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"title": "Know How to Protect Yourself From Lyme Disease on Bay Area Hikes",
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"content": "\u003cp>Northern California has many attractions, but the fact that it’s prime tick habitat isn’t one of them.\u003c/p>\n\u003cp>Adding to the angst surrounding outdoor activities is that tick hotspots are unevenly distributed on a patchy landscape.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Medicine has the tendency to want a vaccine or a clear antibiotic silver bullet, and I don’t think the Lyme system gives us that luxury.’\u003ccite>Nate Nieto, University of Northern Arizona\u003c/cite>\u003c/aside>\n\u003cp>One moment you’re strolling through redwood forests, the next through oak forests, and a couple of hours later you may come across scenic chaparral. While on this iconic hike, you probably don’t realize that you’ve moved through both high- and low-risk Lyme disease areas. The question is, do you know where you are most at risk?\u003c/p>\n\u003cp>The answer is in the oak forest where layers of rich leaf litter are a kind of Club Med for ticks.\u003c/p>\n\u003cp>\u003cstrong>It’s Always Tick Season\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Tick season” exists year-round in northern California. The highest risk is in the spring and early summer due to an abundance of juvenile ticks, known as nymphs (the most virulent life-stage). However, peak diagnosis time extends into July, because it can take a few weeks to realize that you have the disease.\u003c/p>\n\u003cp>Summer is also particularly dangerous for Lyme disease because that’s when people spend the most time outside, and many of the most beautiful hiking areas tend to be tick-ridden.\u003c/p>\n\u003cfigure id=\"attachment_1870758\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1870758\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It’s always tick season in Northern California. Peak season is spring and early summer. \u003ccite>(Bay Area Lyme Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Most people associate Lyme disease with the Northeastern U.S. and the upper Midwest, and for \u003ca href=\"https://www.cdc.gov/lyme/stats/maps.html\">good reason\u003c/a>; the vast majority of cases are reported there, due mostly to the fact that the landscape is blanketed with prime tick habitat. On the west coast, the risk is real, but it’s different.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>How to prevent a tick bite in the first place.\u003c/strong>\n\u003cul>\n\u003cli>\u003cstrong>Dress the part\u003c/strong>: Ticks tend to like to climb upwards, so wear full-length pants, tucked into your socks, and a full length shirt, tucked into your pants\u003c/li>\n\u003cli>\u003cstrong>Pesticide options\u003c/strong>: Chemical tick-repellents or acaricides can be very effective at low dosages. Be sure to read manufacturer’s instructions carefully.\u003c/li>\n\u003cli>\u003cstrong>Clean your body and clothes\u003c/strong>: Take a shower once you get home from a hike and throw your clothes in a hot dryer for a 1-hour cycle.\u003c/li>\n\u003cli>\u003cstrong>Check your pets and yourself\u003c/strong>: Perform a thorough tick check when you get home. Ticks can travel into your house on dogs and cats.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>“There are definitely patches in California where the risk is just as high as the East –it’s just not the same spatial extent,” says Dan Salkeld, research scientist at Colorado State University.\u003c/p>\n\u003cp>The overall abundance of Lyme ticks is relatively low on the West Coast; however, the risk is spread unevenly. Hikers can move from high-risk area to a low-risk area and never know it.\u003c/p>\n\u003cp>In California, “You can be in one valley and rates of Lyme can be as high as in upstate New York, Connecticut or Rhode Island,” says Nate Nieto, a microbiologist at Northern Arizona University in Flagstaff. “Then you go over one ridge, the habitat changes completely –and there’s nothing,”\u003c/p>\n\u003cp>Part of what puts Californians at risk is a lack of awareness — among the public and even among doctors. Much of the research and public health information is based on east coast ecology and may not apply to the West.\u003c/p>\n\u003cp>For many Californian physicians, Lyme disease is just not on the radar, even though according to the \u003ca href=\"http://www.bayarealyme.org/\">Bay Area Lyme Foundation\u003c/a>, Lyme-infected ticks have been located in 42 of California’s 58 counties (highest incidence were in Trinity, Humbolt and Mendocino as of 2014). About 100 cases of Lyme disease are reported in California each year, but according to Supervising Public Health Biologist Kerry Padgett of the state Department of Public Health, the disease is likely more widespread.\u003c/p>\n\u003cp>“There is an under-diagnosis and under-reporting of Lyme disease in California,” says Padgett.\u003c/p>\n\u003cp>\u003cstrong>How Ticks Make Us Sick\u003c/strong>\u003c/p>\n\u003cp>Lyme disease is caused by a microscopic spiral-shaped bacteria called \u003cem>borrelia burgdorferi\u003c/em>. On the west coast, these Lyme disease-causing bacteria live inside the guts of the western blacklegged tick and can travel into the blood streams of bitten animals.Ticks generally live for two or three years. They are born Lyme-free, and will contract or transmit Lyme during feeding, once during each of their three life stages.\u003c/p>\n\u003cfigure id=\"attachment_1870913\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1870913\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-800x572.jpg\" alt=\"\" width=\"800\" height=\"572\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-800x572.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-160x114.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-768x549.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-240x172.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-375x268.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-520x372.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up.jpg 898w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Blue-bellied lizards are our friends. Their blood actually cures infected ticks of Lyme disease. The “grapes” in this lizard’s ear are all feeding ticks. \u003ccite>(Ervic Aquino)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When a Lyme-infected tick bites, it typically takes 36-48 hours for the bacteria to make the journey from the tick’s gut to their mouth and into the blood of their host. The process can take as little as 24 hours.\u003c/p>\n\u003cp>Only 15-20 percent of backlegged ticks contain Lyme disease during their nymph stage, and that number is much lower, 1-2 percent, in adults.\u003c/p>\n\u003cp>\u003cstrong>A Forest Full of Frenemies\u003c/strong>\u003c/p>\n\u003cp>To determine disease risk of a particular place, researchers look to some of the tick’s favorite foods.\u003c/p>\n\u003cp>The most common reservoir of Lyme disease — the species that initially infects ticks — is the western gray squirrel.\u003c/p>\n\u003cp>So avoid gray squirrel habitat and you’re safe? Not so fast.\u003c/p>\n\u003cp>Enter the blue-bellied lizard (also known as the western fence lizard), which is naturally immune to Lyme disease, and has special proteins in its blood that will cleanse infected ticks of the pathogen.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>What to do if you find a tick on you:\u003c/h3>\n\u003cfigure>\n\u003cfigure id=\"attachment_1870759\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1870759 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-800x515.jpg\" alt=\"\" width=\"800\" height=\"515\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-800x515.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-160x103.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-768x494.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-1020x656.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-1180x759.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-960x618.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-240x154.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-375x241.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-520x335.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adult (left) and nymph (right) western blacklegged ticks. \u003ccite>(Bay Area Lyme Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\u003cp>\u003cstrong>If you find a tick on your body, don’t panic! Remove the tick and keep track of what happens.\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>Is the tick feeding? That is, is the tick embedded in the skin?\u003c/li>\n\u003cli>If the tick is embedded, slowly and steadily, with even pressure, remove the entire tick by pulling it straight out with a pair of tweezers. Do not jerk or twist the tick. Remove any mouthparts that break off during removal. Then, if possible, save the tick in a jar or plastic bag. DO NOT try to kill the tick with oil or matches while it’s feeding. (If you do, it will release the contents of its gut into you.)\u003c/li>\n\u003cli>Clean the bite area with rubbing alcohol or soap and warm water.\u003c/li>\n\u003cli>How long did it feed? If it’s less than 36 hours, there’s a high probability that you are safe.\u003c/li>\n\u003cli>Pay attention to your symptoms. If in 6-to-12 days, you have any kind of fever, go and see a doctor.\u003c/li>\n\u003cli>A bulls-eye rash around the tick bite is a sure-fire way to know if you’ve contracted Lyme, but this symptom only shows up in 50-70 percent of cases. Other symptoms include headache, fatigue, and skin rash.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>So, a tick could feed on a squirrel and contract Lyme, which could then be neutralized when it bites a lizard.\u003c/p>\n\u003cp>“If you go into dense black oak woodland, which is prime habitat for ticks and squirrels, we find a higher proportion of infected ticks,” explains Salkeld. “However, if you move into a broken clearing with more light, you’re going to find more lizards, and the prevalence of Lyme goes down.”\u003c/p>\n\u003cp>Lyme disease involves many different species and is ecologically complex, which makes it a notoriously difficult problem to solve for researchers and public health officials.\u003c/p>\n\u003cp>“Medicine has the tendency to want a vaccine or a clear antibiotic silver bullet, and I don’t think the Lyme system gives us that luxury,” says Nieto.\u003c/p>\n\u003cp>“Lyme disease is something that we call, in the science world, a complex system, meaning that there’s a bunch going on here,” he continues. “ there’s a bunch of hosts, there’s a bunch of vectors, and there’s a bunch of pathogens, and that makes things difficult.”\u003c/p>\n\u003cp>\u003cstrong>Mapping a Pathogen\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>California’s diverse landscape and the complex interplay among species makes predicting Lyme tricky. However, the greatest risk posed to Californians might be a lack of awareness. Doctors here are less likely to suspect Lyme when patients come in with characteristic symptoms.\u003c/p>\n\u003cp>“I have talked to physicians who say that they are not aware of Lyme disease in California,” says Salkeld.\u003c/p>\n\u003cp>Organizations, such as the Bay Area Lyme Foundation, along with researchers like Nieto and Salkeld, are working to change the narrative and build the necessary evidence to make doctors aware of the scale of the problem. The foundation has a \u003ca href=\"http://www.bayarealyme.org/blog/bay-area-lyme-foundation-offers-free-tick-testing-nationwide/\">program\u003c/a> offering free tick testing nationwide, which aims to map tick-borne diseases across the country by encouraging concerned citizens to send in samples.\u003c/p>\n\u003cp>“We’re working on gathering real empirical data to show that Lyme is in the ecosystems of the West Coast,” says Nieto, “We’re getting clinical samples, ecological [tick] samples, and wildlife host samples…so we can change the educational paradigm within the medical schools and say, ‘It’s not just the Northeast and upper Midwest’—it’s in California too.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I think Californians should be aware of ticks, and the risks of tick-borne diseases, but the fear of disease should not keep them from enjoying the great outdoors,” adds Padgett. “I really do feel it’s possible to stay tick-safe while recreating and spending time outside.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Northern California has many attractions, but the fact that it’s prime tick habitat isn’t one of them.\u003c/p>\n\u003cp>Adding to the angst surrounding outdoor activities is that tick hotspots are unevenly distributed on a patchy landscape.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Medicine has the tendency to want a vaccine or a clear antibiotic silver bullet, and I don’t think the Lyme system gives us that luxury.’\u003ccite>Nate Nieto, University of Northern Arizona\u003c/cite>\u003c/aside>\n\u003cp>One moment you’re strolling through redwood forests, the next through oak forests, and a couple of hours later you may come across scenic chaparral. While on this iconic hike, you probably don’t realize that you’ve moved through both high- and low-risk Lyme disease areas. The question is, do you know where you are most at risk?\u003c/p>\n\u003cp>The answer is in the oak forest where layers of rich leaf litter are a kind of Club Med for ticks.\u003c/p>\n\u003cp>\u003cstrong>It’s Always Tick Season\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Tick season” exists year-round in northern California. The highest risk is in the spring and early summer due to an abundance of juvenile ticks, known as nymphs (the most virulent life-stage). However, peak diagnosis time extends into July, because it can take a few weeks to realize that you have the disease.\u003c/p>\n\u003cp>Summer is also particularly dangerous for Lyme disease because that’s when people spend the most time outside, and many of the most beautiful hiking areas tend to be tick-ridden.\u003c/p>\n\u003cfigure id=\"attachment_1870758\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1870758\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-on-Leaf_Shutterstock_99641744_-e1500680859219-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It’s always tick season in Northern California. Peak season is spring and early summer. \u003ccite>(Bay Area Lyme Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Most people associate Lyme disease with the Northeastern U.S. and the upper Midwest, and for \u003ca href=\"https://www.cdc.gov/lyme/stats/maps.html\">good reason\u003c/a>; the vast majority of cases are reported there, due mostly to the fact that the landscape is blanketed with prime tick habitat. On the west coast, the risk is real, but it’s different.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>How to prevent a tick bite in the first place.\u003c/strong>\n\u003cul>\n\u003cli>\u003cstrong>Dress the part\u003c/strong>: Ticks tend to like to climb upwards, so wear full-length pants, tucked into your socks, and a full length shirt, tucked into your pants\u003c/li>\n\u003cli>\u003cstrong>Pesticide options\u003c/strong>: Chemical tick-repellents or acaricides can be very effective at low dosages. Be sure to read manufacturer’s instructions carefully.\u003c/li>\n\u003cli>\u003cstrong>Clean your body and clothes\u003c/strong>: Take a shower once you get home from a hike and throw your clothes in a hot dryer for a 1-hour cycle.\u003c/li>\n\u003cli>\u003cstrong>Check your pets and yourself\u003c/strong>: Perform a thorough tick check when you get home. Ticks can travel into your house on dogs and cats.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>“There are definitely patches in California where the risk is just as high as the East –it’s just not the same spatial extent,” says Dan Salkeld, research scientist at Colorado State University.\u003c/p>\n\u003cp>The overall abundance of Lyme ticks is relatively low on the West Coast; however, the risk is spread unevenly. Hikers can move from high-risk area to a low-risk area and never know it.\u003c/p>\n\u003cp>In California, “You can be in one valley and rates of Lyme can be as high as in upstate New York, Connecticut or Rhode Island,” says Nate Nieto, a microbiologist at Northern Arizona University in Flagstaff. “Then you go over one ridge, the habitat changes completely –and there’s nothing,”\u003c/p>\n\u003cp>Part of what puts Californians at risk is a lack of awareness — among the public and even among doctors. Much of the research and public health information is based on east coast ecology and may not apply to the West.\u003c/p>\n\u003cp>For many Californian physicians, Lyme disease is just not on the radar, even though according to the \u003ca href=\"http://www.bayarealyme.org/\">Bay Area Lyme Foundation\u003c/a>, Lyme-infected ticks have been located in 42 of California’s 58 counties (highest incidence were in Trinity, Humbolt and Mendocino as of 2014). About 100 cases of Lyme disease are reported in California each year, but according to Supervising Public Health Biologist Kerry Padgett of the state Department of Public Health, the disease is likely more widespread.\u003c/p>\n\u003cp>“There is an under-diagnosis and under-reporting of Lyme disease in California,” says Padgett.\u003c/p>\n\u003cp>\u003cstrong>How Ticks Make Us Sick\u003c/strong>\u003c/p>\n\u003cp>Lyme disease is caused by a microscopic spiral-shaped bacteria called \u003cem>borrelia burgdorferi\u003c/em>. On the west coast, these Lyme disease-causing bacteria live inside the guts of the western blacklegged tick and can travel into the blood streams of bitten animals.Ticks generally live for two or three years. They are born Lyme-free, and will contract or transmit Lyme during feeding, once during each of their three life stages.\u003c/p>\n\u003cfigure id=\"attachment_1870913\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1870913\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-800x572.jpg\" alt=\"\" width=\"800\" height=\"572\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-800x572.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-160x114.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-768x549.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-240x172.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-375x268.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up-520x372.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/lizard-with-ticks-closer-up.jpg 898w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Blue-bellied lizards are our friends. Their blood actually cures infected ticks of Lyme disease. The “grapes” in this lizard’s ear are all feeding ticks. \u003ccite>(Ervic Aquino)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When a Lyme-infected tick bites, it typically takes 36-48 hours for the bacteria to make the journey from the tick’s gut to their mouth and into the blood of their host. The process can take as little as 24 hours.\u003c/p>\n\u003cp>Only 15-20 percent of backlegged ticks contain Lyme disease during their nymph stage, and that number is much lower, 1-2 percent, in adults.\u003c/p>\n\u003cp>\u003cstrong>A Forest Full of Frenemies\u003c/strong>\u003c/p>\n\u003cp>To determine disease risk of a particular place, researchers look to some of the tick’s favorite foods.\u003c/p>\n\u003cp>The most common reservoir of Lyme disease — the species that initially infects ticks — is the western gray squirrel.\u003c/p>\n\u003cp>So avoid gray squirrel habitat and you’re safe? Not so fast.\u003c/p>\n\u003cp>Enter the blue-bellied lizard (also known as the western fence lizard), which is naturally immune to Lyme disease, and has special proteins in its blood that will cleanse infected ticks of the pathogen.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>What to do if you find a tick on you:\u003c/h3>\n\u003cfigure>\n\u003cfigure id=\"attachment_1870759\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1870759 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-800x515.jpg\" alt=\"\" width=\"800\" height=\"515\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-800x515.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-160x103.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-768x494.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-1020x656.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-1180x759.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-960x618.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-240x154.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-375x241.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1-520x335.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/07/Tick-sizes_Nate_larger-1.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adult (left) and nymph (right) western blacklegged ticks. \u003ccite>(Bay Area Lyme Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\u003cp>\u003cstrong>If you find a tick on your body, don’t panic! Remove the tick and keep track of what happens.\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>Is the tick feeding? That is, is the tick embedded in the skin?\u003c/li>\n\u003cli>If the tick is embedded, slowly and steadily, with even pressure, remove the entire tick by pulling it straight out with a pair of tweezers. Do not jerk or twist the tick. Remove any mouthparts that break off during removal. Then, if possible, save the tick in a jar or plastic bag. DO NOT try to kill the tick with oil or matches while it’s feeding. (If you do, it will release the contents of its gut into you.)\u003c/li>\n\u003cli>Clean the bite area with rubbing alcohol or soap and warm water.\u003c/li>\n\u003cli>How long did it feed? If it’s less than 36 hours, there’s a high probability that you are safe.\u003c/li>\n\u003cli>Pay attention to your symptoms. If in 6-to-12 days, you have any kind of fever, go and see a doctor.\u003c/li>\n\u003cli>A bulls-eye rash around the tick bite is a sure-fire way to know if you’ve contracted Lyme, but this symptom only shows up in 50-70 percent of cases. Other symptoms include headache, fatigue, and skin rash.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>So, a tick could feed on a squirrel and contract Lyme, which could then be neutralized when it bites a lizard.\u003c/p>\n\u003cp>“If you go into dense black oak woodland, which is prime habitat for ticks and squirrels, we find a higher proportion of infected ticks,” explains Salkeld. “However, if you move into a broken clearing with more light, you’re going to find more lizards, and the prevalence of Lyme goes down.”\u003c/p>\n\u003cp>Lyme disease involves many different species and is ecologically complex, which makes it a notoriously difficult problem to solve for researchers and public health officials.\u003c/p>\n\u003cp>“Medicine has the tendency to want a vaccine or a clear antibiotic silver bullet, and I don’t think the Lyme system gives us that luxury,” says Nieto.\u003c/p>\n\u003cp>“Lyme disease is something that we call, in the science world, a complex system, meaning that there’s a bunch going on here,” he continues. “ there’s a bunch of hosts, there’s a bunch of vectors, and there’s a bunch of pathogens, and that makes things difficult.”\u003c/p>\n\u003cp>\u003cstrong>Mapping a Pathogen\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>California’s diverse landscape and the complex interplay among species makes predicting Lyme tricky. However, the greatest risk posed to Californians might be a lack of awareness. Doctors here are less likely to suspect Lyme when patients come in with characteristic symptoms.\u003c/p>\n\u003cp>“I have talked to physicians who say that they are not aware of Lyme disease in California,” says Salkeld.\u003c/p>\n\u003cp>Organizations, such as the Bay Area Lyme Foundation, along with researchers like Nieto and Salkeld, are working to change the narrative and build the necessary evidence to make doctors aware of the scale of the problem. The foundation has a \u003ca href=\"http://www.bayarealyme.org/blog/bay-area-lyme-foundation-offers-free-tick-testing-nationwide/\">program\u003c/a> offering free tick testing nationwide, which aims to map tick-borne diseases across the country by encouraging concerned citizens to send in samples.\u003c/p>\n\u003cp>“We’re working on gathering real empirical data to show that Lyme is in the ecosystems of the West Coast,” says Nieto, “We’re getting clinical samples, ecological [tick] samples, and wildlife host samples…so we can change the educational paradigm within the medical schools and say, ‘It’s not just the Northeast and upper Midwest’—it’s in California too.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think Californians should be aware of ticks, and the risks of tick-borne diseases, but the fear of disease should not keep them from enjoying the great outdoors,” adds Padgett. “I really do feel it’s possible to stay tick-safe while recreating and spending time outside.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>WASHINGTON — After seven years of emphatic campaign promises, Senate Republicans demonstrated Wednesday they don’t have the stomach to repeal Obamacare when it really counts, as the Senate voted 55-45 to reject legislation undoing major portions of Barack Obama’s law without replacing it.\u003c/p>\n\u003cp>Seven Republicans joined all Democrats in rejecting an amendment by Rand Paul of Kentucky that would have repealed most of former President Obama’s health care law, with a two-year delay but no replacement. Congress passed nearly identical legislation in 2015 and sent it to Obama, who unsurprisingly vetoed it.\u003c/p>\n\u003cp>Yet this time, with a president in the White House who says he’s itching to sign the bill, the measure failed on the Senate floor.\u003c/p>\n\u003cp>The Congressional Budget Office has estimated that repealing Obamacare without replacing it would cost more than 30 million Americans their insurance coverage, and that was a key factor in driving away a handful of Republican senators, more than Majority Leader Mitch McConnell could lose in the closely divided Senate.\u003c/p>\n\u003cp>[contextly_sidebar id=”q4yDkDTS4BBB2H9GInIvL8b05XGzSxEH”]\u003c/p>\n\u003cp>The result frustrated other GOP senators, some of whom expressed disbelief that their colleagues would flip-flop on legislation they had voted for only two years ago and long promised to voters. Of the current Republican senators, only moderate Susan Collins of Maine opposed the 2015 repeal bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I think everybody in there, maybe except for one senator, promised their supporters, their voters that they supported repeal of Obamacare,” said Ron Johnson of Wisconsin. “A lot of them said ‘root and branch.’ Now, we’re so far away from that. I’d just remind my colleagues, remember what you promised your voters.”\u003c/p>\n\u003cp>Yet the outcome was no shock in a Senate that’s already shown that unity is elusive when it comes to dealing with Obamacare. The real-world implications of repeal have proved sobering to GOP senators answering to voters who have come to rely on expanded insurance coverage under the law.\u003c/p>\n\u003cp>What the party’s senators will end up agreeing on instead is far from clear. Yet they plunged forward with debate toward their unknown goal, pressured by an impatient president. By week’s end Republicans hope to reach agreement among themselves, and eventually with the House, on some kind of repeal and replacement of the Obama law they have reviled for so long.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility taking shape in talks among senators was a “skinny repeal” that would abolish just a few of the key elements of Obama’s law, including mandates that everyone purchase insurance and taxes that all GOP senators can agree to oppose.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>WASHINGTON — After seven years of emphatic campaign promises, Senate Republicans demonstrated Wednesday they don’t have the stomach to repeal Obamacare when it really counts, as the Senate voted 55-45 to reject legislation undoing major portions of Barack Obama’s law without replacing it.\u003c/p>\n\u003cp>Seven Republicans joined all Democrats in rejecting an amendment by Rand Paul of Kentucky that would have repealed most of former President Obama’s health care law, with a two-year delay but no replacement. Congress passed nearly identical legislation in 2015 and sent it to Obama, who unsurprisingly vetoed it.\u003c/p>\n\u003cp>Yet this time, with a president in the White House who says he’s itching to sign the bill, the measure failed on the Senate floor.\u003c/p>\n\u003cp>The Congressional Budget Office has estimated that repealing Obamacare without replacing it would cost more than 30 million Americans their insurance coverage, and that was a key factor in driving away a handful of Republican senators, more than Majority Leader Mitch McConnell could lose in the closely divided Senate.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The result frustrated other GOP senators, some of whom expressed disbelief that their colleagues would flip-flop on legislation they had voted for only two years ago and long promised to voters. Of the current Republican senators, only moderate Susan Collins of Maine opposed the 2015 repeal bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think everybody in there, maybe except for one senator, promised their supporters, their voters that they supported repeal of Obamacare,” said Ron Johnson of Wisconsin. “A lot of them said ‘root and branch.’ Now, we’re so far away from that. I’d just remind my colleagues, remember what you promised your voters.”\u003c/p>\n\u003cp>Yet the outcome was no shock in a Senate that’s already shown that unity is elusive when it comes to dealing with Obamacare. The real-world implications of repeal have proved sobering to GOP senators answering to voters who have come to rely on expanded insurance coverage under the law.\u003c/p>\n\u003cp>What the party’s senators will end up agreeing on instead is far from clear. Yet they plunged forward with debate toward their unknown goal, pressured by an impatient president. By week’s end Republicans hope to reach agreement among themselves, and eventually with the House, on some kind of repeal and replacement of the Obama law they have reviled for so long.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility taking shape in talks among senators was a “skinny repeal” that would abolish just a few of the key elements of Obama’s law, including mandates that everyone purchase insurance and taxes that all GOP senators can agree to oppose.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"title": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n",
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"excerpt": "'Less people will have coverage. Bottom line.' An interview with the CEO of Tiburcio Vasquez Health Center in Hayward.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Update at 4:05 p.m. ET\u003c/strong>\u003c/p>\n\u003cp>Sen. John McCain, diagnosed with a deadly form of brain cancer just five days ago, returned to applause on the Senate floor Tuesday, where he cast a crucial vote to move forward on repeal of the Affordable Care Act and urged his colleagues to regain their sense of bipartisan cooperation.\u003c/p>\n\u003cp>However, the longtime Arizona senator, two-time presidential candidate and perhaps America’s most famous former prisoner of war, warned that he “will not vote for this bill as it is today,” describing it as “a shell.”\u003c/p>\n\u003cp>McCain said he would attend the Senate for a few days and then go home to Arizona to recuperate.\u003c/p>\n\u003cp>“I have every intention of returning here to give you all reason to regret the nice things you said about me,” he told his fellow senators, addressing the outpouring of support he’s received since announcing his diagnosis.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It was a remarkable moment, to see McCain, whose daughter described him poetically as a “warrior at dusk,” take his place again in the “world’s greatest deliberative body,” where he has represented his Southwestern state for 30 years.\u003c/p>\n\u003cp>McCain, with surgical stitches clearly visible above his left eye, admonished both Republicans and Democrats to work together in the old way and to stop trying to make laws “behind closed doors.”\u003c/p>\n\u003cp>He acknowledged that it was easy to fall victim to the urge to win instead of doing what is right. “Merely preventing your political opponents from getting what they want isn’t very inspiring,” he said.\u003c/p>\n\u003cp>And, he advised strongly: “Stop listening to the bombastic loudmouths on the television, radio and internet. The hell with them!”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=Cw4RqZAKa5A\u003c/p>\n\u003cp>Meanwhile, McCain’s vote, along with a tiebreaker from Vice President Mike Pence, gave Republicans the 51 votes they needed for the “motion to proceed.”\u003c/p>\n\u003cp>A motion to proceed is what it sounds like — a measure to allow debate to begin. There will be 20 hours of debate, which will expire Wednesday, NPR’s Susan Davis reports.\u003c/p>\n\u003cp>Republicans could only lose two votes for a majority without any Democratic support. Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, both voted no.\u003c/p>\n\u003cp>Beyond the motion-to-proceed vote and the ensuing debate, no one is quite sure — not even Republicans — what of substance the GOP will try to pass to overhaul health care, which affects roughly one-sixth of the U.S. economy.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell, of Kentucky, promised to bring a full repeal of the Affordable Care Act with a two-year delay to the floor, which President Trump seemed to be on board with. But, up to this point, the votes aren’t there for that approach; too many Republicans have come out publicly opposing the idea.\u003c/p>\n\u003cp>So then what? If the full repeal isn’t brought to the floor, or if it fails, then it’s on to the Senate’s version of no-holds barred — a “vote-o-rama,” where anyone can bring any amendment to the floor and have it voted on.\u003c/p>\n\u003cp>That would be kind of like doing the work normally done for months in committees out on the Senate floor in a matter of hours and days.\u003c/p>\n\u003cp>[contextly_sidebar id=”A1BV4vIZp3nWCZPcR9pkrpepufcyYqww”]\u003c/p>\n\u003cp>This is just the latest chapter in Republicans’ difficulty replacing the ACA, also known as Obamacare. Legislatively, they have been plagued by starts and stops during the Trump presidency, unable to get their differing ideological factions on the same page.\u003c/p>\n\u003cp>“Obamacare is the law of the land,” House Speaker Paul Ryan, R-Wis., declared after the House’s health care flameout months ago.\u003c/p>\n\u003cp>But, through arm twisting and legislative tweaks, the House eventually passed a version that tinkered with the ACA. The Congressional Budget Office said the law would increase the number of uninsured by tens of millions, especially because of how it would change Medicaid.\u003c/p>\n\u003cp>Nonetheless it was a political victory, if only a lead at halftime. It was greeted by Bud Lights in the House and a Rose Garden celebration with the president of the United States. There was no “45” jersey with GOP on the front and “Trump” on the back, but there might as well have been.\u003c/p>\n\u003cp>One would have thought a new law had been signed. It hadn’t. The House version was headed to the Senate, where it would certainly change and have to be reconciled with the House.\u003c/p>\n\u003cp>Back to the drawing board.\u003c/p>\n\u003cp>Nearly three months later, that Rose Garden ceremony remains the high point for Republicans. The GOP has not been able to gather the votes in the Senate — and that has started to really rankle Trump. His irritation was evident during his appearance Monday at the Boy Scouts National Jamboree in West Virginia.\u003c/p>\n\u003cp>“As the Scout law says, a Scout is trustworthy, loyal,” Trump said. He added, “We could use some more loyalty, I will tell you that.”\u003c/p>\n\u003cp>Speaking of Health and Human Services Secretary Tom Price, who was on stage with him, Trump said, “Hopefully he’s going to get the votes tomorrow to start our path toward killing this horrible thing known as Obamacare that’s really hurting us.”\u003c/p>\n\u003cp>Trump spoke of Price as if he were McConnell, as if he had some control over whipping the votes on health care. Price wasn’t even a senator before joining Trump’s Cabinet; he was a member of the House from Georgia.\u003c/p>\n\u003cp>He went on: “By the way, are you going to get the votes? He better get them. He better get them. Oh, he better. Otherwise, I’ll say, ‘Tom, you’re fired.’ I’ll get somebody.”\u003c/p>\n\u003cp>Then Trump turned to Price, smiling, as if to say, “Only kidding.”\u003c/p>\n\u003cp>Or maybe not. That came on the same day he called his attorney general, Jeff Sessions, “beleaguered.”\u003c/p>\n\u003cp>On Tuesday morning, he tweeted criticism of Sessions, calling him “weak” on Hillary Clinton and “leakers” from the intelligence community.\u003c/p>\n\u003cp>https://twitter.com/realDonaldTrump/status/889790429398528000\u003c/p>\n\u003cp>Speaking to the Scouts, Trump wasn’t quite done yet: “He better get Sen. [Shelley Moore] Capito to vote for it. He better get the other senators to vote for it. It’s time.”\u003c/p>\n\u003cp>At that time, Capito, a West Virginia Republican, was one of the holdouts on voting for what Republicans have so far proposed when it comes to health care. She was one of a dozen or so senators who had not committed to even voting for the motion to proceed. (During Tuesday’s vote, she did support the motion.)\u003c/p>\n\u003cp>The Boy Scouts is supposed to be an apolitical organization, and after the speech, the group put out a statement saying it does not endorse any candidate.\u003c/p>\n\u003cp>Trump has begun referring to Republicans as “they” and “you” (“they” promised to repeal and replace Obamacare for seven years; “you” didn’t do it). It’s a remarkable effort to separate himself from the party he is supposed to lead.\u003c/p>\n\u003cp>He tweeted that any senator who votes against the motion to proceed is for Obamacare.\u003c/p>\n\u003cp>And he seemed to threaten them politically.\u003c/p>\n\u003cp>https://twitter.com/realDonaldTrump/status/889599425458327552\u003c/p>\n\u003cp>Where any of this goes is anyone’s guess. But as a nation watches a new president who is blowing through with Twitter maelstroms and appears ready to politically fire in all directions, the Senate paused for a few moments Tuesday to recognize a man in McCain who means something very different.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And then it was back to the wind — with Trump, speaking immediately after McCain’s remarks on the Senate floor, about how no Democrats had voted in favor of the Republican effort to undo Obamacare and reaffirming his recent negative comments about Sessions.\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=John+McCain+Makes+Dramatic+Return+Amid+Political+Storm&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update at 4:05 p.m. ET\u003c/strong>\u003c/p>\n\u003cp>Sen. John McCain, diagnosed with a deadly form of brain cancer just five days ago, returned to applause on the Senate floor Tuesday, where he cast a crucial vote to move forward on repeal of the Affordable Care Act and urged his colleagues to regain their sense of bipartisan cooperation.\u003c/p>\n\u003cp>However, the longtime Arizona senator, two-time presidential candidate and perhaps America’s most famous former prisoner of war, warned that he “will not vote for this bill as it is today,” describing it as “a shell.”\u003c/p>\n\u003cp>McCain said he would attend the Senate for a few days and then go home to Arizona to recuperate.\u003c/p>\n\u003cp>“I have every intention of returning here to give you all reason to regret the nice things you said about me,” he told his fellow senators, addressing the outpouring of support he’s received since announcing his diagnosis.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It was a remarkable moment, to see McCain, whose daughter described him poetically as a “warrior at dusk,” take his place again in the “world’s greatest deliberative body,” where he has represented his Southwestern state for 30 years.\u003c/p>\n\u003cp>McCain, with surgical stitches clearly visible above his left eye, admonished both Republicans and Democrats to work together in the old way and to stop trying to make laws “behind closed doors.”\u003c/p>\n\u003cp>He acknowledged that it was easy to fall victim to the urge to win instead of doing what is right. “Merely preventing your political opponents from getting what they want isn’t very inspiring,” he said.\u003c/p>\n\u003cp>And, he advised strongly: “Stop listening to the bombastic loudmouths on the television, radio and internet. The hell with them!”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/Cw4RqZAKa5A'\n title='//www.youtube.com/embed/Cw4RqZAKa5A'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Meanwhile, McCain’s vote, along with a tiebreaker from Vice President Mike Pence, gave Republicans the 51 votes they needed for the “motion to proceed.”\u003c/p>\n\u003cp>A motion to proceed is what it sounds like — a measure to allow debate to begin. There will be 20 hours of debate, which will expire Wednesday, NPR’s Susan Davis reports.\u003c/p>\n\u003cp>Republicans could only lose two votes for a majority without any Democratic support. Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, both voted no.\u003c/p>\n\u003cp>Beyond the motion-to-proceed vote and the ensuing debate, no one is quite sure — not even Republicans — what of substance the GOP will try to pass to overhaul health care, which affects roughly one-sixth of the U.S. economy.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell, of Kentucky, promised to bring a full repeal of the Affordable Care Act with a two-year delay to the floor, which President Trump seemed to be on board with. But, up to this point, the votes aren’t there for that approach; too many Republicans have come out publicly opposing the idea.\u003c/p>\n\u003cp>So then what? If the full repeal isn’t brought to the floor, or if it fails, then it’s on to the Senate’s version of no-holds barred — a “vote-o-rama,” where anyone can bring any amendment to the floor and have it voted on.\u003c/p>\n\u003cp>That would be kind of like doing the work normally done for months in committees out on the Senate floor in a matter of hours and days.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This is just the latest chapter in Republicans’ difficulty replacing the ACA, also known as Obamacare. Legislatively, they have been plagued by starts and stops during the Trump presidency, unable to get their differing ideological factions on the same page.\u003c/p>\n\u003cp>“Obamacare is the law of the land,” House Speaker Paul Ryan, R-Wis., declared after the House’s health care flameout months ago.\u003c/p>\n\u003cp>But, through arm twisting and legislative tweaks, the House eventually passed a version that tinkered with the ACA. The Congressional Budget Office said the law would increase the number of uninsured by tens of millions, especially because of how it would change Medicaid.\u003c/p>\n\u003cp>Nonetheless it was a political victory, if only a lead at halftime. It was greeted by Bud Lights in the House and a Rose Garden celebration with the president of the United States. There was no “45” jersey with GOP on the front and “Trump” on the back, but there might as well have been.\u003c/p>\n\u003cp>One would have thought a new law had been signed. It hadn’t. The House version was headed to the Senate, where it would certainly change and have to be reconciled with the House.\u003c/p>\n\u003cp>Back to the drawing board.\u003c/p>\n\u003cp>Nearly three months later, that Rose Garden ceremony remains the high point for Republicans. The GOP has not been able to gather the votes in the Senate — and that has started to really rankle Trump. His irritation was evident during his appearance Monday at the Boy Scouts National Jamboree in West Virginia.\u003c/p>\n\u003cp>“As the Scout law says, a Scout is trustworthy, loyal,” Trump said. He added, “We could use some more loyalty, I will tell you that.”\u003c/p>\n\u003cp>Speaking of Health and Human Services Secretary Tom Price, who was on stage with him, Trump said, “Hopefully he’s going to get the votes tomorrow to start our path toward killing this horrible thing known as Obamacare that’s really hurting us.”\u003c/p>\n\u003cp>Trump spoke of Price as if he were McConnell, as if he had some control over whipping the votes on health care. Price wasn’t even a senator before joining Trump’s Cabinet; he was a member of the House from Georgia.\u003c/p>\n\u003cp>He went on: “By the way, are you going to get the votes? He better get them. He better get them. Oh, he better. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Speaking to the Scouts, Trump wasn’t quite done yet: “He better get Sen. [Shelley Moore] Capito to vote for it. He better get the other senators to vote for it. It’s time.”\u003c/p>\n\u003cp>At that time, Capito, a West Virginia Republican, was one of the holdouts on voting for what Republicans have so far proposed when it comes to health care. She was one of a dozen or so senators who had not committed to even voting for the motion to proceed. (During Tuesday’s vote, she did support the motion.)\u003c/p>\n\u003cp>The Boy Scouts is supposed to be an apolitical organization, and after the speech, the group put out a statement saying it does not endorse any candidate.\u003c/p>\n\u003cp>Trump has begun referring to Republicans as “they” and “you” (“they” promised to repeal and replace Obamacare for seven years; “you” didn’t do it). It’s a remarkable effort to separate himself from the party he is supposed to lead.\u003c/p>\n\u003cp>He tweeted that any senator who votes against the motion to proceed is for Obamacare.\u003c/p>\n\u003cp>And he seemed to threaten them politically.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Where any of this goes is anyone’s guess. But as a nation watches a new president who is blowing through with Twitter maelstroms and appears ready to politically fire in all directions, the Senate paused for a few moments Tuesday to recognize a man in McCain who means something very different.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And then it was back to the wind — with Trump, speaking immediately after McCain’s remarks on the Senate floor, about how no Democrats had voted in favor of the Republican effort to undo Obamacare and reaffirming his recent negative comments about Sessions.\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=John+McCain+Makes+Dramatic+Return+Amid+Political+Storm&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Scientists Are Releasing 20 Million Mosquitoes in Fresno County",
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"content": "\u003cp>This summer, scientists in California are releasing 20 million mosquitoes in an effort to shrink the population of mosquitoes that can carry diseases.\u003c/p>\n\u003cp>It sounds counterintuitive. But the plan is to release millions of sterile male mosquitoes, which will then mate with wild female mosquitoes. The eggs the females lay won’t hatch, researchers say.\u003c/p>\n\u003cp>The project is called \u003ca href=\"https://blog.verily.com/2017/07/debug-fresno-our-first-us-field-study.html\">Debug Fresno\u003c/a> and it’s being undertaken by Verily, a subsidiary of Alphabet, Google’s holding company. It’s the company’s first field study involving sterile mosquitoes in the U.S.\u003c/p>\n\u003cp>Scientists say the goal is to cut the population of \u003cem>Aedes aegypti\u003c/em> mosquitoes — the species responsible for spreading Zika, dengue and chikungunya. \u003cem>A. aegypti\u003c/em> have been present in California’s Central Valley since 2013 and have been a problem in Fresno County.\u003c/p>\n\u003cp>“It’s a terrible nuisance, a terrible biting nuisance. It’s changed the way people can enjoy their backyard and it’s a threat for disease transmission,” Steve Mulligan of Fresno County’s Consolidated Mosquito Abatement District told \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/07/19/scientists-plan-to-trick-zika-carrying-mosquitoes-into-breeding-themselves-out-of-existence/?utm_term=.488aede6eedb\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each week for 20 weeks, the company plans to release 1 million of the sterile, non-biting male mosquitoes in two neighborhoods in Fresno County. The male mosquitoes are bred and infected with \u003cem>Wolbachia\u003c/em>, a bacterium that is “naturally found in at least 40 percent of all insect species,” according to \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46021/title/Bacterium-Blocks-Zika-s-Spread/\">The Scientist magazine\u003c/a>, though it’s normally not found in \u003cem>A. aegypti\u003c/em>.\u003c/p>\n\u003cp>“Over time, we hope to see a steep decline in the presence of \u003cem>Aedes aegypti\u003c/em> in these communities,” Verily says in a statement.\u003c/p>\n\u003cp>In a phenomenon called cytoplasmic incompatibility, “matings between \u003cem>Wolbachia\u003c/em>-infected males and uninfected females results in embryo lethality or low hatch rates,” William Sullivan and Scott L. O’Neill \u003ca href=\"http://www.nature.com/nature/journal/v543/n7644/fig_tab/nature21509_F1.html\">write in the journal Nature\u003c/a>. “Because the effect of \u003cem>Wolbachia\u003c/em> infection on insect reproduction favours the survival of \u003cem>Wolbachia\u003c/em>-infected females over uninfected females, \u003cem>Wolbachia\u003c/em> can rapidly spread through an insect population.”\u003c/p>\n\u003cp>\u003cem>Wolbachia\u003c/em> also helps mosquitoes to avoid carrying diseases like Zika in the first place. \u003cem>A. aegypti\u003c/em> “carrying \u003cem>Wolbachia\u003c/em> bacteria were highly resistant to Zika virus infection, and were unable to transmit the virus via their saliva,” \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46021/title/Bacterium-Blocks-Zika-s-Spread/\">The Scientist writes\u003c/a>, citing a 2016 study in Brazil.\u003c/p>\n\u003cp>The magazine says the bacterium “is not known” to infect humans.\u003c/p>\n\u003cp>Verily is partnering in the project with the Kentucky-based company MosquitoMate and the Consolidated Mosquito Abatement District of Fresno County. They plan to study the \u003cem>A. aegypti\u003c/em> population density and number of eggs hatching in the experimental areas and compare to control neighborhoods to measure the experiment’s effectiveness.\u003c/p>\n\u003cp>It’s not the first time the bacteria-carrying mosquitoes have been released into the wild in the U.S.\u003c/p>\n\u003cp>MosquitoMate and the Florida Keys Mosquito Control District \u003ca href=\"http://fkmcd.maps.arcgis.com/apps/MapJournal/index.html?appid=d8c2b636e93b40b4b940e6042ef286c6\">released 75,000\u003c/a> \u003cem>Wolbachia\u003c/em>-carrying mosquitoes each week for several weeks this spring in the Florida Keys.\u003c/p>\n\u003cp>Last year in Fresno, MosquitoMate and county officials released \u003ca href=\"https://www.theverge.com/2017/7/14/15972950/mosquitoes-google-alphabet-verily-debug-wolbachia-bacteria-fresno-california\">about 800,000\u003c/a> of the mosquitoes. This experiment is a 25-fold increase on that.\u003c/p>\n\u003cp>Verily says it developed “automated mass rearing and sex-sorting processes,” which enable it to breed and release so many of the mosquitoes in such a short time.\u003c/p>\n\u003cp>\u003cem>A. aegypti\u003c/em> is an invasive species to Fresno County, and officials told the \u003cem>Post\u003c/em> they don’t predict an impact on the local ecosystem from reducing or eliminating it.\u003c/p>\n\u003cp>The method Verily is using to cut the mosquito population differs from the experiment the British company Oxitec proposed last year in the Florida Keys. In contrast to the mosquitoes being infected by bacteria, Oxitec has released males that are genetically modified with “a gene that causes the mosquito’s offspring to die in the first two to three days of life,” according to \u003ca href=\"https://www.dallasnews.com/news/zika-virus/2017/07/14/genetically-engineered-mosquitoes-wipe-zika-dallas-county-oppose-local-trials\">The Dallas Morning News\u003c/a>. Many Florida Keys residents \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/20/502717253/florida-keys-approves-trial-of-genetically-modified-mosquitoes-to-fight-zika\">bitterly opposed\u003c/a> the proposed experiment last year; some Texas residents are reacting similarly to a proposed trial there, the \u003cem>Morning News\u003c/em> reports.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From the spring to the fall of 2016, \u003ca href=\"https://www.cdc.gov/media/releases/2017/s0620-virus-carrying-mosquitoes.html\">38 additional counties\u003c/a> in the U.S. reported evidence of the \u003cem>A. aegypti\u003c/em> mosquito, according to the Centers for Disease Control and Prevention. Since the beginning of 2015, \u003ca href=\"https://www.cdc.gov/zika/reporting/case-counts.html\">more than 5,300\u003c/a> symptomatic cases of Zika were reported to the CDC in the U.S., though the vast majority stemmed from people traveling to affected areas. As of Wednesday, the agency said there were \u003ca href=\"https://www.cdc.gov/zika/reporting/2017-case-counts.html\">no reported cases\u003c/a> of people getting Zika in the U.S. this year “through presumed local mosquito-borne transmission.”\u003c/p>\n\n",
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"title": "Scientists Are Releasing 20 Million Mosquitoes in Fresno County | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This summer, scientists in California are releasing 20 million mosquitoes in an effort to shrink the population of mosquitoes that can carry diseases.\u003c/p>\n\u003cp>It sounds counterintuitive. But the plan is to release millions of sterile male mosquitoes, which will then mate with wild female mosquitoes. The eggs the females lay won’t hatch, researchers say.\u003c/p>\n\u003cp>The project is called \u003ca href=\"https://blog.verily.com/2017/07/debug-fresno-our-first-us-field-study.html\">Debug Fresno\u003c/a> and it’s being undertaken by Verily, a subsidiary of Alphabet, Google’s holding company. It’s the company’s first field study involving sterile mosquitoes in the U.S.\u003c/p>\n\u003cp>Scientists say the goal is to cut the population of \u003cem>Aedes aegypti\u003c/em> mosquitoes — the species responsible for spreading Zika, dengue and chikungunya. \u003cem>A. aegypti\u003c/em> have been present in California’s Central Valley since 2013 and have been a problem in Fresno County.\u003c/p>\n\u003cp>“It’s a terrible nuisance, a terrible biting nuisance. It’s changed the way people can enjoy their backyard and it’s a threat for disease transmission,” Steve Mulligan of Fresno County’s Consolidated Mosquito Abatement District told \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/07/19/scientists-plan-to-trick-zika-carrying-mosquitoes-into-breeding-themselves-out-of-existence/?utm_term=.488aede6eedb\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each week for 20 weeks, the company plans to release 1 million of the sterile, non-biting male mosquitoes in two neighborhoods in Fresno County. The male mosquitoes are bred and infected with \u003cem>Wolbachia\u003c/em>, a bacterium that is “naturally found in at least 40 percent of all insect species,” according to \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46021/title/Bacterium-Blocks-Zika-s-Spread/\">The Scientist magazine\u003c/a>, though it’s normally not found in \u003cem>A. aegypti\u003c/em>.\u003c/p>\n\u003cp>“Over time, we hope to see a steep decline in the presence of \u003cem>Aedes aegypti\u003c/em> in these communities,” Verily says in a statement.\u003c/p>\n\u003cp>In a phenomenon called cytoplasmic incompatibility, “matings between \u003cem>Wolbachia\u003c/em>-infected males and uninfected females results in embryo lethality or low hatch rates,” William Sullivan and Scott L. O’Neill \u003ca href=\"http://www.nature.com/nature/journal/v543/n7644/fig_tab/nature21509_F1.html\">write in the journal Nature\u003c/a>. “Because the effect of \u003cem>Wolbachia\u003c/em> infection on insect reproduction favours the survival of \u003cem>Wolbachia\u003c/em>-infected females over uninfected females, \u003cem>Wolbachia\u003c/em> can rapidly spread through an insect population.”\u003c/p>\n\u003cp>\u003cem>Wolbachia\u003c/em> also helps mosquitoes to avoid carrying diseases like Zika in the first place. \u003cem>A. aegypti\u003c/em> “carrying \u003cem>Wolbachia\u003c/em> bacteria were highly resistant to Zika virus infection, and were unable to transmit the virus via their saliva,” \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46021/title/Bacterium-Blocks-Zika-s-Spread/\">The Scientist writes\u003c/a>, citing a 2016 study in Brazil.\u003c/p>\n\u003cp>The magazine says the bacterium “is not known” to infect humans.\u003c/p>\n\u003cp>Verily is partnering in the project with the Kentucky-based company MosquitoMate and the Consolidated Mosquito Abatement District of Fresno County. They plan to study the \u003cem>A. aegypti\u003c/em> population density and number of eggs hatching in the experimental areas and compare to control neighborhoods to measure the experiment’s effectiveness.\u003c/p>\n\u003cp>It’s not the first time the bacteria-carrying mosquitoes have been released into the wild in the U.S.\u003c/p>\n\u003cp>MosquitoMate and the Florida Keys Mosquito Control District \u003ca href=\"http://fkmcd.maps.arcgis.com/apps/MapJournal/index.html?appid=d8c2b636e93b40b4b940e6042ef286c6\">released 75,000\u003c/a> \u003cem>Wolbachia\u003c/em>-carrying mosquitoes each week for several weeks this spring in the Florida Keys.\u003c/p>\n\u003cp>Last year in Fresno, MosquitoMate and county officials released \u003ca href=\"https://www.theverge.com/2017/7/14/15972950/mosquitoes-google-alphabet-verily-debug-wolbachia-bacteria-fresno-california\">about 800,000\u003c/a> of the mosquitoes. This experiment is a 25-fold increase on that.\u003c/p>\n\u003cp>Verily says it developed “automated mass rearing and sex-sorting processes,” which enable it to breed and release so many of the mosquitoes in such a short time.\u003c/p>\n\u003cp>\u003cem>A. aegypti\u003c/em> is an invasive species to Fresno County, and officials told the \u003cem>Post\u003c/em> they don’t predict an impact on the local ecosystem from reducing or eliminating it.\u003c/p>\n\u003cp>The method Verily is using to cut the mosquito population differs from the experiment the British company Oxitec proposed last year in the Florida Keys. In contrast to the mosquitoes being infected by bacteria, Oxitec has released males that are genetically modified with “a gene that causes the mosquito’s offspring to die in the first two to three days of life,” according to \u003ca href=\"https://www.dallasnews.com/news/zika-virus/2017/07/14/genetically-engineered-mosquitoes-wipe-zika-dallas-county-oppose-local-trials\">The Dallas Morning News\u003c/a>. Many Florida Keys residents \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/20/502717253/florida-keys-approves-trial-of-genetically-modified-mosquitoes-to-fight-zika\">bitterly opposed\u003c/a> the proposed experiment last year; some Texas residents are reacting similarly to a proposed trial there, the \u003cem>Morning News\u003c/em> reports.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From the spring to the fall of 2016, \u003ca href=\"https://www.cdc.gov/media/releases/2017/s0620-virus-carrying-mosquitoes.html\">38 additional counties\u003c/a> in the U.S. reported evidence of the \u003cem>A. aegypti\u003c/em> mosquito, according to the Centers for Disease Control and Prevention. Since the beginning of 2015, \u003ca href=\"https://www.cdc.gov/zika/reporting/case-counts.html\">more than 5,300\u003c/a> symptomatic cases of Zika were reported to the CDC in the U.S., though the vast majority stemmed from people traveling to affected areas. As of Wednesday, the agency said there were \u003ca href=\"https://www.cdc.gov/zika/reporting/2017-case-counts.html\">no reported cases\u003c/a> of people getting Zika in the U.S. this year “through presumed local mosquito-borne transmission.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment",
"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"headTitle": "Why ‘Repeal and Replace’ Collapsed: 8 Takeaways on the Senate’s Health Care Meltdown | KQED",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cstrong> Updated 10:30 a.m. Tuesday \u003c/strong>\u003c/p>\n\u003cp>After seven years of promising to repeal the Affordable Care Act, Republican efforts at passing a health care bill on their own may have ended Monday night as the bill working its way through the Senate was effectively blocked. Two more GOP senators — \u003ca href=\"https://www.lee.senate.gov/public/index.cfm?p=press-releases&id=988195A6-7C42-4878-A59F-3FA344D170C9\">Mike Lee\u003c/a> of Utah and \u003ca href=\"https://twitter.com/JerryMoran/status/887108026246803456\">Jerry Moran\u003c/a> of Kansas — came out in opposition to the bill, which means it cannot get enough support to pass.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">My colleague \u003ca href=\"https://twitter.com/SenMikeLee\">@SenMikeLee\u003c/a> and I will not support the MTP to this version of BCRA. \u003ca href=\"https://twitter.com/hashtag/HealthcareBill?src=hash\">#HealthcareBill\u003c/a>\u003c/p>\n\u003cp>— Jerry Moran (@JerryMoran) \u003ca href=\"https://twitter.com/JerryMoran/status/887107267824406528\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Shortly afterward, President Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">wrote\u003c/a>, “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!\u003c/p>\n\u003cp>— Donald J. Trump (@realDonaldTrump) \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Senate Majority Leader Mitch McConnell put out a statement promising to do just that, pointing to a 2015 bill passed by Congress and vetoed by President Barack Obama. It would repeal the ACA with a two-year delay, giving a fixed deadline for Congress to replace the law. McConnell would still need 50 votes to bring that to the floor.\u003c/p>\n\u003cp>McConnell has previously said turning to Democrats to come up with fixes for the current health care system is his next step, and several senators who criticized the crafting of the current bill in private have called for such a bipartisan process.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One such senator is John McCain, R-Ariz., who was kept from returning to Washington this week due to unexpected surgery for a blood clot, requiring GOP leaders to delay their push for the overhaul bill. In a statement late Monday, McCain \u003ca href=\"https://www.mccain.senate.gov/public/index.cfm/press-releases?ID=B2B6EBD7-6DF4-4E2D-BB59-98B40EAAA784\">said\u003c/a>, “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”\u003c/p>\n\u003cp>McCain has been among the more moderate Republicans who have joined several GOP governors in opposing the Republican health care bill’s proposed cuts to Medicaid. The bill would have represented a generational restructuring of the entitlement program. The Congressional Budget Office has not yet given its estimates on the impact of the latest Senate bill, but estimates on an earlier version showed the reductions in Medicaid coverage would have meant 15 million fewer Americans would have coverage under the program in 10 years.\u003c/p>\n\u003cp>In addition to paralyzing the GOP on its top political pledge for the better part of a decade, stalling on the health care bill could tie up the rest of the party’s agenda, including efforts at major tax reform. The health care bill has dominated work on Capitol Hill for the first six months of Trump’s term, typically the most potent period for an administration to move legislation, which is also the first period in a decade when the GOP has controlled both chambers of Congress and the White House.\u003c/p>\n\u003cp>On Tuesday Trump said he was deeply “disappointed” by the collapse of the GOP effort to rewrite Obama’s health care law.\u003c/p>\n\u003cp>Trump told reporters during a lunch with service members that Republicans have been talking for years about repealing and replacing “Obamacare,” and is disappointed they couldn’t deliver. He said it’s time to “Let Obamacare fail,” and says that “I’m not going to own it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Trump said letting Obamacare fail will encourage Democrats to come to the table and negotiate. He also says he does not blame Majority Leader Mitch McConnell for the decision by two more Republican senators to come out against the legislation, effectively killing the bill.\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=Republican+Health+Care+Bill+Falls+Short%2C+Dealing+Blow+To+Trump+Agenda&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong> Updated 10:30 a.m. Tuesday \u003c/strong>\u003c/p>\n\u003cp>After seven years of promising to repeal the Affordable Care Act, Republican efforts at passing a health care bill on their own may have ended Monday night as the bill working its way through the Senate was effectively blocked. Two more GOP senators — \u003ca href=\"https://www.lee.senate.gov/public/index.cfm?p=press-releases&id=988195A6-7C42-4878-A59F-3FA344D170C9\">Mike Lee\u003c/a> of Utah and \u003ca href=\"https://twitter.com/JerryMoran/status/887108026246803456\">Jerry Moran\u003c/a> of Kansas — came out in opposition to the bill, which means it cannot get enough support to pass.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">My colleague \u003ca href=\"https://twitter.com/SenMikeLee\">@SenMikeLee\u003c/a> and I will not support the MTP to this version of BCRA. \u003ca href=\"https://twitter.com/hashtag/HealthcareBill?src=hash\">#HealthcareBill\u003c/a>\u003c/p>\n\u003cp>— Jerry Moran (@JerryMoran) \u003ca href=\"https://twitter.com/JerryMoran/status/887107267824406528\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Shortly afterward, President Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">wrote\u003c/a>, “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!\u003c/p>\n\u003cp>— Donald J. Trump (@realDonaldTrump) \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Senate Majority Leader Mitch McConnell put out a statement promising to do just that, pointing to a 2015 bill passed by Congress and vetoed by President Barack Obama. It would repeal the ACA with a two-year delay, giving a fixed deadline for Congress to replace the law. McConnell would still need 50 votes to bring that to the floor.\u003c/p>\n\u003cp>McConnell has previously said turning to Democrats to come up with fixes for the current health care system is his next step, and several senators who criticized the crafting of the current bill in private have called for such a bipartisan process.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One such senator is John McCain, R-Ariz., who was kept from returning to Washington this week due to unexpected surgery for a blood clot, requiring GOP leaders to delay their push for the overhaul bill. In a statement late Monday, McCain \u003ca href=\"https://www.mccain.senate.gov/public/index.cfm/press-releases?ID=B2B6EBD7-6DF4-4E2D-BB59-98B40EAAA784\">said\u003c/a>, “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”\u003c/p>\n\u003cp>McCain has been among the more moderate Republicans who have joined several GOP governors in opposing the Republican health care bill’s proposed cuts to Medicaid. The bill would have represented a generational restructuring of the entitlement program. The Congressional Budget Office has not yet given its estimates on the impact of the latest Senate bill, but estimates on an earlier version showed the reductions in Medicaid coverage would have meant 15 million fewer Americans would have coverage under the program in 10 years.\u003c/p>\n\u003cp>In addition to paralyzing the GOP on its top political pledge for the better part of a decade, stalling on the health care bill could tie up the rest of the party’s agenda, including efforts at major tax reform. The health care bill has dominated work on Capitol Hill for the first six months of Trump’s term, typically the most potent period for an administration to move legislation, which is also the first period in a decade when the GOP has controlled both chambers of Congress and the White House.\u003c/p>\n\u003cp>On Tuesday Trump said he was deeply “disappointed” by the collapse of the GOP effort to rewrite Obama’s health care law.\u003c/p>\n\u003cp>Trump told reporters during a lunch with service members that Republicans have been talking for years about repealing and replacing “Obamacare,” and is disappointed they couldn’t deliver. He said it’s time to “Let Obamacare fail,” and says that “I’m not going to own it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Trump said letting Obamacare fail will encourage Democrats to come to the table and negotiate. He also says he does not blame Majority Leader Mitch McConnell for the decision by two more Republican senators to come out against the legislation, effectively killing the bill.\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=Republican+Health+Care+Bill+Falls+Short%2C+Dealing+Blow+To+Trump+Agenda&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\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",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\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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"content": "\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-11b-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Aaron-car-768x576.jpg\" Title=\"Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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