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"content": "\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"TJaQ7ImJONsaQhBNKC359DYzk8X4H5t4\"]\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "whats-your-california-lawmaker-say-on-cbo-score-on-gop-health-bill",
"title": "What's Your Lawmaker Saying About CBO Score on AHCA?",
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"headTitle": "What’s Your Lawmaker Saying About CBO Score on AHCA? | KQED",
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"content": "\u003cp>After the Congressional Budget Office on Wednesday released its long-awaited score on the Republican health care plan that passed the House of Representatives on May 4, KQED gathered reactions from California’s congressional caucus on the analysis.\u003c/p>\n\u003cp>We asked each of California’s 54 members of Congress — 52 in the House (excluding a vacancy) and the state’s two senators — to comment on the score by the nonpartisan \u003ca href=\"https://www.cbo.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">CBO\u003c/a>, and aggregated their reactions on social media, too. We included links to their Twitter and Facebook pages where you can see some of their statements, plus additional comments they’ve made.\u003c/p>\n\u003cp>Whether the Senate will go along with the House legislation is unclear. But Senate Majority Leader Mitch McConnell has previously said the chamber would first await the CBO score — which includes estimates of the GOP bill’s impact on the federal budget and uninsured Americans — before proceeding.\u003c/p>\n\u003cp>\u003cstrong>Senate\u003c/strong>\u003cstrong>\u003cbr>\nDianne Feinstein\u003cbr>\n\u003c/strong>“The new Republican plan to repeal the \u003cem>Affordable Care Act\u003c/em> is no better than the old plan—23 million Americans still lose health care, Medicaid still gets gutted, premiums will still increase and the richest Americans still reap huge tax cuts.\u003c/p>\n\u003cp>“This version of the bill, which hasn’t received a single congressional hearing, would devastate millions of families and shred our country’s health care safety net. I’ll do all I can to oppose it.”\u003cbr>\n\u003ca href=\"https://twitter.com/SenFeinstein\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/SenatorFeinstein/\">Facebook\u003c/a>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Kamala Harris\u003cbr>\n\u003c/strong>“Access to quality and affordable health care in America should be a right, not a privilege. This nonpartisan report makes clear that if the Republican health care bill becomes law, middle class families will pay more for health care, costs for seniors will increase, 14 million more Americans will be uninsured next year, and 23 million more Americans uninsured over the next decade. This bill is nothing short of a disaster.\u003c/p>\n\u003cp>“Instead of working in a bipartisan, transparent way to lower costs and expand coverage, Senate Republicans have chosen to work in secret behind closed doors, out of view from the American people. A public debate over health care is one the American people need and deserve – doctors, patients, advocates, and stakeholders should all have a seat at the table.\u003c/p>\n\u003cp>“I will continue to urge my Republican colleagues to open up this process, and reject any bill that will raise costs, reduce coverage, or allow discrimination against women, those with pre-existing conditions, and seniors.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/KamalaHarris\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/KamalaHarris/\">Facebook\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\nHouse of Representatives\u003cbr>\nDoug LaMalfa (R-Richvale, District 1)\u003cbr>\n\u003c/strong>\u003cem>From his office: “\u003c/em>The Congressman has not issued a reaction statement at this time. The CBO score has proven to be extremely unreliable in the past. The original CBO score for the ACA assumed that 23 million people would be covered on the exchanges. In 2017, they were off by 12 million people. Patients will have the freedom to choose their own healthcare without the government forcing them to do anything – and it will ultimately lower costs and increase choice for consumers.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepLaMalfa\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLaMalfa/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jared Huffman (D-San Rafael, District 2)\u003cbr>\n\u003c/strong>“VERIFIED: House \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> bill = higher premiums, less coverage, and 23 million more uninsured.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepHuffman\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepHuffman/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>John Garamendi (D-Walnut Grove, District 3)\u003cbr>\n\u003c/strong>“The CBO score for the latest version of TrumpCare confirms what we already knew: the bill is a disaster. 23 million people will lose their health insurance by 2026. Premiums will skyrocket for older, sicker Americans. Insurance will get worse for those who are able to afford it. And many insurance markets could end up destabilized. America’s wealthiest, however, would receive a trillion-dollar tax cut.\u003c/p>\n\u003cp>Those may be the values of President Trump and Speaker Ryan, but those aren’t American values, and I’ll do everything I can to make sure this bill never becomes law.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepGaramendi\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/repgaramendi/\">Facebook\u003c/a>\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Tom McClintock (R-Elk Grove, District 4)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMcClintock\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/jointom/?hc_ref=SEARCH\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mike Thompson (D-St. Helena, District 5)\u003cbr>\n\u003c/strong>“Despite assurances from Speaker Ryan and the President, today’s CBO score confirms that their reckless repeal of the ACA will leave 23 million more Americans without health insurance. That’s unacceptable. Republicans claimed they would replace the ACA with a better healthcare bill, but instead they drafted and passed a bill that would rip healthcare away from families, allow states to end protections for pre-existing conditions, and let insurers charge seniors more just because of their age. This bill is a disaster, and if the President signs it into law, he will be signing away healthcare for men, women, and children all across the country.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepThompson\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMikeThompson/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Doris Matsui (D-Sacramento, District 6)\u003cbr>\n\u003c/strong>“The Congressional Budget Office confirmed today that millions of families would lose health coverage under Trumpcare. House Republicans passed their reckless bill without listening to their constituents about how harmful it would be, and without an independent analysis of its effects.\u003c/p>\n\u003cp>“Now, we learn that the last minute, backroom changes made to the bill right before passage would still leave Americans behind. Health insurance would be ripped away from 23 million Americans, more than $800 billion would be cut from Medicaid, and people with pre-existing conditions and those nearing retirement age would be charged exorbitantly more.\u003c/p>\n\u003cp>“This bill will leave American families paying more for less care, and it must be stopped.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/DorisMatsui\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/doris.matsui/\">Facebook\u003cbr>\n\u003c/a>\u003cstrong>\u003cbr>\nAmi Bera (D-Elk Grove, District 7)\u003cbr>\n\u003c/strong>“As we suspected \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>AHCA\u003c/a> would force older sicker Americans to pay more for less coverage \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\n\u003c/strong>“\u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a> confirms what we suspected: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>AHCA\u003c/a> would still kick 23 million Americans off their health care.\u003c/p>\n\u003cp>Nonpartisan experts say \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>\u003cb>AHCA\u003c/b>\u003c/a> would drive up premiums by 20% NEXT YEAR. This will harm millions of hardworking Americans \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>\u003cb>CBOScore\u003c/b>\u003c/a>“\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBera\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAmiBera/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Paul Cook (R-Yucca Valley, District 8)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepPaulCook\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepPaulCook/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jerry McNerney (D-Stockton, District 9)\u003cbr>\n\u003c/strong>“Higher costs and fewer Americans covered – as a mathematician, I can tell you this just doesn’t add up. \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a>“\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMcNerney\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/jerrymcnerney/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jeff Denham (R-Turlock, District 10)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepJeffDenham\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJeffDenham\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mark DeSaulnier (D-Concord, District 11)\u003c/strong>\u003cbr>\nStatement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepDeSaulnier\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMarkDeSaulnier/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Nancy Pelosi (D-San Francisco, District 12)\u003cbr>\n\u003c/strong>“Today’s devastating CBO score hammers home Trumpcare’s dire consequences for working families and seniors across the country. House Republicans have tattooed themselves with a Trumpcare bill that means higher costs, 23 million hard-working Americans losing coverage, shredding key protections, a crushing age tax and stealing from Medicare.\u003c/p>\n\u003cp>[contextly_sidebar id=”yoYZAgj5Vq479pKM4Q8IddhiqdvzvTSc”]\u003c/p>\n\u003cp>“If House Republicans have their way, many Americans with pre-existing conditions will be pushed off their insurance and forced into high risk pools with soaring costs and frightening limits on the care they need. Some Americans with pre-existing conditions would no longer be able to afford coverage of any kind. Trumpcare would also gut the essential health benefits for millions of Americans, meaning huge cost increases for basic coverage like maternity care, addiction and mental health treatment, and emergency services. Under Trumpcare, after an illness or injury, many Americans will find they’ve been paying for health coverage that doesn’t cover much at all.\u003c/p>\n\u003cp>“Trumpcare is a billionaire’s tax cut disguised as a health care bill: one of the largest transfers of wealth from working families to the rich in our history. Despite the pleas of families across America and the urgent warnings of almost every doctors’ and patient group, Republicans are still pushing to enact this moral monstrosity. Democrats in Congress and across the country will continue to fight with all our strength to protect seniors and hard-working families from Trumpcare.”\u003cbr>\n\u003ca href=\"https://twitter.com/NancyPelosi\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/pelosiforcongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Barbara Lee (D-Oakland, District 13)\u003cbr>\n\u003c/strong>“\u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a> confirms what we’ve known all along: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> is cruel, it’s dangerous & it will rip healthcare from 23 MILLION ppl who need it.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBarbaraLee\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/BarbaraLeeforCongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jackie Speier (D-Peninsula, District 14)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSpeier\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/JackieSpeier/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Eric Swalwell (D-Dublin, District 15)\u003cbr>\n\u003c/strong>Declined to comment.\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSwalwell\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanEricSwalwell/\">Facebook\u003c/a>\u003c/p>\n\u003cp>[contextly_sidebar id=”AjzUMT1G9smdI7uVYvmC8Yh2k4my3LnH”]\u003c/p>\n\u003cp>\u003cstrong>Jim Costa (D-Fresno, District 16)\u003cbr>\n\u003c/strong>“As I have said before, the American Health Care Act is a bad bill, and it was made even worse by the amendments Republicans added before it barely passed the House along party lines. If passed by the Senate and signed into law in its current form, 23 million Americans will lose their health care coverage, many of them seniors, low-income individuals and families, and veterans. In the San Joaquin Valley, the act will harm hundreds of thousands of our friends and neighbors through drastic cuts to Medi-Cal. Today’s Congressional Budget Office’s score affirms just how toxic this bill will be if it becomes law.\u003c/p>\n\u003cp>“Although the Affordable Care Act is not perfect, the American Health Care Act as passed by the House three weeks ago is not the answer. We need to work together on a bipartisan basis to find real solutions to the problems in the ACA, solutions which will increase access to quality and affordable health care coverage for all Americans. The American Health Care Act will do just the opposite, as made clear by today’s Congressional Budget Office score.\u003c/p>\n\u003cp>“Again, I hope the Senate takes seriously the damage this bill would have on our country’s health care system, and either oppose the bill or change it substantially. We simply cannot allow our nation’s health care policy to be another partisan battlefield. We must put the health of our citizens and our country first.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepJimCosta\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJimCosta/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ro Khanna (D-Fremont, District 17)\u003cbr>\n\u003c/strong>“Twenty-three million people at risk of losing their health care is 23 million too many. I find it incredibly hard to believe that Republicans in the House voted to pass this health care bill without knowing what was at stake.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RoKhannaUSA\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRoKhanna/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Anna Eshoo (D-Silicon Valley, District 18)\u003cbr>\n\u003c/strong>“The nonpartisan Congressional Budget Office (CBO) has once again put out the facts on Trumpcare, and they further confirm how damaging the legislation is.\u003c/p>\n\u003cp>After the dead-of-night changes by Republicans, the legislation provides less coverage for higher costs, with 23 million Americans projected to lose their health insurance. Essential health benefits will be eviscerated for millions of Americans, creating huge cost increases for basic coverage such as maternity care, addiction and mental health treatment, and emergency services. The bill also strips away Medicaid from millions of low-income families and children, and imposes a crushing age tax on older Americans.\u003c/p>\n\u003cp>“Republican and Democratic Senators alike have said Trumpcare is dead on arrival in the upper chamber. We can only hope it stays that way.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepAnnaEshoo\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAnnaEshoo/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Zoe Lofgren (D-San Jose, District 19)\u003cbr>\n\u003c/strong>“23 million people lose their health care. What more needs to be said?”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepZoeLofgren\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/zoelofgren/\">Facebook\u003c/a>\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Jimmy Panetta (D-Carmel Valley, District 20)\u003cbr>\n\u003c/strong>“The most recent analysis of the American Health Care Act (AHCA) by the nonpartisan CBO demonstrates that the majority’s changes to their initial bill were just as detrimental as their first attempt. The CBO reports that this quickly and carelessly crafted legislation will leave 23 million Americans uninsured and increase premiums for those who need health care the most. The AHCA targets every day Americans, including people living with pre-existing conditions, expectant mothers, veterans, and those seeking mental health treatment.\u003c/p>\n\u003cp>[contextly_sidebar id=”vcgT4Hj1ZWWqkcttdlmLVQHXwBfB7zbF”]\u003c/p>\n\u003cp>“I remain deeply concerned about the impact that the AHCA would have on the district should it ever pass in its current form in the Senate. I hope that my colleagues in the Senate heed our constituent’s calls for a thoughtful health care plan that helps, not hurts, Americans.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepJimmyPanetta\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJimmyPanetta/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>David Valadao (R-Hanford, District 21)\u003cbr>\n\u003c/strong>“Under the current system, the Central Valley lacks access to quality health care. Costs continue to increase while treatment options and choice decline. By creating a system that encourages competition and puts patients in charge, we will stabilize our health care system. In return, care will improve, costs will go down, and more and more individuals will choose to purchase insurance. While the CBO report doesn’t show the whole picture, it confirms we are on the right path. The American Healthcare Act is just the first step in the process of overhauling our failing health care system and I will continue working to ensure my constituents have access to the best health care possible.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepDavidValadao\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanDavidValadao/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Devin Nunes (R- Tulare, District 22)\u003cbr>\n\u003c/strong>Statement requested\u003cbr>\n\u003ca href=\"https://twitter.com/@Rep_DevinNunes\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/Congressman-Devin-Nunes-376470350795/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Kevin McCarthy (R-Bakersfield, District 23)\u003cbr>\n\u003c/strong>“The CBO reports yet again that our plan will keep a promise \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Obamacare?src=hash\">\u003cs>#\u003c/s>Obamacare\u003c/a> broke—premiums will go down.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>“Obamacare is broken, leaving millions of Americans with fewer choices and higher premiums. That is why the House took action and passed the American Health Care Act. Our plan will lower premiums, create more health care choices, and refocus programs like Medicaid on helping Americans that need it most. Today, the Congressional Budget Office (CBO) affirmed that the multiple layers of work done in the House have produced a bill that meets these principles. The CBO also identified that this bill will reduce the deficit by $119 billion, paving the way for the Senate to do its work to repeal and replace Obamacare.\u003c/p>\n\u003cp>“What hits Americans the hardest with Obamacare are the rising premiums. In fact, the Department of Health and Human Services just reported that average health insurance premiums on the federal Obamacare exchange’s individual market have doubled since 2013 as Obamacare was nearly fully implemented. Coverage is meaningless if you can’t afford it, and Obamacare’s rising premiums have eaten deep into the budgets of millions of Americans. The CBO reports yet again that our plan will keep a promise Obamacare broke—premiums will go down. Congress must act so that people across the country can pay less for health care coverage and finally get relief from a failing law.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@GOPLeader\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanKevinMcCarthy/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>[contextly_sidebar id=”slM3u5fhTJN6JRvWJUC1pulDVAmEICSV”]\u003c/p>\n\u003cp>\u003cstrong>Salud Carbajal (D-Santa Barbara, District 24)\u003cbr>\n\u003c/strong>“Republicans passed their healthcare repeal in the House weeks ago and today, the CBO confirmed just how harmful this bill is in their stunning analysis report. Next year alone, this plan would leave 14 million Americans uninsured, and many with preexisting conditions forced off their insurance plans by skyrocketing premium costs. My colleagues in the Senate must put the health of the American public over political games and outright reject this cruel piece of legislation.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepCarbajal\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CarbajalForCongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Steve Knight (R-Santa Clarita, District 25)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@SteveKnight25\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepresentativeSteveKnight/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Julia Brownley (D-Westlake Village, District 26)\u003cbr>\n\u003c/strong>“Ripping healthcare away from 23 million Americans and eliminating protections for women’s health may be a win for Republican extremism in Congress but it’s a disaster for the American people.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@JuliaBrownley26\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJuliaBrownley/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Judy Chu\u003c/strong>\u003cstrong> (D-Monterey Park, District 27)\u003cbr>\n\u003c/strong>“Thanks to the \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a> score, we now know what they’re celebrating: a plan to kick 23 million off insurance & raise premiums for seniors by 800%”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepJudyChu\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJudyChu/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Adam Schiff (D-Burbank, District 28)\u003cbr>\n\u003c/strong>\u003cstrong>“\u003c/strong>Today, the nonpartisan CBO confirmed that TrumpCare will throw 23 million off their insurance. This ill-considered bill, passed before members could review it or obtain the CBO analysis, increases out of pocket costs, puts caps on coverage, eliminates coverage for those with preexisting conditions, and even imposes an age tax on older Americans. And all of this to give a tax cut some of the country’s wealthiest families.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepAdamSchiff\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAdamSchiff/\">Facebook \u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Tony Cardenas (D-San Fernando Valley, District 29)\u003cbr>\n\u003c/strong>“Next year, literally NEXT YEAR 14 million more ppl will be uninsured if the Republicans continue ramming \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/trumpcare?src=hash\">\u003cs>#\u003c/s>trumpcare\u003c/a> thru congress \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a>\u003c/p>\n\u003cp>“Next up in men deciding women’s healthcare… \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOscore?src=hash\">\u003cs>#\u003c/s>CBOscore\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/trumpcare?src=hash\">\u003cs>#\u003c/s>trumpcare\u003c/a>\u003c/p>\n\u003cp>“Can your grandpa or grandma afford their premium to go up 800 Percent? Can your mom or dad? Can you? \u003ca class=\"twitter-atreply pretty-link js-nav\" href=\"https://twitter.com/AARP\">\u003cs>@\u003c/s>AARP\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOSCORE?src=hash\">\u003cs>#\u003c/s>CBOSCORE\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a>\u003c/p>\n\u003cp>“Ive heard frm a lot of folks that the ban on limits is the 1 thing that kept them from bankruptcy or losing their home.They’re now in danger\u003c/p>\n\u003cp>“Bottom line: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> will force Americans to pay more for less. Seniors, working families, and those w/ pre-ex cndtns will be hit hardest.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepCardenas\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/repcardenas/\">Facebook\u003cbr>\n\u003c/a>\u003cstrong>\u003cbr>\nBrad Sherman\u003c/strong>\u003cstrong> (D-Sherman Oaks, District 30)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@BradSherman\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanBradSherman/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Pete Aguilar (D-San Bernadino, District 31)\u003cbr>\n\u003c/strong>“This new analysis confirms what we feared: this isn’t a health care bill at all. Trumpcare will strip tens of millions of Americans of health care coverage by eviscerating Medicaid. Inland Empire children and seniors will be forced to pay the price for Republicans’ political games. Americans with pre-existing conditions will be at the mercy of their health insurance companies as to whether they’ll have access to coverage. And middle-class families will be forced to foot the bill so millionaires and billionaires can get a tax break. This is shameful.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepPeteAguilar\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/reppeteaguilar/\">Facebook\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\nGrace Napolitano (D-El Monte, District 32)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@gracenapolitano\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepGraceNapolitano/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ted Lieu (D-Torrance, District 33)\u003cbr>\n\u003c/strong>“We all will die. The AHCA, however, will accelerate it for 23 million people.\u003c/p>\n\u003cp>“CBO score shows \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> isn’t just a long-term disaster, it would be an immediate disaster. Premiums will rise by 20% in 2018. \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOSCORE?src=hash\">\u003cs>#\u003c/s>CBOSCORE\u003c/a>.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@tedlieu\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepTedLieu/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>District 34: Vacancy\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Norma Torres (D-Pomona, District 35)\u003cbr>\n\u003c/strong>“The analysis released by CBO comes as no surprise. Just as the first version, the new version of the Republican health plan will leave millions uninsured, provide less coverage, and raise costs for seniors, families, and those with pre-existing conditions. Most troubling for me is that the bulk of the savings come from taking $884 billion out of Medicaid, directly impacting the 300,000 residents of the 35\u003csup>th\u003c/sup> congressional district who rely on Medi-Cal for their healthcare.\u003c/p>\n\u003cp>“This whole ordeal has been an exercise in irresponsible governing. In order to pass their bill, Republicans sacrificed basic services like mental health care and prescription drugs and will allow insurance companies to charge more to women and individuals with pre-existing conditions. There’s a reason Republicans didn’t wait for a CBO score to pass their bill; they knew it was just as bad, if not worse, than the original. The American people deserve better. I hope the Senate will be the voice of reason and put a stop to this disaster before it’s too late.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@NormaJTorres\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepNormaTorres/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Dr. Raul Ruiz (D-Palm Desert, District 36)\u003cbr>\n\u003c/strong>“Today’s revised CBO score confirms that the American Health Care Act is devastating to people across the country. 14 million more will be uninsured within a year and 23 million more will be uninsured over a decade. It explains in dire terms how this bill will shift the burden of costs onto seniors, working families, and patients with pre-existing conditions, hitting hardest the people who need care the most, while giving tax breaks to millionaires. This is far too great a toll on the American people.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@CongressmanRuiz\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanRaulRuizMD/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Karen Bass (D-Los Angeles, District 37)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepKarenBass\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepKarenBass/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Linda Sanchez (D-Orange, District 38)\u003cbr>\n\u003c/strong>“Republicans recklessly rushed to pass a bill without knowing the impact their legislation would have on our country. What we now know is Republicans voted to kick 23 million Americans off of their insurance. Millions of those who would still have insurance would be covered by stripped down plans, gutted of essential health benefits, that barely provide any protection at all. Even more troubling, is the CBO’s view that under Trumpcare insurance may become unaffordable for people with pre-existing conditions, essentially a death sentence for older and sicker Americans.”\u003c/p>\n\u003cp>“House Republicans passed a bad bill and now they have to own the consequences of that vote. They put their own politics ahead of the wellbeing of their constituents. Hardworking Americans would be the biggest losers under Trumpcare. For seven years, Republicans said they had the ‘Better Way.’ This CBO report shows the Republican plan is the wrong way for America.”\u003cbr>\n\u003ca href=\"https://twitter.com/@RepLindaSanchez\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongresswomanLindaSanchez/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ed Royce (R-Fullerton, District 39)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepEdRoyce\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/EdRoyce/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Lucille Roybal-Allard (D-Los Angel\u003c/strong>\u003cstrong>es, District 40)\u003cbr>\n\u003c/strong>“BIG NEWS: The \u003ca class=\"twitter-atreply pretty-link js-nav\" href=\"https://twitter.com/HouseGOP\">\u003cs>@\u003c/s>HouseGOP\u003c/a> ACA repeal would rip away 23 million Americans’ health coverage. I proudly voted against this disgraceful bill.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepRoybalAllard\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRoybalAllard/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mark Takano (D-Riverside, District 41)\u003cbr>\n\u003c/strong>“The \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a> score is in: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> 3.0 still means 23 million fewer Americans with coverage by 2026. Proud to have voted no.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepMarkTakano\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMarkTakano/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ken Calvert (R-Corona, District 42)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/KenCalvert\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepKenCalvert/?ref=br_rs\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Maxine Waters (D-Inglewood, District 43)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/MaxineWaters\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/MaxineWaters/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Nanette Barragan (D-San Pedro, District 44)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBarragan\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongresswomanBarragan/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mimi Walters (R-Laguna Niguel, District 45)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMimiWalters\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMimiWalters/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Lou Correa (D-Santa Ana, District 46)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepLouCorrea\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLouCorrea/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Alan Lowenthal (D-Long Beach, District 47)\u003cbr>\n\u003c/strong>“The Congressional Budget Office (CBO) has again detailed how cruel the GOP healthcare plan is, despite the House GOPs best attempts to make it sound like an improvement. The approved House version from the GOP will result in tens of millions of Americans losing healthcare coverage. According to the CBO, 14 million people in the first year, reaching a total of 23 million by 2026. The CBO estimates that in total, 51 million Americans will be without health insurance by 2026 under the GOP plan. Exactly like the President’s budget released yesterday, the Republican health bill gouges the poor to pay for tax cuts to the rich. Make no mistake, this plan would seriously hurt the people across the country that need healthcare the most. And I could never, and will never, support such a heartless and ill-conceived plan.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepLowenthal\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLowenthal/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Dana Rohrabacher (R-Costa Mesa, District 48)\u003cbr>\n\u003c/strong>Declined to comment.\u003cbr>\n\u003ca href=\"https://twitter.com/DanaRohrabacher\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRohrabacher/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Darrell Issa (R-Vista, District 49)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/DarrellIssa\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanIssa/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Duncan D. Hunter (R-Lakeside, District 50)\u003cbr>\n\u003c/strong>Statement requested\u003cem>\u003cbr>\n\u003c/em>\u003ca href=\"https://twitter.com/Rep_Hunter\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/DuncanHunter/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Juan Vargas (D-San Diego, District 51)\u003cbr>\n\u003c/strong>Statement requested\u003cbr>\n\u003ca href=\"https://twitter.com/RepJuanVargas\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJuanVargas/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Scott Peters (D-La Jolla, District 52)\u003cbr>\n\u003c/strong>“The Republican healthcare repeal bill puts a huge burden on the backs of working families and seniors to pave the way for a tax cut for the wealthiest Americans. Instead of fixing what isn’t working in our healthcare system, this bill would make it worse: destabilizing insurance markets in some parts of the country, putting health insurance out of the reach of many Americans with pre-existing conditions, and even weakening employer-based plans in states that waive essential health benefits.\u003c/p>\n\u003cp>“In San Diego, this bill would be particularly hard on our veterans. The drastic cuts to Medicaid would rip the rug out from under thousands of veterans and their families who depend on the program for healthcare. Many veterans aren’t even eligible for the tax credits in this plan, which would make it more difficult for them to afford coverage. Our veterans have earned better than this.\u003c/p>\n\u003cp>“When you have a healthcare plan that would lead to 23 million fewer Americans having health insurance, is opposed by hospitals, doctors, and nurses, and throws our seniors, veterans, and working families out in the cold, it’s pretty clear that you need to go back to the drawing board. I’m ready to get to work with everyone – Republicans and Democrats – on a real plan to fix our healthcare system.”\u003cbr>\n\u003ca href=\"https://twitter.com/@ScottPetersSD\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepScottPeters/\">Facebook\u003c/a>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>Susan Davis (D-San Diego, District 53)\u003cbr>\n\u003c/strong>“The CBO report confirms the fears I have been hearing from my constituents. TrumpCare will still leave millions uninsured, increase premiums, and discriminate against people with pre-existing conditions. It’s not too late for Republicans to join with Democrats and work together to build on the success of the Affordable Care Act.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSusanDavis\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepSusanDavis/\">Facebook\u003c/a>\u003c/p>\n\n",
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"title": "What's Your Lawmaker Saying About CBO Score on AHCA? | KQED",
"description": "After the Congressional Budget Office on Wednesday released its long-awaited score on the Republican health care plan that passed the House of Representatives on May 4, KQED gathered reactions from California's congressional caucus on the analysis. We asked each of California's 54 members of Congress — 52 in the House (excluding a vacancy) and the state's two senators — to comment on the score by the nonpartisan CBO, and aggregated their reactions on social media, too. We included links to their Twitter and Facebook pages where you can see some of their statements, plus additional comments they’ve made. Whether the Senate will go along",
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"headline": "What's Your Lawmaker Saying About CBO Score on AHCA?",
"datePublished": "2017-05-24T16:27:37-07:00",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After the Congressional Budget Office on Wednesday released its long-awaited score on the Republican health care plan that passed the House of Representatives on May 4, KQED gathered reactions from California’s congressional caucus on the analysis.\u003c/p>\n\u003cp>We asked each of California’s 54 members of Congress — 52 in the House (excluding a vacancy) and the state’s two senators — to comment on the score by the nonpartisan \u003ca href=\"https://www.cbo.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">CBO\u003c/a>, and aggregated their reactions on social media, too. We included links to their Twitter and Facebook pages where you can see some of their statements, plus additional comments they’ve made.\u003c/p>\n\u003cp>Whether the Senate will go along with the House legislation is unclear. But Senate Majority Leader Mitch McConnell has previously said the chamber would first await the CBO score — which includes estimates of the GOP bill’s impact on the federal budget and uninsured Americans — before proceeding.\u003c/p>\n\u003cp>\u003cstrong>Senate\u003c/strong>\u003cstrong>\u003cbr>\nDianne Feinstein\u003cbr>\n\u003c/strong>“The new Republican plan to repeal the \u003cem>Affordable Care Act\u003c/em> is no better than the old plan—23 million Americans still lose health care, Medicaid still gets gutted, premiums will still increase and the richest Americans still reap huge tax cuts.\u003c/p>\n\u003cp>“This version of the bill, which hasn’t received a single congressional hearing, would devastate millions of families and shred our country’s health care safety net. I’ll do all I can to oppose it.”\u003cbr>\n\u003ca href=\"https://twitter.com/SenFeinstein\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/SenatorFeinstein/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Kamala Harris\u003cbr>\n\u003c/strong>“Access to quality and affordable health care in America should be a right, not a privilege. This nonpartisan report makes clear that if the Republican health care bill becomes law, middle class families will pay more for health care, costs for seniors will increase, 14 million more Americans will be uninsured next year, and 23 million more Americans uninsured over the next decade. This bill is nothing short of a disaster.\u003c/p>\n\u003cp>“Instead of working in a bipartisan, transparent way to lower costs and expand coverage, Senate Republicans have chosen to work in secret behind closed doors, out of view from the American people. A public debate over health care is one the American people need and deserve – doctors, patients, advocates, and stakeholders should all have a seat at the table.\u003c/p>\n\u003cp>“I will continue to urge my Republican colleagues to open up this process, and reject any bill that will raise costs, reduce coverage, or allow discrimination against women, those with pre-existing conditions, and seniors.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/KamalaHarris\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/KamalaHarris/\">Facebook\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\nHouse of Representatives\u003cbr>\nDoug LaMalfa (R-Richvale, District 1)\u003cbr>\n\u003c/strong>\u003cem>From his office: “\u003c/em>The Congressman has not issued a reaction statement at this time. The CBO score has proven to be extremely unreliable in the past. The original CBO score for the ACA assumed that 23 million people would be covered on the exchanges. In 2017, they were off by 12 million people. Patients will have the freedom to choose their own healthcare without the government forcing them to do anything – and it will ultimately lower costs and increase choice for consumers.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepLaMalfa\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLaMalfa/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jared Huffman (D-San Rafael, District 2)\u003cbr>\n\u003c/strong>“VERIFIED: House \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> bill = higher premiums, less coverage, and 23 million more uninsured.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepHuffman\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepHuffman/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>John Garamendi (D-Walnut Grove, District 3)\u003cbr>\n\u003c/strong>“The CBO score for the latest version of TrumpCare confirms what we already knew: the bill is a disaster. 23 million people will lose their health insurance by 2026. Premiums will skyrocket for older, sicker Americans. Insurance will get worse for those who are able to afford it. And many insurance markets could end up destabilized. America’s wealthiest, however, would receive a trillion-dollar tax cut.\u003c/p>\n\u003cp>Those may be the values of President Trump and Speaker Ryan, but those aren’t American values, and I’ll do everything I can to make sure this bill never becomes law.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepGaramendi\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/repgaramendi/\">Facebook\u003c/a>\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Tom McClintock (R-Elk Grove, District 4)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMcClintock\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/jointom/?hc_ref=SEARCH\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mike Thompson (D-St. Helena, District 5)\u003cbr>\n\u003c/strong>“Despite assurances from Speaker Ryan and the President, today’s CBO score confirms that their reckless repeal of the ACA will leave 23 million more Americans without health insurance. That’s unacceptable. Republicans claimed they would replace the ACA with a better healthcare bill, but instead they drafted and passed a bill that would rip healthcare away from families, allow states to end protections for pre-existing conditions, and let insurers charge seniors more just because of their age. This bill is a disaster, and if the President signs it into law, he will be signing away healthcare for men, women, and children all across the country.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepThompson\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMikeThompson/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Doris Matsui (D-Sacramento, District 6)\u003cbr>\n\u003c/strong>“The Congressional Budget Office confirmed today that millions of families would lose health coverage under Trumpcare. House Republicans passed their reckless bill without listening to their constituents about how harmful it would be, and without an independent analysis of its effects.\u003c/p>\n\u003cp>“Now, we learn that the last minute, backroom changes made to the bill right before passage would still leave Americans behind. Health insurance would be ripped away from 23 million Americans, more than $800 billion would be cut from Medicaid, and people with pre-existing conditions and those nearing retirement age would be charged exorbitantly more.\u003c/p>\n\u003cp>“This bill will leave American families paying more for less care, and it must be stopped.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/DorisMatsui\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/doris.matsui/\">Facebook\u003cbr>\n\u003c/a>\u003cstrong>\u003cbr>\nAmi Bera (D-Elk Grove, District 7)\u003cbr>\n\u003c/strong>“As we suspected \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>AHCA\u003c/a> would force older sicker Americans to pay more for less coverage \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\n\u003c/strong>“\u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a> confirms what we suspected: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>AHCA\u003c/a> would still kick 23 million Americans off their health care.\u003c/p>\n\u003cp>Nonpartisan experts say \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/AHCA?src=hash\">\u003cs>#\u003c/s>\u003cb>AHCA\u003c/b>\u003c/a> would drive up premiums by 20% NEXT YEAR. This will harm millions of hardworking Americans \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>\u003cb>CBOScore\u003c/b>\u003c/a>“\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBera\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAmiBera/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Paul Cook (R-Yucca Valley, District 8)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepPaulCook\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepPaulCook/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jerry McNerney (D-Stockton, District 9)\u003cbr>\n\u003c/strong>“Higher costs and fewer Americans covered – as a mathematician, I can tell you this just doesn’t add up. \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a>“\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMcNerney\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/jerrymcnerney/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jeff Denham (R-Turlock, District 10)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepJeffDenham\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJeffDenham\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mark DeSaulnier (D-Concord, District 11)\u003c/strong>\u003cbr>\nStatement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepDeSaulnier\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMarkDeSaulnier/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Nancy Pelosi (D-San Francisco, District 12)\u003cbr>\n\u003c/strong>“Today’s devastating CBO score hammers home Trumpcare’s dire consequences for working families and seniors across the country. House Republicans have tattooed themselves with a Trumpcare bill that means higher costs, 23 million hard-working Americans losing coverage, shredding key protections, a crushing age tax and stealing from Medicare.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“If House Republicans have their way, many Americans with pre-existing conditions will be pushed off their insurance and forced into high risk pools with soaring costs and frightening limits on the care they need. Some Americans with pre-existing conditions would no longer be able to afford coverage of any kind. Trumpcare would also gut the essential health benefits for millions of Americans, meaning huge cost increases for basic coverage like maternity care, addiction and mental health treatment, and emergency services. Under Trumpcare, after an illness or injury, many Americans will find they’ve been paying for health coverage that doesn’t cover much at all.\u003c/p>\n\u003cp>“Trumpcare is a billionaire’s tax cut disguised as a health care bill: one of the largest transfers of wealth from working families to the rich in our history. Despite the pleas of families across America and the urgent warnings of almost every doctors’ and patient group, Republicans are still pushing to enact this moral monstrosity. Democrats in Congress and across the country will continue to fight with all our strength to protect seniors and hard-working families from Trumpcare.”\u003cbr>\n\u003ca href=\"https://twitter.com/NancyPelosi\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/pelosiforcongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Barbara Lee (D-Oakland, District 13)\u003cbr>\n\u003c/strong>“\u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOScore?src=hash\">\u003cs>#\u003c/s>CBOScore\u003c/a> confirms what we’ve known all along: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> is cruel, it’s dangerous & it will rip healthcare from 23 MILLION ppl who need it.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBarbaraLee\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/BarbaraLeeforCongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Jackie Speier (D-Peninsula, District 14)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSpeier\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/JackieSpeier/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Eric Swalwell (D-Dublin, District 15)\u003cbr>\n\u003c/strong>Declined to comment.\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSwalwell\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanEricSwalwell/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Jim Costa (D-Fresno, District 16)\u003cbr>\n\u003c/strong>“As I have said before, the American Health Care Act is a bad bill, and it was made even worse by the amendments Republicans added before it barely passed the House along party lines. If passed by the Senate and signed into law in its current form, 23 million Americans will lose their health care coverage, many of them seniors, low-income individuals and families, and veterans. In the San Joaquin Valley, the act will harm hundreds of thousands of our friends and neighbors through drastic cuts to Medi-Cal. Today’s Congressional Budget Office’s score affirms just how toxic this bill will be if it becomes law.\u003c/p>\n\u003cp>“Although the Affordable Care Act is not perfect, the American Health Care Act as passed by the House three weeks ago is not the answer. We need to work together on a bipartisan basis to find real solutions to the problems in the ACA, solutions which will increase access to quality and affordable health care coverage for all Americans. The American Health Care Act will do just the opposite, as made clear by today’s Congressional Budget Office score.\u003c/p>\n\u003cp>“Again, I hope the Senate takes seriously the damage this bill would have on our country’s health care system, and either oppose the bill or change it substantially. We simply cannot allow our nation’s health care policy to be another partisan battlefield. We must put the health of our citizens and our country first.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepJimCosta\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJimCosta/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ro Khanna (D-Fremont, District 17)\u003cbr>\n\u003c/strong>“Twenty-three million people at risk of losing their health care is 23 million too many. I find it incredibly hard to believe that Republicans in the House voted to pass this health care bill without knowing what was at stake.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RoKhannaUSA\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRoKhanna/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Anna Eshoo (D-Silicon Valley, District 18)\u003cbr>\n\u003c/strong>“The nonpartisan Congressional Budget Office (CBO) has once again put out the facts on Trumpcare, and they further confirm how damaging the legislation is.\u003c/p>\n\u003cp>After the dead-of-night changes by Republicans, the legislation provides less coverage for higher costs, with 23 million Americans projected to lose their health insurance. Essential health benefits will be eviscerated for millions of Americans, creating huge cost increases for basic coverage such as maternity care, addiction and mental health treatment, and emergency services. The bill also strips away Medicaid from millions of low-income families and children, and imposes a crushing age tax on older Americans.\u003c/p>\n\u003cp>“Republican and Democratic Senators alike have said Trumpcare is dead on arrival in the upper chamber. We can only hope it stays that way.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepAnnaEshoo\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAnnaEshoo/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Zoe Lofgren (D-San Jose, District 19)\u003cbr>\n\u003c/strong>“23 million people lose their health care. What more needs to be said?”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepZoeLofgren\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/zoelofgren/\">Facebook\u003c/a>\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Jimmy Panetta (D-Carmel Valley, District 20)\u003cbr>\n\u003c/strong>“The most recent analysis of the American Health Care Act (AHCA) by the nonpartisan CBO demonstrates that the majority’s changes to their initial bill were just as detrimental as their first attempt. The CBO reports that this quickly and carelessly crafted legislation will leave 23 million Americans uninsured and increase premiums for those who need health care the most. The AHCA targets every day Americans, including people living with pre-existing conditions, expectant mothers, veterans, and those seeking mental health treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I remain deeply concerned about the impact that the AHCA would have on the district should it ever pass in its current form in the Senate. I hope that my colleagues in the Senate heed our constituent’s calls for a thoughtful health care plan that helps, not hurts, Americans.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepJimmyPanetta\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJimmyPanetta/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>David Valadao (R-Hanford, District 21)\u003cbr>\n\u003c/strong>“Under the current system, the Central Valley lacks access to quality health care. Costs continue to increase while treatment options and choice decline. By creating a system that encourages competition and puts patients in charge, we will stabilize our health care system. In return, care will improve, costs will go down, and more and more individuals will choose to purchase insurance. While the CBO report doesn’t show the whole picture, it confirms we are on the right path. The American Healthcare Act is just the first step in the process of overhauling our failing health care system and I will continue working to ensure my constituents have access to the best health care possible.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepDavidValadao\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanDavidValadao/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Devin Nunes (R- Tulare, District 22)\u003cbr>\n\u003c/strong>Statement requested\u003cbr>\n\u003ca href=\"https://twitter.com/@Rep_DevinNunes\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/Congressman-Devin-Nunes-376470350795/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Kevin McCarthy (R-Bakersfield, District 23)\u003cbr>\n\u003c/strong>“The CBO reports yet again that our plan will keep a promise \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Obamacare?src=hash\">\u003cs>#\u003c/s>Obamacare\u003c/a> broke—premiums will go down.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>“Obamacare is broken, leaving millions of Americans with fewer choices and higher premiums. That is why the House took action and passed the American Health Care Act. Our plan will lower premiums, create more health care choices, and refocus programs like Medicaid on helping Americans that need it most. Today, the Congressional Budget Office (CBO) affirmed that the multiple layers of work done in the House have produced a bill that meets these principles. The CBO also identified that this bill will reduce the deficit by $119 billion, paving the way for the Senate to do its work to repeal and replace Obamacare.\u003c/p>\n\u003cp>“What hits Americans the hardest with Obamacare are the rising premiums. In fact, the Department of Health and Human Services just reported that average health insurance premiums on the federal Obamacare exchange’s individual market have doubled since 2013 as Obamacare was nearly fully implemented. Coverage is meaningless if you can’t afford it, and Obamacare’s rising premiums have eaten deep into the budgets of millions of Americans. The CBO reports yet again that our plan will keep a promise Obamacare broke—premiums will go down. Congress must act so that people across the country can pay less for health care coverage and finally get relief from a failing law.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@GOPLeader\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanKevinMcCarthy/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Salud Carbajal (D-Santa Barbara, District 24)\u003cbr>\n\u003c/strong>“Republicans passed their healthcare repeal in the House weeks ago and today, the CBO confirmed just how harmful this bill is in their stunning analysis report. Next year alone, this plan would leave 14 million Americans uninsured, and many with preexisting conditions forced off their insurance plans by skyrocketing premium costs. My colleagues in the Senate must put the health of the American public over political games and outright reject this cruel piece of legislation.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepCarbajal\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CarbajalForCongress/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Steve Knight (R-Santa Clarita, District 25)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@SteveKnight25\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepresentativeSteveKnight/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Julia Brownley (D-Westlake Village, District 26)\u003cbr>\n\u003c/strong>“Ripping healthcare away from 23 million Americans and eliminating protections for women’s health may be a win for Republican extremism in Congress but it’s a disaster for the American people.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@JuliaBrownley26\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJuliaBrownley/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Judy Chu\u003c/strong>\u003cstrong> (D-Monterey Park, District 27)\u003cbr>\n\u003c/strong>“Thanks to the \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a> score, we now know what they’re celebrating: a plan to kick 23 million off insurance & raise premiums for seniors by 800%”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepJudyChu\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJudyChu/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Adam Schiff (D-Burbank, District 28)\u003cbr>\n\u003c/strong>\u003cstrong>“\u003c/strong>Today, the nonpartisan CBO confirmed that TrumpCare will throw 23 million off their insurance. This ill-considered bill, passed before members could review it or obtain the CBO analysis, increases out of pocket costs, puts caps on coverage, eliminates coverage for those with preexisting conditions, and even imposes an age tax on older Americans. And all of this to give a tax cut some of the country’s wealthiest families.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepAdamSchiff\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepAdamSchiff/\">Facebook \u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Tony Cardenas (D-San Fernando Valley, District 29)\u003cbr>\n\u003c/strong>“Next year, literally NEXT YEAR 14 million more ppl will be uninsured if the Republicans continue ramming \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/trumpcare?src=hash\">\u003cs>#\u003c/s>trumpcare\u003c/a> thru congress \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a>\u003c/p>\n\u003cp>“Next up in men deciding women’s healthcare… \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOscore?src=hash\">\u003cs>#\u003c/s>CBOscore\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/trumpcare?src=hash\">\u003cs>#\u003c/s>trumpcare\u003c/a>\u003c/p>\n\u003cp>“Can your grandpa or grandma afford their premium to go up 800 Percent? Can your mom or dad? Can you? \u003ca class=\"twitter-atreply pretty-link js-nav\" href=\"https://twitter.com/AARP\">\u003cs>@\u003c/s>AARP\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOSCORE?src=hash\">\u003cs>#\u003c/s>CBOSCORE\u003c/a> \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a>\u003c/p>\n\u003cp>“Ive heard frm a lot of folks that the ban on limits is the 1 thing that kept them from bankruptcy or losing their home.They’re now in danger\u003c/p>\n\u003cp>“Bottom line: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> will force Americans to pay more for less. Seniors, working families, and those w/ pre-ex cndtns will be hit hardest.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepCardenas\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/repcardenas/\">Facebook\u003cbr>\n\u003c/a>\u003cstrong>\u003cbr>\nBrad Sherman\u003c/strong>\u003cstrong> (D-Sherman Oaks, District 30)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@BradSherman\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanBradSherman/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Pete Aguilar (D-San Bernadino, District 31)\u003cbr>\n\u003c/strong>“This new analysis confirms what we feared: this isn’t a health care bill at all. Trumpcare will strip tens of millions of Americans of health care coverage by eviscerating Medicaid. Inland Empire children and seniors will be forced to pay the price for Republicans’ political games. Americans with pre-existing conditions will be at the mercy of their health insurance companies as to whether they’ll have access to coverage. And middle-class families will be forced to foot the bill so millionaires and billionaires can get a tax break. This is shameful.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepPeteAguilar\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/reppeteaguilar/\">Facebook\u003c/a>\u003cbr>\n\u003cstrong>\u003cbr>\nGrace Napolitano (D-El Monte, District 32)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@gracenapolitano\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepGraceNapolitano/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ted Lieu (D-Torrance, District 33)\u003cbr>\n\u003c/strong>“We all will die. The AHCA, however, will accelerate it for 23 million people.\u003c/p>\n\u003cp>“CBO score shows \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/Trumpcare?src=hash\">\u003cs>#\u003c/s>Trumpcare\u003c/a> isn’t just a long-term disaster, it would be an immediate disaster. Premiums will rise by 20% in 2018. \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBOSCORE?src=hash\">\u003cs>#\u003c/s>CBOSCORE\u003c/a>.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@tedlieu\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepTedLieu/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>District 34: Vacancy\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Norma Torres (D-Pomona, District 35)\u003cbr>\n\u003c/strong>“The analysis released by CBO comes as no surprise. Just as the first version, the new version of the Republican health plan will leave millions uninsured, provide less coverage, and raise costs for seniors, families, and those with pre-existing conditions. Most troubling for me is that the bulk of the savings come from taking $884 billion out of Medicaid, directly impacting the 300,000 residents of the 35\u003csup>th\u003c/sup> congressional district who rely on Medi-Cal for their healthcare.\u003c/p>\n\u003cp>“This whole ordeal has been an exercise in irresponsible governing. In order to pass their bill, Republicans sacrificed basic services like mental health care and prescription drugs and will allow insurance companies to charge more to women and individuals with pre-existing conditions. There’s a reason Republicans didn’t wait for a CBO score to pass their bill; they knew it was just as bad, if not worse, than the original. The American people deserve better. I hope the Senate will be the voice of reason and put a stop to this disaster before it’s too late.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@NormaJTorres\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepNormaTorres/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Dr. Raul Ruiz (D-Palm Desert, District 36)\u003cbr>\n\u003c/strong>“Today’s revised CBO score confirms that the American Health Care Act is devastating to people across the country. 14 million more will be uninsured within a year and 23 million more will be uninsured over a decade. It explains in dire terms how this bill will shift the burden of costs onto seniors, working families, and patients with pre-existing conditions, hitting hardest the people who need care the most, while giving tax breaks to millionaires. This is far too great a toll on the American people.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@CongressmanRuiz\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanRaulRuizMD/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Karen Bass (D-Los Angeles, District 37)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepKarenBass\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepKarenBass/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Linda Sanchez (D-Orange, District 38)\u003cbr>\n\u003c/strong>“Republicans recklessly rushed to pass a bill without knowing the impact their legislation would have on our country. What we now know is Republicans voted to kick 23 million Americans off of their insurance. Millions of those who would still have insurance would be covered by stripped down plans, gutted of essential health benefits, that barely provide any protection at all. Even more troubling, is the CBO’s view that under Trumpcare insurance may become unaffordable for people with pre-existing conditions, essentially a death sentence for older and sicker Americans.”\u003c/p>\n\u003cp>“House Republicans passed a bad bill and now they have to own the consequences of that vote. They put their own politics ahead of the wellbeing of their constituents. Hardworking Americans would be the biggest losers under Trumpcare. For seven years, Republicans said they had the ‘Better Way.’ This CBO report shows the Republican plan is the wrong way for America.”\u003cbr>\n\u003ca href=\"https://twitter.com/@RepLindaSanchez\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongresswomanLindaSanchez/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ed Royce (R-Fullerton, District 39)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepEdRoyce\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/EdRoyce/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Lucille Roybal-Allard (D-Los Angel\u003c/strong>\u003cstrong>es, District 40)\u003cbr>\n\u003c/strong>“BIG NEWS: The \u003ca class=\"twitter-atreply pretty-link js-nav\" href=\"https://twitter.com/HouseGOP\">\u003cs>@\u003c/s>HouseGOP\u003c/a> ACA repeal would rip away 23 million Americans’ health coverage. I proudly voted against this disgraceful bill.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/@RepRoybalAllard\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRoybalAllard/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mark Takano (D-Riverside, District 41)\u003cbr>\n\u003c/strong>“The \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/CBO?src=hash\">\u003cs>#\u003c/s>CBO\u003c/a> score is in: \u003ca class=\"twitter-hashtag pretty-link js-nav\" href=\"https://twitter.com/hashtag/TrumpCare?src=hash\">\u003cs>#\u003c/s>TrumpCare\u003c/a> 3.0 still means 23 million fewer Americans with coverage by 2026. Proud to have voted no.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepMarkTakano\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMarkTakano/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Ken Calvert (R-Corona, District 42)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/KenCalvert\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepKenCalvert/?ref=br_rs\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Maxine Waters (D-Inglewood, District 43)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/MaxineWaters\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/MaxineWaters/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Nanette Barragan (D-San Pedro, District 44)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepBarragan\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongresswomanBarragan/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Mimi Walters (R-Laguna Niguel, District 45)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepMimiWalters\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepMimiWalters/\">Facebook\u003cbr>\n\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Lou Correa (D-Santa Ana, District 46)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepLouCorrea\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLouCorrea/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Alan Lowenthal (D-Long Beach, District 47)\u003cbr>\n\u003c/strong>“The Congressional Budget Office (CBO) has again detailed how cruel the GOP healthcare plan is, despite the House GOPs best attempts to make it sound like an improvement. The approved House version from the GOP will result in tens of millions of Americans losing healthcare coverage. According to the CBO, 14 million people in the first year, reaching a total of 23 million by 2026. The CBO estimates that in total, 51 million Americans will be without health insurance by 2026 under the GOP plan. Exactly like the President’s budget released yesterday, the Republican health bill gouges the poor to pay for tax cuts to the rich. Make no mistake, this plan would seriously hurt the people across the country that need healthcare the most. And I could never, and will never, support such a heartless and ill-conceived plan.”\u003cbr>\n\u003ca href=\"https://twitter.com/RepLowenthal\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepLowenthal/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Dana Rohrabacher (R-Costa Mesa, District 48)\u003cbr>\n\u003c/strong>Declined to comment.\u003cbr>\n\u003ca href=\"https://twitter.com/DanaRohrabacher\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepRohrabacher/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Darrell Issa (R-Vista, District 49)\u003cbr>\n\u003c/strong>Statement requested\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/DarrellIssa\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/CongressmanIssa/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Duncan D. Hunter (R-Lakeside, District 50)\u003cbr>\n\u003c/strong>Statement requested\u003cem>\u003cbr>\n\u003c/em>\u003ca href=\"https://twitter.com/Rep_Hunter\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/DuncanHunter/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Juan Vargas (D-San Diego, District 51)\u003cbr>\n\u003c/strong>Statement requested\u003cbr>\n\u003ca href=\"https://twitter.com/RepJuanVargas\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepJuanVargas/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Scott Peters (D-La Jolla, District 52)\u003cbr>\n\u003c/strong>“The Republican healthcare repeal bill puts a huge burden on the backs of working families and seniors to pave the way for a tax cut for the wealthiest Americans. Instead of fixing what isn’t working in our healthcare system, this bill would make it worse: destabilizing insurance markets in some parts of the country, putting health insurance out of the reach of many Americans with pre-existing conditions, and even weakening employer-based plans in states that waive essential health benefits.\u003c/p>\n\u003cp>“In San Diego, this bill would be particularly hard on our veterans. The drastic cuts to Medicaid would rip the rug out from under thousands of veterans and their families who depend on the program for healthcare. Many veterans aren’t even eligible for the tax credits in this plan, which would make it more difficult for them to afford coverage. Our veterans have earned better than this.\u003c/p>\n\u003cp>“When you have a healthcare plan that would lead to 23 million fewer Americans having health insurance, is opposed by hospitals, doctors, and nurses, and throws our seniors, veterans, and working families out in the cold, it’s pretty clear that you need to go back to the drawing board. I’m ready to get to work with everyone – Republicans and Democrats – on a real plan to fix our healthcare system.”\u003cbr>\n\u003ca href=\"https://twitter.com/@ScottPetersSD\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepScottPeters/\">Facebook\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Susan Davis (D-San Diego, District 53)\u003cbr>\n\u003c/strong>“The CBO report confirms the fears I have been hearing from my constituents. TrumpCare will still leave millions uninsured, increase premiums, and discriminate against people with pre-existing conditions. It’s not too late for Republicans to join with Democrats and work together to build on the success of the Affordable Care Act.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003ca href=\"https://twitter.com/RepSusanDavis\">Twitter\u003c/a>, \u003ca href=\"https://www.facebook.com/RepSusanDavis/\">Facebook\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>As Congress continues to battle over the \u003ca href=\"https://www.bloomberg.com/politics/articles/2017-05-18/house-may-be-forced-to-vote-again-on-gop-s-obamacare-repeal-bill\" target=\"_blank\" rel=\"noopener noreferrer\">future of health care\u003c/a> in America and, by extension, the fate of millions of Californians who currently receive coverage through the Affordable Care Act (ACA), we found ourselves asking a simple question: Where do California’s lawmakers get their health insurance?\u003c/p>\n\u003cp>Before the ACA fully went into effect in 2014, members of Congress received their coverage through the \u003ca href=\"https://www.opm.gov/healthcare-insurance/healthcare/\" target=\"_blank\" rel=\"noopener noreferrer\">Federal Employees Health Benefits Program\u003c/a>, or FEHB. But the ACA required lawmakers and their staff to leave FEHB and get coverage through the local insurance marketplaces, called “exchanges,” set up by the new law. Many started receiving this new coverage on Jan. 1, 2014.\u003c/p>\n\u003cp>Now, if a representative or senator wants to get health care as part of their work in Washington, D.C., they are eligible to purchase a private plan through \u003ca href=\"https://dchealthlink.com/\" target=\"_blank\" rel=\"noopener noreferrer\">DC Health Link\u003c/a>, the local exchange for residents of Washington, D.C.\u003c/p>\n\u003cp>[contextly_sidebar id=”MBzhimnqr8SJObj8liKRnDzKFQNodx1V”]\u003c/p>\n\u003cp>Lawmakers aren’t required to get their coverage through the DC exchange; they can choose to be insured through a spouse’s job, Medicare, or purchase a private individual health policy outside of the exchange. But if lawmakers do purchase a “gold plan” on DC Health Link, the federal government will pay about three-quarters of the cost — a tempting incentive that’s not available elsewhere.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>KQED reached out to California’s members of Congress to see what insurance they each have. We will continue to update the post as we receive responses.\u003c/p>\n\u003cdiv class=\"callout aligncenter\">\n\u003cdiv class=\"tableauPlaceholder\" id=\"viz1528915032110\" style=\"position: relative\">\u003cnoscript>\u003ca href=\"#\">\u003cimg alt=\"Dashboard 1 \" src=\"https://public.tableau.com/static/images/WM/WM-Legionre/Dashboard1/1_rss.png\" style=\"border: none\">\u003c/a>\u003c/noscript>\u003cobject class=\"tableauViz\" style=\"display:none;\">\u003cparam name=\"host_url\" value=\"https%3A%2F%2Fpublic.tableau.com%2F\">\u003cparam name=\"embed_code_version\" value=\"3\">\u003cparam name=\"site_root\" value=\"\">\u003cparam name=\"name\" value=\"WM-Legionre/Dashboard1\">\u003cparam name=\"tabs\" value=\"no\">\u003cparam name=\"toolbar\" value=\"yes\">\u003cparam name=\"static_image\" value=\"https://public.tableau.com/static/images/WM/WM-Legionre/Dashboard1/1.png\">\u003cparam name=\"animate_transition\" value=\"yes\">\u003cparam name=\"display_static_image\" value=\"yes\">\u003cparam name=\"display_spinner\" value=\"yes\">\u003cparam name=\"display_overlay\" value=\"yes\">\u003cparam name=\"display_count\" value=\"yes\">\u003cparam name=\"filter\" value=\"publish=yes\">\u003c/object>\u003c/div>\n\u003cp> \u003cscript type=\"text/javascript\"> var divElement = document.getElementById('viz1528915032110'); var vizElement = divElement.getElementsByTagName('object')[0]; if ( divElement.offsetWidth > 800 ) { vizElement.style.minWidth='500px';vizElement.style.maxWidth='900px';vizElement.style.width='100%';vizElement.style.height='627px';} else if ( divElement.offsetWidth > 500 ) { vizElement.style.minWidth='500px';vizElement.style.maxWidth='900px';vizElement.style.width='100%';vizElement.style.height='627px';} else { vizElement.style.width='100%';vizElement.style.height='727px';} var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); \u003c/script>\u003c/p>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Single-payer health coverage for all Californians would cost the state an estimated $400 billion a year, according to a legislative report released Monday. \u003c/p>\n\u003cp>It’s a little more complicated than writing a check for the full amount, though. \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\">Check out today’s story\u003c/a> about how that high-dollar figure breaks down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "At Contaminated Lab Site, Rigorous Cleanup Standards Again in Question",
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"content": "\u003cp>It’s been more than half a century since an experimental nuclear reactor at the Santa Susana Field Laboratory near Los Angeles \u003ca href=\"https://www.documentcloud.org/documents/2271069-report-of-the-santa-susana-field-laboratory-panel.html#document/p10/a352292\">suffered a partial nuclear meltdown\u003c/a>, spewing radiation over a period of weeks.\u003c/p>\n\u003cp>Private industry and government agencies followed that with repeated \u003ca href=\"https://www.documentcloud.org/documents/2424338-11-30-07-preliminary-assessment-site-inspection.html#document/p21/a351479\">chemical \u003c/a>spills,\u003ca href=\"https://www.documentcloud.org/documents/2271069-report-of-the-santa-susana-field-laboratory-panel.html#document/p9/a339581\"> accidental releases \u003c/a>of more radioactive material and \u003ca href=\"https://www.documentcloud.org/documents/2752144-1958-Burn-Pit-Memo.html#document/p1/a282086\">the open-air burning of poisonous chemicals\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/2337520-carr-declaration.html#document/p40/a238263\">gases\u003c/a> at the former site use for the development and testing of nuclear reactors, rockets, missiles and munitions.\u003c/p>\n\u003cp>Both\u003ca href=\"https://www.documentcloud.org/documents/2761443-NASA-DTSC-Final-AOC-Dec-2010.html#document/p12/a352294\"> NASA\u003c/a> and the federal \u003ca href=\"https://www.documentcloud.org/documents/2761442-64791-SSFL-DOE-AOC-Final.html#document/p5/a339563\">Department of Energy\u003c/a> are behind on their legal \u003ca href=\"https://www.nasa.gov/home/hqnews/2010/dec/HQ_10-326_Santa_Susana.html\">agreements \u003c/a>to clean up all traces of the pollution they’d caused at the mountaintop laboratory about 30 miles northwest of downtown Los Angeles.\u003c/p>\n\u003cp>The Boeing Company, which inherited more than three-quarters of the laboratory grounds when it acquired \u003ca href=\"http://www.rocket.com/\">Aerojet Rocketdyne\u003c/a> in 1996, waged a\u003ca href=\"https://www.documentcloud.org/documents/2428063-the-federal-court-ruling-that-overturned-sb-990.html#document/p13/a242520\"> successful lawsuit\u003c/a> to overturn similarly \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=200720080SB990&search_keywords=\">rigorous cleanup requirements\u003c/a> for its share of the land.\u003c/p>\n\u003cp>Instead, it has been preparing its cleanup under the terms of a 2007 consent order in which the state Department of Toxic Substances Control \u003ca href=\"https://www.documentcloud.org/documents/2500793-ref-13.html#document/p8/a352028\">allows the company to write \u003c/a>its own risk assessment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=”Qk5l28CgHB2xlwhGy1TZJOiCNrqhhiVM”]\u003c/p>\n\u003cp>Boeing has completed numerous studies on where the contamination is and how to clean it up, in accordance with DTSC requirements. It’s filed scores of reports.\u003c/p>\n\u003cp>The 2007 order stipulates that Boeing must complete remediation of contaminated soil and related cleanup tasks \u003ca href=\"https://www.documentcloud.org/documents/2500793-ref-13.html#document/p10/a352720\">by the end of next month\u003c/a>. Dave Dassler, the company’s site closure director, estimates that might require digging out and hauling away up to 400,000 cubic yards of dirt, enough to fill the Rose Bowl. The digging hasn’t even started.\u003c/p>\n\u003ch3>Boeing Creates Easement to Set Aside Land as Open Space\u003c/h3>\n\u003cp>Many public health and environmental activists say that Boeing’s characterization of the threat posed by the contamination at Santa Susana is far too permissive for a severely contaminated site that is only half a mile away and steeply uphill from residential neighborhoods.\u003c/p>\n\u003cp>But a recent Boeing legal maneuver may clear the way for the company to negotiate terms that are even less rigorous.\u003c/p>\n\u003cfigure id=\"attachment_11367884\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11367884\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-800x535.jpg\" alt=\"The Santa Susana Field Laboratory is surrounded by suburbs that extend to within half a mile of the lab gate.\" width=\"800\" height=\"535\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-520x348.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Santa Susana Field Laboratory is surrounded by suburbs that extend to within half a mile of the lab gate. \u003ccite>(Chris Richard)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Company officials have long declared that Boeing will preserve its property as open space to protect wildlife and preserve pre-Columbian historic sites in the hills adjacent to former test and accident sites.\u003c/p>\n\u003cp>Now, Boeing has made that commitment legally binding by granting the Pennsylvania-based \u003ca href=\"http://northamericanlandtrust.org/\">North American Land Trust\u003c/a> a \u003ca href=\"https://www.documentcloud.org/documents/3698554-Grant-Deed.html#document/p4/a351999\">conservation easement\u003c/a> that declares the company’s property permanent open space.\u003c/p>\n\u003cp>For years, activists have predicted that Santa Susana, which is surrounded by suburbs, might be turned into a housing development. Now the company’s agreement with the land trust \u003ca href=\"https://www.documentcloud.org/documents/3698554-Grant-Deed.html#document/p8/a352001\">bars \u003c/a>residential, commercial, industrial or agricultural development, North American president Stephen Johnson said.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘My organization never felt this land had a secure open space future until now.’\u003ccite>Clark Stevens, Resource Conservation District of the Santa Monica Mountains\u003c/cite>\u003c/aside>\n\u003cp>Clark Stevens, executive officer of the \u003ca href=\"http://www.rcdsmm.org/\">Resource Conservation District of the Santa Monica Mountains\u003c/a>, said the agreement protects a vital travel corridor for wildlife, such as deer and mountain lions, between the Los Padres National Forest to the north and the Santa Monica Mountains.\u003c/p>\n\u003cp>Stevens, who has worked with conservation easements for 15 years, said Boeing stands to receive a substantial tax write-off for voiding its property’s development value. He said the public will benefit as well, because the building ban is legally inviolable.\u003c/p>\n\u003cp>“It rides with the land,” he said. “It doesn’t matter who the owner is in the future. They will be restricted by the conservation easement. My organization never felt this land had a secure open space future until now, because Boeing saying they would keep it open space was just a policy that could change. This easement changes that. It has teeth.”\u003c/p>\n\u003cp>With a firm development prohibition in place, it’s appropriate to reconsider cleanup standards, Stevens said.\u003c/p>\n\u003cp>“Now that we know we have protected open space, we should take seriously the fact that no one will ever live there and not overdo the cleanup,” he said. “My organization does habitat restoration. You can’t restore land that has been scraped to bare rock.”\u003c/p>\n\u003cfigure id=\"attachment_11459642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11459642\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/HirschMic-800x510.jpg\" alt=\"Dan Hirsch, president of the nuclear watchdog group Committee to Bridge the Gap and director of the Program on Environmental and Nuclear Policy at UC Santa Cruz. \" width=\"800\" height=\"510\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-800x510.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-160x102.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-1020x650.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-1180x752.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-960x612.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-240x153.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-375x239.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-520x331.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dan Hirsch, president of the nuclear watchdog group Committee to Bridge the Gap and director of the Program on Environmental and Nuclear Policy at UC Santa Cruz. \u003ccite>(Chris Richard/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Like other Boeing officials, company spokeswoman Megan Hilfer has argued that Boeing is committed to making its property clean enough for people to live there.\u003c/p>\n\u003cp>Now, with the easement in place, the cleanup standard Boeing will apply “remains to be seen,” Hilfer said in a telephone interview.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The problem is that the people living nearby aren’t open space. They are real people who for the rest of their lives will face the risk of exposure to the toxic contamination leaking off that site.’\u003ccite>Dan Hirsh, president, Committee to Bridge the Gap\u003c/cite>\u003c/aside>\n\u003cp>“We look forward to working with the DTSC to determine the appropriate cleanup actions for Boeing’s portion of Santa Susana,” she said.\u003c/p>\n\u003cp>Dan Hirsch, president of the nuclear watchdog group \u003ca href=\"http://committeetobridgethegap.org/\">Committee to Bridge the Gap\u003c/a> and director of the \u003ca href=\"https://socialsciences.ucsc.edu/academics/singleton.php?&singleton=true&cruz_id=dohirsch\" target=\"_blank\" rel=\"noopener noreferrer\">Program on Environmental and Nuclear Policy at UC Santa Cruz,\u003c/a> fears the conservation easement will undermine a thorough cleanup at the field laboratory. By declaring its land “open space,” Boeing glosses over the fact that its contamination is very close to residential neighborhoods, Hirsch said.\u003c/p>\n\u003cp>“The problem is that the people living nearby aren’t open space. They are real people who for the rest of their lives will face the risk of exposure to the toxic contamination leaking off that site,” he said.\u003c/p>\n\u003cp>The Simi Hills, where the laboratory is located, lie between the suburban communities of Chatsworth and Simi Valley. Residential neighborhoods extend to within half a mile of the laboratory gates, and \u003ca href=\"http://www.simivalley.org/index.aspx?page=795\">a new housing development\u003c/a> is rising just north of the portion of Santa Susana where the experimental reactor once operated.\u003c/p>\n\u003cp>At a public meeting this month, the \u003ca href=\"http://www.dtsc.ca.gov/SiteCleanup/Santa_Susana_Field_Lab/ssfl_contacts.cfm\" target=\"_blank\" rel=\"noopener noreferrer\">project team leader \u003c/a>for Santa Susana at the state \u003ca href=\"http://www.dtsc.ca.gov\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Toxic Substances Control\u003c/a>, Mark Malinowski, said the department only recently received a copy of Boeing’s easement agreement and hasn’t determined how it might affect the cleanup.\u003c/p>\n\u003cp>But Malinowski questioned whether the laboratory endangers its neighbors. He said a detailed survey of a property next to the laboratory’s most active radiological site didn’t find any contaminants that would pose a public threat. DTSC spokesman Russ Edmondson said the same holds true for the rest of the land around the laboratory.\u003c/p>\n\u003cfigure id=\"attachment_11439172\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11439172 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut.jpg\" alt=\"\" width=\"1920\" height=\"1285\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-520x348.jpg 520w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mark Malinowski, Santa Susana project team leader for the state Department of Toxic Substances Control, answers a question at a public meeting. \u003ccite>(Chris Richard)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That drew a terse response from Denise Duffield, associate director of Physicians for Social Responsibility in Los Angeles.\u003c/p>\n\u003cp>“So how do they know better than the National Academy of Sciences?” she asked. “The academy says there is \u003ca href=\"https://www.nirs.org/press/06-30-2005/\">no safe exposure level\u003c/a> for radioactivity.”\u003c/p>\n\u003ch3>How Rigorous Should the Safety Standards Be?\u003c/h3>\n\u003cp>The \u003ca href=\"http://www.waterboards.ca.gov/losangeles/\">Los Angeles Regional Water Quality Control Board \u003c/a>has repeatedly called attention to poisons and radioactive material in runoff from the laboratory. In 2007, for instance, it fined Boeing \u003ca href=\"https://www.documentcloud.org/documents/3701400-pressrelease2007-0911boeingpaysfine.html\">$471,000 \u003c/a> for releasing wastewater with elevated levels of chromium, dioxin, lead and mercury. Tests in 2009 found elevated levels of \u003ca href=\"https://www.documentcloud.org/documents/3717250-RWQCB-NPDES-Outfal-008-and-009-Status-Report.html#document/p2/a352759\">cesium-137\u003c/a>, copper and\u003ca href=\"https://www.documentcloud.org/documents/3717250-RWQCB-NPDES-Outfal-008-and-009-Status-Report.html#document/p2/a352758\"> lead\u003c/a>. In 2010, the board fined Boeing again after the laboratory’s runoff contained levels of radioactive materials, dioxins, mercury and other contaminants that the board \u003ca href=\"https://www.documentcloud.org/documents/3717282-50621720-Complaint.html#document/p5/a352775\">considered excessive\u003c/a>. This time, the fine was for \u003ca href=\"https://www.documentcloud.org/documents/3699738-50624955-CJ.html#document/p3/a352286\">$500,000.\u003c/a>\u003cspan class=\"SS_L3\">\u003cspan class=\"verdana\">\u003cbr>\n\u003c/span>\u003c/span>\u003c/p>\n\u003cp>In an interview, Malinowski stood by his claim.\u003c/p>\n\u003cp>“The numbers that the water board looks at for their discharge limits are much, much lower than human health standards are,” he said. “They are extremely low numbers.”\u003c/p>\n\u003cp>The water board isn’t the only government agency with stricter requirements than those the DTSC is applying at Santa Susana. Records show the department is holding Boeing to much weaker standards than the federal government’ s general guidelines as well. One example: The state has accepted a threshold for strontium 90, a carcinogen, that is \u003ca href=\"https://www.documentcloud.org/documents/3453382-PRGs-EPA-vs-DTSC.html#document/p2/a337179\">more than 1,000 times\u003c/a> more lenient than the EPA \u003ca href=\"https://www.documentcloud.org/documents/3453382-PRGs-EPA-vs-DTSC.html#document/p1/a337178\">cleanup standard\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-11378766 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-800x550.jpg\" alt=\"RS24779_Lead-qut\" width=\"800\" height=\"550\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-800x550.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-160x110.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-1020x702.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-1180x812.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-960x661.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-240x165.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-375x258.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-520x358.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003c/p>\n\u003cp>Before it can clean up a toxic site, a pollution control agency has to identify where the contamination is and how dangerous it is. To do that, it chooses from a range of possible “risk-based screening levels” that can be used to create a pollution map.\u003c/p>\n\u003cp>The federal EPA’s standard for determining how much pollution must be removed from a polluted site is to achieve a contaminant level low enough that the pollution can be expected to cause no more than one cancer per million people over a 30-year period.\u003c/p>\n\u003cp>Regulators may set different screening levels depending on the land’s expected use, but residential scenarios are strict, because that’s where people spend the most time and face the greatest risk from pollutants.\u003c/p>\n\u003cp>For instance, the EPA considers the possibility that residents will eat fruit and vegetables from backyard gardens. It’s not that the EPA is trying to promote gardening. It’s the agency’s way of acknowledging that often, ingesting contaminants is more dangerous than merely passing by them or touching them.\u003c/p>\n\u003cp>Boeing has argued that a residential cleanup isn’t necessary at Santa Susana because nobody is going to live there. The company has promised that it would clean the land to a residential standard anyway, to be absolutely sure that the environment is protected, as well as the health of people living nearby or visiting the site.\u003c/p>\n\u003cp>Some residential scenarios are more rigorous than others. DTSC scientists who assesses the health risks of pollution \u003ca href=\"https://www.documentcloud.org/documents/3519086-65750-DTSC-Comments-on-Draft-HH-RBSLs-TM-2012-05.html#document/p6/a344374\">recommended \u003c/a>including a strict residential standard in setting the screening levels for Santa Susana. But in 2013, the department \u003ca href=\"https://www.documentcloud.org/documents/2433969-boeing-soil-scl-submittal-and-dtsc-approval.html#document/p4/a245064\">accepted\u003c/a> a Boeing method that \u003ca href=\"https://www.documentcloud.org/documents/3516752-Risk-Assessment-Excerpt.html\">skipped\u003c/a> the strictest benchmarks.\u003c/p>\n\u003cp>One result was a 2015 risk assessment in which Boeing discreetly contradicted itself. It started out by claiming the pollution \u003ca href=\"https://www.documentcloud.org/documents/3515375-66635-Draft-RCRA-Facility-Investigation-Data.html#document/p26/a343144\">really wasn’t that bad\u003c/a>. But buried in an appendix was an acknowledgment that if Boeing were to factor in the possibility of people eating fruit and vegetables grown on the site, it would have to admit to a cancer risk as high as \u003ca href=\"https://www.documentcloud.org/documents/3515375-66635-Draft-RCRA-Facility-Investigation-Data.html#document/p622/a343149\">three in 10\u003c/a>.\u003c/p>\n\u003cp>An assessment for another portion of the laboratory grounds acknowledged that if Boeing were to apply the strict standard there, it would have to admit the pollution was severe enough that for every 10 hypothetical people living there,\u003ca href=\"https://www.documentcloud.org/documents/3522589-Draft-RCRA-Facility-Investigation-Data-Summary.html#document/p2856/a345374\"> nine would get cancer\u003c/a>.\u003c/p>\n\u003cp>The revelations\u003ca href=\"https://www.documentcloud.org/documents/3515481-SSFL-Letter-to-B-Lee.html#document/p2/a343151\"> infuriated elected officials\u003c/a>, who pointed out that real people live very close to these sites. The DTSC \u003ca href=\"https://www.documentcloud.org/documents/3514661-67213-2016-08-23-DTSC-Cmmnt-Ltr-and-Cmmnts-for.html#document/p2/a343156\">ordered\u003c/a> Boeing to change its assessments to include gardens. But Boeing didn’t change its screening methods.\u003c/p>\n\u003cfigure id=\"attachment_11459714\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11459714\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/Detwiler-800x529.jpg\" alt=\"John Detwiler, who lives just downhill from the Santa Susana Field Laboratory, told a public meeting recently that he’s angry and disappointed at the state Department of Toxic Substances Control’s failure to clean up the laboratory. \" width=\"800\" height=\"529\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-800x529.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-1020x674.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-1180x780.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-960x635.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-375x248.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-520x344.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">John Detwiler, who lives just downhill from the Santa Susana Field Laboratory, told a public meeting recently that he’s angry and disappointed at the state Department of Toxic Substances Control’s failure to clean up the laboratory. \u003ccite>(Chris Richard/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In response to repeated inquiries, department public affairs officials offered no explanation as to why the DTSC allowed Boeing to continue to employ a screening method the department had expressly forbidden.\u003c/p>\n\u003cp>However, in a March 24 email, Boeing spokeswoman Megan Hilfer defended the company’s ongoing use of the less rigorous standard.\u003c/p>\n\u003cp>“When considering a risk-based approach, future land use is a critical consideration to ensure the property is adequately cleaned for that end use, while also protecting against adverse cleanup impacts to natural and cultural resources,” the email states.\u003c/p>\n\u003cp>“This is why including a garden exposure pathway in that assessment for Santa Susana, as some have suggested, makes no sense: the property will be legally-restricted open space where no produce of any kind will ever be grown for consumption on-site.”\u003c/p>\n\u003cp>Such arguments anger John Detwiler, who lives just downhill from the laboratory.\u003c/p>\n\u003cp>“Don’t tell me no pollution comes down every time it rains, every time the ground shakes, when the wind blows, we’re all victims,” he said. “Including me. Including my wife. Including her daughter. We’re all victims.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Note:\u003c/strong> Reporting for this \u003ca href=\"https://ww2.kqed.org/news/tag/santa-susana-field-laboratory/\" target=\"_blank\" rel=\"noopener noreferrer\">series of stories\u003c/a> received financial support from the \u003ca href=\"http://www.fij.org\">Fund for Investigative Journalism\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Boeing set aside the land near L.A. for conservation, but watchdogs fear cleanup standards will slip at Santa Susana Field Laboratory.",
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"title": "At Contaminated Lab Site, Rigorous Cleanup Standards Again in Question | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s been more than half a century since an experimental nuclear reactor at the Santa Susana Field Laboratory near Los Angeles \u003ca href=\"https://www.documentcloud.org/documents/2271069-report-of-the-santa-susana-field-laboratory-panel.html#document/p10/a352292\">suffered a partial nuclear meltdown\u003c/a>, spewing radiation over a period of weeks.\u003c/p>\n\u003cp>Private industry and government agencies followed that with repeated \u003ca href=\"https://www.documentcloud.org/documents/2424338-11-30-07-preliminary-assessment-site-inspection.html#document/p21/a351479\">chemical \u003c/a>spills,\u003ca href=\"https://www.documentcloud.org/documents/2271069-report-of-the-santa-susana-field-laboratory-panel.html#document/p9/a339581\"> accidental releases \u003c/a>of more radioactive material and \u003ca href=\"https://www.documentcloud.org/documents/2752144-1958-Burn-Pit-Memo.html#document/p1/a282086\">the open-air burning of poisonous chemicals\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/2337520-carr-declaration.html#document/p40/a238263\">gases\u003c/a> at the former site use for the development and testing of nuclear reactors, rockets, missiles and munitions.\u003c/p>\n\u003cp>Both\u003ca href=\"https://www.documentcloud.org/documents/2761443-NASA-DTSC-Final-AOC-Dec-2010.html#document/p12/a352294\"> NASA\u003c/a> and the federal \u003ca href=\"https://www.documentcloud.org/documents/2761442-64791-SSFL-DOE-AOC-Final.html#document/p5/a339563\">Department of Energy\u003c/a> are behind on their legal \u003ca href=\"https://www.nasa.gov/home/hqnews/2010/dec/HQ_10-326_Santa_Susana.html\">agreements \u003c/a>to clean up all traces of the pollution they’d caused at the mountaintop laboratory about 30 miles northwest of downtown Los Angeles.\u003c/p>\n\u003cp>The Boeing Company, which inherited more than three-quarters of the laboratory grounds when it acquired \u003ca href=\"http://www.rocket.com/\">Aerojet Rocketdyne\u003c/a> in 1996, waged a\u003ca href=\"https://www.documentcloud.org/documents/2428063-the-federal-court-ruling-that-overturned-sb-990.html#document/p13/a242520\"> successful lawsuit\u003c/a> to overturn similarly \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=200720080SB990&search_keywords=\">rigorous cleanup requirements\u003c/a> for its share of the land.\u003c/p>\n\u003cp>Instead, it has been preparing its cleanup under the terms of a 2007 consent order in which the state Department of Toxic Substances Control \u003ca href=\"https://www.documentcloud.org/documents/2500793-ref-13.html#document/p8/a352028\">allows the company to write \u003c/a>its own risk assessment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Boeing has completed numerous studies on where the contamination is and how to clean it up, in accordance with DTSC requirements. It’s filed scores of reports.\u003c/p>\n\u003cp>The 2007 order stipulates that Boeing must complete remediation of contaminated soil and related cleanup tasks \u003ca href=\"https://www.documentcloud.org/documents/2500793-ref-13.html#document/p10/a352720\">by the end of next month\u003c/a>. Dave Dassler, the company’s site closure director, estimates that might require digging out and hauling away up to 400,000 cubic yards of dirt, enough to fill the Rose Bowl. The digging hasn’t even started.\u003c/p>\n\u003ch3>Boeing Creates Easement to Set Aside Land as Open Space\u003c/h3>\n\u003cp>Many public health and environmental activists say that Boeing’s characterization of the threat posed by the contamination at Santa Susana is far too permissive for a severely contaminated site that is only half a mile away and steeply uphill from residential neighborhoods.\u003c/p>\n\u003cp>But a recent Boeing legal maneuver may clear the way for the company to negotiate terms that are even less rigorous.\u003c/p>\n\u003cfigure id=\"attachment_11367884\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11367884\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-800x535.jpg\" alt=\"The Santa Susana Field Laboratory is surrounded by suburbs that extend to within half a mile of the lab gate.\" width=\"800\" height=\"535\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24633_DSC_0055-qut-520x348.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Santa Susana Field Laboratory is surrounded by suburbs that extend to within half a mile of the lab gate. \u003ccite>(Chris Richard)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Company officials have long declared that Boeing will preserve its property as open space to protect wildlife and preserve pre-Columbian historic sites in the hills adjacent to former test and accident sites.\u003c/p>\n\u003cp>Now, Boeing has made that commitment legally binding by granting the Pennsylvania-based \u003ca href=\"http://northamericanlandtrust.org/\">North American Land Trust\u003c/a> a \u003ca href=\"https://www.documentcloud.org/documents/3698554-Grant-Deed.html#document/p4/a351999\">conservation easement\u003c/a> that declares the company’s property permanent open space.\u003c/p>\n\u003cp>For years, activists have predicted that Santa Susana, which is surrounded by suburbs, might be turned into a housing development. Now the company’s agreement with the land trust \u003ca href=\"https://www.documentcloud.org/documents/3698554-Grant-Deed.html#document/p8/a352001\">bars \u003c/a>residential, commercial, industrial or agricultural development, North American president Stephen Johnson said.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘My organization never felt this land had a secure open space future until now.’\u003ccite>Clark Stevens, Resource Conservation District of the Santa Monica Mountains\u003c/cite>\u003c/aside>\n\u003cp>Clark Stevens, executive officer of the \u003ca href=\"http://www.rcdsmm.org/\">Resource Conservation District of the Santa Monica Mountains\u003c/a>, said the agreement protects a vital travel corridor for wildlife, such as deer and mountain lions, between the Los Padres National Forest to the north and the Santa Monica Mountains.\u003c/p>\n\u003cp>Stevens, who has worked with conservation easements for 15 years, said Boeing stands to receive a substantial tax write-off for voiding its property’s development value. He said the public will benefit as well, because the building ban is legally inviolable.\u003c/p>\n\u003cp>“It rides with the land,” he said. “It doesn’t matter who the owner is in the future. They will be restricted by the conservation easement. My organization never felt this land had a secure open space future until now, because Boeing saying they would keep it open space was just a policy that could change. This easement changes that. It has teeth.”\u003c/p>\n\u003cp>With a firm development prohibition in place, it’s appropriate to reconsider cleanup standards, Stevens said.\u003c/p>\n\u003cp>“Now that we know we have protected open space, we should take seriously the fact that no one will ever live there and not overdo the cleanup,” he said. “My organization does habitat restoration. You can’t restore land that has been scraped to bare rock.”\u003c/p>\n\u003cfigure id=\"attachment_11459642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11459642\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/HirschMic-800x510.jpg\" alt=\"Dan Hirsch, president of the nuclear watchdog group Committee to Bridge the Gap and director of the Program on Environmental and Nuclear Policy at UC Santa Cruz. \" width=\"800\" height=\"510\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-800x510.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-160x102.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-1020x650.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-1180x752.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-960x612.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-240x153.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-375x239.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/HirschMic-520x331.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dan Hirsch, president of the nuclear watchdog group Committee to Bridge the Gap and director of the Program on Environmental and Nuclear Policy at UC Santa Cruz. \u003ccite>(Chris Richard/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Like other Boeing officials, company spokeswoman Megan Hilfer has argued that Boeing is committed to making its property clean enough for people to live there.\u003c/p>\n\u003cp>Now, with the easement in place, the cleanup standard Boeing will apply “remains to be seen,” Hilfer said in a telephone interview.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The problem is that the people living nearby aren’t open space. They are real people who for the rest of their lives will face the risk of exposure to the toxic contamination leaking off that site.’\u003ccite>Dan Hirsh, president, Committee to Bridge the Gap\u003c/cite>\u003c/aside>\n\u003cp>“We look forward to working with the DTSC to determine the appropriate cleanup actions for Boeing’s portion of Santa Susana,” she said.\u003c/p>\n\u003cp>Dan Hirsch, president of the nuclear watchdog group \u003ca href=\"http://committeetobridgethegap.org/\">Committee to Bridge the Gap\u003c/a> and director of the \u003ca href=\"https://socialsciences.ucsc.edu/academics/singleton.php?&singleton=true&cruz_id=dohirsch\" target=\"_blank\" rel=\"noopener noreferrer\">Program on Environmental and Nuclear Policy at UC Santa Cruz,\u003c/a> fears the conservation easement will undermine a thorough cleanup at the field laboratory. By declaring its land “open space,” Boeing glosses over the fact that its contamination is very close to residential neighborhoods, Hirsch said.\u003c/p>\n\u003cp>“The problem is that the people living nearby aren’t open space. They are real people who for the rest of their lives will face the risk of exposure to the toxic contamination leaking off that site,” he said.\u003c/p>\n\u003cp>The Simi Hills, where the laboratory is located, lie between the suburban communities of Chatsworth and Simi Valley. Residential neighborhoods extend to within half a mile of the laboratory gates, and \u003ca href=\"http://www.simivalley.org/index.aspx?page=795\">a new housing development\u003c/a> is rising just north of the portion of Santa Susana where the experimental reactor once operated.\u003c/p>\n\u003cp>At a public meeting this month, the \u003ca href=\"http://www.dtsc.ca.gov/SiteCleanup/Santa_Susana_Field_Lab/ssfl_contacts.cfm\" target=\"_blank\" rel=\"noopener noreferrer\">project team leader \u003c/a>for Santa Susana at the state \u003ca href=\"http://www.dtsc.ca.gov\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Toxic Substances Control\u003c/a>, Mark Malinowski, said the department only recently received a copy of Boeing’s easement agreement and hasn’t determined how it might affect the cleanup.\u003c/p>\n\u003cp>But Malinowski questioned whether the laboratory endangers its neighbors. He said a detailed survey of a property next to the laboratory’s most active radiological site didn’t find any contaminants that would pose a public threat. DTSC spokesman Russ Edmondson said the same holds true for the rest of the land around the laboratory.\u003c/p>\n\u003cfigure id=\"attachment_11439172\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11439172 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut.jpg\" alt=\"\" width=\"1920\" height=\"1285\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/RS25132__DSC0190-qut-520x348.jpg 520w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mark Malinowski, Santa Susana project team leader for the state Department of Toxic Substances Control, answers a question at a public meeting. \u003ccite>(Chris Richard)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That drew a terse response from Denise Duffield, associate director of Physicians for Social Responsibility in Los Angeles.\u003c/p>\n\u003cp>“So how do they know better than the National Academy of Sciences?” she asked. “The academy says there is \u003ca href=\"https://www.nirs.org/press/06-30-2005/\">no safe exposure level\u003c/a> for radioactivity.”\u003c/p>\n\u003ch3>How Rigorous Should the Safety Standards Be?\u003c/h3>\n\u003cp>The \u003ca href=\"http://www.waterboards.ca.gov/losangeles/\">Los Angeles Regional Water Quality Control Board \u003c/a>has repeatedly called attention to poisons and radioactive material in runoff from the laboratory. In 2007, for instance, it fined Boeing \u003ca href=\"https://www.documentcloud.org/documents/3701400-pressrelease2007-0911boeingpaysfine.html\">$471,000 \u003c/a> for releasing wastewater with elevated levels of chromium, dioxin, lead and mercury. Tests in 2009 found elevated levels of \u003ca href=\"https://www.documentcloud.org/documents/3717250-RWQCB-NPDES-Outfal-008-and-009-Status-Report.html#document/p2/a352759\">cesium-137\u003c/a>, copper and\u003ca href=\"https://www.documentcloud.org/documents/3717250-RWQCB-NPDES-Outfal-008-and-009-Status-Report.html#document/p2/a352758\"> lead\u003c/a>. In 2010, the board fined Boeing again after the laboratory’s runoff contained levels of radioactive materials, dioxins, mercury and other contaminants that the board \u003ca href=\"https://www.documentcloud.org/documents/3717282-50621720-Complaint.html#document/p5/a352775\">considered excessive\u003c/a>. This time, the fine was for \u003ca href=\"https://www.documentcloud.org/documents/3699738-50624955-CJ.html#document/p3/a352286\">$500,000.\u003c/a>\u003cspan class=\"SS_L3\">\u003cspan class=\"verdana\">\u003cbr>\n\u003c/span>\u003c/span>\u003c/p>\n\u003cp>In an interview, Malinowski stood by his claim.\u003c/p>\n\u003cp>“The numbers that the water board looks at for their discharge limits are much, much lower than human health standards are,” he said. “They are extremely low numbers.”\u003c/p>\n\u003cp>The water board isn’t the only government agency with stricter requirements than those the DTSC is applying at Santa Susana. Records show the department is holding Boeing to much weaker standards than the federal government’ s general guidelines as well. One example: The state has accepted a threshold for strontium 90, a carcinogen, that is \u003ca href=\"https://www.documentcloud.org/documents/3453382-PRGs-EPA-vs-DTSC.html#document/p2/a337179\">more than 1,000 times\u003c/a> more lenient than the EPA \u003ca href=\"https://www.documentcloud.org/documents/3453382-PRGs-EPA-vs-DTSC.html#document/p1/a337178\">cleanup standard\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-11378766 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-800x550.jpg\" alt=\"RS24779_Lead-qut\" width=\"800\" height=\"550\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-800x550.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-160x110.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-1020x702.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-1180x812.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-960x661.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-240x165.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-375x258.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/03/RS24779_Lead-qut-520x358.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003c/p>\n\u003cp>Before it can clean up a toxic site, a pollution control agency has to identify where the contamination is and how dangerous it is. To do that, it chooses from a range of possible “risk-based screening levels” that can be used to create a pollution map.\u003c/p>\n\u003cp>The federal EPA’s standard for determining how much pollution must be removed from a polluted site is to achieve a contaminant level low enough that the pollution can be expected to cause no more than one cancer per million people over a 30-year period.\u003c/p>\n\u003cp>Regulators may set different screening levels depending on the land’s expected use, but residential scenarios are strict, because that’s where people spend the most time and face the greatest risk from pollutants.\u003c/p>\n\u003cp>For instance, the EPA considers the possibility that residents will eat fruit and vegetables from backyard gardens. It’s not that the EPA is trying to promote gardening. It’s the agency’s way of acknowledging that often, ingesting contaminants is more dangerous than merely passing by them or touching them.\u003c/p>\n\u003cp>Boeing has argued that a residential cleanup isn’t necessary at Santa Susana because nobody is going to live there. The company has promised that it would clean the land to a residential standard anyway, to be absolutely sure that the environment is protected, as well as the health of people living nearby or visiting the site.\u003c/p>\n\u003cp>Some residential scenarios are more rigorous than others. DTSC scientists who assesses the health risks of pollution \u003ca href=\"https://www.documentcloud.org/documents/3519086-65750-DTSC-Comments-on-Draft-HH-RBSLs-TM-2012-05.html#document/p6/a344374\">recommended \u003c/a>including a strict residential standard in setting the screening levels for Santa Susana. But in 2013, the department \u003ca href=\"https://www.documentcloud.org/documents/2433969-boeing-soil-scl-submittal-and-dtsc-approval.html#document/p4/a245064\">accepted\u003c/a> a Boeing method that \u003ca href=\"https://www.documentcloud.org/documents/3516752-Risk-Assessment-Excerpt.html\">skipped\u003c/a> the strictest benchmarks.\u003c/p>\n\u003cp>One result was a 2015 risk assessment in which Boeing discreetly contradicted itself. It started out by claiming the pollution \u003ca href=\"https://www.documentcloud.org/documents/3515375-66635-Draft-RCRA-Facility-Investigation-Data.html#document/p26/a343144\">really wasn’t that bad\u003c/a>. But buried in an appendix was an acknowledgment that if Boeing were to factor in the possibility of people eating fruit and vegetables grown on the site, it would have to admit to a cancer risk as high as \u003ca href=\"https://www.documentcloud.org/documents/3515375-66635-Draft-RCRA-Facility-Investigation-Data.html#document/p622/a343149\">three in 10\u003c/a>.\u003c/p>\n\u003cp>An assessment for another portion of the laboratory grounds acknowledged that if Boeing were to apply the strict standard there, it would have to admit the pollution was severe enough that for every 10 hypothetical people living there,\u003ca href=\"https://www.documentcloud.org/documents/3522589-Draft-RCRA-Facility-Investigation-Data-Summary.html#document/p2856/a345374\"> nine would get cancer\u003c/a>.\u003c/p>\n\u003cp>The revelations\u003ca href=\"https://www.documentcloud.org/documents/3515481-SSFL-Letter-to-B-Lee.html#document/p2/a343151\"> infuriated elected officials\u003c/a>, who pointed out that real people live very close to these sites. The DTSC \u003ca href=\"https://www.documentcloud.org/documents/3514661-67213-2016-08-23-DTSC-Cmmnt-Ltr-and-Cmmnts-for.html#document/p2/a343156\">ordered\u003c/a> Boeing to change its assessments to include gardens. But Boeing didn’t change its screening methods.\u003c/p>\n\u003cfigure id=\"attachment_11459714\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11459714\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/Detwiler-800x529.jpg\" alt=\"John Detwiler, who lives just downhill from the Santa Susana Field Laboratory, told a public meeting recently that he’s angry and disappointed at the state Department of Toxic Substances Control’s failure to clean up the laboratory. \" width=\"800\" height=\"529\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-800x529.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-1020x674.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-1180x780.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-960x635.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-375x248.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Detwiler-520x344.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">John Detwiler, who lives just downhill from the Santa Susana Field Laboratory, told a public meeting recently that he’s angry and disappointed at the state Department of Toxic Substances Control’s failure to clean up the laboratory. \u003ccite>(Chris Richard/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In response to repeated inquiries, department public affairs officials offered no explanation as to why the DTSC allowed Boeing to continue to employ a screening method the department had expressly forbidden.\u003c/p>\n\u003cp>However, in a March 24 email, Boeing spokeswoman Megan Hilfer defended the company’s ongoing use of the less rigorous standard.\u003c/p>\n\u003cp>“When considering a risk-based approach, future land use is a critical consideration to ensure the property is adequately cleaned for that end use, while also protecting against adverse cleanup impacts to natural and cultural resources,” the email states.\u003c/p>\n\u003cp>“This is why including a garden exposure pathway in that assessment for Santa Susana, as some have suggested, makes no sense: the property will be legally-restricted open space where no produce of any kind will ever be grown for consumption on-site.”\u003c/p>\n\u003cp>Such arguments anger John Detwiler, who lives just downhill from the laboratory.\u003c/p>\n\u003cp>“Don’t tell me no pollution comes down every time it rains, every time the ground shakes, when the wind blows, we’re all victims,” he said. “Including me. Including my wife. Including her daughter. We’re all victims.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Note:\u003c/strong> Reporting for this \u003ca href=\"https://ww2.kqed.org/news/tag/santa-susana-field-laboratory/\" target=\"_blank\" rel=\"noopener noreferrer\">series of stories\u003c/a> received financial support from the \u003ca href=\"http://www.fij.org\">Fund for Investigative Journalism\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Secret Republican Senate Talks Are Shaping Health Care Legislation",
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"content": "\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secret+Republican+Senate+Talks+Are+Shaping+Health+Care+Legislation&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secret+Republican+Senate+Talks+Are+Shaping+Health+Care+Legislation&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Central Valley Rep. Jeff Denham was grilled by constituents on Tuesday upset with his vote to approve the Republican-drafted American Health Care Act that passed the House of Representatives last week.\u003c/p>\n\u003cp>The city of Riverbank invited the Stanislaus County congressman to meet with constituents over coffee at a local teen center. Although the event was planned long before the health care vote, City Manager Sean Scully said interest picked up in recent days after the vote took place.\u003c/p>\n\u003cp>Most questions centered on Denham’s vote for the AHCA.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FKQEDnews%2Fvideos%2F1447610475313345%2F&show_text=0&width=560\" width=\"800\" height=\"420\" style=\"border:none;overflow:hidden\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"true\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“I’m trying to understand how, when nurses are telling you to vote against this, when physicians — even though you’re saying that that’s who you’re trying to support — tell you to vote against this, you as a farmer are not listening to the people that are caring for these patients,” said Mechelle Perea-Ryan, an Oakdale nurse practitioner and educator of 25 years. “I don’t understand how you can do that vote with a clear conscience. … How come you are not listening to what we have to say?”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I am listening,” Denham replied. “Under this important debate I’ve gone out to the hospitals, I’ve gone out and talked to the nurses. I’ve gone out and actually asked the questions on how do you fix our overcrowded emergency rooms. How do you get doctors to actually take Medi-Cal patients?\u003c/p>\n\u003cp>“There are a lot of challenges that not only have I listened, but I am fighting to make sure that we actually have a good response in this bill.”\u003c/p>\n\u003cp>Denham wasn’t the first to face upset constituents: Since the election of President Trump, California’s representatives have faced \u003ca href=\"https://ww2.kqed.org/news/2017/02/04/resist-protesters-descend-on-california-republicans-town-hall/\">lively crowds\u003c/a> at town halls and district events, with many voters urging the delegation to take a \u003ca href=\"https://ww2.kqed.org/news/2017/04/17/its-feinstein-vs-hecklers-at-town-hall-in-sf/\">hard stance \u003c/a>against the new administration and policies.\u003c/p>\n\u003cp>\u003cem>[contextly_sidebar id=”TgQZGALylkIdilNkAdOrMF9Y2tI9lPr0″]\u003c/em>\u003c/p>\n\u003cp>At a town hall that Denham (R-Turlock) held in April in Denair — which also drew a large, \u003ca href=\"http://audio.californiareport.org/archive/R201704180850/c\">rowdy crowd\u003c/a> — he told them \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-rep-jeff-denham-1492484959-htmlstory.html\">he was a no vote\u003c/a> on the earlier draft of the GOP health care bill.\u003c/p>\n\u003cp>Last Thursday, he voted yes — along with \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\">California’s 14 other Republican members of Congress\u003c/a> — on the latest Republican health legislation.\u003c/p>\n\u003cp>A few people at the event challenged him, accusing him of lying.\u003c/p>\n\u003cp>“During the town hall, you specifically said you were not going to repeal and replace the Affordable Care Act,” said Naramsen Goriel of Modesto. “Why did you lie to us?”\u003c/p>\n\u003cp>“Let’s be honest about what I said and be honest about the entire situation,” Denham replied. “Actually, what I said was, I cannot support a bill that does not address pre-existing conditions. (Denham was interrupted by people shouting: “This one doesn’t.”)\u003c/p>\n\u003cp>“Under the current plan, a state would have to opt out,” he continued. “They’d have to apply to the federal government to do that and they’d have to actually make sure they have a risk pool available.”\u003c/p>\n\u003cp>Denham co-sponsored a \u003ca href=\"http://docs.house.gov/billsthisweek/20170501/Upton%20Amendment.pdf\">late amendment\u003c/a> to the GOP bill that would provide $8 billion over the next five years to help pay for the insurance costs of Americans with pre-existing conditions. The AHCA allows states to apply for waivers to let insurers charge those sick consumers more.\u003c/p>\n\u003cp>One of his constituents at the Riverbank meeting challenged him on the high-risk pools.\u003c/p>\n\u003cp>“Do you have experience actually dealing with buying on a high-risk pool?” asked Brooke Myung of Riverbank, who said she worked in insurance billing. She noted that when she and her husband went to get him health insurance after he lost it at work, “it would have cost us our entire income, $2,000 every month. Except, there was a waiting period before we were allowed to buy. And then it was six months before it would cover his medication that keeps him alive.”\u003c/p>\n\u003cp>She added: “So how are we supposed to be assured that people in other states — because, yes, California won’t apply for waivers — but people in other states need to be protected from that, too. That’s unacceptable.”\u003c/p>\n\u003cp>Myung received applause from other attendees. “No part of this is OK,” she said. “No part of it helps to defend Americans, Californians specifically.”\u003c/p>\n\u003cp>Denham told her she had an open invitation to meet with him: “I would love to have you come in and walk me through the process that you’ve gone through. … Help me to understand.”\u003c/p>\n\u003cp>After the vote but ahead of the Riverbank event, Denham said that while “coverage in the Valley has expanded — and that’s a good thing — the access issues that existed before the ACA have only gotten worse with the expanded coverage.”\u003c/p>\n\u003cp>He added that California ranked near the bottom for Medicaid reimbursement rates, “creating a disincentive for physicians to accept more patients covered through Medi-Cal.”[contextly_sidebar id=”hTJ3zCw79M7GuP3WbL7lzRSR1YwiYhNA”]\u003c/p>\n\u003cp>“This coupled with the fact that we have been unable to recruit new physicians to our district has created a situation where coverage does not necessarily equal care, and families must resort to overflowing emergency rooms to be seen,” he has previously said.\u003c/p>\n\u003cp>“The American Health Care Act, as amended, is a good first step toward putting control over personal health care choices back into the hands of individuals — not the federal government — while ensuring important protections remain in place for those with pre-existing conditions and in high-risk pools,” Denham said.\u003c/p>\n\u003cp>Denham’s Stanislaus County seat has been an early target for Democrats, with Hillary Clinton outpacing Donald Trump in the 10th district by 3 points. Federal elections records shows five Democrats have filed to run against Denham, who was re-elected for a third time in November with 52 percent of the vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Miranda Leitsinger and Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Central Valley Rep. Jeff Denham was grilled by constituents on Tuesday upset with his vote to approve the Republican-drafted American Health Care Act that passed the House of Representatives last week.\u003c/p>\n\u003cp>The city of Riverbank invited the Stanislaus County congressman to meet with constituents over coffee at a local teen center. Although the event was planned long before the health care vote, City Manager Sean Scully said interest picked up in recent days after the vote took place.\u003c/p>\n\u003cp>Most questions centered on Denham’s vote for the AHCA.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FKQEDnews%2Fvideos%2F1447610475313345%2F&show_text=0&width=560\" width=\"800\" height=\"420\" style=\"border:none;overflow:hidden\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"true\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“I’m trying to understand how, when nurses are telling you to vote against this, when physicians — even though you’re saying that that’s who you’re trying to support — tell you to vote against this, you as a farmer are not listening to the people that are caring for these patients,” said Mechelle Perea-Ryan, an Oakdale nurse practitioner and educator of 25 years. “I don’t understand how you can do that vote with a clear conscience. … How come you are not listening to what we have to say?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I am listening,” Denham replied. “Under this important debate I’ve gone out to the hospitals, I’ve gone out and talked to the nurses. I’ve gone out and actually asked the questions on how do you fix our overcrowded emergency rooms. How do you get doctors to actually take Medi-Cal patients?\u003c/p>\n\u003cp>“There are a lot of challenges that not only have I listened, but I am fighting to make sure that we actually have a good response in this bill.”\u003c/p>\n\u003cp>Denham wasn’t the first to face upset constituents: Since the election of President Trump, California’s representatives have faced \u003ca href=\"https://ww2.kqed.org/news/2017/02/04/resist-protesters-descend-on-california-republicans-town-hall/\">lively crowds\u003c/a> at town halls and district events, with many voters urging the delegation to take a \u003ca href=\"https://ww2.kqed.org/news/2017/04/17/its-feinstein-vs-hecklers-at-town-hall-in-sf/\">hard stance \u003c/a>against the new administration and policies.\u003c/p>\n\u003cp>\u003cem>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/em>\u003c/p>\n\u003cp>At a town hall that Denham (R-Turlock) held in April in Denair — which also drew a large, \u003ca href=\"http://audio.californiareport.org/archive/R201704180850/c\">rowdy crowd\u003c/a> — he told them \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-rep-jeff-denham-1492484959-htmlstory.html\">he was a no vote\u003c/a> on the earlier draft of the GOP health care bill.\u003c/p>\n\u003cp>Last Thursday, he voted yes — along with \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\">California’s 14 other Republican members of Congress\u003c/a> — on the latest Republican health legislation.\u003c/p>\n\u003cp>A few people at the event challenged him, accusing him of lying.\u003c/p>\n\u003cp>“During the town hall, you specifically said you were not going to repeal and replace the Affordable Care Act,” said Naramsen Goriel of Modesto. “Why did you lie to us?”\u003c/p>\n\u003cp>“Let’s be honest about what I said and be honest about the entire situation,” Denham replied. “Actually, what I said was, I cannot support a bill that does not address pre-existing conditions. (Denham was interrupted by people shouting: “This one doesn’t.”)\u003c/p>\n\u003cp>“Under the current plan, a state would have to opt out,” he continued. “They’d have to apply to the federal government to do that and they’d have to actually make sure they have a risk pool available.”\u003c/p>\n\u003cp>Denham co-sponsored a \u003ca href=\"http://docs.house.gov/billsthisweek/20170501/Upton%20Amendment.pdf\">late amendment\u003c/a> to the GOP bill that would provide $8 billion over the next five years to help pay for the insurance costs of Americans with pre-existing conditions. The AHCA allows states to apply for waivers to let insurers charge those sick consumers more.\u003c/p>\n\u003cp>One of his constituents at the Riverbank meeting challenged him on the high-risk pools.\u003c/p>\n\u003cp>“Do you have experience actually dealing with buying on a high-risk pool?” asked Brooke Myung of Riverbank, who said she worked in insurance billing. She noted that when she and her husband went to get him health insurance after he lost it at work, “it would have cost us our entire income, $2,000 every month. Except, there was a waiting period before we were allowed to buy. And then it was six months before it would cover his medication that keeps him alive.”\u003c/p>\n\u003cp>She added: “So how are we supposed to be assured that people in other states — because, yes, California won’t apply for waivers — but people in other states need to be protected from that, too. That’s unacceptable.”\u003c/p>\n\u003cp>Myung received applause from other attendees. “No part of this is OK,” she said. “No part of it helps to defend Americans, Californians specifically.”\u003c/p>\n\u003cp>Denham told her she had an open invitation to meet with him: “I would love to have you come in and walk me through the process that you’ve gone through. … Help me to understand.”\u003c/p>\n\u003cp>After the vote but ahead of the Riverbank event, Denham said that while “coverage in the Valley has expanded — and that’s a good thing — the access issues that existed before the ACA have only gotten worse with the expanded coverage.”\u003c/p>\n\u003cp>He added that California ranked near the bottom for Medicaid reimbursement rates, “creating a disincentive for physicians to accept more patients covered through Medi-Cal.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“This coupled with the fact that we have been unable to recruit new physicians to our district has created a situation where coverage does not necessarily equal care, and families must resort to overflowing emergency rooms to be seen,” he has previously said.\u003c/p>\n\u003cp>“The American Health Care Act, as amended, is a good first step toward putting control over personal health care choices back into the hands of individuals — not the federal government — while ensuring important protections remain in place for those with pre-existing conditions and in high-risk pools,” Denham said.\u003c/p>\n\u003cp>Denham’s Stanislaus County seat has been an early target for Democrats, with Hillary Clinton outpacing Donald Trump in the 10th district by 3 points. Federal elections records shows five Democrats have filed to run against Denham, who was re-elected for a third time in November with 52 percent of the vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Miranda Leitsinger and Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "House Passes GOP Health Care Bill, But It Still Has a Long Way to Go",
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"content": "\u003cp>\u003cstrong>Update, 1:25 p.m., Thursday:\u003c/strong>\u003cbr>\nThe House voted Thursday to narrowly approve a Republican-drafted measure that would eliminate many of the provisions of the Affordable Care Act — the first step toward keeping one of President Trump’s campaign pledges and a victory for GOP lawmakers who have long railed against Obamacare, as the ACA is commonly known. The vote was 217-213.\u003c/p>\n\u003cp>The measure moves to the Senate, where its fate is far from certain.\u003c/p>\n\u003cp>After passing the measure, House Republicans jumped on buses for a quick trip to an unusual victory lap event in the White House Rose Garden — given that the measure has a long way before it actually becomes law.\u003c/p>\n\u003cp>[contextly_sidebar id=”tLBOmNSoftUFhfMXsUMurzLjMnS7I88a”]\u003c/p>\n\u003cp>Trump promised that premiums and deductibles would be coming down under the GOP plan and said that he feels “confident” the measure will make it through the Senate. “It’s going to be an unbelievable victory when we get it through the Senate,” he added. Trump also praised House Speaker Paul Ryan as “a genius” for engineering Thursday’s legislative win.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Speaking after Trump in the Rose Garden, Ryan asserted the GOP bill was “the beginning of the end of Obamacare.”\u003c/p>\n\u003cp>House Majority Leader Kevin McCarthy told lawmakers “finally after years of waiting, we have the chance to do something good today.”\u003c/p>\n\u003cp>Democrats accused Republicans of ramming the bill through without fully understanding its provisions or its implications.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-11440299\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-800x800.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-160x160.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-960x960.png 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-240x240.png 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-375x375.png 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-520x520.png 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-32x32.png 32w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-50x50.png 50w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-64x64.png 64w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-96x96.png 96w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-128x128.png 128w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-150x150.png 150w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP.png 1000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>All Republican representatives from California \u003ca href=\"https://ww2.kqed.org/news/2017/05/04/how-your-california-rep-voted-on-gop-health-care-bill/\" target=\"_blank\">voted for the bill\u003c/a>.\u003c/p>\n\u003cp>The bill included last-minute amendments designed to draw votes from the most conservative House Republicans in the House Freedom Caucus, as well as from their more moderate counterparts.\u003c/p>\n\u003cp>The changes were necessary after the original bill \u003ca href=\"http://www.npr.org/2017/03/24/521395060/ryan-trump-meet-as-more-republicans-defect-from-health-care-bill\">was pulled\u003c/a> from the floor in March when it became apparent it would not pass. And last week, GOP leaders considered bringing it back, but then \u003ca href=\"http://www.npr.org/2017/04/28/526050474/congress-passes-spending-bill-to-avoid-shutdown-again-punts-on-health-care\">decided not to risk another vote\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=”qEVVPcKYRU6s9yEbCbNdQE46SAXieUvA”]\u003c/p>\n\u003cp>Republican members had their arms twisted by Trump in phone calls, and attended a last-minute pep rally Thursday morning, in which GOP House leaders reportedly told them it was \u003ca href=\"http://www.foxbusiness.com/markets/2017/05/04/gop-revives-struggling-health-care-bill-and-plans-house-vote.html\">“time to live or die by this day.”\u003c/a>\u003c/p>\n\u003cp>The measure, known as the American Health Care Act, was called “a monstrosity” by House Minority Leader Nancy Pelosi, who said centrist Republicans who voted for the bill will have “walked the plank from moderate to radical,” adding “you will glow in the dark,” after voting for the bill.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-11440300\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-800x800.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-160x160.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-960x960.png 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-240x240.png 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-375x375.png 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-520x520.png 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-32x32.png 32w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-50x50.png 50w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-64x64.png 64w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-96x96.png 96w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-128x128.png 128w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-150x150.png 150w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill.png 1000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003cbr>\nRepublicans appear to have finally gotten their health care bill.\u003c/p>\n\u003cp>After seven years of repeal-and-replace rhetoric against the Affordable Care Act, two presidential campaigns waged for and against it and a recent high-profile failure, GOP House leaders say they have the votes for their bill.\u003c/p>\n\u003cp>The trouble is this bill is likely never to become law — at least in its current iteration.\u003c/p>\n\u003cp>Here’s why: While the bill is expected to pass the House (narrowly) Thursday afternoon, it still has to go to the Senate. It’s being done with a wink and a promise that the Senate will overhaul substantial portions of the bill.\u003c/p>\n\u003cp>“This thing is going to the United States Senate. It’s going to change in my view in the United States Senate in some way,” Rep. Tom Cole of Oklahoma, a deputy whip in the House, told \u003cem>NPR’s Morning Edition\u003c/em>. (He’s one of the people in charge of making sure Republicans have the votes.) “Then we have to have a conference to work out the differences. \u003cem>If\u003c/em> we can do that, then it has to still pass the House and the Senate again before it ever gets to the president. So at some point, you just have to move.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/526833507/526833508\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Sure, the Senate is controlled by Republicans, too, but they have an even slimmer majority there with equally fractious divisions. If they lose three votes, the bill goes down.\u003c/p>\n\u003cp>Sen. Tom Cotton of Arkansas has been doing a delicate dance on Medicaid expansion. His state took federal money to expand Medicaid, but he’s called it a “welfare program” and said “\u003ca href=\"http://www.mediaite.com/online/gop-senator-republican-healthcare-plan-is-not-going-to-work-to-bring-down-premiums/\">able-bodied adults\u003c/a>” shouldn’t be on it.\u003c/p>\n\u003cp>After an angry town hall, he changed his tune, saying the House bill was “\u003ca href=\"https://www.arktimes.com/ArkansasBlog/archives/2017/04/18/tom-cottons-obamacare-repeal-dance\">moving too fast; I didn’t think it got it right\u003c/a>.” He also has indicated he’s against it in its current form because, “I simply think that it’s not going to work to bring down premiums for working Arkansans or working Americans around the country.”\u003c/p>\n\u003cp>Other senators, like Sens. Lisa Murkowski of Alaska, Susan Collins of Maine, Bob Corker of Tennessee, Rob Portman of Ohio and Bill Cassidy of Louisiana, are in favor of repeal, but \u003ca href=\"https://www.corker.senate.gov/public/index.cfm/2017/1/senators-introduce-amendment-to-improve-process-for-repealing-and-replacing-health-care-law-in-timely-fashion\">want something “stable” \u003c/a>to replace it. They have indicated that affordability, coverage and rural access (like what the bill means for rural hospitals) are key.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell is going to allow amendments. That means the bill will change. And if even a comma is inserted, it has to pass the House — again.\u003c/p>\n\u003cp>And that is inevitably going to bring back this whole game of whack-a-mole in the House.\u003c/p>\n\u003cp>Exhausted yet?\u003c/p>\n\u003cp>Wait, there’s more. Because Democrats aren’t going to sign onto something that guts the coverage mandates of the Affordable Care Act, Republicans can’t get 60 votes to advance the legislation.\u003c/p>\n\u003cp>[contextly_sidebar id=”VajiqRclxG7Eyq4VufiI3TOZ6hfrnGMq”]\u003c/p>\n\u003cp>So in order to pass it, they’re going to have to use the process known as \u003cstrong>reconciliation\u003c/strong>. That allows legislation to pass with just a majority (plus one). But there’s a catch — it has to be tied to the budget.\u003c/p>\n\u003cp>Get ready to hear a whole lot more about the \u003cstrong>“Byrd Rule.”\u003c/strong> What’s that? The Committee for a Responsible Federal Budget \u003ca href=\"http://www.crfb.org/blogs/byrd-rule-and-its-effect-health-reform-short-guide\">explains it this way\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>“Although reconciliation bills are granted many privileges that are not available to most other legislation (see Reconciliation 101), they remain bound by several conditions. Some of these restrictions championed by former Senator Robert Byrd (D-WV) and established in Section 313 of the Budget Act are jointly referred to as the ‘Byrd Rule.’ The Byrd Rule disallows “extraneous matter” from being included in a reconciliation bill, extraneous matter being defined in three major categories of restrictions.\u003c/p>\n\u003cp>“First, reconciliation legislation must only involve budget-related changes and cannot include policies that have no fiscal impact, that have ‘merely incidental’ fiscal impacts, or that increase the deficit if the committee did not follow its reconciliation instructions (including proposals outside of a committee’s proper jurisdiction—more on this below). Second, reconciliation bills cannot change Social Security spending or dedicated revenue, which are considered ‘off-budget.’ And finally, provisions in a reconciliation bill cannot increase the deficit in any fiscal year after the window of the reconciliation bill (usually ten years in the future) unless the costs outside the budget window are offset by other savings in the bill.”\u003c/p>\u003c/blockquote>\n\u003cp>The umpire of what qualifies under the Byrd Rule is the \u003cstrong>Senate parliamentarian\u003c/strong>. Her name is Elizabeth MacDonough. \u003ca href=\"http://www.politico.com/story/2015/01/senate-parliamentarian-elizabeth-macdonough-obamacare-114274\">Politico\u003c/a> wrote of her in 2015:\u003c/p>\n\u003cblockquote>\u003cp>“[S]he may very well be the most powerful person in Washington in determining how far Republicans can go in trying to repeal Obamacare. As the Senate parliamentarian, MacDonough will make the decisions on which pieces of the law qualify to be repealed using a complicated budget procedure called reconciliation. Her decisions would allow Senate Republicans to vote to kill major provisions of the health care law under a simple 51-vote majority without giving Democrats a chance to filibuster.”\u003c/p>\u003c/blockquote>\n\u003cp>MacDonough was appointed in 2012, and even though she’s liked on Capitol Hill by both sides, past parliamentarians (\u003ca href=\"http://www.politico.com/story/2012/02/new-parliamentarian-knows-her-way-around-072526\">known colloquially on the Hill as “parls”\u003c/a>) have come under fire because the majority party didn’t like how they ruled. \u003ca href=\"http://www.politico.com/story/2015/01/senate-parliamentarian-elizabeth-macdonough-obamacare-114274\">More from Politico\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>“Republicans protested decisions by then-parliamentarian Alan Frumin in the 2010 health care reform fight, when Democrats used the budget fast-track tool to pass a small part of the Affordable Care Act. In 2001, Republicans fired Robert Dove as parliamentarian after he ruled against them on how many reconciliation bills could be used. That was actually his second stint in the job: Democrats had fired Dove when they took the majority in 1987.”\u003c/p>\u003c/blockquote>\n\u003cp>Reconciliation — and what fits and doesn’t fit into it — isn’t the GOP’s only complication. Their biggest one is the policy itself. It has a lot of shortcomings.\u003c/p>\n\u003cp>The nonpartisan \u003cstrong>Congressional Budget Office\u003c/strong> said of the last iteration of the House bill that it would save money but would leave some 24 million without insurance.\u003c/p>\n\u003cp>So the GOP bill would be less generous in terms of benefits and cover fewer. And the only reason it would save money is because the repeal bill would \u003ca href=\"http://www.politico.com/story/2017/03/trump-obamacare-promises-236021\">cut $880 billion from Medicaid\u003c/a>.\u003c/p>\n\u003cp>That would break Trump’s promises of “insurance for everybody” and “no cuts to Social Security, Medicare & Medicaid.”\u003c/p>\n\u003cp>The CBO won’t get out an analysis of the bill before Republicans are planning to vote. Politically, that gives them a chance to wipe their brows and not have to defend something that could be difficult to defend.\u003c/p>\n\u003cp>It’s morally questionable, though, to vote on something without knowing its cost or consequences. And what happens when the CBO score does come out — and they’ve already voted for it without the opportunity to make changes?\u003c/p>\n\u003cp>And there’s the issue of the popular \u003cstrong>pre-existing conditions\u003c/strong> provision in Obamacare — that requires insurance companies to cover people with pre-existing conditions.\u003c/p>\n\u003cp>Trump claimed as late as this week that this bill would guarantee people with pre-existing conditions would continue to be covered. But Republicans’ attempts at doing that are very different from how Obamacare achieves it.\u003c/p>\n\u003cp>The GOP plan would essentially allow states to take sicker people out of the broader pool of people buying coverage and put them into a “high-risk pool.” That, in theory, would bring down the cost of insurance for healthier people, but drive up the cost for the sick. Depending upon how much costs increase, that could shut some or many of the people who definitely need health care out of the insurance market.\u003c/p>\n\u003cp>High-risk pools \u003ca href=\"http://www.npr.org/2017/02/03/513311344/republicans-consider-restoring-high-risk-pools-in-obamacare-replacement\">haven’t shown great results\u003c/a> where they have been currently implemented. Part of the problem has been funding. That’s why Trump picked up two more votes with a proposal for $8 billion more for those pools, but experts say that’s not even likely enough.\u003c/p>\n\u003cp>[contextly_sidebar id=”eunRwEXPkmqidH6LoEqaj64hk4ZeBZMv”]\u003c/p>\n\u003cp>The U.S. government already has very high-profile high-risk pools, Medicare and Medicaid. Medicare, health care for the elderly, is popular but expensive.\u003c/p>\n\u003cp>A big point of Obamacare was to not go down that potentially problematic funding lane. Healthier people might pay a little more, but if you got sick, it wouldn’t bankrupt you.\u003c/p>\n\u003cp>So why the rush to get this through if it has all these holes and it may not be what eventually becomes law anyway? Politics. The House finally has a chance to tell its base it did something, it passed \u003cem>something\u003c/em> to repeal and replace Obamacare.\u003c/p>\n\u003cp>The House goes on recess next week, and Republicans want to get this done and hand Trump a win before then.\u003c/p>\n\u003cp>It’s a huge relief for House Speaker Paul Ryan, who was feeling the heat of not being able to govern House Republicans.\u003c/p>\n\u003cp>It’s a huge relief for Trump, who has been made to look ineffectual with no legislative wins to speak of in his first 100 days and little other major accomplishments in that time — despite Republicans being in charge of the White House, the House and Senate.\u003c/p>\n\u003cp>But remember, the GOP plan that failed previously had just a \u003ca href=\"https://poll.qu.edu/national/release-detail?ReleaseID=2443\">17 percent approval rating\u003c/a>. And, policywise, it hasn’t changed all that much.\u003c/p>\n\u003cp>President Obama ran into a similar problem — health care is very difficult to message about but very easy to poke holes in. And Democrats lost control of the House in 2010 because of health care.\u003c/p>\n\u003cp>Now, the Affordable Care Act, Obama’s signature legislative achievement, has had a resurgence in public opinion. Gallup found approval of the ACA at 55 percent this month, the first time it’s ever reached a majority in the poll.\u003c/p>\n\u003cp>https://twitter.com/realDonaldTrump/status/858659215451271168\u003c/p>\n\u003cp>President Trump says the GOP bill can’t be compared to the ACA “because Obamacare is dead.”\u003c/p>\n\u003cp>First of all, that’s not true. The last CBO analysis of the ACA said it’s not in a death spiral.\u003c/p>\n\u003cp>Second, anything that comes after Obamacare has to be compared to it.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>What’s that you say, health care \u003cem>and\u003c/em> legislating are complicated? Yes, they are, and there’s still a long way to go.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Expected+To+Pass+Its+Health+Care+Bill+At+Long+Last%2C+But+Still+A+Long+Way+To+Go&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 1:25 p.m., Thursday:\u003c/strong>\u003cbr>\nThe House voted Thursday to narrowly approve a Republican-drafted measure that would eliminate many of the provisions of the Affordable Care Act — the first step toward keeping one of President Trump’s campaign pledges and a victory for GOP lawmakers who have long railed against Obamacare, as the ACA is commonly known. The vote was 217-213.\u003c/p>\n\u003cp>The measure moves to the Senate, where its fate is far from certain.\u003c/p>\n\u003cp>After passing the measure, House Republicans jumped on buses for a quick trip to an unusual victory lap event in the White House Rose Garden — given that the measure has a long way before it actually becomes law.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Trump promised that premiums and deductibles would be coming down under the GOP plan and said that he feels “confident” the measure will make it through the Senate. “It’s going to be an unbelievable victory when we get it through the Senate,” he added. Trump also praised House Speaker Paul Ryan as “a genius” for engineering Thursday’s legislative win.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Speaking after Trump in the Rose Garden, Ryan asserted the GOP bill was “the beginning of the end of Obamacare.”\u003c/p>\n\u003cp>House Majority Leader Kevin McCarthy told lawmakers “finally after years of waiting, we have the chance to do something good today.”\u003c/p>\n\u003cp>Democrats accused Republicans of ramming the bill through without fully understanding its provisions or its implications.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-11440299\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-800x800.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-160x160.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-960x960.png 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-240x240.png 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-375x375.png 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-520x520.png 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-32x32.png 32w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-50x50.png 50w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-64x64.png 64w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-96x96.png 96w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-128x128.png 128w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP-150x150.png 150w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/McCarthy_ModifiedGOP.png 1000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>All Republican representatives from California \u003ca href=\"https://ww2.kqed.org/news/2017/05/04/how-your-california-rep-voted-on-gop-health-care-bill/\" target=\"_blank\">voted for the bill\u003c/a>.\u003c/p>\n\u003cp>The bill included last-minute amendments designed to draw votes from the most conservative House Republicans in the House Freedom Caucus, as well as from their more moderate counterparts.\u003c/p>\n\u003cp>The changes were necessary after the original bill \u003ca href=\"http://www.npr.org/2017/03/24/521395060/ryan-trump-meet-as-more-republicans-defect-from-health-care-bill\">was pulled\u003c/a> from the floor in March when it became apparent it would not pass. And last week, GOP leaders considered bringing it back, but then \u003ca href=\"http://www.npr.org/2017/04/28/526050474/congress-passes-spending-bill-to-avoid-shutdown-again-punts-on-health-care\">decided not to risk another vote\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Republican members had their arms twisted by Trump in phone calls, and attended a last-minute pep rally Thursday morning, in which GOP House leaders reportedly told them it was \u003ca href=\"http://www.foxbusiness.com/markets/2017/05/04/gop-revives-struggling-health-care-bill-and-plans-house-vote.html\">“time to live or die by this day.”\u003c/a>\u003c/p>\n\u003cp>The measure, known as the American Health Care Act, was called “a monstrosity” by House Minority Leader Nancy Pelosi, who said centrist Republicans who voted for the bill will have “walked the plank from moderate to radical,” adding “you will glow in the dark,” after voting for the bill.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-11440300\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-800x800.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-800x800.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-160x160.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-960x960.png 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-240x240.png 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-375x375.png 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-520x520.png 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-32x32.png 32w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-50x50.png 50w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-64x64.png 64w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-96x96.png 96w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-128x128.png 128w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill-150x150.png 150w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/05/Pelosi_ModifiedBill.png 1000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003cbr>\nRepublicans appear to have finally gotten their health care bill.\u003c/p>\n\u003cp>After seven years of repeal-and-replace rhetoric against the Affordable Care Act, two presidential campaigns waged for and against it and a recent high-profile failure, GOP House leaders say they have the votes for their bill.\u003c/p>\n\u003cp>The trouble is this bill is likely never to become law — at least in its current iteration.\u003c/p>\n\u003cp>Here’s why: While the bill is expected to pass the House (narrowly) Thursday afternoon, it still has to go to the Senate. It’s being done with a wink and a promise that the Senate will overhaul substantial portions of the bill.\u003c/p>\n\u003cp>“This thing is going to the United States Senate. It’s going to change in my view in the United States Senate in some way,” Rep. Tom Cole of Oklahoma, a deputy whip in the House, told \u003cem>NPR’s Morning Edition\u003c/em>. (He’s one of the people in charge of making sure Republicans have the votes.) “Then we have to have a conference to work out the differences. \u003cem>If\u003c/em> we can do that, then it has to still pass the House and the Senate again before it ever gets to the president. So at some point, you just have to move.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/526833507/526833508\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Sure, the Senate is controlled by Republicans, too, but they have an even slimmer majority there with equally fractious divisions. If they lose three votes, the bill goes down.\u003c/p>\n\u003cp>Sen. Tom Cotton of Arkansas has been doing a delicate dance on Medicaid expansion. His state took federal money to expand Medicaid, but he’s called it a “welfare program” and said “\u003ca href=\"http://www.mediaite.com/online/gop-senator-republican-healthcare-plan-is-not-going-to-work-to-bring-down-premiums/\">able-bodied adults\u003c/a>” shouldn’t be on it.\u003c/p>\n\u003cp>After an angry town hall, he changed his tune, saying the House bill was “\u003ca href=\"https://www.arktimes.com/ArkansasBlog/archives/2017/04/18/tom-cottons-obamacare-repeal-dance\">moving too fast; I didn’t think it got it right\u003c/a>.” He also has indicated he’s against it in its current form because, “I simply think that it’s not going to work to bring down premiums for working Arkansans or working Americans around the country.”\u003c/p>\n\u003cp>Other senators, like Sens. Lisa Murkowski of Alaska, Susan Collins of Maine, Bob Corker of Tennessee, Rob Portman of Ohio and Bill Cassidy of Louisiana, are in favor of repeal, but \u003ca href=\"https://www.corker.senate.gov/public/index.cfm/2017/1/senators-introduce-amendment-to-improve-process-for-repealing-and-replacing-health-care-law-in-timely-fashion\">want something “stable” \u003c/a>to replace it. They have indicated that affordability, coverage and rural access (like what the bill means for rural hospitals) are key.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell is going to allow amendments. That means the bill will change. And if even a comma is inserted, it has to pass the House — again.\u003c/p>\n\u003cp>And that is inevitably going to bring back this whole game of whack-a-mole in the House.\u003c/p>\n\u003cp>Exhausted yet?\u003c/p>\n\u003cp>Wait, there’s more. Because Democrats aren’t going to sign onto something that guts the coverage mandates of the Affordable Care Act, Republicans can’t get 60 votes to advance the legislation.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>So in order to pass it, they’re going to have to use the process known as \u003cstrong>reconciliation\u003c/strong>. That allows legislation to pass with just a majority (plus one). But there’s a catch — it has to be tied to the budget.\u003c/p>\n\u003cp>Get ready to hear a whole lot more about the \u003cstrong>“Byrd Rule.”\u003c/strong> What’s that? The Committee for a Responsible Federal Budget \u003ca href=\"http://www.crfb.org/blogs/byrd-rule-and-its-effect-health-reform-short-guide\">explains it this way\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>“Although reconciliation bills are granted many privileges that are not available to most other legislation (see Reconciliation 101), they remain bound by several conditions. Some of these restrictions championed by former Senator Robert Byrd (D-WV) and established in Section 313 of the Budget Act are jointly referred to as the ‘Byrd Rule.’ The Byrd Rule disallows “extraneous matter” from being included in a reconciliation bill, extraneous matter being defined in three major categories of restrictions.\u003c/p>\n\u003cp>“First, reconciliation legislation must only involve budget-related changes and cannot include policies that have no fiscal impact, that have ‘merely incidental’ fiscal impacts, or that increase the deficit if the committee did not follow its reconciliation instructions (including proposals outside of a committee’s proper jurisdiction—more on this below). Second, reconciliation bills cannot change Social Security spending or dedicated revenue, which are considered ‘off-budget.’ And finally, provisions in a reconciliation bill cannot increase the deficit in any fiscal year after the window of the reconciliation bill (usually ten years in the future) unless the costs outside the budget window are offset by other savings in the bill.”\u003c/p>\u003c/blockquote>\n\u003cp>The umpire of what qualifies under the Byrd Rule is the \u003cstrong>Senate parliamentarian\u003c/strong>. Her name is Elizabeth MacDonough. \u003ca href=\"http://www.politico.com/story/2015/01/senate-parliamentarian-elizabeth-macdonough-obamacare-114274\">Politico\u003c/a> wrote of her in 2015:\u003c/p>\n\u003cblockquote>\u003cp>“[S]he may very well be the most powerful person in Washington in determining how far Republicans can go in trying to repeal Obamacare. As the Senate parliamentarian, MacDonough will make the decisions on which pieces of the law qualify to be repealed using a complicated budget procedure called reconciliation. Her decisions would allow Senate Republicans to vote to kill major provisions of the health care law under a simple 51-vote majority without giving Democrats a chance to filibuster.”\u003c/p>\u003c/blockquote>\n\u003cp>MacDonough was appointed in 2012, and even though she’s liked on Capitol Hill by both sides, past parliamentarians (\u003ca href=\"http://www.politico.com/story/2012/02/new-parliamentarian-knows-her-way-around-072526\">known colloquially on the Hill as “parls”\u003c/a>) have come under fire because the majority party didn’t like how they ruled. \u003ca href=\"http://www.politico.com/story/2015/01/senate-parliamentarian-elizabeth-macdonough-obamacare-114274\">More from Politico\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>“Republicans protested decisions by then-parliamentarian Alan Frumin in the 2010 health care reform fight, when Democrats used the budget fast-track tool to pass a small part of the Affordable Care Act. In 2001, Republicans fired Robert Dove as parliamentarian after he ruled against them on how many reconciliation bills could be used. That was actually his second stint in the job: Democrats had fired Dove when they took the majority in 1987.”\u003c/p>\u003c/blockquote>\n\u003cp>Reconciliation — and what fits and doesn’t fit into it — isn’t the GOP’s only complication. Their biggest one is the policy itself. It has a lot of shortcomings.\u003c/p>\n\u003cp>The nonpartisan \u003cstrong>Congressional Budget Office\u003c/strong> said of the last iteration of the House bill that it would save money but would leave some 24 million without insurance.\u003c/p>\n\u003cp>So the GOP bill would be less generous in terms of benefits and cover fewer. And the only reason it would save money is because the repeal bill would \u003ca href=\"http://www.politico.com/story/2017/03/trump-obamacare-promises-236021\">cut $880 billion from Medicaid\u003c/a>.\u003c/p>\n\u003cp>That would break Trump’s promises of “insurance for everybody” and “no cuts to Social Security, Medicare & Medicaid.”\u003c/p>\n\u003cp>The CBO won’t get out an analysis of the bill before Republicans are planning to vote. Politically, that gives them a chance to wipe their brows and not have to defend something that could be difficult to defend.\u003c/p>\n\u003cp>It’s morally questionable, though, to vote on something without knowing its cost or consequences. And what happens when the CBO score does come out — and they’ve already voted for it without the opportunity to make changes?\u003c/p>\n\u003cp>And there’s the issue of the popular \u003cstrong>pre-existing conditions\u003c/strong> provision in Obamacare — that requires insurance companies to cover people with pre-existing conditions.\u003c/p>\n\u003cp>Trump claimed as late as this week that this bill would guarantee people with pre-existing conditions would continue to be covered. But Republicans’ attempts at doing that are very different from how Obamacare achieves it.\u003c/p>\n\u003cp>The GOP plan would essentially allow states to take sicker people out of the broader pool of people buying coverage and put them into a “high-risk pool.” That, in theory, would bring down the cost of insurance for healthier people, but drive up the cost for the sick. Depending upon how much costs increase, that could shut some or many of the people who definitely need health care out of the insurance market.\u003c/p>\n\u003cp>High-risk pools \u003ca href=\"http://www.npr.org/2017/02/03/513311344/republicans-consider-restoring-high-risk-pools-in-obamacare-replacement\">haven’t shown great results\u003c/a> where they have been currently implemented. Part of the problem has been funding. That’s why Trump picked up two more votes with a proposal for $8 billion more for those pools, but experts say that’s not even likely enough.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The U.S. government already has very high-profile high-risk pools, Medicare and Medicaid. Medicare, health care for the elderly, is popular but expensive.\u003c/p>\n\u003cp>A big point of Obamacare was to not go down that potentially problematic funding lane. Healthier people might pay a little more, but if you got sick, it wouldn’t bankrupt you.\u003c/p>\n\u003cp>So why the rush to get this through if it has all these holes and it may not be what eventually becomes law anyway? Politics. The House finally has a chance to tell its base it did something, it passed \u003cem>something\u003c/em> to repeal and replace Obamacare.\u003c/p>\n\u003cp>The House goes on recess next week, and Republicans want to get this done and hand Trump a win before then.\u003c/p>\n\u003cp>It’s a huge relief for House Speaker Paul Ryan, who was feeling the heat of not being able to govern House Republicans.\u003c/p>\n\u003cp>It’s a huge relief for Trump, who has been made to look ineffectual with no legislative wins to speak of in his first 100 days and little other major accomplishments in that time — despite Republicans being in charge of the White House, the House and Senate.\u003c/p>\n\u003cp>But remember, the GOP plan that failed previously had just a \u003ca href=\"https://poll.qu.edu/national/release-detail?ReleaseID=2443\">17 percent approval rating\u003c/a>. And, policywise, it hasn’t changed all that much.\u003c/p>\n\u003cp>President Obama ran into a similar problem — health care is very difficult to message about but very easy to poke holes in. And Democrats lost control of the House in 2010 because of health care.\u003c/p>\n\u003cp>Now, the Affordable Care Act, Obama’s signature legislative achievement, has had a resurgence in public opinion. Gallup found approval of the ACA at 55 percent this month, the first time it’s ever reached a majority in the poll.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>President Trump says the GOP bill can’t be compared to the ACA “because Obamacare is dead.”\u003c/p>\n\u003cp>First of all, that’s not true. The last CBO analysis of the ACA said it’s not in a death spiral.\u003c/p>\n\u003cp>Second, anything that comes after Obamacare has to be compared to it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What’s that you say, health care \u003cem>and\u003c/em> legislating are complicated? Yes, they are, and there’s still a long way to go.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Expected+To+Pass+Its+Health+Care+Bill+At+Long+Last%2C+But+Still+A+Long+Way+To+Go&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medical Student Suicides Prompt Schools to Finally Take Action",
"title": "Medical Student Suicides Prompt Schools to Finally Take Action",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>\u003cem>This post was updated May 22 to include the radio version, which you can listen to by scrolling down.\u003c/em>\u003c/p>\n\u003cp>Last year, all of the accumulated data pointing to the poor mental health of medical students in general suddenly became more than just numbers at USC's Keck School of Medicine.\u003c/p>\n\u003cp>A Keck student, 25-year-old Sean Petro, had failed to show up for a clinical rotation. Eventually, campus police found his body in a closet of his apartment, where he had hung himself. In addition to attending medical school, Petro had just become an officer in the Navy Reserve, and had hopes of becoming a flight surgeon.\u003c/p>\n\u003cp>At Keck, he was just one year shy of graduating.\u003c/p>\n\u003cp>His suicide shocked Ranjita Raghavan, now in her third year at the medical school, a year behind Petro.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s really scary,\" she says, speaking about medical school suicides in general. \"It’s one of those things that’s really alarming.\"\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/science/2017/05/WEBSuicideDocsGorn170522.mp3\" title=\"Click on the play button below to listen to the radio story\" program=\"Future of You\" image=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/05/SciencePlayer_BG.jpeg\"]\u003c/p>\n\u003cp>Her own schedule illustrates how daunting a medical student's life can be. Six days a week, she rises at 4:30 a.m. and doesn't return home till 7 p.m. Whatever free time she has is used to study and eat.\u003c/p>\n\u003cp>\"No one said medical school’s going to be easy,\" she says. \"But you just don’t know from the outside. I come off as a happy person, but it was really tough for me the first two years.\"\u003c/p>\n\u003cp>She says although she is generally upbeat about her medical school experience, she still can't quite get her mind around all the data that shows so many students are exhibiting signs of burnout, not to mention thinking about suicide.\u003c/p>\n\u003cp>\u003cstrong>A Known Risk\u003c/strong>\u003c/p>\n\u003cp>After aspiring doctors receive a prized acceptance letter to medical school, they face a daunting reality.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is so much buzz in our circle right now, in the academic and physician circle, and now it’s reaching a level that can no longer be pushed under the rug. It’s becoming scandalous.'\u003ccite>Dr. Andres Sciolla, psychiatrist, UC Davis School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>Get ready for 80-hour work weeks for the next seven years of med school and residency. Get ready for trying to commit a crush of information to sleep-deprived brain cells. Get ready for little time spent with family and friends. Oh, and by the way, get ready for making decisions resulting in life and death.\u003c/p>\n\u003cp>And get ready for, potentially, thoughts about ending your own life.\u003c/p>\n\u003cp>No one knows the exact number of medical students or residents who have killed themselves in the U.S.; there is no requirement to report suicide rates in medical school or residency programs. But multiple studies have shown these doctors-in-training are at risk for suicide, and the reality of poor mental health among the population is well-known.\u003c/p>\n\u003cp>Last year, a\u003ca href=\"http://jamanetwork.com/journals/jama/article-abstract/2589340\" target=\"_blank\" rel=\"noopener noreferrer\"> meta-study \u003c/a>published in the \u003cem>Journal of the American Medical Association\u003c/em> looked at 117,000 medical students around the world. The findings: 11 percent had considered ending their lives.\u003c/p>\n\u003cp>A 2008\u003ca href=\"https://www.med.upenn.edu/gastro/documents/Dyrbye.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> of over 4,000 students at seven U.S. medical schools found as high as 13 percent having suicidal thoughts. For comparison, in the U.S., the rate of suicidal ideation among the general population is just 7 percent for 18 to-25 -year-olds, according to 2013 \u003ca href=\"https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">numbers\u003c/a> from the U.S. Centers for Disease Control and Prevention. For 26- to 49-year-olds, it is 4 percent.\u003c/p>\n\u003cp>And while a 2014 \u003ca href=\"http://journals.lww.com/academicmedicine/Fulltext/2014/03000/Burnout_Among_U_S__Medical_Students,_Residents,.25.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> found a slightly lower rate of suicidal ideation among medical students, residents and young doctors compared to others in their age group, it found significantly higher rates of depression and burnout.\u003c/p>\n\u003cp>\u003cstrong>Schools, Programs React\u003c/strong>\u003c/p>\n\u003cp>The data, combined with a number of actual suicides by medical students and residents, have prompted schools and residency programs across California and the country to initiate programs to reduce stress, require mental-health screenings and offer counseling.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don’t know that we recognized the need. I think medicine traditionally has been a profession that says, ‘You just do it.’ ”\u003ccite>Donna Elliott, senior associate dean of student affairs, USC\u003c/cite>\u003c/aside>\n\u003cp>The programs have been instituted over just the last several years; traditionally, stress and mental health problems are not issues the institutions have specifically addressed, mental health experts say.\u003c/p>\n\u003cp>That's changing because Petro's death is only one of several recent suicides by medical students and residents around the country, says Andres Sciolla, a psychiatrist at the UC Davis School of Medicine.\u003c/p>\n\u003cp>Sciolla says the suicides of two doctors-in-training in New York City in 2014 galvanized the idea among the medical community that something needed to be done.\u003c/p>\n\u003cp>\"It’s a very big topic that the general public just doesn’t know about,” Sciolla says. “There is so much buzz in our circle right now, in the academic and physician circle, and now it’s reaching a level that can no longer be pushed under the rug. It’s becoming scandalous.”\u003c/p>\n\u003cp>Sciolla helped institute a mental health program at UC Davis to catch problems before they can turn into crises. Residents fill out an online confidential survey to help identify those who are dealing with high levels of stress. Those individuals are contacted and offered counseling and other resources so they don't have to suffer in silence.\u003c/p>\n\u003cp>At the Keck School of Medicine, administrators started to address student mental health even before Petro's death. That's partly because in 2014, the same year national attention focused on the resident suicides in New York, another medical student who was enrolled at USC disappeared and was never found. That same year, a faculty physician took his own life.\u003c/p>\n\u003cp>Donna Elliott, the senior associate dean of student affairs at USC, says those local and national incidents were a loud wake-up call.\u003c/p>\n\u003cp>“There's a strong need in medical schools now in supporting students’ mental health,\" Elliott says. A big first step in that direction, she says, is the need to change the culture of shame and stigma around burnout, depression and suicide.\u003c/p>\n\u003cp>USC has hired a director of medical student wellness, instituted mandatory \"Keck Check\" mental health\u003cem> \u003c/em>evaluation sessions and now requires students to take several mental-health days off every year.\u003c/p>\n\u003cp>\u003cstrong>'Slow Going'\u003c/strong>\u003c/p>\n\u003cp>In the past, Elliott says, \"I don’t know that we recognized the need. I think medicine traditionally has been a profession that says, ‘You just do it.’ ”\u003c/p>\n\u003cp>Indeed the stigma and shame of suicide is more pronounced in the medical community, says Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention.\u003c/p>\n\u003cp>Moutier, while working at UC San Diego, was the driving force behind the first med school suicide prevention program in California, \u003ca href=\"https://healthsciences.ucsd.edu/som/hear/Documents/suicide-prevention-depression-awareness.pdf\">back in 2009\u003c/a>.\u003c/p>\n\u003cp>\"At the time, it felt like few were doing that work, and it felt like swimming upstream to get it done,\" Moutier says. \"And it became even more difficult when I would take ideas to the regional or national level. It was slow going.\"\u003c/p>\n\u003cp>Moutier points to the irony that those attending to people’s health are facing their own health crisis. “It’s such a disconnect that health professionals don’t take this seriously,” she says.\u003c/p>\n\u003cp>She calls the problem a public health crisis–not just for the medical providers, but for their patients as well.\u003c/p>\n\u003cp>“This is a major problem,” Moutier says. “I mean, if you’re looking at the fact that almost a \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2467822\" target=\"_blank\" rel=\"noopener noreferrer\">quarter of interns\u003c/a> are thinking of suicide, what kind of care are they giving patients?”\u003c/p>\n\u003cp>A national movement is now afoot to address the issue. The Accreditation Council for Graduate Medical Education last year \u003ca href=\"https://www.acgme.org/Portals/0/PDFs/JointReleaseFinal_Letterhead.pdf\">launched an initiative\u003c/a> to prevent medical school and residency suicides, and it hopes to require residency training programs to have wellness initiatives in place starting in July.\u003c/p>\n\u003cp>However, a \u003ca href=\"http://www.acgme.org/Portals/0/PDFs/Nasca-Community/Section-VI-Memo-3-10-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent ACGME decision\u003c/a> raised the\u003ca href=\"https://www.nytimes.com/2017/03/10/health/us-doctors-residents-24-hour-shifts.html\" target=\"_blank\" rel=\"noopener noreferrer\"> number of continuous hours\u003c/a> first-year residents can work, from 16 to 24.\u003c/p>\n\u003cp>Among other medical schools across the state, UCSF now requires third-year medical students, who typically spend up to 80 hours a week on hospital rotations, to attend check-in mental-health sessions. Stanford School of Medicine has a similar program to identify and help those who might be struggling with stress and burnout. One residency program at Stanford also offers stress-reduction perks like free delivery of groceries to residents' homes and time to exercise.\u003c/p>\n\u003cp>All of these efforts are a good start, but just a start, says Sidney Zisook, director of the psychiatry residency program at UC San Diego.\u003c/p>\n\u003cp>“There’s been a code of silence throughout the years. Places have tried to cover this up and hush it up, no question,\" Zisook says. “I do think things are moving in a positive direction now. But certainly institutions need to take a much more serious look at this.”\u003c/p>\n\u003cp>Raghavan, the third-year medical student from USC, says she recognizes the support she is getting from the school.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"On your own, you never have enough time to sit and think about what you need. I mean, when do I have time to do that?\" she says with a laugh. \"So I appreciate the school thinking about that for you, and trying to do something about it.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This post was updated May 22 to include the radio version, which you can listen to by scrolling down.\u003c/em>\u003c/p>\n\u003cp>Last year, all of the accumulated data pointing to the poor mental health of medical students in general suddenly became more than just numbers at USC's Keck School of Medicine.\u003c/p>\n\u003cp>A Keck student, 25-year-old Sean Petro, had failed to show up for a clinical rotation. Eventually, campus police found his body in a closet of his apartment, where he had hung himself. In addition to attending medical school, Petro had just become an officer in the Navy Reserve, and had hopes of becoming a flight surgeon.\u003c/p>\n\u003cp>At Keck, he was just one year shy of graduating.\u003c/p>\n\u003cp>His suicide shocked Ranjita Raghavan, now in her third year at the medical school, a year behind Petro.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s really scary,\" she says, speaking about medical school suicides in general. \"It’s one of those things that’s really alarming.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Her own schedule illustrates how daunting a medical student's life can be. Six days a week, she rises at 4:30 a.m. and doesn't return home till 7 p.m. Whatever free time she has is used to study and eat.\u003c/p>\n\u003cp>\"No one said medical school’s going to be easy,\" she says. \"But you just don’t know from the outside. I come off as a happy person, but it was really tough for me the first two years.\"\u003c/p>\n\u003cp>She says although she is generally upbeat about her medical school experience, she still can't quite get her mind around all the data that shows so many students are exhibiting signs of burnout, not to mention thinking about suicide.\u003c/p>\n\u003cp>\u003cstrong>A Known Risk\u003c/strong>\u003c/p>\n\u003cp>After aspiring doctors receive a prized acceptance letter to medical school, they face a daunting reality.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is so much buzz in our circle right now, in the academic and physician circle, and now it’s reaching a level that can no longer be pushed under the rug. It’s becoming scandalous.'\u003ccite>Dr. Andres Sciolla, psychiatrist, UC Davis School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>Get ready for 80-hour work weeks for the next seven years of med school and residency. Get ready for trying to commit a crush of information to sleep-deprived brain cells. Get ready for little time spent with family and friends. Oh, and by the way, get ready for making decisions resulting in life and death.\u003c/p>\n\u003cp>And get ready for, potentially, thoughts about ending your own life.\u003c/p>\n\u003cp>No one knows the exact number of medical students or residents who have killed themselves in the U.S.; there is no requirement to report suicide rates in medical school or residency programs. But multiple studies have shown these doctors-in-training are at risk for suicide, and the reality of poor mental health among the population is well-known.\u003c/p>\n\u003cp>Last year, a\u003ca href=\"http://jamanetwork.com/journals/jama/article-abstract/2589340\" target=\"_blank\" rel=\"noopener noreferrer\"> meta-study \u003c/a>published in the \u003cem>Journal of the American Medical Association\u003c/em> looked at 117,000 medical students around the world. The findings: 11 percent had considered ending their lives.\u003c/p>\n\u003cp>A 2008\u003ca href=\"https://www.med.upenn.edu/gastro/documents/Dyrbye.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> of over 4,000 students at seven U.S. medical schools found as high as 13 percent having suicidal thoughts. For comparison, in the U.S., the rate of suicidal ideation among the general population is just 7 percent for 18 to-25 -year-olds, according to 2013 \u003ca href=\"https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">numbers\u003c/a> from the U.S. Centers for Disease Control and Prevention. For 26- to 49-year-olds, it is 4 percent.\u003c/p>\n\u003cp>And while a 2014 \u003ca href=\"http://journals.lww.com/academicmedicine/Fulltext/2014/03000/Burnout_Among_U_S__Medical_Students,_Residents,.25.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> found a slightly lower rate of suicidal ideation among medical students, residents and young doctors compared to others in their age group, it found significantly higher rates of depression and burnout.\u003c/p>\n\u003cp>\u003cstrong>Schools, Programs React\u003c/strong>\u003c/p>\n\u003cp>The data, combined with a number of actual suicides by medical students and residents, have prompted schools and residency programs across California and the country to initiate programs to reduce stress, require mental-health screenings and offer counseling.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I don’t know that we recognized the need. I think medicine traditionally has been a profession that says, ‘You just do it.’ ”\u003ccite>Donna Elliott, senior associate dean of student affairs, USC\u003c/cite>\u003c/aside>\n\u003cp>The programs have been instituted over just the last several years; traditionally, stress and mental health problems are not issues the institutions have specifically addressed, mental health experts say.\u003c/p>\n\u003cp>That's changing because Petro's death is only one of several recent suicides by medical students and residents around the country, says Andres Sciolla, a psychiatrist at the UC Davis School of Medicine.\u003c/p>\n\u003cp>Sciolla says the suicides of two doctors-in-training in New York City in 2014 galvanized the idea among the medical community that something needed to be done.\u003c/p>\n\u003cp>\"It’s a very big topic that the general public just doesn’t know about,” Sciolla says. “There is so much buzz in our circle right now, in the academic and physician circle, and now it’s reaching a level that can no longer be pushed under the rug. It’s becoming scandalous.”\u003c/p>\n\u003cp>Sciolla helped institute a mental health program at UC Davis to catch problems before they can turn into crises. Residents fill out an online confidential survey to help identify those who are dealing with high levels of stress. Those individuals are contacted and offered counseling and other resources so they don't have to suffer in silence.\u003c/p>\n\u003cp>At the Keck School of Medicine, administrators started to address student mental health even before Petro's death. That's partly because in 2014, the same year national attention focused on the resident suicides in New York, another medical student who was enrolled at USC disappeared and was never found. That same year, a faculty physician took his own life.\u003c/p>\n\u003cp>Donna Elliott, the senior associate dean of student affairs at USC, says those local and national incidents were a loud wake-up call.\u003c/p>\n\u003cp>“There's a strong need in medical schools now in supporting students’ mental health,\" Elliott says. A big first step in that direction, she says, is the need to change the culture of shame and stigma around burnout, depression and suicide.\u003c/p>\n\u003cp>USC has hired a director of medical student wellness, instituted mandatory \"Keck Check\" mental health\u003cem> \u003c/em>evaluation sessions and now requires students to take several mental-health days off every year.\u003c/p>\n\u003cp>\u003cstrong>'Slow Going'\u003c/strong>\u003c/p>\n\u003cp>In the past, Elliott says, \"I don’t know that we recognized the need. I think medicine traditionally has been a profession that says, ‘You just do it.’ ”\u003c/p>\n\u003cp>Indeed the stigma and shame of suicide is more pronounced in the medical community, says Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention.\u003c/p>\n\u003cp>Moutier, while working at UC San Diego, was the driving force behind the first med school suicide prevention program in California, \u003ca href=\"https://healthsciences.ucsd.edu/som/hear/Documents/suicide-prevention-depression-awareness.pdf\">back in 2009\u003c/a>.\u003c/p>\n\u003cp>\"At the time, it felt like few were doing that work, and it felt like swimming upstream to get it done,\" Moutier says. \"And it became even more difficult when I would take ideas to the regional or national level. It was slow going.\"\u003c/p>\n\u003cp>Moutier points to the irony that those attending to people’s health are facing their own health crisis. “It’s such a disconnect that health professionals don’t take this seriously,” she says.\u003c/p>\n\u003cp>She calls the problem a public health crisis–not just for the medical providers, but for their patients as well.\u003c/p>\n\u003cp>“This is a major problem,” Moutier says. “I mean, if you’re looking at the fact that almost a \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2467822\" target=\"_blank\" rel=\"noopener noreferrer\">quarter of interns\u003c/a> are thinking of suicide, what kind of care are they giving patients?”\u003c/p>\n\u003cp>A national movement is now afoot to address the issue. The Accreditation Council for Graduate Medical Education last year \u003ca href=\"https://www.acgme.org/Portals/0/PDFs/JointReleaseFinal_Letterhead.pdf\">launched an initiative\u003c/a> to prevent medical school and residency suicides, and it hopes to require residency training programs to have wellness initiatives in place starting in July.\u003c/p>\n\u003cp>However, a \u003ca href=\"http://www.acgme.org/Portals/0/PDFs/Nasca-Community/Section-VI-Memo-3-10-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent ACGME decision\u003c/a> raised the\u003ca href=\"https://www.nytimes.com/2017/03/10/health/us-doctors-residents-24-hour-shifts.html\" target=\"_blank\" rel=\"noopener noreferrer\"> number of continuous hours\u003c/a> first-year residents can work, from 16 to 24.\u003c/p>\n\u003cp>Among other medical schools across the state, UCSF now requires third-year medical students, who typically spend up to 80 hours a week on hospital rotations, to attend check-in mental-health sessions. Stanford School of Medicine has a similar program to identify and help those who might be struggling with stress and burnout. One residency program at Stanford also offers stress-reduction perks like free delivery of groceries to residents' homes and time to exercise.\u003c/p>\n\u003cp>All of these efforts are a good start, but just a start, says Sidney Zisook, director of the psychiatry residency program at UC San Diego.\u003c/p>\n\u003cp>“There’s been a code of silence throughout the years. Places have tried to cover this up and hush it up, no question,\" Zisook says. “I do think things are moving in a positive direction now. But certainly institutions need to take a much more serious look at this.”\u003c/p>\n\u003cp>Raghavan, the third-year medical student from USC, says she recognizes the support she is getting from the school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"On your own, you never have enough time to sit and think about what you need. I mean, when do I have time to do that?\" she says with a laugh. \"So I appreciate the school thinking about that for you, and trying to do something about it.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Network of Scientists Works to Help Patients With Undiagnosed Diseases",
"title": "Network of Scientists Works to Help Patients With Undiagnosed Diseases",
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"content": "\u003cp>WHITTIER, Calif. -- Lynn Whittaker stood in the hallway of her home looking at the framed photos on the wall. In one, her son Andrew is playing high school water polo. In another, he’s holding a trombone.\u003cbr>\nThe images show no hint of his life today: the seizures that leave him temporarily paralyzed, the weakness that makes him fall over, his labored speech, his scrambled thoughts.\u003c/p>\n\u003cp>Andrew, 28, can no longer feed himself or walk on his own. The past nine years have been a blur of doctor appointments, hospital visits and medical tests that have failed to produce answers.\u003c/p>\n\u003cp>“You name it, he doesn’t have it,” his mother said. \u003c/p>\n\u003cp>Andrew has never had a clear diagnosis. He and his family are in a torturous state of suspense, hanging their hopes on every new exam and evaluation. \u003c/p>\n\u003cp>Recently, they have sought help from the Undiagnosed Diseases Network, a federally funded coalition of universities, clinicians, hospitals and researchers dedicated to solving the nation’s toughest medical mysteries. The doctors and scientists in the network harness advances in genetic science to identify rare, sometimes unknown, illnesses.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/319736138\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>At UCLA, one of the network’s sites, Andrew’s medical team would map his genetic makeup, then bring him in for a week of exams and consultations with specialists.\u003c/p>\n\u003cp>\u003cstrong>Writing A New Disease Encyclopedia\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The Undiagnosed Diseases Network was founded in 2015 with a $43 million grant from the National Institutes of Health (NIH). Building on work already being done at NIH, the initiative expanded to include universities across the country: Duke, Columbia and Stanford are among the other sites. The goals are to provide answers for patients with mysterious diseases and to learn more about the disorders.\u003cbr>\nA proposal last month by President Donald Trump to cut the NIH budget by $5.8 billion could put the program in jeopardy.\u003c/p>\n\u003cp>Even with the best technology and the finest brains at work, progress is slow. Since its launch, the network has received nearly 1,400 applications on behalf of patients. It has accepted 545 for review so far. Just 74 of the cases have been diagnosed, including 11 at UCLA. Andrew Whittaker’s case is among many in progress.\u003c/p>\n\u003cp>It’s like battling “an unknown enemy,” said Euan Ashley, one of the principal investigators of the network’s Stanford University site. “That is a particular form of torment that other patients don’t have.” \u003c/p>\n\u003cp>A diagnosis can end families’ painful odyssey while helping physicians and scientists better understand rare diseases and human physiology, said Rachel Ramoni, former executive director of the network, which is based at Harvard University. \u003c/p>\n\u003cp>Researchers throughout the network use advanced medical technology. For example, to study patients’ gene expression and disease progression, they can make models using nearly transparent zebrafish, whose genetic structure is similar to that of humans. And scientists can conduct whole genome sequencing, which allows the medical team to read a patient’s DNA and identify changes that can reveal what may be causing a disease.\u003c/p>\n\u003cp>“We have powerful techniques to look at every gene that is being expressed as well as every gene that is inherited,” said Stanley Nelson, one of UCLA’s principal investigators and the lead doctor on Andrew’s case. “This is an example of true precision medicine.” \u003c/p>\n\u003cp>Nelson said the network can examine all known genes -- not just the ones believed to have mutations that cause diseases. Doing that can lead to the discovery of new illnesses.\u003c/p>\n\u003cp>“Part of what we have to do is keep building that library, that encyclopedia of what gene and what gene mutations cause what symptoms,” Nelson said. “It’s just incomplete at this moment.” \u003c/p>\n\u003cp>Already the work is helping patients and their families come to terms with their illnesses. In one case, at Stanford, a toddler was diagnosed with two rare diseases, including a connective tissue disorder called Marfan Syndrome, after doctors conducted a form of sequencing that looks for changes in coded genetic segments known as exons. \u003c/p>\n\u003cp>Sometimes answers come from something decidedly lower-tech: collaboration among clinicians and researchers who share experiences, data and expertise.\u003c/p>\n\u003cp>“A lot of times your ability to be diagnosed depends on who is in the room,” Ramoni said. “And what we are doing with the network is we are expanding exponentially the number of people in the room.”\u003cbr>\nDoctors at one institution might think their patient is a unique case, only to learn that colleagues elsewhere have a patient with a similar illness. But even when diseases are diagnosed or gene mutations are discovered, treatments may still not be available. \u003c/p>\n\u003cp>\u003cstrong>A Life-Changing Mystery\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Andrew Whittaker’s odyssey began one afternoon at age 19, when he started trembling and couldn’t speak. Doctors suspected he was suffering from anxiety and prescribed medication to control it. But Andrew said he continued to have “episodes,” during which everything just went blank.\u003c/p>\n\u003cp>“It’s like there’s not enough blood going to your brain,” he said. “You can’t think.” \u003c/p>\n\u003cp>Andrew also started losing his balance and falling off his bicycle. The family visited several hospitals. Doctors discovered that the receptors in his brain were malfunctioning and that he lacked sufficient dopamine, a chemical compound in the body responsible for transmitting signals between nerve cells. As a result, Andrew has some symptoms similar to those of Parkinson’s disease. Doctors also confirmed he was having seizures. \u003c/p>\n\u003cp>Still, Andrew’s symptoms didn’t add up to any known disease.\u003c/p>\n\u003cp>One afternoon last fall at precisely noon, as Andrew sat propped up on the living room couch, Lynn’s phone alarm sounded, signaling it was time for his medication. Lynn pried open Andrew’s hand, which was clenched into a fist, and dropped in the pills. \u003c/p>\n\u003cp>To keep Andrew from falling, the family has lowered his bed and removed carpet from the house. They also bought him a wheelchair. Their precautions don’t always work. One morning, Lynn was in the kitchen when she heard a crash. “I ran in there and he’s laid flat on his back,” she said. \u003c/p>\n\u003cp>Andrew is close to his mom. But he also gets frustrated. He can’t shower or dress without her help. He’s had to give up the things he loved to do: printing T-shirts. Skateboarding. Shooting short films. He’s lost friends and can’t imagine dating anymore.\u003c/p>\n\u003cp>“Girlfriends? Forget about it,” he said, his face twitching as he talks. “They want a guy who can do stuff for them, not the other way around.” \u003c/p>\n\u003cp>\u003cstrong>Running The Medical Gauntlet\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>On a Monday morning in late January, Andrew and his parents were in an exam room at UCLA. Lynn teased her son, saying she was going to put him in a freezer until doctors figured out what was wrong.\u003cbr>\n“Then we’ll pull you back out again,” she said, smiling.\u003c/p>\n\u003cp>“I’ll never get pulled out,” Andrew responded. \u003c/p>\n\u003cp>“Yes, you will,” she said. “You will.”\u003c/p>\n\u003cp>Nelson, Andrew’s main doctor, walked into the room. He told Andrew he’d read through the medical records. “We’re going to try to figure you out.” \u003c/p>\n\u003cp>The work Nelson does is personal. His teenage son, Dylan, has Duchenne muscular dystrophy, a genetic disorder that causes muscle degeneration and weakness. Nelson knows his son’s disease will eventually take his life, but he said having a diagnosis makes all the difference. \u003c/p>\n\u003cp>“My heart very much goes out to the families that don’t even get an adequate diagnosis,” he said.\u003cbr>\nNelson suspects that Andrew’s disease is genetic as well. \u003c/p>\n\u003cp>He asked the Whittakers to describe their son’s journey and he conducted a short physical exam, asking Andrew to push against his hand and touch his own nose. Andrew trembled and his shoulders tensed, but he did it.\u003c/p>\n\u003cp>The rest of the week, Andrew underwent several other diagnostic tests, including a muscle biopsy, an EEG, MRI and a lumbar puncture. He remained upbeat, though running the medical gauntlet clearly wore him out. He also met with UCLA specialists in brain degeneration and muscle and nerve disorders. \u003c/p>\n\u003cp>At week’s end, Nelson sat down with the family to explain what he’d found. He had reviewed Andrew’s genome and compared it with that of both parents. Andrew had one copy of a defective gene that leads to Parkinson’s but the genome sequencing didn’t show a second copy, without which it could not be Parkinson’s.\u003c/p>\n\u003cp>He also explained that Andrew’s illness was clearly progressive and that his brain was shrinking, making it harder for him to process language and information. Nelson said he still didn’t have a diagnosis -- he believed it was a brand-new disease. \u003c/p>\n\u003cp>Nelson planned to continue poring over the test results, conducting additional exams and communicating with others in the network. He also is analyzing Andrew’s muscle, skin and blood to see whether any mutated gene is expressed abnormally. \u003c/p>\n\u003cp>Even in the absence of a clear diagnosis, Nelson said, rare diseases like Andrew’s help educate scientists and may help other patients. “These are the people we as a society will owe a great debt of gratitude,” he said. “They are effectively donating their lives to this process.” \u003c/p>\n\u003cp>Lynn Whittaker was disappointed. “We are still left with just hope that they will come up with something,” she lamented. “What else do we have?” \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Andrew said his relatives have asked if he’s scared the doctors will find something. “I’m more scared if they don’t,” he replied.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>WHITTIER, Calif. -- Lynn Whittaker stood in the hallway of her home looking at the framed photos on the wall. In one, her son Andrew is playing high school water polo. In another, he’s holding a trombone.\u003cbr>\nThe images show no hint of his life today: the seizures that leave him temporarily paralyzed, the weakness that makes him fall over, his labored speech, his scrambled thoughts.\u003c/p>\n\u003cp>Andrew, 28, can no longer feed himself or walk on his own. The past nine years have been a blur of doctor appointments, hospital visits and medical tests that have failed to produce answers.\u003c/p>\n\u003cp>“You name it, he doesn’t have it,” his mother said. \u003c/p>\n\u003cp>Andrew has never had a clear diagnosis. He and his family are in a torturous state of suspense, hanging their hopes on every new exam and evaluation. \u003c/p>\n\u003cp>Recently, they have sought help from the Undiagnosed Diseases Network, a federally funded coalition of universities, clinicians, hospitals and researchers dedicated to solving the nation’s toughest medical mysteries. The doctors and scientists in the network harness advances in genetic science to identify rare, sometimes unknown, illnesses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/319736138&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/319736138'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At UCLA, one of the network’s sites, Andrew’s medical team would map his genetic makeup, then bring him in for a week of exams and consultations with specialists.\u003c/p>\n\u003cp>\u003cstrong>Writing A New Disease Encyclopedia\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The Undiagnosed Diseases Network was founded in 2015 with a $43 million grant from the National Institutes of Health (NIH). Building on work already being done at NIH, the initiative expanded to include universities across the country: Duke, Columbia and Stanford are among the other sites. The goals are to provide answers for patients with mysterious diseases and to learn more about the disorders.\u003cbr>\nA proposal last month by President Donald Trump to cut the NIH budget by $5.8 billion could put the program in jeopardy.\u003c/p>\n\u003cp>Even with the best technology and the finest brains at work, progress is slow. Since its launch, the network has received nearly 1,400 applications on behalf of patients. It has accepted 545 for review so far. Just 74 of the cases have been diagnosed, including 11 at UCLA. Andrew Whittaker’s case is among many in progress.\u003c/p>\n\u003cp>It’s like battling “an unknown enemy,” said Euan Ashley, one of the principal investigators of the network’s Stanford University site. “That is a particular form of torment that other patients don’t have.” \u003c/p>\n\u003cp>A diagnosis can end families’ painful odyssey while helping physicians and scientists better understand rare diseases and human physiology, said Rachel Ramoni, former executive director of the network, which is based at Harvard University. \u003c/p>\n\u003cp>Researchers throughout the network use advanced medical technology. For example, to study patients’ gene expression and disease progression, they can make models using nearly transparent zebrafish, whose genetic structure is similar to that of humans. And scientists can conduct whole genome sequencing, which allows the medical team to read a patient’s DNA and identify changes that can reveal what may be causing a disease.\u003c/p>\n\u003cp>“We have powerful techniques to look at every gene that is being expressed as well as every gene that is inherited,” said Stanley Nelson, one of UCLA’s principal investigators and the lead doctor on Andrew’s case. “This is an example of true precision medicine.” \u003c/p>\n\u003cp>Nelson said the network can examine all known genes -- not just the ones believed to have mutations that cause diseases. Doing that can lead to the discovery of new illnesses.\u003c/p>\n\u003cp>“Part of what we have to do is keep building that library, that encyclopedia of what gene and what gene mutations cause what symptoms,” Nelson said. “It’s just incomplete at this moment.” \u003c/p>\n\u003cp>Already the work is helping patients and their families come to terms with their illnesses. In one case, at Stanford, a toddler was diagnosed with two rare diseases, including a connective tissue disorder called Marfan Syndrome, after doctors conducted a form of sequencing that looks for changes in coded genetic segments known as exons. \u003c/p>\n\u003cp>Sometimes answers come from something decidedly lower-tech: collaboration among clinicians and researchers who share experiences, data and expertise.\u003c/p>\n\u003cp>“A lot of times your ability to be diagnosed depends on who is in the room,” Ramoni said. “And what we are doing with the network is we are expanding exponentially the number of people in the room.”\u003cbr>\nDoctors at one institution might think their patient is a unique case, only to learn that colleagues elsewhere have a patient with a similar illness. But even when diseases are diagnosed or gene mutations are discovered, treatments may still not be available. \u003c/p>\n\u003cp>\u003cstrong>A Life-Changing Mystery\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Andrew Whittaker’s odyssey began one afternoon at age 19, when he started trembling and couldn’t speak. Doctors suspected he was suffering from anxiety and prescribed medication to control it. But Andrew said he continued to have “episodes,” during which everything just went blank.\u003c/p>\n\u003cp>“It’s like there’s not enough blood going to your brain,” he said. “You can’t think.” \u003c/p>\n\u003cp>Andrew also started losing his balance and falling off his bicycle. The family visited several hospitals. Doctors discovered that the receptors in his brain were malfunctioning and that he lacked sufficient dopamine, a chemical compound in the body responsible for transmitting signals between nerve cells. As a result, Andrew has some symptoms similar to those of Parkinson’s disease. Doctors also confirmed he was having seizures. \u003c/p>\n\u003cp>Still, Andrew’s symptoms didn’t add up to any known disease.\u003c/p>\n\u003cp>One afternoon last fall at precisely noon, as Andrew sat propped up on the living room couch, Lynn’s phone alarm sounded, signaling it was time for his medication. Lynn pried open Andrew’s hand, which was clenched into a fist, and dropped in the pills. \u003c/p>\n\u003cp>To keep Andrew from falling, the family has lowered his bed and removed carpet from the house. They also bought him a wheelchair. Their precautions don’t always work. One morning, Lynn was in the kitchen when she heard a crash. “I ran in there and he’s laid flat on his back,” she said. \u003c/p>\n\u003cp>Andrew is close to his mom. But he also gets frustrated. He can’t shower or dress without her help. He’s had to give up the things he loved to do: printing T-shirts. Skateboarding. Shooting short films. He’s lost friends and can’t imagine dating anymore.\u003c/p>\n\u003cp>“Girlfriends? Forget about it,” he said, his face twitching as he talks. “They want a guy who can do stuff for them, not the other way around.” \u003c/p>\n\u003cp>\u003cstrong>Running The Medical Gauntlet\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>On a Monday morning in late January, Andrew and his parents were in an exam room at UCLA. Lynn teased her son, saying she was going to put him in a freezer until doctors figured out what was wrong.\u003cbr>\n“Then we’ll pull you back out again,” she said, smiling.\u003c/p>\n\u003cp>“I’ll never get pulled out,” Andrew responded. \u003c/p>\n\u003cp>“Yes, you will,” she said. “You will.”\u003c/p>\n\u003cp>Nelson, Andrew’s main doctor, walked into the room. He told Andrew he’d read through the medical records. “We’re going to try to figure you out.” \u003c/p>\n\u003cp>The work Nelson does is personal. His teenage son, Dylan, has Duchenne muscular dystrophy, a genetic disorder that causes muscle degeneration and weakness. Nelson knows his son’s disease will eventually take his life, but he said having a diagnosis makes all the difference. \u003c/p>\n\u003cp>“My heart very much goes out to the families that don’t even get an adequate diagnosis,” he said.\u003cbr>\nNelson suspects that Andrew’s disease is genetic as well. \u003c/p>\n\u003cp>He asked the Whittakers to describe their son’s journey and he conducted a short physical exam, asking Andrew to push against his hand and touch his own nose. Andrew trembled and his shoulders tensed, but he did it.\u003c/p>\n\u003cp>The rest of the week, Andrew underwent several other diagnostic tests, including a muscle biopsy, an EEG, MRI and a lumbar puncture. He remained upbeat, though running the medical gauntlet clearly wore him out. He also met with UCLA specialists in brain degeneration and muscle and nerve disorders. \u003c/p>\n\u003cp>At week’s end, Nelson sat down with the family to explain what he’d found. He had reviewed Andrew’s genome and compared it with that of both parents. Andrew had one copy of a defective gene that leads to Parkinson’s but the genome sequencing didn’t show a second copy, without which it could not be Parkinson’s.\u003c/p>\n\u003cp>He also explained that Andrew’s illness was clearly progressive and that his brain was shrinking, making it harder for him to process language and information. Nelson said he still didn’t have a diagnosis -- he believed it was a brand-new disease. \u003c/p>\n\u003cp>Nelson planned to continue poring over the test results, conducting additional exams and communicating with others in the network. He also is analyzing Andrew’s muscle, skin and blood to see whether any mutated gene is expressed abnormally. \u003c/p>\n\u003cp>Even in the absence of a clear diagnosis, Nelson said, rare diseases like Andrew’s help educate scientists and may help other patients. “These are the people we as a society will owe a great debt of gratitude,” he said. “They are effectively donating their lives to this process.” \u003c/p>\n\u003cp>Lynn Whittaker was disappointed. “We are still left with just hope that they will come up with something,” she lamented. “What else do we have?” \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California Lawmakers Advance Single-Payer Health Bill",
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"content": "\u003cp>\u003cstrong>Update\u003c/strong> 8:00 a.m\u003c/p>\n\u003cp>A proposal to substantially remake California's health care system by eliminating insurance companies and guaranteeing coverage for everyone has cleared the first legislative hurdle.\u003c/p>\n\u003cp>The state Senate Health Committee voted to advance the measure on Wednesday as hundreds of nurses and advocates converged on the state Capitol to show their support. \u003c/p>\n\u003cp>The plan, known as single-payer health care, is getting a new look in California as President Donald Trump struggles to repeal and replace former President Barack Obama's health care law.\u003c/p>\n\u003cp>The proposal, promoted by the state's powerful nursing union and two Democratic senators, is still a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats are eager to stand up to the Republican president.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We have the chance to make universal health care a reality now,\" Democratic state Sen. Ricardo Lara of the Los Angeles-area city of Bell Gardens said last month. \"It's time to talk about how we get to health care for all that covers more and costs less.\"\u003c/p>\n\u003cp>The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally.\u003c/p>\n\u003cp>Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health care providers such as doctors and hospitals and pay the bills for everyone.\u003c/p>\n\u003cp>However, an essential question is still unanswered: Where will the money come from? California health care expenditures last year totaled more than $367 billion, according to the Center for Health Policy Research at University of California, Los Angeles.\u003c/p>\n\u003cp>The measure envisions using all public money now spent on health care — from Medicare, Medicaid, federal public health funds and \"Obamacare\" subsidies. But it would also require tax increases on businesses, individuals or both.\u003c/p>\n\u003cp>Lara, who wrote the legislation with Democratic Sen. Toni Atkins of San Diego, says they are working on the details.\u003c/p>\n\u003cp>Employers, business groups and health plans have mobilized in opposition, warning that the measure would require massive tax increases and force patients into lengthy waits to see a doctor.\u003c/p>\n\u003cp>They say the state should stay focused on implementing Obama's health care law, which is credited with significantly reducing the ranks of the uninsured in California.\u003c/p>\n\u003cp>\"California can't afford a single-payer health care system,\" said Charles Bacchi, president and CEO of the California Association of Health Plans. \"It's going to reduce the quality of care. We think it will restrict access to care, and it will be incredibly disruptive to all the Californians who currently get health care coverage through their employer.\"\u003c/p>\n\u003cp>The idea faces significant hurdles.\u003c/p>\n\u003cp>The legislation, SB562, would affect everyone — not just the roughly 8 percent of Californians without insurance — including people on Medicare and private, employer-sponsored insurance, plans that are generally well-liked.\u003c/p>\n\u003cp>Replacing billions of dollars in health care spending by employers and individuals would require significant tax increases, which must have support from two-thirds of the Assembly and Senate.\u003c/p>\n\u003cp>Even if it were to clear the Legislature and be signed by Democratic Gov. Jerry Brown, it would require cooperation from Trump's administration to waive rules about federal Medicare and Medicaid dollars.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The idea to substantially increase the government's role in health care comes as Trump and Republicans in Congress look to reduce it. The conservative House Freedom Caucus on Wednesday announced its support for a newly revised GOP health care bill, a month after the group's opposition forced Republican leaders to pull the legislation.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update\u003c/strong> 8:00 a.m\u003c/p>\n\u003cp>A proposal to substantially remake California's health care system by eliminating insurance companies and guaranteeing coverage for everyone has cleared the first legislative hurdle.\u003c/p>\n\u003cp>The state Senate Health Committee voted to advance the measure on Wednesday as hundreds of nurses and advocates converged on the state Capitol to show their support. \u003c/p>\n\u003cp>The plan, known as single-payer health care, is getting a new look in California as President Donald Trump struggles to repeal and replace former President Barack Obama's health care law.\u003c/p>\n\u003cp>The proposal, promoted by the state's powerful nursing union and two Democratic senators, is still a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats are eager to stand up to the Republican president.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We have the chance to make universal health care a reality now,\" Democratic state Sen. Ricardo Lara of the Los Angeles-area city of Bell Gardens said last month. \"It's time to talk about how we get to health care for all that covers more and costs less.\"\u003c/p>\n\u003cp>The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally.\u003c/p>\n\u003cp>Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health care providers such as doctors and hospitals and pay the bills for everyone.\u003c/p>\n\u003cp>However, an essential question is still unanswered: Where will the money come from? California health care expenditures last year totaled more than $367 billion, according to the Center for Health Policy Research at University of California, Los Angeles.\u003c/p>\n\u003cp>The measure envisions using all public money now spent on health care — from Medicare, Medicaid, federal public health funds and \"Obamacare\" subsidies. But it would also require tax increases on businesses, individuals or both.\u003c/p>\n\u003cp>Lara, who wrote the legislation with Democratic Sen. Toni Atkins of San Diego, says they are working on the details.\u003c/p>\n\u003cp>Employers, business groups and health plans have mobilized in opposition, warning that the measure would require massive tax increases and force patients into lengthy waits to see a doctor.\u003c/p>\n\u003cp>They say the state should stay focused on implementing Obama's health care law, which is credited with significantly reducing the ranks of the uninsured in California.\u003c/p>\n\u003cp>\"California can't afford a single-payer health care system,\" said Charles Bacchi, president and CEO of the California Association of Health Plans. \"It's going to reduce the quality of care. We think it will restrict access to care, and it will be incredibly disruptive to all the Californians who currently get health care coverage through their employer.\"\u003c/p>\n\u003cp>The idea faces significant hurdles.\u003c/p>\n\u003cp>The legislation, SB562, would affect everyone — not just the roughly 8 percent of Californians without insurance — including people on Medicare and private, employer-sponsored insurance, plans that are generally well-liked.\u003c/p>\n\u003cp>Replacing billions of dollars in health care spending by employers and individuals would require significant tax increases, which must have support from two-thirds of the Assembly and Senate.\u003c/p>\n\u003cp>Even if it were to clear the Legislature and be signed by Democratic Gov. Jerry Brown, it would require cooperation from Trump's administration to waive rules about federal Medicare and Medicaid dollars.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The idea to substantially increase the government's role in health care comes as Trump and Republicans in Congress look to reduce it. The conservative House Freedom Caucus on Wednesday announced its support for a newly revised GOP health care bill, a month after the group's opposition forced Republican leaders to pull the legislation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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