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PBS NewsHour

Read the draft of the bipartisan health care deal

The PBS NewsHour has obtained the draft language of the Senate bipartisan health care deal brokered by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., and discussed with President Donald Trump and White House staff.

This is a draft and not final legislation, but encompasses key ideas and language likely to be in any version that moves forward.

Click on the document below to read the full legislation.

READ MORE: Trump gives more mixed signals in bipartisan health deal

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Trump gives more mixed signals in bipartisan health deal

File photo of President Donald Trump by Yuri Gripas/Reuters

File photo of President Donald Trump by Yuri Gripas/Reuters

WASHINGTON — President Donald Trump sent more perplexing signals Wednesday about whether he backs a bipartisan Senate deal for steadying health insurance markets, saying he backs lawmakers’ efforts to strike that compromise but “can never support” federal bailouts for insurers.

A chief sponsor of the agreement, Sen. Lamar Alexander, R-Tenn., said Trump called him Wednesday morning and encouraged him to continue his effort, but left himself wiggle room. Alexander and Sen. Patty Murray, D-Wash., reached their accord a day earlier for a two-year continuation of federal subsidies to insurers that Trump has halted, coupled with an easing of some coverage requirements under President Barack Obama’s health care law.

“I’m going to review it,” Alexander said in a brief interview with The Associated Press, describing what Trump said about the deal. “I may want to add something to it. And it may have to be part of a larger negotiation.”

Asked if Trump backs his agreement with Murray, Alexander said, “You’ll have to ask him.” Yet the senator also predicted that “some form of the proposal” would become law by year’s end.

Trump tweeted Wednesday morning, “I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co’s who have made a fortune w/ O’Care.”

Trump’s erratic signals have added uncertainty to the proposal’s fate.

READ MORE: Senators take a bipartisan step toward a health care fix

The accord has been hailed by Democrats and some Republicans who say the payments must be continued to avoid roiling health insurance marketplaces. Top congressional Republicans have given the plan a frosty reception and many conservatives oppose it, saying it would prop up Obama’s Affordable Care Act, a law they’ve long vowed to repeal.

Under Obama’s statute, insurers are required to reduce costs like co-payments and deductibles to lower-income customers. The program helped more than 6 million people this year at a cost of $7 billion.

The insurance industry and outside analysts have said halting the federal subsidies would force insurers — who still must provide the cost reductions to consumers — to boost premiums and leave some unprofitable markets. Trump halted the payments last week.

The nonpartisan Congressional Budget Office has estimated that ending the subsidies would push premiums up by an average 20 percent next year. This would especially hit people buying their own health insurance who earn too much to qualify for tax credits that reduce premiums for millions of others who do qualify for the aid.

Trump’s quickly shifting stances angered Senate Minority Leader Chuck Schumer of New York, who took to the Senate floor Wednesday morning to accuse Trump of backing down on this issue and others whenever the hard right objects.

“This president keeps zigging and zagging so it’s impossible to govern,” Schumer said. “Our only hope is that maybe tomorrow he’ll be for this again.”

Doug Andres, spokesman for House Speaker Paul Ryan, said Wednesday, “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare.”

Senate Majority Leader Mitch McConnell, R-Ky., was noncommittal about the agreement, saying, “We haven’t had a chance to think about the way forward yet.”

Both McConnell and Ryan have been eager to turn national attention away from the GOP push to scuttle Obama’s law, which crashed in the Senate twice, and toward an effort to cut taxes.

WATCH: Senators reach bipartisan deal on resuming payments to health insurers

In remarks Tuesday in the Rose Garden, Trump called the deal “a very good solution” that would calm insurance markets, giving him time to pursue his goal of scrapping the Affordable Care Act.

But in an evening speech at the conservative Heritage Foundation, he said that “while I commend” the work by the two senators, “I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”

Rep. Mark Walker of North Carolina, chairman of the conservative Republican Study Committee in the House, tweeted: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”

Freedom Caucus Chairman Rep. Mark Meadows, who’s been at work on a proposal of his own, was slightly more positive, calling the Alexander-Murray bill “a good start” but saying much more work needed to be done.

The deal includes provisions allowing states faster and easier access to waivers that would allow them to shape their own marketplace plans under the health law.

It would provide for a new low-cost catastrophic coverage insurance option for all consumers. It would also restore $106 million for outreach and enrollment programs aimed at prodding people to buy policies — efforts that Trump has slashed.

A federal judge ruled in a 2014 lawsuit brought by House Republicans that Congress never legally authorized spending money for the insurers’ subsidies. Obama and Trump, initially, continued making the payments, though Trump declared last week he would pull the plug.


Associated Press reporters Jill Colvin and Ken Thomas contributed to this report.

The post Trump gives more mixed signals in bipartisan health deal appeared first on PBS NewsHour.

New Mexico deploys best practices to avoid the worst outcomes in the opioid crisis

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JUDY WOODRUFF: We return to our series on the opioid epidemic, America Addicted.

In a moment, William Brangham looks at how federal law enforcement was undermined when it came to stopping shipments of the drugs.

Let’s begin with a report from the Southwest.

While states nationwide have been scrambling to tackle the crisis, New Mexico has been hard at work with an aggressive response for years. And yet its death rate from overdoses remains stubbornly high.

Hari Sreenivasan begins our report in northern New Mexico.

DR. GINA PEREZ-BARON, Las Clinicas del Norte: How’d your week go this week?

HARI SREENIVASAN: This is what progress against the opioid epidemic looks like.

ANTHONY OCANA, Patient: I kind of messed up. I had a bunch of friends up there, and we started drinking and stuff. And a guy pulled out a baggie, and it was meth. And I kind of messed up, and I…

DR. GINA PEREZ-BARON: Kind of relapsed with meth.

ANTHONY OCANA: Relapsed with meth.

HARI SREENIVASAN: It’s the latest relapse for Anthony Ocana (ph). His doctor, Gina Perez-Baron at Las Clinicas del Norte, had already discovered it during a routine drug screen.

DR. GINA PEREZ-BARON: I’m glad you told me. Not happy, but glad you told me.

HARI SREENIVASAN: Then the surprise. Anthony’s drug of choice is heroin.

DR. GINA PEREZ-BARON: Did they have heroin? Did they have — they did? No kidding. And you didn’t use? All right.

HARI SREENIVASAN: A small success here in Rio Arriba County against a staggering problem that Perez-Baron says can only be won with a million small successes.

DR. GINA PEREZ-BARON: Yes, I may have relapsed, but this time I didn’t do heroin, right, you know? Or if I did heroin, I didn’t inject it, you know? Those are all small recoveries. Those are all small victories.

HARI SREENIVASAN: The opioid epidemic struck this corner of New Mexico more than a decade before the rest of the nation, for reasons that aren’t entirely clear.

Lieutenant Billy Merrifield of the sheriff’s office:

LT. BILLY MERRIFIELD, Rio Arriba County Sheriff’s Office: It’s hard to say what actually fuels it, other than it’s such — this drug, it just — once they use it once, it’s like it takes control of them.

HARI SREENIVASAN: Some blame poverty and high unemployment. Others an aggressive overprescription of legal pills in the area. Others still the normalization of illegal drug use — so widespread now that multiple generations often use together.

Regardless, you can see the fallout almost everywhere. Needles scattered throughout the countryside…

LT. BILLY MERRIFIELD: We could probably drive along this whole roadway, and we’re going to find them.

HARI SREENIVASAN: And overdose rates five times the rest of the country. But this has also meant that New Mexico got a big head start on nearly every evidence-based strategy now being rolled out elsewhere.

That includes widespread harm reduction and needle exchange programs that are still extremely limited in many states.

PHILIP FIUTY, Santa Fe Mountain Center Outreach Worker: You can just throw those right in here.


PHILIP FIUTY: As long as the lids are tight.

HARI SREENIVASAN: There’s a residential treatment center in the county facility on the banks of the Rio Grande.

And in the outpatient clinic where Perez-Baron works, there are even trauma-based group sessions for low-income Medicaid patients designed to get at the underlying emotional wounds that often fuel addictions.

EUTIMIA SANCHEZ, Las Clinicas del Norte Patient: I was molested when I was young. And I think that’s what happened.

DR. GINA PEREZ-BARON: We don’t have a single patient where trauma doesn’t play a part in their addiction. What addiction is really an effort to avoid pain.

WOMAN: Losing my son, it’s taken lot out of me. I have relapsed over and over.

HARI SREENIVASAN: After more than a decade, these interventions have started paying off, says Lauren Reichelt, the county’s health and human services director.

Overdose death rates fell here in 2015.

LAUREN REICHELT, Rio Arriba County Department of Health and Human Services: We brought it down by 30 percent, which I consider significant. And then it looks like, in 2016, we have held steady. And so that’s at a time when everybody else’s has been increasing.

HARI SREENIVASAN: At the state level, even bigger moves. As early as 2001, New Mexico became the first state to increase access to the overdose reversal drug naloxone, now in widespread use.

WOMAN: It reverses the heroin you just injected.

HARI SREENIVASAN: New Mexico is now a leader in training some at-risk populations on how to reverse an overdose, like inmates preparing to leave Albuquerque’s Metropolitan Detention Center.

NURSE, Metropolitan Detention Center: What I am hoping for is that even just one of you guys can reverse somebody to give that one person a chance to rethink what they’re doing to their lives, what they’re doing to themselves, what they’re doing to their families.

HARI SREENIVASAN: And in Albuquerque Public Schools, one of the largest school districts in the United States, there is early opioid education, like this lesson by a substance abuse prevention counselor in a seventh-grade health class.

KIM CHAVEZ, Crossroads Counselor: Metropolitan Detention Center: So, remember, opioids come in our painkillers and they come in heroin. So look at the difference in this brain.

HARI SREENIVASAN: Despite all those efforts — and the gains in hard-hit Rio Arriba County — the number of overdose deaths statewide is still staggeringly high. Around 500 per year, or 25 deaths per 100,000 residents. The national average is 16 overdose deaths per 100,000.

Many of those bodies show up here on a cold metal table.

Medical investigator Dr. Hannah Kastenbaum:

DR. HANNAH KASTENBAUM, New Mexico Office of the Medical Investigator: Several in a day are concerning for drug deaths, for overdose deaths. Every day, we’re here at one of these tables examining some young person who shouldn’t otherwise be dead. Every day.

HARI SREENIVASAN: New Mexico seems to be doing everything. They have aggressive treatment. They have harm reduction. They have early education. They even track every opioid being prescribed.

So why is it so bad? Part of the answer is the freeway we’re driving on. Two national highways cross New Mexico — I-40 east to west, I-25 north to south. They meet in Albuquerque.

RUDY MORA, Undersheriff, Bernalillo County: We’re jumping on here onto I-40 westbound. This road is literally the pipeline of America.

HARI SREENIVASAN: A pipeline that keeps drugs from Mexico pulsing through the state, says Rudy Mora, the Bernalillo County undersheriff.

Mora says he’s been involved in close to a thousand large-scale drug seizures over the course of his career. Hidden cargo, including heroin, meth, pills, marijuana, frequently travel on from Albuquerque in concealed compartments in tractor-trailers, discovered during routine stops and planned raids along this highway.

Illegal activity and busts are frequent here because New Mexico serves as a Wal-Mart style distribution center in the international drug trade, he says.

RUDY MORA: And once they can get those drugs across the international border, then they can start breaking their drugs apart and distributing them from there.

MIKE GALLAGHER, Investigative Reporter, Albuquerque Journal: They’re looking to see if there’s dope hidden, stuck in there and hidden, covered up by the fruit. And so he’s going to be shining his light and digging through the fruit.

HARI SREENIVASAN: Mike Gallagher, an investigative reporter for The Albuquerque Journal, says Mexican cartels have streamlined the entire process. They now operate deep within the U.S. and control every piece of the pipeline.

MIKE GALLAGHER: From the point of origin, where the poppies are grown, to the lab, to the smuggling organizations to the delivery points in Albuquerque and the Northeast Heights.

HARI SREENIVASAN: One example of many: this now closed auto body shop in Southwest Albuquerque, tied in a federal investigation to the Juarez cartel. In an auto body shop in Mexico, they’d open vehicles up, create secret compartments, and stash drugs inside to get it across the border.

Then they’d come to an auto body shop here in Albuquerque, where those vehicles would be opened up, the drugs would be taken out, money would be put back in, and then the vehicles would go back across.

But the drugs, Gallagher says, continue on.

MIKE GALLAGHER: Oklahoma City, Tulsa, Saint Louis, Memphis, Atlanta, Charleston, into New Jersey, Ohio, and as far north as Massachusetts.

WILL GLASPY, Special Agent in Charge, Drug Enforcement Administration: The Mexican criminal organizations understand that some of their loads are going to be seized. That’s cost of doing business to them.

HARI SREENIVASAN: Will Glaspy is a special agent in charge with the Drug Enforcement Administration. Until recently, he oversaw the El Paso division, which includes New Mexico.

The cartels, Glaspy says, play a numbers game that will continue to be in their favor, unless the U.S. wants to drastically reduce commerce with Mexico. Last year alone, roughly 5.8 million trucks legally dove over the border at points of entry, along with 75 million personal vehicles. More than 42 million pedestrians crossed by foot.

WILL GLASPY: For us, it’s a game of cat and mouse. We’re always looking for the avenues or the cover that the criminal organizations are using to smuggle the drugs. Once we find that, then we can focus on that until the traffickers move to something else.

HARI SREENIVASAN: Confiscated drugs from the nearby border crossings are stored in a drug vault near Glaspy’s old office. Tens of thousands of pounds often line the shelves. But no matter how much is seized, Glaspy says, it’s just a small fraction of what flows in — a sign of a bigger problem.

WILL GLASPY: They have realized that they have got this huge market in the United States, so they have ramped up production of heroin and really flooded the streets of the United States with this deadly poison.

EUTIMIA SANCHEZ: It just blocks the pain is what it does, you know? Numbs it.

HARI SREENIVASAN: Back in Rio Arriba County, stories like Eutimia Sanchez’s help explain why the national opioid epidemic has been so hard to beat back.

In recent years, she turned to pills and cocaine to block her pain — the physical pain from a fall, she says, and the anxiety of everyday life. For long stretches of time, she fights for sobriety. But they’re always interrupted by moments like this:

EUTIMIA SANCHEZ: I relapsed this weekend, before my dad and everybody showed up. The pain is so bad that I just — I can’t. So, you know, I go self-medicate with drugs, you know?

HARI SREENIVASAN: Addiction continues to rage in Rio Arriba County, despite the small band of health providers and their many efforts. Despite aggressive law-enforcement action and the county’s recent drop in death rates.

Dr. Leslie Hayes says treatment can work wonders for individual payments, but this county is still filled with poverty, unemployment, and trauma. Pain in search of a painkiller.

DR. LESLIE HAYES, El Centro Family Health: I have heard law enforcement say we’re not going to arrest our way out of this problem. The same is also true for medicine. We’re not going to treat our way out of this problem. We want to stop it earlier. Stop it by not prescribing inappropriately, and by getting other things in their lives that are meaningful.

HARI SREENIVASAN: The nature of addiction means that most solutions and victories here will continue being small and incremental.

There are times when Sanchez still reaches for drugs. But more often now, times when she reaches for helps.

EUTIMIA SANCHEZ: I will have cravings, and there’s time they have stopped. Because I will call somebody up and take a walk or do something else. They will remind me of the things that we have been working on.

HARI SREENIVASAN: Working to cope … a work in progress.

For the PBS NewsHour, I’m Hari Sreenivasan in New Mexico.


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How a serious illness gave Eugene O’Neill his dark literary power

Author and playwright Eugene O'Neill in the library of his New York Home. (Photo by NY Daily News Archive via Getty Images)

Author and playwright Eugene O’Neill in the library of his New York Home. Photo by NY Daily News Archive via Getty Images

Monday marks the 129th birthday of the Nobel and Pulitzer Prize-winning playwright Eugene O’Neill. Long before he sat down to compose the dramas that have long enlightened and haunted audiences, O’Neill contracted tuberculosis, and like most people suffering serious illnesses, it forever changed him.

In O’Neill’s case (as I wrote several years ago in the Journal of the American Medical Association), the infection was a transformation that enabled him to divine his genius and artistic soul.

O’Neill was the son of a famous actor, James O’Neill, who was constantly touring in plays on the road. As a result of his family and personal history, he famously complained during his last hours of life, “Born in a hotel room and died in a hotel room.” (Indeed, on Nov. 7, 1953, at the age of 65, he did die in a hotel room, the Shelton Hall in Boston.)

READ MORE: F. Scott Fitzgerald’s life was a study in destructive alcoholism

Years earlier, sometime in the fall of 1912, a 24-year-old O’Neill developed a “bad cold” accompanied by tonsillitis that refused to resolve. In the following weeks, he began coughing up blood and developed pleurisy. By Thanksgiving his physician determined that Eugene was suffering from tuberculosis, which in the decades leading up to World War II was the leading cause of death for Americans aged 20 to 45 years.

When it came to tuberculosis, like so many other aspects of life, some seemed to randomly draw the short straw.

O’Neill’s diagnosis of tuberculosis was, of course, recounted in his masterpiece “Long Day’s Journey Into Night.” Less well known is that one of his earliest plays, “The Straw,” was drawn from his experiences as a patient in a tuberculosis sanatorium. Aptly, O’Neill used the metaphor of the children’s game of drawing straws for his title: When it came to tuberculosis, like so many other aspects of life, some seemed to randomly draw more short straws than others.

Written between 1918 and 1919, and set in 1910, “The Straw” depicts a love affair between two patients — a young reporter named Stephen Murray and a young woman, Eileen Carmody — with tuberculosis and markedly different fates. Aside from its literary merit, the play faithfully documents the daily routines of an early 20th-century tuberculosis sanatorium.

In real life, Eugene’s father initially elected to send his son to the Fairfield County State Tuberculosis Sanatorium, in Shelton, Connecticut, a few miles from New Haven. Those who could afford it were charged $4 a week; those who could not were admitted free of charge and supported by the state.

READ MORE: How poet John Keats met his early end

In 1854, a 9-year-old James had immigrated from famine-struck Ireland to the slums of Buffalo, New York. He eventually transformed himself into a successful actor who played on Broadway and across the nation, in roles ranging from Shakespearian leads to, most famously, the Count of Monte Cristo. Yet long after he became relatively wealthy, James O’Neill could never shake off his difficult years of abject poverty and was notoriously tight-fisted.

Portrait of playwright Eugene O'Neill as a child. Courtesy of the Beinecke Rare Book & Manuscript Library

Portrait of playwright Eugene O’Neill as a child. Courtesy of the Beinecke Rare Book & Manuscript Library

Penury aside, the choice of Fairfield suggested that James was not exactly sanguine about Eugene’s chances of recovery. When father and son arrived at the seedy institution on Dec. 9, 1912, they found that the physical plant consisted of little more than a ramshackle clinic building and a smattering of cottages housing exceedingly ill patients. Dressed in a brand new suit that his father had hand-tailored for his son, Eugene was admitted but stayed only two days. Eugene’s low state of mind, combined with an appeal made by his physician, inspired James to cough up the cash and send the young man to a far more “luxurious” facility, the Gaylord Farm Sanatorium in Wallingford, Connecticut.

Regardless of the medical, economic or social circumstances of the patients each facility admitted, the majority of American tuberculosis sanatoria were framed by strict rules on how patients should act, sleep, dress and exercise; what they should eat and when; and even with whom they should and should not associate. Relationships between men and women patients were strictly forbidden.

Patients endured weekly weigh-ins to make sure their disease was being held in check rather than “consuming” their bodies. Those who failed to improve after a trial of the prescribed dietary and fresh-air regimens were often transferred to an “incurables” facility so as not to diminish the “cure rate” of a particular sanatorium, essential to recruiting new and paying customers.

Much of the plot of “The Straw” is based on Eugene’s relationship with another Gaylord Farm Sanatorium patient named Catherine “Kitty” Mackay, who hailed from a working class Irish family in nearby Waterbury. Kitty had been treated at Gaylord for five months a year earlier, but because her mother was dead and she was the principal caregiver for her nine younger sisters and brothers, she was prematurely discharged. When Eugene met her in March of 1913, Kitty was 23 and seriously ill with a TB relapse. O’Neill was attracted by Kitty’s beauty and thirst for knowledge.

READ MORE: The failed Broadway musical I wish every medical student could see

Of note, there were two major infractions at Gaylord that could lead to immediate discharge. The first was drinking alcohol; the second was a love affair between patients. Between his relationship with Kitty and his legendary consumption of alcohol, Eugene broke both these rules but, apparently, with no repercussions.

O’Neill credited his hospitalization with inspiring him to plumb the depths of his psyche, a tool necessary for a life of composing profound dramas.

By May 1913, five months after his admission to Gaylord, Eugene’s weight had increased from 148 to 164 pounds, and his physicians declared him cured. After convincing James that he was no longer a contagious threat, Eugene returned to his family’s seashore cottage, the very home that served as the setting for both of his plays, “Ah Wilderness!” and “Long Day’s Journey Into Night.” He never saw Kitty again. She was discharged six months after Eugene but, according to the Gaylord Farm records, died on May 17, 1915.

Seven months after his release from Gaylord Farm, O’Neill wrote a note of appreciation to his physician David R. Lyman expressing a wish to visit the sanatorium: “If, as they say, it is sweet to visit the place one was born in, then it will be doubly sweet for me to visit the place I was reborn in—for my second birth was the only one which had my full approval.”

Throughout his life, O’Neill credited his hospitalization with inspiring him to plumb the depths of his psyche, a tool necessary for a life of composing profound dramas. In essence, tuberculosis provided O’Neill with a second chance at life, when, as he noted to his physician, “[I] should have been cast down by my fate—and wasn’t.”

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