The Senate’s Health Care Secrecy Is a Breathtaking Contempt for Democracy

(THIS ARTICLE IS COURTESY OF SLATE POLITICS)

The Senate’s Health Care Secrecy Is a Breathtaking Contempt for Democracy

Millions will suffer, for a tax cut.

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Senate Majority Leader Mitch McConnell speaks to members of the media after the weekly Senate Republican Policy Luncheon at the Capitol May 9.

Alex Wong/Getty Images

While much of Washington fixates on Donald Trump and his scandals, a small band of Senate Republicans is working—in secret—on a bill that would slash health insurance for tens of millions of Americans and jeopardize access for millions more. And they’re doing this on a so-called fast track meant to preclude debate. The reason for this rushed process? To obscure the obvious: that at heart, the American Health Care Act is little more than a massive tax cut for the wealthiest Americans.

Jamelle BouieJAMELLE BOUIE

Jamelle Bouie is Slates chief political correspondent.

Once the working group emerges from its cloister, the bill will be scored by the Congressional Budget Office, and then—in a sharp break with procedure—bypass the committee process and go straight to the floor without a public hearing. There are even suggestions that Senate Majority Leader Mitch McConnell will use legislative gamesmanship to avoid debate entirely, so Republicans can pass the bill without any discussion of its contents and provisions. As Paul Ryan did in the House of Representatives, McConnell intends to restructure one-sixth of the American economy with as little input as possible, freezing out experts, industry representatives, and Democratic lawmakers. This, despite overwhelming opposition from the public; in one recent poll, just 23 percent of respondents said they approved of the Republican health care bill.

And what will the public get if and when the final version of the bill is passed into law? Millions of Americans will either lose their health insurance, see massive new costs, or face added obstacles, from “lifetime” caps on care to limits based on pre-existing conditions.

There’s no indication Republicans are thinking deeply about free market reforms to the American health care system. But let’s just say they are. Perhaps a drastically less-regulated insurance market is worth the cost to ordinary individuals and families. If that’s the case, then Republicans owe the country both honesty and transparency. It will get neither. Instead, every indication is that the GOP will push through with a process that holds deliberation in contempt. That’s not to say Republicans aren’t responding to someone—there are groups, like the Republican base, that want this bill—but the broad public opposes the effort.

As it stands, there’s a chance the Senate health care bill could pass before the July 4 holiday. Compare this to the process behind the Affordable Care Act. It took most of 2009 for Democrats to produce a bill: months of negotiation—including a summer of talks between Democratic and Republican senators—that involved debate and input, as lawmakers produced drafts, defended proposals, and sold their plan to the public. Congress saw testimony from patients and other ordinary people, and citizens were able to lobby lawmakers with their input.

It was as open a process as possible, and while Democrats weren’t immune to misleading rhetoric (“if you like your plan, you can keep it”), the final law wasn’t a surprise. It did what Democrats and the president said it would. And the party was proud of their work. “This is a big fucking deal,” Vice President Joe Biden famously whispered.

None of this is true of Republicans and the AHCA. Theirs is a closed, secretive process. There are no drafts, no inkling of the plan. No speeches defending its major planks or hearings where lawmakers and experts hash out concerns. When pressed with questions, Republicans from the Senate working group refuse to answer. Indeed, asked if it was important to bring a bill to the public, Republicans say, in effect, no. “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it,” said Sen. Orrin Hatch.

This might be tolerable if Republicans were open about the effects of their plan. But they aren’t. They’re lying. Tom Price, secretary of health and human services, insists that the bill preserves Medicaid, telling CNN, “We believe the Medicaid population will be cared for in a better way under our program because it will be more responsive to them.” In reality, the bill phases out the Medicaid expansion and makes additional cuts, slashing 14 million people from the program. President Trump has made assurances that the bill “guarantees” coverage for people with pre-existing conditions, which just isn’t true. Vice President Mike Pence promises “a dynamic national health insurance marketplace that lowers costs, increases quality and gives more choices to working families.” Given the massive coverage losses projected under the GOP’s health care plan, there’s no evidence that anything approaching that promise is on the horizon.

Republicans are pushing forward on an unpopular bill that, by every independent account, will harm millions of Americans. To justify this sprint, the White House is actively sabotaging insurance markets while telling the public that the Affordable Care Act is failing. And in taking this course, they’ve shown a breathtaking contempt for democracy, insulating themselves from any political pressure, lying about the policies in question, and hiding this bankrupt process from the country.

This cowardly and factional governing—meant to satisfy a small minority of Republican Party backers, not the public at large—will likely backfire. Given Democratic anger, the president’s unpopularity, and broad discontent with the bill in question, there are decent odds this story ends with a Democratic victory in the 2018 elections and a chance to repair the damage. But between now and then, real people will suffer. Real people will have to decide if they can afford continued treatment. Real people will die. And as far as anyone can tell, the point of all of this—the secrecy and dishonesty and likely pain—is tax cuts. That’s it.

North Korea: Otto Warmbier Has “Sever Neurological Damage”

(COMMENTARY: FOR THE SAKE OF THE PEOPLE OF NORTH KOREA IT IS TIME FOR THE GOVERNMENTS OF THE WORLD TO REMOVE THE ANIMAL KIM JONG UN FROM POWER “BY ANY MEANS NECESSARY”)(TRS)

 

(THIS ARTICLE IS COURTESY OF CNN)

Recently released North Korea detainee Otto Warmbier has suffered severe neurological damage, and his family flatly rejects the regime’s explanation for his condition, reporters were told Thursday in his Ohio hometown.

Warmbier, a 22-year-old college student who returned Tuesday to the United States after 17 months in detention, is in stable condition at University of Cincinnati Medical Center but has a “severe neurological injury,” hospital spokeswoman Kelly Martin said.
Martin declined to elaborate, saying doctors will share more information about Warmbier’s condition in a separate news conference Thursday afternoon.
But Warmbier’s father left no doubt he blames North Korea, blasting the secretive regime in a 23-minute news conference at his son’s alma mater, Wyoming High School, north of Cincinnati.

Student freed from North Korea lands in US

Student freed from North Korea lands in US
The family doesn’t believe North Korea’s explanation that Otto fell into a coma after contracting botulism and taking a sleeping pill shortly after he was sentenced in March 2016, Fred Warmbier said.
“Even if you believe their explanation of botulism and a sleeping pill causing a coma — and we don’t — there is no excuse for any civilized nation to have kept his condition a secret and denied him top-notch medical care for so long,” Warmbier said.
The father, wearing the cream sport coat his son wore during his televised trial in North Korea, stopped short of saying how he believed his son was injured.
“We’re going to leave that to the doctors (to explain) today,” he said.

Why does North Korea detain some US citizens?

Why does North Korea detain some US citizens?
He called on North Korea to release other American detainees.
“There’s no excuse for the way the North Koreans treated our son. And no excuse for the way they’ve treated so many others,” he said. “No other family should have to endure what the Warmbiers have.”

Conviction and release

Otto Warmbier was a University of Virginia student when he was detained in January 2016 at the airport in Pyongyang while on his way home. He had been on a tour of the reclusive country, his parent said.
North Korean authorities claimed they had security footage of him trying to steal a banner containing a political slogan that was hanging from a wall of his Pyongyang hotel.
That was used as evidence in his hourlong trial. He was found guilty of committing a “hostile act” against the country and sentenced in March 2016 to 15 years of hard labor. It was the last time he was seen publicly before this week.
His parents learned of their son’s condition — what North Korea called a coma — only last week, they said in a statement.

Critical of Obama administration

Fred Warmbier appeared critical of the Obama administration’s handling of Otto’s detention, saying the family heeded the US government’s initial advice to take a low profile “without result.”
In contrast, he praised the Trump administration’s efforts: “They have our thanks for bringing Otto home.”
When asked whether then-President Barack Obama could have done more, Fred Warmbier replied, “I think the results speak for themselves.”

Three other US detainees

Warmbier’s release coincided with basketball star Dennis Rodman’s latest visit to North Korea, though Michael Anton, a US national security spokesman, told CNN there is no connection between the two.

CNN on the ground: Waiting for Dennis Rodman

CNN on the ground: Waiting for Dennis Rodman
Fred Warmbier said the same Thursday.
“Dennis Rodman had nothing to do with Otto,” he said.
Rodman was asked by reporters Tuesday if he would bring up the cases of Warmbier and three other Americans detained in North Korea. “That’s not my purpose right now,” he said. “My purpose is to go over there and try to see if I can keep bringing sports to North Korea.”
The other Americans held by Pyongyang are Kim Sang Duk and Kim Hak-song, academics who worked at the Pyongyang University of Science and Technology, and businessman named Kim Dong Chul.

Here Are All the Ways President Trump Praised the GOP Health Care Bill He Just Called ‘Mean’

(THIS ARTICLE IS COURTESY OF TIME.COM)

Here Are All the Ways President Trump Praised the GOP Health Care Bill He Just Called ‘Mean’

6-13-2017
President Donald Trump on Tuesday criticized the House-passed health care bill, calling it “mean” in a meeting with Republican senators and urging them to develop a “more generous” version. But just over a month ago, the president repeatedly praised the GOP-sponsored legislation, describing it as a “great plan” after a vote confirmed the bill’s approval in the House.

Here are all the ways Trump lauded the American Health Care Act in his speech from the White House Rose Garden on May 4th:

Trump said the bill would make insurance prices go down

“And I will say this, that as far as I’m concerned, your premiums, they’re going to start to come down,” Trump said during the beginning of his remarks, before later adding: “And I think, most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it’s a great plan. And ultimately, that’s what it’s all about.”

A forecast from the Congressional Budget Office, an independent, nonpartisan agency, said that premiums will actually increase over the next few years should the bill pass in its current form, and long-term effects will ultimately fall to individual states.

He said it was good because it would repeal and replace Obamacare

“Right now, the insurance companies are fleeing. It’s been a catastrophe. And this is a great plan,” Trump said. “I actually think it will get even better. And this is, make no mistake, this is a repeal and replace of Obamacare. Make no mistake about it. Make no mistake.”

He said it was great because it was done quickly

“And this really helps it. A lot of people said, how come you kept pushing healthcare, knowing how tough it is? Don’t forget, Obamacare took 17 months. Hillary Clinton tried so hard — really valiantly, in all fairness, to get healthcare through. Didn’t happen,” Trump remarked. “We’ve really been doing this for eight weeks, if you think about it. And this is a real plan. This is a great plan. And we had no support from the other party.”

He said it had “great features”

“But we want to brag about the plan, because this plan really — uh oh,” Trump began before he was cut off by a laughing audience. “Well, we may. But we’re just going to talk a little bit about the plan, how good it is, some of the great features.”

The CBO in the same aforementioned report said that if the bill goes through in its current condition, 23 million Americans will lose insurance over the next 10 years.

And overall, he said it was good because of the “talent” that helped develop it

“So what we have is something very, very incredibly well-crafted. Tell you what, there is a lot of talent standing behind me. An unbelievable amount of talent, that I can tell you. I mean it,” Trump gushed.

“But we have an amazing group of people standing behind me,” the president added. “They worked so hard and they worked so long. And when I said, let’s do this, let’s go out, just short little shots for each one of us and let’s say how good this plan is — we don’t have to talk about this unbelievable — wasn’t it unbelievable? So we don’t have to say it again. But it’s going to be an unbelievable victory, actually, when we get it through the Senate.”

More than 100,000 ill in deadly cholera outbreak in Yemen

(THIS ARTICLE IS COURTESY OF CNN)

A cholera outbreak in war-torn Yemen continues to spread at a rapid pace. Over 124,000 cases have been recorded as of Tuesday, with 923 people — a quarter of them children — dead in the current outbreak, the United Nations Children’s Fund said in a statement Tuesday.

Cholera is an infection caused by ingestion of Vibrio cholerae bacteria in water or food contaminated with feces. Symptoms include sudden onset of watery diarrhea that can lead to death by severe dehydration. According to the World Health Organization, cholera is widespread in the Middle Eastern nation of Yemen, with the number of cases surging since late April.
“The fact of the matter is, this is really a dire humanitarian situation and seemingly is only getting worse, particularly for children,” UNICEF spokesman Christopher Tidey said.
Aid workers say Yemen, which has weathered civil conflict and terrorism for the past two years, is experiencing a humanitarian crisis. Not only are millions of civilians living in the crossfire, but they can no longer afford food, shelter or medicine, as the violence has devastated the economy.

Millions in need of assistance

Of Yemen’s population of 27.4 million, UNICEF estimates that 18.8 million are in need of humanitarian assistance, Tidey said. Two-thirds of the population does not have access to safe drinking water or adequate sanitation. Of the country’s 12.6 million children, 1.6 million are displaced while nearly 80%, or 9.6 million, require humanitarian assistance, Tidey said.
No age group can avoid cholera. People over 60, for instance, represent 33% of all fatalities from the disease, according to UNICEF. Cholera has an extremely short incubation period of just two hours to five days, and unlike other diarrheal diseases, it can kill even healthy adults within hours, according to the WHO.
While adults in Yemen are suffering, half of all cholera infections there are occurring in children, said Meritxell Relaño, the UNICEF representative in the country.
“Children continue to bear the brunt of the war in Yemen. Many who have become ill or have died from cholera were suffering from malnutrition,” Relaño said.
In fact, more than half of the population is food-insecure, according to the CIA’s World Factbook.
About 2.2 million Yemeni children are malnourished, 462,000 of them severely so and thus currently at risk of death, Tidey said.
“When you have children already in that precarious situation in terms of their own health and well-being and then you have a cholera outbreak on top of that, well, that obviously makes them more vulnerable,” he said.

Efforts to help

Countries facing complex emergencies are particularly vulnerable to cholera outbreaks, according to the WHO. That includes Yemen, where the disease has affected about 268 districts in 19 of its 22 governorates, the organization says. Yemen’s cholera fatality rate, 0.8%, is nearing what is considered the emergency threshold, 1%.
To stop the spread, the WHO and UNICEF are honing in on the areas reporting the highest number of cases. The WHO has established four cholera treatment facilities and 16 oral dehydration centers in the country. Along with training health workers to manage cases, the WHO is providing emergency medical supplies to treatment facilities.
Dr. Nevio Zagaria, head of the WHO’s office in Yemen, said in a statement that the organization has identified hot spots. “Stamp out cholera in these places, and we can slow the spread of the disease and save lives,” Zagaria said. “At the same time, we’re continuing to support early and proper treatment for the sick and conducting prevention activities across the country.”
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UNICEF is involved in providing water and sanitation services and support, including disinfecting water tanks and wells, as well as getting clean water to children.
More than two years of conflict also means damage to societal infrastructure. Medical supplies are flowing into Yemen at a third of the rate of before the conflict began, Tidey said, adding that UNICEF has “95 verified attacks on health facilities, including personnel.”
“We know that health and sanitation haven’t received their salaries in about nine months,” Tidey said. “Nearly half of all the health facilities in the country are not functional. So those two things combined with the ongoing conflict itself makes it very difficult for people who need treatment to access it.”

A Calendar Tells Us Our Age: Our Mind And Body Do Not Have To Agree

(THIS ARTICLE IS COURTESY OF NAUTILUS: SCIENCE AND AUTHOR ANIL ANANTHASWAMY)

In 1979, psychologist Ellen Langer and her students carefully refurbished an old monastery in Peterborough, New Hampshire, to resemble a place that would have existed two decades earlier. They invited a group of elderly men in their late 70s and early 80s to spend a week with them and live as they did in 1959, “a time when an IBM computer filled a whole room and panty hose had just been introduced to U.S. women,” Langer wrote. Her idea was to return the men, at least in their minds, to a time when they were younger and healthier—and to see if it had physiological consequences.

Every day Langer and her students met with the men to discuss “current” events. They talked about the first United States satellite launch, Fidel Castro entering Havana after his march across Cuba, and the Baltimore Colts winning the NFL championship game. They discussed “current” books: Ian Fleming’s Goldfinger and Leon Uris’ Exodus. They watched Ed Sullivan and Jack Benny and Jackie Gleason on a black-and-white TV, listened to Nat King Cole on the radio, and saw Marilyn Monroe in Some Like It Hot. Everything was transporting the men back to 1959.

When Langer studied the men after a week of such sensory and mindful immersion in the past, she found that their memory, vision, hearing, and even physical strength had improved. She compared the traits to those of a control group of men, who had also spent a week in a retreat. The control group, however, had been told the experiment was about reminiscing. They were not told to live as if it were 1959. The first group, in a very objective sense, seemed younger. The team took photographs of the men before and after the experiment, and people who knew nothing about the study said the men looked younger in the after-pictures, says Langer, who today is a professor of psychology at Harvard University.

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IN THE YEAR 1959A psychology experiment that took seniors back to a time when they were young—1959, to be exact, evoked by the images above—revealed that living as they did in 1959 improved their memory, vision, and hearing.
Clockwise: Robert Riger / Getty Images; Wikipedia; Wikipedia; Luis Korda/ Wikipedia; Wikipedia; Wikipedia

Langer’s experiment was a tantalizing demonstration that our chronological age based on our birthdate is a misleading indicator of aging. Langer, of course, was tackling the role of the mind in how old we feel and act. Since her study, others have taken a more objective look at the aging body. The goal is to determine an individual’s “biological age,” a term that aims to capture the body’s physiological development and decline with time, and predict, with reasonable accuracy, the risks of disease and death. As scientists have worked to pinpoint a person’s biological age, they have learned that organs and tissues often age differently, making it difficult to reduce biological age to a single number. They have also made a discovery that echoes Langer’s work. How old we feel—our subjective age—can influence how we age. Where age is concerned, the pages torn off a calendar do not tell the whole story.

While we intuitively know what it means to grow old, precise definitions of aging haven’t been easy to come by. In 1956, British gerontologist and author Alex Comfort (later famous for writing The Joy of Sex) memorably defined senescence as “a decrease in viability and an increase in vulnerability.” Any given individual, he wrote, would die from “randomly distributed causes.” Evolutionary biologists think of aging as something that reduces our ability to survive and reproduce because of “internal physiological deterioration.” Such deterioration, in turn, can be understood in terms of cellular functions: The older the cells in an organ, the more likely they are to stop dividing and die, or develop mutations that lead to cancer. This leads us to the idea that our bodies may have a true biological age.

The road to determining that age, though, has not been a straight one. One approach is to look for so-called biomarkers of aging, something that’s changing in the body and can be used as a predictor of the likelihood of being struck by age-related diseases or of how much longer one has left to live. An obvious set of biomarkers could be attributes like blood pressure or body weight. Both tend to go up as the body ages. But they are unreliable. Blood pressure can be affected by medication and body weight depends on lifestyle and diet, and there are people who certainly don’t gain weight as they age.

Where age is concerned, the pages torn off  calendar do not tell the whole story.

In the 1990s, one promising biomarker stood out: stretches of DNA called telomeres. They appear at the ends of chromosomes, serving as caps that protect the chromosomes from fraying. Telomeres have often been likened to the plastic tips that similarly protect shoelaces. It turns out that telomeres themselves get shorter and shorter each time a cell divides. And when the telomere shortens beyond a point, the cell dies. There’s a strong relationship between telomere length and health and diseases, such as cancer and atherosclerosis.

But despite a range of studies trying to find such a link, it’s been hard to make the case for telomeres as accurate biomarkers of aging. In 2013, Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh, and her student Jason Sanders reviewed the existing literature on telomeres and concluded that “if telomere length is a biomarker of human aging, it is a weak biomarker with poor predictive accuracy.”

“Twenty years ago, people had high hopes that telomere length could actually explain aging, as in biological aging. There was a hope that it would be the root cause of aging,” says Steve Horvath, a geneticist and biostatistician at the University of California, Los Angeles. “Now we know that that’s simply not the case. In the last 10 to 15 years, people realized that there must be other mechanisms that play an important role in aging.”

Attention shifted to how fast stem cells are being depleted in the body, or the efficacy of mitochondria (the organelles inside our cells that produce the energy needed for cells to function). Horvath scoured the data for reliable markers, looking at, for example, levels of gene expression for any strong correlations to aging. He found none.

But that didn’t mean there weren’t reliable biomarkers. There was one set of data Horvath had been studiously avoiding. This had to do with DNA methylation, a process cells use to switch off genes. Methylation mainly involves the addition of a so-called methyl group to cytosine, one of the four main bases that make up strands of DNA. Because DNA methylation does not alter the core genetic sequence, but rather modifies gene expression externally, the process is called epigenetics.

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EPIGENETIC CLOCKUCLA geneticist Steve Horvath (above) identified methylation levels on the human genome that serve as remarkable signs of biological aging. “I had never seen anything like it,” he says. “It’s a cliché, but it really was a smoking gun.”
Courtesy of Steve Horvath

Horvath didn’t think that epigenetics would have anything to do with aging. “I had data sitting there and I would not really touch them, because I thought there was no meaning in it anyway,” he says.

But some time in 2009, Horvath gave in and analyzed a dataset of methylation levels at 27,000 locations on the human genome—an analysis “you can do in an hour,” he says. Nothing in his 10 years of analyzing genomic datasets had prepared him for the results. “I had never seen anything like it,” he says. “It’s a cliché, but it really was a smoking gun.”

Because their minds were taken back to a time when they were younger, their bodies went back too.

After a few more years of “labor intensive” work, Horvath identified 353 special sites on the human genome that were present in cells in every tissue and organ. Horvath developed an algorithm that used the methylation levels at these 353 sites—regardless of the cell type—to establish an epigenetic clock. His algorithm took into account that in some of these 353 sites, the methylation levels decreased with age, while in others they increased.

In 2013, Horvath published the results of his analysis of 8,000 samples taken from 51 types of healthy tissue and cells, and the conclusions were striking. When he calculated a single number for the biological age of the person based on the weighted average of the methylation levels at the 353 sites, he found that this number correlated well with the chronological age of the person (it was off by less than 3.6 years in 50 percent of the people—a far better correlation than has been obtained for any other biomarker). He also discovered that for middle-aged people and older, the epigenetic clock starts slowing down or speeding up—providing a way of telling whether someone is aging faster or slower than the calendar suggests.

Despite the correlation, Horvath says that biological age, rather than being for the whole body, is better applied to specific tissues and organs, whether it’s bone, blood, heart, lungs, muscles, or even the brain. The difference between the biological age and chronological age can be negative, zero, or positive. A negative deviation means that the tissue or organ is younger than expected; a zero indicates that the tissue is aging normally; and a positive deviation means the tissue or organ is older. Data show that different tissues can age at different rates.

In general, diseases speed up the epigenetic clock, and this is particularly striking in patients with Down’s syndrome or in those infected with HIV. In both cases, the tissues tend to age faster than normal. For instance, the blood and brain tissue in those infected with HIV show accelerated aging. Obesity causes the liver to age faster. And studies of people who died of Alzheimer’s disease show that the prefrontal cortex undergoes accelerated aging. Horvath also analyzed 6,000 samples of cancerous tissue and found that the epigenetic clock was ticking much faster in such cases, showing that the tissue had aged significantly more than the chronological age.

Despite this wealth of data, there is a gaping hole in our understanding of this striking correlation between methylation markers and biological age. “The biggest weakness of the epigenetic clock is that we just don’t understand the precise molecular mechanism behind it,” says Horvath. His speculation—and he stresses it’s just speculation—is that the epigenetic clock is related to what he calls the “epigenetic maintenance system,” molecular and enzymatic processes that maintain the epigenome and protect it from damage. “I feel that these markers are a footprint of that mechanism,” says Horvath. But “why is it so accurate? What pathway relates to it? That’s the biggest challenge right now,” he adds.

Even without understanding exactly how and why it works, the epigenetic clock gives researchers a tool to test the efficacy of anti-aging interventions that can potentially slow aging. “It’d be very exciting to develop a therapy that allows us to reset the epigenetic clock,” says Horvath.

While Horvath is thinking about hormonal treatments, Langer’s work with elderly men at the monastery in New Hampshire suggests that we can use the power of our mind to influence the body. Langer didn’t publish her results in a scientific journal in 1979. At the time, she didn’t have the resources to do a thorough study for the leading journals. “When you run a retreat over the course of five days, it’s very hard to control for everything,” Langer says. “Also, I didn’t have the funds to have, for instance, a vacationing control group. I could have published it in a second-rate journal, but I didn’t see any point to that. I wanted to get the information out there and I wrote it first in a book for Oxford University Press, so it was reviewed.”

Also, her argument that mind and body are one was potentially a little too path-breaking for the journals. “I think they were unlikely to buy the theoretical part of it,” she says. “The findings, improving vision and hearing in an elderly population, were so unusual that they were not going to rush to publish and stick their necks out.” Since then, Langer has pursued the mind-body connection and its effects on physiology and aging in rigorous studies that have been published in numerous scientific journals and books.

Traditionally, the mind-body problem refers to the difficulty of explaining how our ostensibly non-material mental states can affect the material body (clearly seen in the placebo effect). To Langer, the mind and body are one. “Wherever you put the mind you are necessarily putting the body,” she says.

So Langer began asking if subjective mental states could influence something as objective as the levels of blood sugar in patients with Type 2 diabetes. The 46 subjects in her study, all suffering from Type 2 diabetes, were asked to play computer games for 90 minutes. On their desk was a clock. They were asked to switch games every 15 minutes. The twist in the study was that for one-third of the subjects, the clock was ticking slower than real time, for one-third it was going faster, and for the last third, the clock was keeping real time.

Most of us are slaves to our chronological age.

“The question we were asking was would blood sugar level follow real or perceived time,” says Langer. “And the answer is perceived time.” This was a striking illustration of psychological processes—in this case the subjective perception of time—influencing metabolic processes in the body that control the level of blood sugar.

Although Langer did not explore a connection between the mind and epigenetic changes, other studies suggest such a link. In 2013, Richard Davidson of the University of Wisconsin at Madison and his colleagues reported that even one day of mindfulness meditation can impact the expression of genes. In their study, 19 experienced meditators were studied before and after a full day of intensive meditation. For control, the researchers similarly studied a group of 21 people who engaged in a full day of leisure. At the end of the day, the meditators showed lowered levels of activity of inflammatory genes—exactly the kind of effect seen when one takes anti-inflammatory drugs. The study also showed lowered activity of genes that are involved in epigenetically controlling expressions of other genes. The state of one’s mind, it seems, can have an epigenetic effect.

Such studies taken together provide clues as to why the week-long retreat in New Hampshire reversed some of the age-related attributes in elderly men. Because their minds were taken back to a time when they were younger, their bodies too went back to that earlier time, bringing about some of the physiological changes that resulted in improved hearing or grip strength.

But it’s important to point out that biological aging is an inexorable process—and there comes a time when no amount of thinking positive thoughts can halt aging. If body and mind are one and the same—as Langer suggests—then an aging body and aging mind go hand-in-hand, limiting our ability to influence physiological decline with psychological deftness.

Still, Langer thinks that how we age has a lot to do with our perceptions of what aging means—often reinforced by culture and society. “Whether it’s about aging or anything else, if you are surrounded by people who have certain expectations for you, you tend to meet those expectations, positive or negative,” says Langer.

Most of us are slaves to our chronological age, behaving, as the saying goes, age-appropriately. For example, young people often take steps to recover from a minor injury, whereas someone in their 80s may accept the pain that comes with the injury and be less proactive in addressing the problem. “Many people, because of societal expectations, all too often say, ‘Well, what do you expect, as you get older you fall apart,’ ” says Langer. “So, they don’t do the things to make themselves better, and it becomes a self-fulfilling prophecy.”

It’s this perception of one’s age, or subjective age, that interests Antonio Terracciano, a psychologist and gerontologist at Florida State University College of Medicine. Horvath’s work shows that biological age is correlated with diseases. Can one say the same thing about subjective age?

People’s perception of their own age can differ markedly from person to person. People between the ages of 40 and 80, for example, tend to think they are younger. People who are 60 may say that they feel like they are 50 or 55, or sometimes even 45. Rarely will they say they feel older. However, people in their 20s often perceive their age to be the same as their chronological age, and may say they feel somewhat older.

Terracciano and colleagues have found that subjective age correlates with certain physiological markers of aging, such as grip strength, walking speed, lung capacity, and even the levels of C-reactive protein in the blood, an indication of inflammation in the body. The younger you feel you are, the better are these indicators of age and health: You walk faster, have better grip strength and lung capacity, and less inflammation.

Subjective age affects cognition and is an indicator of the likelihood of developing dementia. Terracciano and colleagues looked at data collected from 5,748 people aged 65 or older. The subjects’ cognitive abilities were evaluated to establish a baseline and they were then followed for a period of up to four years. The subjects were also asked about how old they felt at each instance. The researchers found that those who had a higher subjective age to start with were more likely to develop cognitive impairments and even dementia.

These correlation studies have limitations, however. For example, it’s possible that physically active people, who have better walking speed and lung capacity, and lower levels of C-reactive protein in their blood, naturally feel younger. How can one establish that our subjective age influences physiology and not the other way around?

That’s exactly what Yannick Stephan of the University of Grenoble in France and colleagues tried to find out. They recruited 49 adults, aged between 52 and 91, and divided them into an experimental and control group. Both groups were first asked their subjective age—how old they felt as opposed to their chronological age—and tested for grip strength to establish a baseline. The experimental group was told they had done better than 80 percent of people their age. The control group received no feedback. After this experimental manipulation, both groups were tested again for grip strength and asked about how old they felt. The experimental group reported feeling, on average, younger than their baseline subjective age. No such change was seen in the control group. Also, the experimental group showed an increase in grip strength, while the grip strength of the control decreased somewhat.

These correlations do not necessarily mean that feeling young causes better health. Terracciano’s next step is to correlate subjective age with quantitative biological markers of age. While no study has yet been done to find associations between the newly developed epigenetic markers and subjective age, Terracciano is keen to see if there are strong correlations.

Still, the message seems to be that our chronological age really is just a number. “If people think that because they are getting older they cannot do things, or cut their social ties, or incorporate this negative view which limits their life, that can be really detrimental,” says Terracciano. “Fighting those negative attitudes, challenging yourself, keeping an open mind, being engaged socially, can absolutely have a positive impact.”

Senate returns more pessimistic than ever on healthcare

(THIS ARTICLE IS COURTESY OF THE HILL NEWSPAPER)

Senate returns more pessimistic than ever on healthcare

Senators went into a recess skeptical over whether they could agree to legislation repealing and replacing ObamaCare.

They will return on Monday more doubtful than ever.

Sen. Richard Burr (R-N.C.), one of Senate Majority Leader Mitch McConnell’s (R-Ky.) most loyal allies, said Thursday that it’s “unlikely” the GOP will get a healthcare deal.

“I don’t see a comprehensive healthcare plan this year,” he told a local news station.

Senate Republicans hoped to have a draft bill this week, but it now looks like there will at best be an outline.

A Senate Republican aide said it’s too early to begin drafting legislation that can come to the floor in the next few weeks.“Parameters are more likely,” said the aide, who explained that McConnell wants to keep the details held closely so the legislation doesn’t get picked apart before lawmakers have a chance to consider it carefully.

“The last thing we want to do is litigate this in the press,” the aide said. “We want to discuss parameters and concepts without releasing a draft.”

“Maybe they can start talking to members about a specific product next week, but I would not be surprised if we don’t,” said another Senate GOP aide.

More unhelpful news came in the form of a Kaiser Family Foundation poll underscoring how unpopular the bill approved by the House is.

It found that three-quarters of Americans surveyed think the House bill does not fulfill President Trump’s promises on healthcare.

A full 82 percent said federal funding for ObamaCare’s expansion of Medicaid should be continued, an issue that deeply divides the Senate GOP. The House bill ends the ObamaCare funds in 2020.

Yet another factor for Republicans is Trump’s approval rating, which has fallen to its lowest point with Republicans since he took office in the latest Reuters/Ipsos tracking poll.

Republicans already had sought to lower expectations.

McConnell conceded last week that, “I don’t know how we get to 50 [votes] at the moment.”

He sounded more optimistic about passing major tax reform legislation, rating its chances as “pretty good.”

Republicans control 52 seats and can afford only two defections from their ranks. Vice President Pence could cast the deciding vote in case of a 50-50 tie.

The Senate GOP hasn’t given up hope on healthcare and faces tremendous pressure from the White House and House Republicans to hold a vote.

Republicans for years have promised to repeal ObamaCare, so failure would be a major blow. They also face pressure to finish their work on healthcare because of the tax reform push.

The GOP is using special budgetary rules to prevent Democrats from filibustering legislation on tax reform and healthcare.

Republicans can’t move to tax reform until the healthcare debate is finished because once they pass a new budget resolution that would allow them to move tax legislation with 51 votes, they will lose the vehicle set up to enable a healthcare bill that would circumvent a Democratic filibuster.

Those on a special 13-member working group have heard very little about the drafting efforts that were supposed to take place over the recess.

Senate Budget Committee Chairman Mike Enzi (R-Wyo.) was to provide the framework in consultation with GOP leaders and Senate Finance Committee Chairman Orrin Hatch (R-Utah).

A major sticking point in the Senate is Medicaid. The House bill would cut nearly $900 billion from the program and cap the federal contribution for expanded enrollment in that program by 2020.

Several Republican governors from Medicaid expansion states, led by Govs. John Kasich (Ohio) and Rick Snyder (Mich.), earlier this year came out against the House bill, warning that it failed to provide adequate resources.

Sen. Rob Portman (R-Ohio) said he wants a more gradual “glide path” for capping the expansion, an idea not popular with conservatives.

Twenty Republican senators, including Portman, represent states that opted to expand Medicaid, and many of them worry that cutting federal funding will cause significant budget problems at home.

But another group of GOP governors, primarily from states that opted out of the Medicaid expansion, want to end federal support for the expansion.

Senators are divided as well over proposals to limit federal assistance for health insurance subsidies, which would hit older, low-income Americans disproportionately.

McConnell hasn’t set a deadline for passing the ObamaCare repeal-and-replace bill, but he has indicated concern about the debate dragging on for months, which could imperil tax reform.

“We can’t take forever,” he told Bloomberg TV last month.

By raising doubts about the possibility of getting a deal that musters 51 votes, the GOP leader is putting pressure on his colleagues to either come together or move on before the August recess.

McConnell has told colleagues that the 13-member working group will put together a bill and that he will bring it to the floor for a vote, but he has stopped short of promising that it will pass — in contrast to Speaker Paul Ryan (R-Wis.), who earlier this year guaranteed that the House bill would pass.

If the Senate bill fails on the floor, McConnell is likely to declare the GOP conference has worked its will and move on.

Even as the House voted to narrowly pass the House’s American Health Care Act last month, there was already strong pessimism among Senate Republicans about the chances of putting together a comprehensive package in the upper chamber.

A senior GOP senator at the time said the chances of getting 51 votes for legislation based on the House healthcare bill were less than 1 in 5.

When House Republicans debated healthcare reform earlier this year, some of their Senate colleagues said privately that they thought it might be better if the legislation died in the lower chamber.

VA Director Says That Marijuana Would Help Veterans If They Were Allowed To Us It

(THIS ARTICLE IS COURTESY OF ‘THE HILL’ NEWS PAPER)

VA chief: Medical marijuana could help vets
Veterans Affairs Secretary David Shulkin said Wednesday he’s open to expanding the use of medical marijuana to help service members suffering from post-traumatic stress disorder (PTSD), but noted it’s strictly limited by federal law.
“There may be some evidence that this is beginning to be helpful and we’re interested in looking at that and learning from that,” Shulkin told reporters, pointing to states where medical pot is legal.
The VA has come under pressure from some influential veterans groups, including the American Legion, to reclassify marijuana to allow federal research into its effect on troops with PTSD or traumatic brain injuries.
Under current policy, VA doctors are barred from prescribing medical marijuana to patients, but Congress passed a measure last year allowing them to discuss it in states where it is legal.
“Right now, federal law does not prevent us at VA to look at that as an option for veterans,” said Shulkin, who is a trained physician. “I believe that everything that could help veterans should be debated by Congress and by medical experts and we will implement that law.”
Relaxing enforcement of marijuana laws, however, would conflict with several top administration officials who take a hard-line approach on drugs, including Attorney General Jeff Sessions.
Shulkin, who spoke at the White House about President Trump’s proposed reforms at the scandal-plagued agency, is a holdover from the Obama administration. The Senate confirmed him unanimously in February to lead the VA.

A Highly Contagious Dog Flu Has Hit Florida

(THIS ARTICLE IS COURTESY OF TIME NEWS)

A Highly Contagious Dog Flu Has Hit Florida. Here’s What to Know

May 31, 2017

An outbreak of the dog flu, which has sickened hundreds of canines across the country over the last two years, has hit Florida for the first time. The highly contagious virus recently infected at least a dozen dogs in the Sunshine State, the University of Florida’s College of Veterinary Medicine said Wednesday. While the virus strain is not usually fatal and is not known to be transferrable to humans, it can spread rapidly and cause debilitating complications.

“There’s always that concern that another large outcome could happen again,” said Michael San Filippo, a spokesman for the American Veterinary Medical Association (AVMA), referring to an outbreak of the dog flu in Chicago in 2015, when hundreds of illnesses were reported. “We don’t want people to panic because typically, from what we know, it’s usually mild, although it can progress and can lead to other infections and be serious. We want to catch these things as early as possible.”

Here’s what to know about the dog flu:

What is the dog flu?

Canine influenza, more commonly known as the dog flu, is a respiratory disease that is easily spread among dogs, according to the Centers for Disease Control and Prevention (CDC). Symptoms are similar to what humans have when infected with the flu, including coughing, runny nose and fever. However, some dogs can suffer from life-threatening pneumonia. There are two different viruses, including the latest H3N2 virus, which was first detected in dogs in the U.S. in 2015. At the time, more than 1,000 illnesses were reported in Illinois, where it began, and several nearby states, according to the AVMA. At least six cases were fatal, the organization said. The affected states included Georgia, Massachusetts, New Jersey, Alabama, California, Texas, New York, Iowa, Michigan, Wisconsin and Indiana, according to Cornell’s Animal Health Diagnostic Center.

What happened in Florida?

At least 12 dogs were recently diagnosed with canine influenza after either attending two dog shows or being exposed to infected animals from the events, health officials said. The disease appears to have stemmed from a dog show in Perry, Ga. and another in Deland, Fla. — both of which took place late this month. All dogs being treated are in stable condition, according to the Florida Department of Agriculture and Consumer Services. This is the first time H3N2 canine influenza has been found in the state, health officials said.

It’s unclear how many cases of canine influenza there currently are in the country, as statistics are generally tracked locally, not nationally, a ccording to Edward Dubovi, a v irology professor at Cornell’s Animal Health Diagnostic Center. The 2015 outbreak appeared to have ebbed by that October, said C olin Parrish, another virology professor at Cornell. But health officials in Chicago say the dog flu is still a problem in the area. The Chicago Veterinary Medical Association, which did not provide recent statistics, urged pet owners in March to be “vigilant” and “take necessary action steps “ to prevent their dogs from contracting the virus.

How can dog flu be prevented?

Pet owners can discuss with a veterinarian whether their dogs should be vaccinated for the virus. Dogs are at the highest risk of contracting the virus at animal shelters, boarding kennels, grooming salons, canine daycare, dog parks and other locations where the animals are in close quarters.

We Have Been Duped: Obama Care Is Not Raising Our Insurance, Republicans Are

(THIS ARTICLE IS COURTESY OF U.S. NEWS AND WORLD REPORT)

You’ve Been Duped

The Affordable Care Act isn’t raising your premiums. Republicans are.

You’ve Been Duped

By J. Mario Molina | Opinion Contributor

May 30, 2017, at 11:20 a.m.

As I watch the debate unfold over repeal of the Affordable Care Act, I keep thinking about the Hans Christian Anderson story “The Emperor’s New Clothes.” In the story, the emperor’s weavers convince him that they have made him clothes of special cloth, invisible to those too stupid to appreciate their beauty. The emperor parades through town stark naked, and his subjects are too afraid to state the obvious until one little boy blurts out that the emperor has no clothes. The emperor looks down and realizes the boy is right.

You might guess that President Donald Trump is the emperor in my metaphor, but you’d be wrong. The emperor is the American public, who has been duped into believing that the Affordable Care Act is failing, even as Republicans work behind the scenes to destroy it.

And who is the little boy in this story? I am. I am the former CEO of a health insurance company, and I have been warning publicly what will happen if Trump continues to effectively sabotage the Affordable Care Act. Earlier this month, I lost my job.

When Trump ran for president, he promised reforms to ensure there would be health insurance for everyone and that it would be a “lot less expensive” than under President Barack Obama’s health care law. We have yet to see the plan he described during his campaign. Instead, earlier this month, House Republicans passed the American Health Care Act – a bill the nonpartisan Congressional Budget Office determined would cause 23 million Americans to lose health insurance coverage.


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PHIL HANDS/TRIBUNE CONTENT AGENCY


When confronted with the dire projections about how their bill will make insurance unaffordable for their constituents, most of the representatives who voted for the bill often echo a line that Republican House Speaker Paul Ryan, Secretary of Health and Human Services Tom Price and Trump have used repeatedly: that the Affordable Care Act is in a so-called “death spiral” that will inevitably “explode,” so they need to pass a bill, no matter how terrible, before it does. That narrative is patently false. In fact, most of the instability driving up premiums in the marketplace can be directly traced to Republicans’ efforts to undermine the health care law for their own political purposes.

What CBO Estimates Say About the House Health Bill
Bloomberg

Florida Republican Sen. Marco Rubio, for example, was among the first to land a blow. In 2014, he proudly led a successful effort to cut funding for the “risk corridors” program. Rubio called the payments made from these funds a “bailout” for insurers, but in fact the program was an integral backstop to help control premiums as insurance companies in the marketplaces adjusted to the new population they were covering. The consequence of that ploy to score political points was that some insurers left the marketplace, and many Americans’ premiums went up.

Since Trump took office in January, these kinds of sneak attacks on the law have accelerated. During the final week of the open enrollment period, when consumers can sign up for a marketplace health care plan or choose a new one, Trump officials within the Department of Health and Human Services decided to cancel advertising and outreach for the HealthCare.gov website. That decision came despite the fact that it is well documented that younger, healthier enrollees tend to sign up at the last minute. It was a transparent effort to damage the stability of the health insurance marketplace and to create the illusion that demand for insurance was decreasing.


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Perhaps the most drastic way that the Trump administration is sabotaging American’s health insurance is by refusing to commit to reimbursing health plans for the cost-sharing reduction payments they make to lower out-of-pocket costs for their lowest income members. Insurance companies are currently in the process of determining their rates for the 2018 plan year, and without a guarantee from the administration that they will receive the payments they are owed, they will factor that added cost into their premiums for next year. And you don’t have to take my word for it – the Kaiser Family Foundation estimates that insurers would need to raise premiums for silver-level plans by an average of 19 percent to compensate if the administration will not commit to making the cost-sharing reduction payments.

One common thread in all these efforts is that Americans who purchase their health coverage through the individual market are the ones harmed, not insurance companies. The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.

If you think Obamacare is failing, I have one simple message for you: Open your eyes and stop being the emperor.

Democrat strikes back over healthcare
Reuters

Tags: health care, health care reform, American Health Care Act, Affordable Care Act, Republican Party

J. Mario Molina OPINION CONTRIBUTOR

J. Mario Molina, M.D., is the former CEO of Molina Healthcare, one of the largest health insurance companies serving Medicaid and Marketplace programs. He has three decades of experience caring for low-income patients.

G.O.P. Health Bill Would Leave 23 Million More Uninsured in a Decade, C.B.O. Says

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Protesters demonstrated outside the Capitol as Republican members of the House narrowly passed the health care bill this month. CreditGabriella Demczuk for The New York Times

WASHINGTON — A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated.

It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers.

“Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” the budget office concluded.

GRAPHIC

New C.B.O. Score: G.O.P. Health Bill Would Save Government Billions but Leave Millions Uninsured

A look at crucial numbers in the Congressional Budget Office report.

OPEN GRAPHIC

The new forecast of the nonpartisan Congressional Budget Office, Capitol Hill’s official scorekeeper, is another blow to Republican efforts to undo President Barack Obama’s signature domestic achievement. The Senate has already said it will make substantial changes to the measure passed by the House, but even Senator Mitch McConnell of Kentucky, the majority leader, is sounding uncertain about his chances of finding a majority to repeal and replace the health law.

Continue reading the main story

“I don’t know how we get to 50 at the moment,” Mr. McConnell told Reuters on Wednesday. “But that’s the goal.”

The new report from the budget office is sure to influence Republican senators, who are writing their own version of the legislation behind closed doors. The report provided fresh ammunition for Democrats trying to kill the repeal bill, which they have derided as “Trumpcare.”

 

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Reporter Margot Sanger-Katz examines high-risk pools, the controversy at the heart of the health care debate.

By ROBIN STEIN, MARGOT SANGER-KATZ and SUSAN JOAN ARCHER on Publish DateMay 24, 2017. Photo by Brendan Smialowski/Agence France-Presse — Getty Images. Watch in Times Video »

Republicans in Congress generally focus more on reducing health costs than on expanding coverage. Their proposals will inevitably cover fewer people than the Affordable Care Act, they say, because they will not compel people to buy insurance.

Republicans have been trying to repeal Mr. Obama’s health law since the day he signed it in March 2010. But the task is proving more difficult than they expected. Many parts of the law have become embedded in the nation’s health care system, and consumers have risen up to defend it, now that they fear losing its protection. At the same time, other consumers, upset about the mandate to buy insurance they can barely afford, are demanding changes in the law.

The budget office issued two reports on earlier versions of the House bill in March. Both said that the legislation would increase the number of uninsured by 14 million next year and by 24 million within a decade, compared with the current law.

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The Parts of the Affordable Care Act That the Republican Bill Will Keep or Discard

A comparison of the amended bill with key components of the Affordable Care Act.

OPEN GRAPHIC

Republican senators appear as determined as ever to replace the health law.

“The status quo under Obamacare is completely unacceptable and totally unsustainable,” Mr. McConnell said Wednesday, a few hours before the budget office issued its report. “Prices are skyrocketing, choice is plummeting, the marketplace is collapsing and countless more Americans will get hurt if we don’t act.”

“Beyond likely reiterating things we already know — like that fewer people will buy a product they don’t want when the government stops forcing them to — the updated report will allow the Senate procedurally to move forward in working to draft its own health care legislation,” he added.

The instability of the health law’s insurance marketplaces was underscored again on Wednesday when Blue Cross and Blue Shield of Kansas City, a nonprofit insurer, announced that it would not offer coverage under the law for 2018. The insurer lost more than $100 million in 2016 selling individual policies under the law, said Danette Wilson, the company’s chief executive.

Senator Chuck Schumer of New York, the minority leader, speaking to reporters in Washington on Tuesday.CreditAl Drago/The New York Times

“This is unsustainable,” she said in a statement. “We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of the market is a barrier to our continued participation.”

While the vast majority of people the company covers get insurance through an employer or a private Medicare plan, Blue Cross of Kansas City covers about 67,000 people in Kansas City and western Missouri under the federal health care law. The company’s departure could leave 25 counties in western Missouri without an insurer, said Cynthia Cox, a researcher at the Kaiser Family Foundation.

Democrats say much of that instability stems from Republican efforts to repeal and undermine the Affordable Care Act. The Senate minority leader, Chuck Schumer of New York, harshly criticized House Republicans for voting on their revised repeal measure without an updated analysis from the budget office.

“Republicans were haunted by the ghost of C.B.O. scores past, so they went ahead without one,” Mr. Schumer said. That action, he said, was reckless — “like test-driving a brand-new car three weeks after you’ve already signed on the dotted line and paid the dealer in full.”

The House repeal bill was approved on May 4 by a vote of 217 to 213, without support from any Democrats. It would eliminate tax penalties for people who go without health insurance and would roll back state-by-state expansions of Medicaid, which have provided coverage to millions of low-income people. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.

A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making more than $75,000 a year and families making more than $150,000.

Senior Republican senators say they want to reconfigure the tax credits to provide more financial assistance to lower-income people and to older Americans, who could face much higher premiums under the House bill.

The House bill would roll back a number of insurance requirements in the Affordable Care Act, which Republicans say have driven up the cost of coverage.

In the weeks leading up to passage of the House bill, Republican leaders revised it to win support from some of the most conservative members of their party.

Under the House bill, states could opt out of certain provisions of the health care law, including one that requires insurers to provide a minimum set of health benefits and another that prohibits them from charging higher premiums based on a person’s health status.

Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.

Senate Republican have been meeting several days a week, trying to thrash out their differences on complex questions of health policy and politics, like the future of Medicaid.

Asked why Democrats had been excluded, Mr. McConnell said, “We’re not going to waste our time talking to people that have no interest in fixing the problem.”

Democrats have said they would gladly work with Republicans if the Republicans would renounce their goal of repealing Mr. Obama’s health care law.