Two legislative efforts in the Senate to make changes to the Affordable Care Act — one that seeks to make a more dramatic overhaul than the other — face a critical week ahead in Washington as Republicans, especially, need to decide which bill they will back.
Much of the dueling over the two bills — both of which are up against deadlines to get through the Senate by the end of the month — is being played out on Twitter.
Sens. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, and Patty Murray, D-Wash., the ranking member, are hoping to finalize the details of a bipartisan bill they have been working on to make some short-term fixes to the ACA.
The other bill, introduced Sept. 13 by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin, seeks to take the federal dollars being spent on the ACA's Medicaid expansion, tax credits, cost-sharing reduction subsidies and the basic health plan funds and turn them into block grants to be split among the 50 states and the District of Columbia.
Like three other Republican bills that failed in July, the Graham-Cassidy bill has yet to secure the 51 votes needed to pass it using the Senate's budget reconciliation rules of a simple majority — an opportunity that expires Sept. 30.
Senate Majority Leader Mitch McConnell, R-Ky., agreed to bring the legislation to the Senate floor for a vote if Graham, Cassidy, Heller and Johnson can ensure at least 50 Republicans will be on board. The Republicans intend to rely on Vice President Mike Pence to cast the deciding 51st vote, if needed.
McConnell also asked for the Congressional Budget Office to rush its cost estimate of the Graham-Cassidy bill.
But the day after the bill was introduced, Sen. Rand Paul, R-Ky., tweeted that he opposed the legislation because it "keeps 90% of Obamacare in place."
"Why continue putting out bills breaking our promise to repeal?" Paul asked in another Sept. 15 tweet, adding that Graham-Cassidy "redistributes, doesn't repeal. It is more Obamacare Lite!"
The three Republican senators that voted against McConnell's final repeal effort in July — Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine — so far have avoided tweeting how they may vote on Graham-Cassidy.
But during a Sept. 17 appearance on CBS' "Face the Nation," McCain voiced his support for the Alexander-Murray effort and reiterated the need for making legislation go through the "regular order" process of holding committee hearings — declaring he was opposed to any moves to "ram" a proposal through Congress without the public vetting.
"That's not the way to do it," McCain said.
Over the past few days, several Democrats — spurred on by Andy Slavitt, the former head of the Centers for Medicare and Medicaid Services during the last two years of the Obama administration — have taken to Twitter to express their opposition to Graham-Cassidy, including Senate Minority Leader Chuck Schumer, D-N.Y., who tweeted the situation was a "red alert" and that "We need your voices more than ever!"
"Not surprised those who wish for unlimited [government] spending regardless of patient outcomes oppose" the bill, Cassidy tweeted Sept. 14.
The Louisiana senator followed up that tweet with several more, targeting critics like the American Cancer Society, AARP and America's Essential Hospitals.
In a series of Sept. 15 tweets, AARP had been particularly pointed in its criticism of Graham-Cassidy — insisting the legislation failed to contain bipartisan solutions for improving the U.S. healthcare system, carried the same flaws as earlier proposals rejected by many groups and would price gouge older Americans.
AARP also said the bill's caps on Medicaid — the government's insurance program for the poor — would "jeopardize the ability of older Americans to stay in their own homes as they age."
The American Cancer Society's Cancer Action Network tweeted Sept. 14 that "Cancer patients need bipartisan healthcare fixes, not distractions," and urged Cassidy and Graham in an attached statement to work within, and not around, the Alexander-Murray process.
Cassidy's tweet to the America's Essential Hospitals appeared to be in response to its Sept. 15 statement, in which it said the Republicans' latest attempt to repeal the ACA would violate the group's core principles of maintaining coverage for those who have it, preserving access and protecting hospitals that care for low-income and other vulnerable people.
House leadership, however, expressed support on Twitter for the Graham-Cassidy bill — signaling that if the legislation manages to make it through the Senate, the lower chamber, which passed a different repeal-and-replace package on May 4, may be prepared to adopt it.
"I appreciate Senators Graham and Cassidy continuing to work on a plan to pass the Senate. I'll take federalism over Obamacare any day," House Speaker Paul Ryan, R-Wis., said in a Sept. 15 tweet.
"Obamacare is failing. Graham-Cassidy returns control to states and empowers them to innovate and stabilize costs," House Majority Leader Kevin McCarthy, R-Calif., tweeted shortly thereafter.
Medicare-for-all bill's timing meant as benchmark for the future
Meanwhile, former presidential candidate Sen. Bernie Sanders, I-Vt., acknowledged Sept. 17 he did not expect his legislation aimed at overhauling the Medicare program and making it universal for all Americans to be adopted anytime soon.
"I fully admit that," he said during an appearance on NBC's "Meet the Press."
"But we need to put the benchmark down there and go forward," he said.
Sanders also admitted that it is going to take a lot of discussion to convince Americans to embrace a "Medicare-for-all" single-payer structure.
The Vermont senator said his immediate goal by introducing the bill on Sept. 13 was to "beat back these disastrous Republican proposals that would throw millions and millions of people off of the health insurance."
The bill was also timed to provoke questions about why the U.S. is the only major economy where citizens are not guaranteed healthcare, which is spending at least twice as much as other industrialized countries on services and yet has worse outcomes, and pays the higher amounts for prescription drugs.
Sanders noted that private insurance companies spend between 12% and 18% on administration costs, but the costs of administering the Medicare program is only 2%.
He said under his bill, Americans could save about $500 billion a year just in administration costs.
Sanders also estimated that allowing Medicare to negotiate prices for prescription drugs could save the nation another $100 billion.
Baseball's DiMaggio played role in breast cancer gene discovery
Had it not been for American baseball player Joe DiMaggio — the Yankee Clipper — the scientific work that led to the discovery of the gene known to predispose some women to breast cancer, BRCA1, may never have happened, or at least, may have been slowed, according to Mary-Claire King, the woman responsible for the 1990 breakthrough.
In April 1981, King was scheduled to give a presentation at the National Institutes of Health, or NIH, that was critical to her securing a grant to pursue her genetic research, she explained in a Sept. 14 blog in the Huffington Post.
But the week began badly for King, who was a young professor at the University of California at Berkeley at the time, with her husband leaving her and her house getting robbed.
King, now a professor of genome sciences and medicine at the University of Washington in Seattle, ran into more trouble when she almost missed her flight for her presentation at the NIH.
King was trying to make sure she and her five-year-old daughter Emily made it to their own flight on time, while ensuring her elderly "fairly frail" mother, who was traveling to Chicago the same day, also made it safely to her own airline gate.
In observing the family's distress, a tall stranger stepped up to help, offering to watch the little girl for a few minutes while King escorted her mother to her gate.
"My mother looked at me and said, 'You can't leave Emily with a total stranger,'" King said.
But recognizing the man, King quickly told her mother, "Mom, if you can't trust Joe DiMaggio, who can you trust?"
Thanks to DiMaggio, King said she and her daughter made it on time to Washington, where she won her grant — funds she otherwise may have lost. The grant supported the project that led King's lab to demonstrate in 1990 that breast cancer is genetically inherited in some families by mapping to chromosome 17q21, or BRCA1.