system and assuring that the cost of premiums will be lowered. “They’ve promised too much. They say they’re going to fix health care and premiums are going to go down,” Paul said on ABC News’ “This Week.”

    Democrats “better stand for something,” says party’s Senate leader. “Here’s the number one lesson from Georgia Sixth,” Sen. Chuck Schumer said on ABC News’ “This Week” of the recent congressional race in suburban Atlanta. “Democrats need a strong, bold, sharp-edged and commonsense economic agenda — policy, platform, message that appeal to the middle class … and unite Democrats.”

    Koch brothers plan stepped-up spending: “More optimistic now about what we can accomplish.” The Koch brothers’ political network plans to pick up the pace of spending in the run-up to 2018, despite major policy disagreements with the Trump administration that include skepticism of the health care bill now being debated in the Senate.

    No Ramadan celebration at White House, though Trump said during campaign he was open to it. For the first time in over two decades, the White House did not host an Iftar, or Eid, celebration dinner to mark the month of Ramadan, the Islamic holy month when Muslims fast during daylight hours. Last year, then-presidential candidate Donald Trump told ABC News’ Jonathan Karl in an interview that he would be open to continuing the tradition of hosting an Iftar dinner.


    @Acosta: WH says Monday briefing will be off-camera. #democracyindarkness

    @yashar: NEW: Kushner firm’s $285 million Deutsche Bank loan came just before Election Day@PostKranish reports

    @JordynPhelps: Trump returns to attacking @SenWarren, calling her a “highly overrated voice”: “I call her Pocahontas and that’s an insult to Pocahontas”

    @mviser: My look Jared Kushner’s stint in Somerville real estate while at Harvard. Angry tenants. Big profits. A $50k mistake

    @evanmcmurry: NEW: Sen. Ben Sasse uncommitted on Senate GOP health care bill, he says at Koch brothers conference in Colorado Springs. – @rickklein

    @realDonaldTrump: Hillary Clinton colluded with the Democratic Party in order to beat Crazy Bernie Sanders. Is she allowed to so collude? Unfair to Bernie!

    The Note is a daily ABC News feature that highlights the key political moments of the day ahead. Please check back tomorrow for the latest.

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    Senate Leaders Try to Appease Members as Support for Health Bill Slips

    But as more analysis of the bill reached state officials, especially in places that expanded Medicaid access under the Affordable Care Act, misgivings grew. Senator Bill Cassidy, a Louisiana Republican and doctor who is considered a critical vote, said he remained undecided. Louisiana, with its high levels of poverty, recently expanded Medicaid.


    Continue reading the main story

    “There are things in this bill which adversely affect my state, that are peculiar to my state,” Mr. Cassidy said on CBS’s “Face the Nation.”

    The bill was drafted in secret, mainly by the Senate majority leader, Mitch McConnell of Kentucky, who unveiled it on Thursday. Mr. McConnell wants a vote this week, before lawmakers take a break for the Fourth of July holiday.

    Senator Jerry Moran of Kansas, usually a reliable vote for Senate Republican leaders, said on Fox News, “I just don’t know whether the votes will be there by the end of the week.”

    Where Senators Stand on the Health Care Bill

    Senate Republican leaders unveiled their health care bill on Thursday.

    Over the weekend, senators and their aides were poring over the bill, drafting possible amendments, preparing speeches and compiling personal stories from constituents whom they portrayed as either beneficiaries or victims of the Affordable Care Act.

    But the bill’s supporters were battling an internal threat: reluctant Republicans. Senator Ron Johnson of Wisconsin said Sunday that “there’s no way we should be voting” on the legislation this week. “No way.”

    “I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this for me to vote for a motion to proceed,” Mr. Johnson said on NBC’s “Meet the Press.”

    And Senator Susan Collins, Republican of Maine, said on ABC’s “This Week”: “It’s hard for me to see the bill passing this week, but that’s up to the majority leader. We could well be in all night a couple of nights.”

    The U.S. Chamber of Commerce, the National Federation of Independent Business and the National Retail Federation have all said they support the bill. Thomas J. Donohue, the president of the Chamber of Commerce, said it would “help stabilize crumbling insurance markets” and eliminate “ill-conceived Washington mandates and taxes.”


    How the G.O.P. Health Bill Would Change Medicaid

    The reporter Margot Sanger-Katz examines how the Republican health plan aims to roll back a program that insures one in five Americans.

    By MARGOT SANGER-KATZ, ROBIN STEIN and SARAH STEIN KERR on Publish Date June 22, 2017.

    Photo by Doug Mills/The New York Times.

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    But much of the nation’s $3 trillion health care industry opposes the bill. And Mr. McConnell has done little to woo the health care stakeholders whom Mr. Obama courted assiduously from his first months in office.


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    The concerns expressed by outside groups also appear to be growing. Top lieutenants in Charles G. and David H. Koch’s political network sharply criticized the legislation over the weekend, saying it was insufficiently conservative and did not do enough to rein in the growth of Medicaid. And a number of Republican governors have joined doctors, hospitals and patient advocacy groups in opposing the bill, in part because of its cuts to Medicaid.

    Mr. McConnell has only a few days to wheel, deal and cajole reluctant senators to get behind legislation that has grown less popular with more exposure. He has considerable firepower to win votes by guaranteeing amendments that would address the concerns of individual Republican senators, and by playing on their loyalty to him and to conservative voters still demanding an end to the Affordable Care Act. At the same time, Democrats say, he has striking liabilities. Mr. Trump has endorsed the bill, and Democrats say they will take every opportunity to link the legislation to an unpopular president.

    And the Democratic wall of opposition is backed by less partisan voices. Senators are being flooded with appeals like this from the advocacy arm of the American Cancer Society: “Cancer is scary enough. Don’t take away our coverage.”

    The American Childhood Cancer Organization, a charitable group formed by parents, is mobilizing a small army of grass-roots lobbyists with the message that the bill, with its deep cuts to Medicaid, “will threaten the lives of children battling cancer.”


    How Senate Republicans Plan to Dismantle Obamacare

    A comparison of the Senate health care with the Affordable Care Act.

    The United States Conference of Catholic Bishops said the Senate bill was “unacceptable as written” and would “wreak havoc on low-income families.” At the same time, the bishops said they liked two sections that seek to “prohibit the use of taxpayer funds to pay for abortion or plans that cover it.”

    Republicans are finding allies to be few and inconstant. Mr. Trump has said he is “very supportive” of the Senate bill. But that support will be of limited help to Mr. McConnell. Few senators feel loyal to Mr. Trump, whose erratic message has often weakened his influence on Capitol Hill.

    After pushing for passage of the House repeal bill, he criticized it as “mean” several weeks later. A spokeswoman, Sarah Huckabee Sanders, said last week that Mr. Trump did not necessarily support cuts to Medicaid, even though his budget and the Senate bill would make such cuts.


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    Kellyanne Conway, a top adviser to Mr. Trump, claimed on Sunday that the Senate bill did not actually cut Medicaid. Ms. Collins said, “I respectfully disagree with her analysis.”

    So far, five Republican senators have announced that they cannot support the bill as drafted: Dean Heller of Nevada, who says it cuts coverage too deeply, and four conservatives — Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Mr. Johnson — who say it does not do enough to lower health costs. Other Republicans, like Ms. Collins and Senator Lisa Murkowski of Alaska, have expressed misgivings, and Senator Ben Sasse of Nebraska declined to say Sunday how he would vote.

    Senate leaders, trying to muster support, are looking for ways to address a conspicuous omission: The bill requires insurers to accept anyone who applies, but repeals the mandate for people to have coverage and does not replace it with anything. So people could wait and buy insurance only when they need it. Insurers say they need large numbers of healthy people to help pay for those who are sick.

    Republicans said they might revise their bill to establish a six-month waiting period for people who go without insurance and then want to sign up, in the belief that this would encourage consumers to maintain continuous coverage.

    The House bill has an incentive, imposing a 30 percent surcharge on premiums for people who have gone without insurance. But the Congressional Budget Office said this provision could backfire. As a result of the surcharge, it said, two million fewer people would enroll, and the people most likely to be deterred are those who are healthy.

    The Senate’s answer also has potential problems. For someone with cancer, a six-month waiting period could be a death sentence.

    The Senate fight is happening amid a striking shift in public opinion. Fifty-one percent of Americans now have favorable views of the Affordable Care Act, according to a monthly tracking poll by the Kaiser Family Foundation. “That’s the first time in our 79 tracking polls over seven years that this share has topped 50 percent,” said Craig Palosky, a spokesman for the foundation.


    Senator Lisa Murkowski, Republican of Alaska, said any legislation must recognize her state’s high health care costs, where premiums average about $1,000 a month for an individual.

    J. Scott Applewhite/Associated Press

    Medicaid is by far the largest program of federal grants to the states, and state officials are always trying to tweak the formula for distributing that money to their advantage.


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    The House and Senate bills would convert Medicaid from an open-ended entitlement program to a system of per-capita payments for beneficiaries. A novel feature of the Senate bill would redistribute federal Medicaid money from higher-spending states like New York to lower-spending states like Alabama.

    One noteworthy exception to this provision is tailor-made for Alaska. “This paragraph shall not apply to any state that has a population density of less than 15 individuals per square mile,” it says.

    Only five states — Alaska, Montana, North Dakota, South Dakota and Wyoming — meet that criterion, and Alaska’s two Republican senators have expressed concern about the bill’s potential effects on their state, where medical costs are exceptionally high.

    Ms. Murkowski said federal legislation must recognize Alaska’s high costs. Premiums on the insurance exchange there average about $1,000 a month for an individual, according to federal data. But the special provision may not be enough to win Ms. Murkowski’s vote. She is also concerned about two other sections of the bill: one that would cut federal funds for the expansion of Medicaid under the Affordable Care Act and one that would block federal Medicaid payments to Planned Parenthood.

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    GOP Health Bill Breaks Trump’s Promise to Lower Deductibles

    WASHINGTON — President Donald Trump may not have the most detailed knowledge of health care policy, but he knows what people hate: High deductibles.

    Trump has made these complaints about Obamacare, which are shared by many insurance customers and critics of the bill alike, a centerpiece of his rhetoric on health care for years.

    “Our healthcare plan will lower premiums deductibles — and be great healthcare!” he tweeted last month. A few days earlier he tweeted that Republicans would provide “much lower premiums deductibles.” In March, he complained that “deductibles are so high you don’t even get to use [insurance]” under Obamacare.

    But the Senate bill released last week and the House bill passed last month take the opposite approach: They include policies that encourage higher deductibles and dramatically raise out-of-pocket costs, in some cases by thousands of dollars per person. The president has embraced both efforts even though they violate his repeated promises.

    “There’s no question that people in the individual insurance market would end up with higher deductibles under the Senate bill, much like the House,” Larry Levitt, senior vice president at the Kaiser Family Foundation, told NBC News.

    It’s not hard to understand why deductibles would go up under the two Republican plans. There are two major provisions in the Senate bill, for example, that specifically affect deductibles and expenses.

    First, the Senate bill encourages customers to sign up for plans with higher deductibles. Under Obamacare, the amount of subsidies customers receive to buy coverage are pegged to the price a “silver” plan, which covers about 70 percent of the average user’s medical costs. The average deductibles for these plans right now are about $3,500 for individuals and $7,500 for families, according to an analysis by the consumer site HealthPocket.

    But the Senate bill instead pegs its subsidies to insurance plans that cover only 58 percent of costs. Similar plans on the marketplace this year have average deductibles of more than $6,000 for individuals and $12,000 for families.

    That means customers face an increase of thousands of dollars in deductibles unless they pay more in premiums.

    That’s not the only provision that hikes deductibles, though. Both the House and Senate bills eliminate subsidies that were created just to lower deductibles for low-income customers.

    Under Obamacare, insurers cover a large portion of out-of-pocket costs for individuals making up to 250 percent of the federal poverty level — about $30,000 for an individual and $61,000 for a family of four. In exchange, the federal government reimburses them for the difference. The theory is that customers in this income range would otherwise struggle to benefit from a silver plan with deductibles of $7,500.

    But the House and Senate bills each eliminate these cost-sharing provisions — and the effects would be dramatic, according to a Kaiser Family Foundation analysis. If you’re an individual making around $18,000 a year, your effective deductible would be about $255 under Obamacare. Under the Senate bill, though, that number would jump to over $6,000 — almost 24 times higher.

    There’s no squaring that math with Trump’s pledges.

    The Senate bill also eliminates Obamacare’s Medicaid expansion and reduces the program’s overall growth over time, meaning millions of people currently paying little in out-of-pocket expenses through the government program would be expected to purchase high-deductible private plans instead. There are currently over 11 million people who qualify for Medicaid and have signed up thanks to the expansion, which covers individuals who make up to about $18,000 a year.

    By signing the Senate bill, Trump would clearly break his promise for this group. He’d also break a second promise, which he made in his speech announcing he would run for president and repeatedly on Twitter, not to cut Medicaid.

    “The two bills would move, or at least substantially encourage, the use of [high deductible plans], with some assistance for premiums but no assistance for the other aspects like cost sharing, coinsurance, and deductibles,” John Graves, a professor at Vanderbilt University School of Medicine, said in an e-mail. “Notably these are the aspects folks have complained the most about regarding the [Affordable Care Act’s] private plans.”

    Even people who find insurance with similar deductibles might discover their out-of-pocket costs are higher elsewhere. The Senate bill, like the House, allows states to opt out of Obamacare’s requirement that every plan include certain “essential health benefits” in the hopes of reducing premiums.

    Image: CBO to Release Cost and Reach of Republican Health Care Replacement

    Image: CBO to Release Cost and Reach of Republican Health Care Replacement

    In analyzing the House bill, the Congressional Budget Office predicted waiving these benefits would raise costs by thousands of dollars for currently required items like maternity care and mental health treatment, which were often left out of pre-Obamacare plans.

    Avik Roy, a prominent Republican health adviser who’s supportive of the Senate bill, told NBC News that allowing higher deductible plans, along with other features like allowing insurers to charge older customers higher rates, could lower premiums for young healthy customers. If enough of them entered the marketplace, it could potentially bring down premiums and costs more broadly and perhaps even deductibles.

    To encourage this trend, the Senate bill’s subsidies are more generous for younger customers and less generous for older ones, who could face a significant hike in premiums to go on top of their higher deductibles.

    A number of conservative health experts said this week they were skeptical young, healthy people would purchase plans knowing the deductibles are so high to start, however, especially at lower incomes. If they don’t show up in droves, premiums could increase further.

    “I just don’t see why people would sign up,” Joe Antos, a fellow at the American Enterprise Institute, told NBC News last week.

    This is especially true given that the Senate bill currently has no penalty for going without insurance like Obamacare’s individual mandate or the House bill’s requirement that people maintain coverage or risk a major hike in rates tied to pre-existing conditions.

    Experts across the board say this is a major oversight that needs to be corrected before a final vote, which could come within days.

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