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Senate Republicans attempt to head off Democratic attacks on pre-existing conditions. A group of 10 Senate Republicans announced legislation Friday to guarantee health insurance coverage for people with pre-existing conditions nationwide as a response to scathing attacks from Democrats alleging that the GOP is taking away protections for sick people. Democrats are making health care protections for sick people a major part of their strategy in the 2018 midterm elections. The problem for Republicans is that the Trump administration wants to get rid of Obamacare’s pre-existing condition protections. The Justice Department has declined to defend Obamacare in court, and supports a lawsuit from Texas and 19 other states arguing that, because Congress eliminated the financial penalty for going uninsured, the entire law should be struck down. DOJ doesn’t assert that the entire law should be eliminated, just the protections for pre-existing conditions. Democrats in tight re-election races see an advantage in tying their opponents to the Trump administration’s stance on pre-existing conditions, and also in warning that Trump’s Supreme Court pick Brett Kavanaugh could put such protections in danger because he could vote in favor of the Texas lawsuit if it reaches the Supreme Court.

But Democrats and experts say pre-existing conditions are still in danger even if bill becomes law. The new Republican bill would amend the Health Insurance Portability and Accountability Act to guarantee availability of coverage in the individual or employer-sponsored group market for all Americans, including those with pre-existing conditions. However, the bill doesn’t prevent insurers from charging higher rates based on age or gender, tweeted Larry Levitt, senior vice president for the research firm Kaiser Family Foundation. Obamacare allies charge that the bill is just an attempt to take political cover. “This bill is just an election year scam from Senate Republicans desperate to hide from their own record,” said Brad Woodhouse, campaign director for the Obamacare advocacy group Protect Our Care.

Senate Minority Leader Chuck Schumer tweeted that if the Texas lawsuit is successful, it will get rid of the requirement that insurance plans cover essential health benefits like hospitalization, which are critical for people with pre-existing conditions. “The GOP-led lawsuit — which, again, the Republicans don’t oppose — would also strike down Medicaid expansion, tax credits and premium subsidies and more,” Schumer tweeted.

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Joe Manchin uses Senate GOP’s bill to bash opponent. Sen. Joe Manchin, D-W.Va., is finding the bill useful for his ongoing attacks on his general election opponent West Virginia Attorney General Patrick Morrisey. West Virginia is one of the 20 states part of the lawsuit, a fact that Manchin has been highlighting recently on the campaign trail. He released a statement on Monday saying that the GOP is abandoning Morrisey’s lawsuit. “Senate Republicans have finally admitted that this horrendous lawsuit is dangerous for the country and are scrambling to find a fix,” Manchin said. “Unfortunately, with only a few days before this harmful lawsuit begins, this legislation is just a weak attempt to disguise their efforts to roll back protections for nearly 800,000 West Virginians with pre-existing conditions.” Manchin is one of the most vulnerable red state Democrats running for re-election in 2018. President Trump won West Virginia by more than 30 points in 2016.

McCain’s legacy on healthcare. Sen. John McCain, R-Ariz., who died this past weekend at 81 of brain cancer, was remembered by colleagues and former rivals as a maverick with a major independent streak. One of his last maverick acts was his vote to save Obamacare last July. McCain joined GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska and all Senate Democrats to oppose a “skinny” repeal bill. Several Republican senators believed that McCain was going to vote for the repeal bill and then move on to a conference with the House. But McCain, who opposed Obamacare, disagreed with the process used by the GOP leadership, and ended the repeal effort with a dramatic late-night thumbs-down on the Senate floor.

Nebraska latest state to add ballot initiative on Medicaid expansion. Nebraska state officials on Friday certified a petition to add a question on the November ballot on whether to expand Medicaid under Obamacare. Nebraska became the third state where voters will decide whether to expand Medicaid in their locality for the first time, according to the advocacy group Fairness Project, which seeks to use state ballot measures to advance progressive policy reforms. Idaho and Utah are the other states that have ballot measures this fall to expand Medicaid for the first time. “Voters from across the political spectrum are revolting against politicians who are standing in the way of an America where every family can see a doctor without going bankrupt,” said Jonathan Schleifer, executive director of the Fairness Project, which is helping the ballot campaigns in the states. Montana already expanded Medicaid in 2016, but voters this fall will decide whether to keep the expansion via a question on the ballot.

Senate Democrats probe Rudy Giuliani’s ties to opioid maker Purdue Pharma. Two Democratic senators are seeking to learn more about Rudy Giuliani’s role in shielding Oxycontin-maker Purdue Pharma from criminal charges in the mid-2000s. Sens. Sheldon Whitehouse of Rhode Island and Maggie Hassan of New Hampshire asked the Justice Department Friday to provide documents related to Giuliani’s involvement in a 2007 decision by the Bush administration to not charge Purdue executives with misleading the public over the abuse potential of Oxycontin. Giuliani is now President Trump’s personal attorney and representing him in special counsel Robert Mueller’s probe into Russian meddling in elections. The senators are asking whether Giuliani had an improper conflict of interest stemming from the fact that his consulting firm Giuliani Partners represented Purdue Pharma while also under contract with the DOJ.

In 2006, career federal prosecutors concluded that Purdue Pharma concealed information about the significant abuse potential of Oxycontin, the popular opioid painkiller. But DOJ political appointees blocked indictments against the company and its executives, according to a May report in the New York Times. Purdue Pharma hired Giuliani Partners in 2002 to help lobby the DOJ and the Drug Enforcement Administration. While Giuliani’s firm was negotiating for Purdue Pharma, the former New York mayor was personally raising money for a DEA museum and the firm had a $1 million consulting contract with DOJ to help reorganize its drug investigations.

Shareholders approve Cigna’s $60 billion purchase of Express Scripts. Cigna Corp. and Express Scripts shareholders on Friday approved the insurer’s $60 billion acquisition of the pharmacy benefit manager, following a top activist investor’s decision to drop his opposition to the transaction. Regulatory approval for the deal remains pending, but the companies expect it to close by the end of 2018. “Our combined company will enhance Cigna’s differentiated service-based model, fueled by actionable insights and analytics, to drive innovation and meaningful growth in a highly dynamic market environment,” David Cordani, the insurer’s top executive, said in a statement. “As a result, we will build more effective partnerships, further improve health outcomes and deliver a superior customer experience.” The two companies cleared a key hurdle after 78 percent of Express Script investors and 90 percent of Cigna shareholders voted in favor of the transaction. Activist investor Carl Icahn previously said he would try to block the deal over concerns that Cigna was overpaying for Express Scripts amid heightened scrutiny over the pharmacy benefit manager business model. He later reversed that opposition.

RUNDOWN

Virginian-Pilot Horrific deaths, brutal treatment: Mental illness in America’s jails

Axios How a California bill could upend the dialysis industry

The Hill Trump administration to consider Tennessee request blocking Planned Parenthood from Medicaid

Forbes Why Medicaid expansion is good for your heart

Kaiser Health News McCain’s complicated healthcare legacy: He hated the ACA. He also saved it.

New York Times Did JUUL lure teenagers and get ‘customers for life?’

Reuters Bayer, Johnson & Johnson’s heart drug Xarelto fails trial to widen use