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Protesters authority signs and bark at assembly walking out of the US Capitol in Washington, DC, on May 4, 2017 afterwards the House of Representatives almost anesthetized a Republican accomplishment to abolition and alter Obamacare. (NICHOLAS KAMMNICHOLAS KAMM/AFP/Getty Images)

It’s not a abstruse that amid Admiral Trump’s arch desires is to see the Affordable Affliction Act fail. Every adventitious he gets he chastises Sen. John McCain (R-Ariz.) on his thumbs-down “no” vote that helped kill GOP efforts to abolition the law. The majority of accomplishments the White House has taken as it pertains to the ACA have been to attenuate it. 

So it should be of little abruptness the administering has removed absolute sections about the ACA from the official site, its hub for the Center for Medicaid and CHIP Services. Of the 13 pages committed to the ACA that were overhauled, eight alter to addition folio with agnate information, but on only two do the words “Affordable Affliction Act” appear, according to an analysis released this morning from the Sunlight Foundation. Additionally, addition folio that explained the allocation amid Medicaid and the ACA exchanges was additionally removed and now redirects to an “Error: Folio Not Found” note. (The address can be apprehend in abounding here.)

Here is what a sample folio at acclimated to attending like:

It’s adamantine to say how consequential it is that these pages no best exist. Who knows how abounding Americans have approved out ACA advice on the site? But it absolutely is symbolic of the Trump White House’s analytical efforts to accomplish Obamacare disappear. 

Sunlight, a detached government babysitter group, is tracking the Bloom and Human Services Department website for unannounced changes. In May, its advisers begin a advertence to the ACA had been removed from A agent for the Center for Medicare and Medicaid Services could not acknowledge to our questions about this by this morning, but Sunlight’s Toly Rinberg shared with me that in May a CMS representative gave this explanation on background: “CMS performs accepted updates and aliment to our websites, which includes the afterlight and abatement of agreeable that is not accepted or underutilized.  In this instance, there was a aeon of time aback bodies with Medicare advantage had questions and absorption in the ACA and its appulse on Medicare.  However, the ACA has now been law for over eight years and both and [] are absolute sites for Healthcare Exchange information.” 

It’s a boxy altercation to buy abnormally accustomed that Medicaid recipients and bodies accepting subsidies to buy on the ACA exchanges frequently animation amid the two based on their clashing assets levels (the government accustomed states to aggrandize their Medicaid programs afterwards the access of Obamacare, admitting not all states acquire done so). Sunlight addendum that amid the advice removed are capacity about “eligibility requirements.”

“There has been a change in how advice about ACA is actuality presented or fabricated attainable to the public,” said Sunlight researcher Rachel Bergman. “It’s now assorted centers aural the agency removing their ACA information.” 

For accuracy advocates such as Sunlight, alteration the capacity of a government website without notice is account abundant to accession the issue. But for health-policy experts, the vanishing language is annihilation compared to the Trump administering chipping abroad at the law itself. 

Just this week, the Trump administering arise it was acid allotment for the navigators program, groups trained to advice individuals assurance up for allowance on the federal ACA marketplace. Aftermost abatement I visited one of those navigator sites in Maryland on accessible acceptance day and watched as bodies waited for hours for the adventitious for one-on-one advice abyssal This chestnut didn’t make it into The Post’s final adventure that day, so I allotment it now:

Raphael Ernest, 43, of Argent Spring, said he accustomed circadian emails reminding him to arise in and amend his pay butt advice in the system. 

For the aftermost year, he and his wife acquire been uninsured, but he’s had both his 9-year-old and 1-year-old daughters on Medicaid. Alma Luna, the certified navigator who formed with him Wednesday, doubtable he didn’t apprehend he and his wife were additionally acceptable for Medicaid beneath the amplification so he never requested it.

Ernest could get allowance through his employer, but he couldn’t acquiesce the added than $100 account premium, he said. 

He came in artlessly to amend his abstracts to ensure his daughters remained covered, but Luna offered to analysis on his cachet as well. He absolved out absolutely insured beneath Medicaid. 

After the navigator aphorism was arise Tuesday, HuffPost’s health-care reporter, Jonathan Cohn, offered on Twitter a acute account of why it matters: “The affairs costs beneath than $40 actor aftermost year. In the ambience of federal spending on bloom care, that is nothing. Not akin a rounding error. And the point of the navigators isn’t to run up huge acceptance numbers. It’s to accommodate abetment to bodies who charge it.” 

But that’s aloof one of the cogent means the Trump administering has gotten about aldermanic cessation to abate Obamacare. The New York Times on Wednesday began tracking the changes Trump is authoritative to the ACA. So far it has listed 14 ways. 

“The administering has been able to do a allusive amount, the better change is Congress repealing the alone mandate, but some of the authoritative changes that they’ve proposed or are affective advanced with now will acquire cogent furnishings as well,” said Matt Fiedler, a health-policy able at the Brookings Institution.

Most damaging, he told me, is the White House’s plan to aggrandize “short-term limited-duration policies,” which do not acquire to accede with the basal account standards allowable by the ACA, and about don’t acquire bodies with preexisting conditions. Beneath the ACA, bodies are bound to blockage on those affairs for up to three months, but the Trump aphorism would extend that timeline to a year. These cheaper affairs will apparently allure younger, convalescent enrollees, which leaves sicker Americans affairs the ACA-approved plans, appropriately active up prices, which is what the alone authorization was created to avoid. 

“This will acquiesce a abounding alongside bazaar that doesn’t accommodated the account standards,” Fiedler said. “That’s activity to change the structure, and departs from the intent, of the Affordable Affliction Act.”

Then there’s the advertisement aftermost anniversary that the administering was delaying promised “risk adjustment” payments to insurers. Edwin Park, a Georgetown University assistant of accessible policy, wrote Wednesday that it was addition way the Trump administering was aggravating to “sabotage” the ACA. Afterwards alive whether they’ll accept the payments they were expecting, insurers could accession premiums in 2019 or akin adjudge to cull out of the marketplaces altogether, he explained. 

There’s additionally Medicaid, which grew abundantly beneath the ACA both because of the states that broadcast accommodation and because many low-income individuals who never agitated to boutique for bloom allowance afore begin out they were advantaged to coverage. But the Trump administering is offering waivers to states that appetite to add assignment requirements to the safety-net program, which critics say adds an accidental barrier to care.

But for supporters of the ACA, there is one argent lining, Fiedler said. No amount how adamantine the Trump White House tries to annihilate the law or actualize abashing or abolish it from government sites, it would still crave an act of Congress (or the Supreme Court) to abolition and alter Obamacare entirely.

The ultimate ambition of the ACA was to accommodate added bodies with affordable coverage, and for now, the subsidies abounding bodies accept to advice them pay for their affairs are still in abode as is the Medicaid amplification in 23 states and D.C., which gave millions added Americans chargeless government health-care coverage. 

Opponents, however, altercate the law is a mess, active up costs as insurers abscond from marketplaces. They’re not giving up the action to annihilate it, akin if their available tools as of now are mostly in the easily of the Trump administering and not Congress.


This photo shows the leaves of a marijuana bulb central Ultra Health’s agronomics greenhouse in Bernalillo, N.M. (AP Photo/Susan Montoya Bryan, File)

AHH: North Dakotans could get a adventitious to vote on whether to accept marijuana afterwards supporters of the movement submitted added than 18,000 signatures to the secretary of accompaniment acknowledging arch on the measure, added than the 13,452 appropriate get it on the November ballot.

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“Like a contempo acknowledged medical-marijuana admeasurement in Oklahoma, the accomplishment has abundantly aureate beneath the radar, with no banking abetment from civic biologic action groups such as the Biologic Action Alliance and the Marijuana Action Project,” The Post’s Christopher Ingraham reports. “And like Oklahoma, North Dakota is a deep-red accompaniment that hasn’t voted for a Democratic presidential applicant aback 1964.”

The secretary of accompaniment still needs to accredit the address signatures to authorize the admeasurement for November’s ballot. The bill would accept the possession, auction and use of marijuana for bodies 21 and beforehand in North Dakota and would expunge marijuana aesthetics from North Dakotans’ bent records, Christopher reports.

The accompaniment has one of the everyman ante of marijuana use, but one of the accomplished arrest ante for use of the drug. Fewer than 10 percent of North Dakota association acclimated the biologic in 2016, per the federal Civic Survey on Biologic Use and Health, but in the aforementioned year, 2,513 of the 61,000 association who acclimated marijuana were arrested for simple marijuana possession, according to FBI abstracts aggregate by pro-legalization accumulation NORML. That amount of 41 arrests per 1,000 users is the additional accomplished in the nation.

Wayne Cooper, 70, and his babe Patricia Cooper, 34, airing in the backyard of their home in December 2017, in McClean, Va. Cooper is convalescent from a alarmist displace anaplasty afterwards Patricia absitively to accord her ancestor a allotment of her liver. (Salwan Georges/The Washington Post)

OOF: The Centers for Medicare and Medicaid Services is aggressive to abutting LiveOnNy, one of the nation’s better “organ accretion organizations” (OPOs) afterwards admonishing that it had bootless to accommodated minimum standards of success in bureau collection, our Post colleagues Lenny Bernstein and Kimberly Kindy report.

The letter from CMS aftermost ages warned the bureau would not renew LiveOnNy’s arrangement set to expire on Jan. 31. But a agent for the bureau acclaimed there are affairs to accomplish abiding bureau accretion and transplantation would not be disrupted, Lenny and Kimberly report.

The alignment has amorphous an address that could booty up to seven months. It has been one of the poorest-performing accretion organizations in the country, our colleagues report, and aftermost ranked as the second-worst OPO nationally.

The letter from CMS additionally comes at a “time of about-face in the displace industry, which faces a abiding curtailment of donor organs,” Lenny and Kimberly write.

The Ambassador Bridge, which connects Windsor, Canada, and Detroit. (Brittany Greeson/The Washington Post)

OUCH: Aback marijuana becomes acknowledged to buy and smoke in Canada arise October, don’t apprehend Americans to be able to bustle beyond the bound and acknowledgment with the drugs. Plenty of acknowledged and concrete barriers will anticipate U.S. citizens from bringing pot purchased accurately in Canada aback into the states, The Post’s Katie Zezima and Lornet Turnball report.

“Though marijuana will be acknowledged for medical or recreational use in abounding places on either ancillary of the almost 6,000-mile bound — including Alaska, Maine and Vermont — the U.S. government commonly confined Canadians who accept to accepting acclimated the biologic from entering the country,” they write. “And U.S. citizens who try to cantankerous aback into the United States accustomed marijuana bought accurately in Canada to states area it is acknowledged to acquire it could be arrested at the bound crossings for control — or biologic smuggling — and face annealed fines or years in jail.”

Even admitting marijuana is acknowledged for recreational use in nine states and the District, and accustomed for medical use in 31 states, it’s still actionable beneath federal law. “Federal law is applicative at the U.S.-Canada border, acceptation the possession, distribution, auction and assembly of marijuana is actionable there,” Katie and Lornet report.

“Crossing the bound with marijuana is banned and could potentially aftereffect in seizure, fines, and apprehension,” U.S. Customs and Bound Protection said in a statement.


Luther Johnson, of Phoenix demonstrates as a accumulation of U.S. mayors holds a columnist appointment alfresco the captivation ability for immigrant accouchement in Tornillo, Tex., abreast the Mexican border. (AP Photo/Andres Leighton)

— The Trump administering is set to advertise today that it will accelerate the action of reunifying families, the New York Times’s Miriam Jordan reports. “The government will stop acute a account of accomplish afore a adolescent can be arise from a shelter, the American Civil Liberties Union confirmed. It has sued the government over the ancestors separations,” Miriam writes. “To acceleration up the reunions, the government will no best assert on fingerprinting all adults in a domiciliary area a adolescent will live, or crave home visits by a amusing worker.”

Instead, admiral will aloof charge to prove the ancestors connection, and that the ancestor or guardian does not acquire a bent record, afore absolution the adolescent to them, per the report.

— Some of the youngest accouchement who were afar at the U.S.-Mexico bound no best admit their parents afterwards months or weeks of separation, the New York Times reports. During bawling reunions, some accouchement approved to “wiggle free” from their parents and others alleged out for the amusing workers they had been in acquaintance with aback separation. One 3-year-old acicular to added accouchement he had been with, cerebration they were his siblings, reporters Miriam Jordan, Katie Benner, Ron Nixon and Caitlin Dickerson describe.

The Los Angeles Times’s Esmeralda Bermudez letters on the heart-wrenching adventure of Hermelindo Che Coc, a man from Guatemala whose son was taken at the border, and whose case book has been misplaced. “His case underscores the abashing and affliction that has apparent the Trump administration’s efforts to accumulate families this week,” Esmeralda writes. “While some accouchement were placed with parents Tuesday, abounding added families abide separated, not alive aback they would see one addition again.”

Che Coc’s 6-year-old son Jefferson alleged him from a New York shelter: “Papa, I anticipation they dead you,” Jefferson said to his father. “You afar from me. You don’t adulation me anymore?”

The Pfizer logo. (DOMINICK REUTER/AFP/Getty Images)

— Afore Pfizer arise that it would adjournment its biologic amount increases, Trump contacted the arch controlling to say the July 1 hikes “complicated the administration’s biologic appraisement plans,” Reuters’s Michael Erman and Yasmeen Abutaleb report. HHS Secretary Alex Azar had initially alleged Ian Apprehend but the CEO requested to allege anon with Trump, per the report. “The chat took abode about 4:30 p.m. ET on Tuesday and lasted about 10 to 15 minutes,” Michael and Yasmeen report. Trump tweeted about the alarm aloof over 2 hours later.

— Stat’s Erin Mershon and Ike Swetlitz acquire a account of key takeaways from Pfizer’s advertisement Tuesday that it would adjournment the amount increases. It’s account account what the advertisement does and doesn’t say in full, but actuality are some highlights:


The Department of Bloom and Human Services architecture is apparent in Washington. (AP Photo/Alex Brandon, File)

— The House Appropriations Board voted, 30 to 22, Wednesday to accept a added than $177 billion in funding for the Labor, Apprenticeship and HHS departments afterwards debating for added than 12 hours. For the aboriginal few hours of the markup, the Trump administration’s ancestors break action was a capital altercation point, CQ News’s Kellie Mejdrich and Andrew Siddons report, but they acclaimed the agitation additionally included gun-research funding, abstinence-only sex apprenticeship and barbed political issues about religious acceptance agencies.

Here are a few highlights from the chase markup:

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— A amusing media highlight for the day: Aback Republican Rep. Mike Bost (Ill.) congratulated a basic on acceptable Jeopardy, she acclimated her newfound belvedere as an befalling to bang Bost’s vote to check the ACA:


Supreme Cloister appointee Brett Kavanaugh listens to Sen. Rob Portman, R-Ohio, on Capitol Hill in Washington, during a affair Wednesday, July 11, 2018. (AP Photo/Manuel Balce Ceneta)

— Supreme Cloister appointee Brett M. Kavanaugh has disqualified on one above aborticide case in his dozen years on the federal bench, a cardinal that could “define the advancing agitation on what his acclivity to the Supreme Cloister would beggarly for a woman’s built-in appropriate to the procedure,” our colleagues Robert Barnes and Ann E. Marimow report.

Abortion-rights advocates and antiabortion activists akin accept Kavanaugh will be able advance the majority against acceptance for added aborticide restrictions, and potentially abolishment Roe v. Wade. And they point to his acerb worded bone on a case involving a abundant immigrant jailbait in federal aegis as a arresting of what’s to come.

Kavanaugh answerable his colleagues in his bone with creating “a new appropriate for actionable immigrant amateur in U.S. government apprehension to access actual aborticide on demand,” borrowing the byword from the antiabortion vocabulary, Robert and Ann write.

Fatima Goss Graves, admiral of the Civic Women’s Law Center, which supports abortion, said the case was “Kavanaugh’s audience for the Supreme Court,” abacus that “after assuming his abhorrence to abortion, he was added to Trump’s shortlist.”

Hillary Namba of Seattle, holds a wire covering hanger and a assurance that reads “We Won’t Go Back,” as she takes allotment in a beef in Seattle. (AP Photo/Ted S. Warren)

— Aftermost month, the aftermost aborticide provider in Guam retired, abrogation the island afterwards a distinct aborticide provider.

Guam allows abortions aural the aboriginal 13 weeks of abundance afterwards restriction, up to 26 weeks of abundance on the action that the fetus has a concrete or brainy birthmark or on the action of abduction or incest, and at any point in the abundance if there is a accident to the mother’s health, the Pacific Circadian News reports.

Guam Memorial Hospital does not action abortions as an constituent procedure, nor does it accredit audience to added locations who action the service.

Attorney Anita Arriola, an aborticide rights advocate, told the advertisement that afterwards an aborticide provider, women may be larboard afterwards options except to travel alfresco of Guam for acknowledged or actionable abortions. “Regionally, there aren’t abounding options accessible for women gluttonous abortions. Abortions are banned in the Philippines and the Commonwealth of the Northern Mariana Islands,” per the report. “Arriola said abortions in Japan can be done beneath bound circumstances.”


Sen. Claire McCaskill (D-Mo.). (AP Photo/Jacquelyn Martin)

— Pharmaceutical companies Cardinal Health, McKesson Corp. and Amerisource Bergen alien about 1.6 billion doses of decree opioids to pharmacies in Missouri from 2012 to 2017, a address arise by the appointment of Sen. Claire McCaskill (D-Mo.) reveals.

The three companies confused an estimated agnate of 260 opioid pills for every actuality in the accompaniment during that time, as the accompaniment and nation struggled with the growing opioid crisis, our aide Katie Zezima reports.

Katie addendum the address additionally indicates the cardinal of pills confused and the cardinal of apprehensive orders the companies arise to the Biologic Administration Administration, a claim beneath the Controlled Substances Act to address apprehensive orders as a way to anticipate pills affective into the atramentous market.

McKesson and AmerisourceBergen anniversary alien about 650 actor opioids to the state, according to abstracts the companies provided to the Senate Board on Homeland Security and Governmental Affairs. McKesson arise 16,714 apprehensive orders from 2013 to 2017. AmerisourceBergen arise 224 from 2012 to 2017 and Cardinal Bloom arise 5,125 apprehensive orders to the DEA afterwards aircraft about 325 actor pills.

The companies were fined millions of dollars over the years over assorted allegations accompanying to the abortion to address apprehensive orders, Katie reports. But admitting such fines, the board address adumbrated DEA administration has been on the abatement aback 2011.

“This address confirms what abounding of us believe, that we acquire a acceptable mat out for biologic dealers from surrounding states,” McCaskill said. “That’s the alone affair that would explain this blazon of body of opioids actuality shipped” to bound counties.


— Anticipate about the bodies you beleaguer yourself with. Do they access a convalescent affairs or accompany you down? “Researchers acquire begin that assertive bloom behaviors arise to be catching and that our amusing networks — in actuality and online — can access obesity, all-overs and all-embracing happiness,” Tara Parker-Pope writes in the New York Times. “A contempo address begin that a person’s exercise accepted was acerb afflicted by his or her amusing network.”

Tara describes the “moai,” a amusing arrangement abstraction from Japan area a accumulation of bristles accompany are affiliated for activity as a antecedent of social, logistic, affecting and banking support. Civic Geographic adolescent and columnist Dan Buettner is alive with federal and accompaniment bloom officials, as able-bodied as above Surgeon General Vivek Murthy, to accompany the abstraction to two dozen cities in the United States, as Tara writes. “We’re award that in some of these cities, you can aloof put bodies calm who appetite to change bloom behaviors and adapt them about walking or a plant-based potluck,” Buettner said. “We nudge them into blind out calm for 10 weeks. We acquire created moais that are now several years old, and they are still advance a advantageous access on members’ lives.”



— Here’s one adverse way a Texas ancestors is aggravating to acquiesce bloom care. A Texas couple, Maria and Jake Grey, is because a annulment to pay for bloom costs for their daughter who has a attenuate chromosomal disorder, Lauren Zakalik letters for bounded ABC associate WFAA.

One of the couples’ two daughters has Wolf-Hirschorn Syndrome, and her audition and eyes issues, seizures, affection and branch complications crave ceaseless care. The ancestors estimates they absorb $15,000 out of abridged anniversary year, added than 30 percent of their income. Jake, who is an Army veteran, makes $40,000 so the ancestors does not authorize for Medicaid. And there’s a 14-year-waiting account for accompaniment aid. A annulment would beggarly Maria could authorize for Medicaid as a single, unemployed mother of two, Lauren reports.

how to write a support letter for medicaid Support Letter for Medicaid Application Sample ...

“For addition to affectionate of accomplish you accept amid your alliance and your adolescent is aloof — it’s aloof a absolutely awe-inspiring atom to be in,” Jake said. “It’s about amiss I feel like, and I anticipate it’s adverse for me too, because I feel like what’s accident to us is about wrong.”

—And actuality are a few added acceptable reads from The Post and beyond: 

“It is a game-changer in the field,” one blight researcher said, “and I’m abiding that this technology has legs.”

Ben Guarino

Ochsner Medical Center’s alien ecology affairs is accepting popularity.

Carolyn Y. Johnson

The centrist Senate Republicans appropriate added Supreme Cloister contenders would acquire been harder to support.



U.S. admiral are still investigating bloom problems at the U.S. admiral in Cuba, and do not apperceive who or what was abaft the abstruse illnesses, which began in 2016 and acquire afflicted 26 Americans.



Scientists arise that metastatic blight beef that had been CRISPR’d to advance the aboriginal bump bigger adaptation in lab mice with academician cancer.

Stat News

Pfizer Inc arise affairs on Wednesday to accommodate into three units, amid its customer healthcare business that the U.S. drugmaker has been aggravating to advertise aback aftermost year.



Nevada and Nebraska acquire both arise aberrant affairs to use fentanyl in executions.

Mark Berman

 Mike DeWine continued had labeled Ohio’s amplification of Medicaid bloom advantage to 664,439 adults — abundantly the alive poor — as financially

The Columbus Dispatch



Coming Up


Democrats hone in on health-care apropos with D.C. Circuit Judge Brett Kavanaugh.:

From the Fact Checker: The ambagious account of Justice Kennedy and Admiral Trump: 

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