First Edition: July 26, 2017

Kaiser Health News: Senate Votes To Move Ahead With Obamacare Replacement Bill Debate. What's Next?
So the Senate has voted to start debate on a bill to replace the Affordable Care Act. Now what? Well, it gets wonky. The rules for budget reconciliation, the process the Senate is using that limits debate and allows a bill to pass with only a simple majority, comes with a set of very specific rules. Here are some of the big ones that could shape whatever final bill emerges. (Rovner, 7/25)

Kaiser Health News: Postcard From Capitol Hill: What YouTube Didn’t Show You In Senate Health Care Vote
You had to be there. After days of uncertainty about whether Senate Republicans would vote to begin debating a bill to repeal the Affordable Care Act, it boiled down to a few tense minutes on the Senate floor. As the vote started shortly after 2 p.m. ET, 30 reporters crammed into the small hallway in front of the chamber, waiting for Arizona Republican Sen. John McCain’s dramatic arrival on the elevator. (Bluth, 7/25)

The Associated Press: Senate Opens 'Obamacare' Debate At Last But Outcome In Doubt
Prodded by President Donald Trump, a bitterly divided Senate voted, at last, Tuesday to move forward with the Republicans' long-promised legislation to repeal and replace "Obamacare." There was high drama as Sen. John McCain returned to the Capitol for the first time after being diagnosed with brain cancer to cast a decisive "yes" vote. The final tally was 51-50, with Vice President Mike Pence, exercising his constitutional prerogative, breaking the tie after two Republicans joined all 48 Democrats in voting "no." (Werner, 7/25)

The New York Times: Senate Health Care Decision: Pence Breaks Senate Tie
Senators Shelley Moore Capito of West Virginia, Dean Heller of Nevada and Rob Portman of Ohio, three Republicans who have expressed profound doubts about legislation to repeal and replace the Affordable Care Act, announced Tuesday they will vote to begin debate on the future of health care. (Kaplan, Abelson and Pear, 7/25)

The Wall Street Journal: Senate Health Debate Rolls On After First Option Fails
“We knew this wasn’t going to be easy, and there’s a lot of work ahead of us,” said Sen. John Thune of South Dakota, a member of the Senate GOP leadership. (Armour, Peterson and Hackman, 7/25)

The Washington Post: GOP Bill Is Voted Down As Divided Senate Dives Into Health-Care Debate
“The endgame is to be able to move something at the end of this process across the Senate floor that can get 50 votes and then to get into conference with the House,” said Sen. John Thune (R-S.D.), a top McConnell lieutenant. (Sullivan, Eilperin and Snell, 7/25)

Politico: McConnell Gets A Win In Obamacare Repeal Opening Round
The Senate faces several days of heated debate and tough votes, with the final outcome in doubt. Can Republicans actually repeal and replace Obamacare? Or simply repeal it? Can they roll back the expansion of Medicaid under the Affordable Care Act, which resulted in millions of more enrollees? What about eliminating Obamacare taxes? And defunding Planned Parenthood? What about a “skinny repeal” bill that would get rid of the employer and individual mandates under Obamacare while leaving almost all the rest of the legislation in place? All this is still up in the air. (Bresnahan, 7/25)

Los Angeles Times: With Pence Breaking A Tie, Senate Votes To Begin Debate On Obamacare Repeal Bill
To get to this point, McConnell had to abandon the customary legislative process, forgoing public hearings and committee debate in a way almost never seen for major legislative proposals. And he left Republican lawmakers with a series of legislative options — which polls show are deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more. (Levey, 7/25)

Politico: How The GOP Brought Obamacare Repeal Back From The Dead
As Mitch McConnell strode to the Senate floor on Tuesday, with no votes to spare to keep the GOP’s Obamacare repeal campaign alive, he knew where everyone in his conference stood. Everyone, that is, except for Ron Johnson. (Everett, Kim and Haberkorn, 7/25)

The New York Times: Senate Votes Down Broad Obamacare Repeal
The Senate voted narrowly on Tuesday to begin debate on a bill to repeal major provisions of the Affordable Care Act, but hours later, Republican leaders suffered a setback when their most comprehensive plan to replace President Barack Obama’s health law fell far short of the votes it needed. The Tuesday night tally needed to reach 60 votes to overcome a parliamentary objection. Instead, it fell 43-57. (Kaplan and Pear, 7/25)

The Associated Press: Republicans Collins, Murkowski Oppose GOP Health Vote
Two Republican senators — Susan Collins of Maine and Lisa Murkowski of Alaska — broke with their party and opposed the Senate vote to move ahead on a health care overhaul. The votes by the two women drew criticism from President Donald Trump, who said, "So we had two Republicans that went against us, which is very sad, I think. It's very, very sad for them." (Daly, 7/25)

The Associated Press: Trump: Liberation From 'Obamacare Nightmare' Is Close
Celebrating a slim but symbolic health-care win in Washington, President Donald Trump told supporters in Ohio that the nation was one step closer to liberation from the "Obamacare nightmare." (Salama, 7/26)

The Wall Street Journal: Trump Is Optimistic Senate Will Vote To Begin Debate On Bill To Repeal Obamacare
Mr. Trump, in a 45-minute interview with The Wall Street Journal, said he has been working to secure the 50 votes needed to pass the measure, which he described as a difficult but crucial step toward ultimately putting in place a health-care system that would replace former President Barack Obama’s Affordable Care Act. “I think we’re doing pretty well on health care,” the president said in the Oval Office interview. “We’ll see.” (Nicholas, 7/25)

The Associated Press: McCain Delivers A Key Health Care Vote, Scolding Message
The maverick stood with his party on Tuesday, casting a crucial vote in the Republican drive to repeal "Obamacare." But then, like an angry prophet, Sen. John McCain condemned the tribal politics besetting the nation. Confronting an aggressive brain cancer, the 80-year-old Arizonan served notice he would not vote for the GOP legislation as it stands now. McCain's impassioned speech held the rapt attention of his colleagues in the Senate chamber. (Alonso-Zaldivar, 7/26)

The New York Times: McCain Returns To Cast Vote To Help The President Who Derided Him
He said that although he had voted to begin debate on repealing the Affordable Care Act, he would definitely not vote for a Senate health care bill without major changes. As it turned out, however, Mr. McCain did side late Tuesday with most Senate Republicans who voted — unsuccessfully — to replace the health care law with the most comprehensive plan his party has offered so far. (Steinhauer, 7/25)

USA Today: McCain, Battling Cancer, Returns To Senate And Casts Critical Health Care Vote
Standing in the well of the Senate with the surgical scar over his left eyebrow clearly visible, McCain urged his colleagues to "stop listening to the bombastic loudmouths" on radio, television and the Internet who rail against compromise. "To hell with them!" McCain said. (Gaudiano, 7/25)

The Washington Post: ‘We’re Getting Nothing Done’: McCain, In Emotional Return, Laments What The Senate Has Become
“Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle,” McCain told his colleagues, who gave him the floor for an unusual address usually reserved for a retiring senator. “We’re getting nothing done, my friends. We’re getting nothing done.” (Kane, 7/25)

The Wall Street Journal: McCain Returns To Senate With Calls For Bipartisanship
The senator spared no one—not himself, not Senate Majority Leader Mitch McConnell (R., Ky.). “Sometimes I made it harder to find common ground because of something harsh I said to a colleague,” Mr. McCain said. “Sometimes I wanted to win more for the sake of winning than to achieve a contested policy.” (Hughes, 7/25)

Politico: McCain Returns — Backing And Blasting His Own Party
Trump hailed McCain in not one but two Tuesday tweets. The president called McCain an "American hero," apparently changing his mind two years after declaring on the campaign trail that "he's not a war hero" and "I like people who weren't captured." McCain spent more than five years as a prisoner of war in Vietnam, earning several medals for valor. (Schor, 7/25)

The Associated Press: Senate Health Care Debate Could Be Suspenseful And Raucous
The Senate's days-long debate on health care features a dynamic that's relatively rare on Capitol Hill. Genuine suspense. Debate kicked off Tuesday without an obvious endgame. Several Republicans voted to start debate but said the bill will have to be changed for them to vote to actually pass the legislation later this week. The amendment process promises to be extensive and freewheeling. And victory for Republicans and President Donald Trump is not guaranteed. (Ohlemacher, 7/26)

The New York Times: Republicans Are Voting This Week To Repeal Or Replace Obamacare. Here Are Their Proposals.
The Senate voted Tuesday to begin debate on repealing the Affordable Care Act. On Tuesday night, the Senate failed to pass one of three proposals, a revised version of its plan to repeal and replace the current law. Here are the next steps. (Park, Parlapiano and Sanger-Katz, 7/25)

The Washington Post: As Senate Starts Debate To Topple The ACA, Even Senators Don’t Know Where It Will Lead
Based on what senators were saying on Tuesday, here are some of the plans and amendment likely to come up for debate or a vote — potentially in different combinations — in coming days. (Goldstein and Winfield Cunningham, 7/25)

The Wall Street Journal: Health-Care Bill: What’s Next?
Under the procedural rules Senate Republicans have adopted to pass health-care legislation with a simple majority, rather than the 60 votes usually needed, they are limited in how much of the ACA they can repeal. Any measure must be generally related to taxes or spending. So only parts of the ACA can be knocked down, and only certain kinds of replacements can be proposed. (Armour, 7/26)

USA Today: The Senate Agreed To Debate A Health Care Bill. Now What?
The Senate is expected to vote midday Wednesday on an amendment that would create a clean repeal of the Affordable Care Act that wouldn’t take effect for two years. The delay is intended to give lawmakers time to come together on a replacement plan before people lose their health care. But even with conservative support, the clean repeal is not likely to pass because at least three Republican senators — Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia — have all said they wouldn’t vote for a repeal without a replacement. Other lawmakers have also expressed concern. (Collins and Shesgreen, 7/25)

Politico: What's Next In The Senate Repeal Saga? Good Question 
Once the Senate burns through its 20 hours of debate, split among Republicans and Democrats, it goes to a vote-a-rama, which at this point looks like it will be late Thursday. Theoretically that allows for unlimited amendments as long as they are relevant. But probably a few dozen will be voted on. (Demko, 7/25)

The New York Times: ‘Skinny’ Obamacare Repeal Would Clash With Republicans’ Health Care Promises
If the current options for overhauling the health care system can’t get a majority of Senate votes, the majority leader, Mitch McConnell, has a new backup plan, according to senators and lobbyists: a simple bill that eliminates three of Obamacare’s least popular provisions. The plan, which has been nicknamed “skinny repeal,” would eliminate the Affordable Care Act’s individual mandate, the employer mandate and a tax on medical devices, at least for a few years. (Sanger-Katz, 7/25)

The Washington Post: ‘Skinny Repeal’ Could Be The Senate’s Health-Care Bill Of Last Resort
In substance, this plan would repeal just three parts of the ACA, according to several sources familiar with the approach. It would eliminate the requirement that most Americans carry health insurance as well as the requirement that employers with at least 50 full-time employees offer coverage to their workers. Both are central elements of the 2010 health-care law and its least popular aspects with the public. The “skinny” plan also would rescind the tax on medical devices, one of several taxes the ACA created to help pay for other elements of the law. A close variant of this surfaced two years ago in the House, as part of the GOP’s strategy back then to lower federal deficits. Congressional budget analysts estimated at the time that 15 million fewer Americans would have insurance coverage “most years” as a result. (Goldstein, 7/25)

Politico: McConnell's Fallback: A 'Skinny' ACA Repeal
The plan wouldn't touch Obamacare's Medicaid expansion, making it more palatable to Senate moderates. But it could trigger significant resistance by preserving the ACA's insurance regulations, which senators like Mike Lee of Utah and Rand Paul of Kentucky have insisted need to be struck down. "How do the ultra-conservatives vote for it?" asked one former Senate Republican aide. (Diamond, 7/25)

Reuters: Factbox: What Might Be In U.S. Senate's Mystery Healthcare Bill
Senate Republicans would likely go for a bare-minimum “skinny repeal” only if other approaches ... cannot win approval. (Abutaleb, 7/25)

The Washington Post: Senate Health-Care Bill Amendment Votes
Moderates may be concerned the “death spiral” would hurt too many people in the individual market. (Soffen and Schaul, 7/25)

The New York Times Fact Check: For Trump’s ‘Victims’ Of Obamacare, Senate Bill May Be Worse
Ahead of a Senate vote to begin debate over health care, President Trump pressed Republicans on Monday afternoon to fulfill their seven-year promise to repeal and replace the Affordable Care Act, surrounded by families whom he characterized as “victims” of the law.“ For 17 years, Obamacare has wreaked havoc on the lives of innocent, hard-working Americans,” he mistakenly said of the law, passed in 2010, before listing “terrific reforms” in the Senate bill. Here’s an assessment. (Qui, 7/25)

The Wall Street Journal: Shifting Views On Health Law Challenge GOP
Obamacare had been unpopular for at least the past four years, opinion surveys shows, suggesting that their move to change the law would draw public support. But the Senate action comes amid increased public backing for the 2010 health law—as well as for the idea that the government should play a role in helping people obtain health insurance. That is one reason that moving an overhaul of the law through Congress has been so balky for the GOP. (Chinni, 7/25)

The Washington Post: Here’s How Local TV News Is Making It Harder For The Senate To Repeal Obamacare
Senate efforts have failed so far for a variety of reasons. But here’s one that hasn’t yet been explored: local television news. That drumbeat of coverage in their home districts during Senate debates may have made some GOP senators think twice about angering constituents — including those of their own party. (Fowler and Gollust, 7/26)

The Wall Street Journal: Fears Obamacare Would Be A Job Killer Were Wrong, Study Finds
Projections that the Obama administration’s signature health-care legislation would drive workers out of the labor force have proved wrong, according to a new paper by researchers at Stanford University. (Derby, 7/25)

The Washington Post: 1 Million Jobs On The Line As Senate Votes On Health Care
America could lose more than a million jobs if the Senate votes to repeal the Affordable Care Act on Tuesday. That’s according to a report from George Washington University’s Milken Institute School of Public Health and the Commonwealth Fund. (Long, 7/25)

The Associated Press: Key ACA Insurer Urges Gov't To Keep Customer Subsidies
One of the biggest insurers in the Affordable Care Act's marketplaces is warning the federal government that it must preserve cost-sharing payments for low-income customers to avoid hurting millions of people. Centene Corp. said Tuesday that a better-than-expected performance in those individual insurance markets prompted it to beat Wall Street expectations in the second quarter and raise its forecast for 2017. (7/25)

The New York Times: Celgene To Pay $280 Million To Settle Fraud Suit Over Cancer Drugs
The pharmaceutical company Celgene has agreed to pay $280 million to settle claims that it marketed the cancer drugs Thalomid and Revlimid for unapproved uses, the company said on Tuesday. Under the terms of the settlement, which resulted from a lawsuit filed by a whistle-blower — a former sales representative at Celgene — the company will pay $259.3 million to the United States and $20.7 million to 28 states and the District of Columbia. (Thomas, 7/25)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean's Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

USA Today: Stem Cell Company For Sports Legends Facing Financial Complaints
The company that manufactured experimental stem cell medicine for several aging sports heroes is facing several complaints in court for large unpaid bills, as well as a complaint by an investor who accuses the company of misusing funds and fraud. (Schrotenboer, 7/25)

The New York Times: How To Boost Resilience In Midlife
Much of the scientific research on resilience — our ability to bounce back from adversity — has focused on how to build resilience in children. But what about the grown-ups? (Parker-Pope, 7/25)

The Washington Post: Sperm Concentration Has Declined 50 Percent In 40 Years In Three Continents
The quality of sperm from men in North America, Europe and Australia has declined dramatically over the past 40 years, with a 52.4 percent drop in sperm concentration, according to a study published Tuesday. The research — the largest and most comprehensive look at the topic, involving data from 185 studies and 42,000 men around the world between 1973 and 2011 — appears to confirm fears that male reproductive health may be declining. (Cha, 7/25)

NPR: Young Athletes Who Specialize Too Soon Risk More Injuries
If you're involved in high school athletics, you know the scene. There's increasing pressure to specialize in a single sport and play it year-round. The upside? Focusing on one sport can help give kids the edge they need to compete on elite club teams — or travel teams. Many athletes hope to attract the attention of college recruiters, or be offered a sports scholarship. This emphasis on competitive success has become widespread throughout the U.S., according to a consensus statement from the American Medical Society for Sports Medicine. (Aubrey, 7/25)

The Associated Press: Missouri Sends Governor Law Tightening Abortion Regulations
Missouri lawmakers on Tuesday delivered Republican Gov. Eric Greitens a political win by sending him a wide-ranging bill tightening abortion regulations that would give the attorney general power to prosecute violations, prompting critics to say the changes are aimed at limiting access to abortion in a state that already has tough restrictions. (Ballentine, 7/25)