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Dean Heller says GOP made ‘big mistake’ by tackling Obamacare first. Sen. Dean Heller, R-Nev., believes Republican lawmakers made a “big mistake” by pushing to repeal the Affordable Care Act as their first big legislative initiative at the outset of the Trump administration. Heller, who is facing a bruising re-election fight in November, argued that Republicans could have moved repeal and replace legislation to the president’s desk if they had waited longer and dealt with tax reform and a transportation package from the start. “We jumped in with two feet and we were not ready. We weren’t ready, and the results were obvious,” Heller told the Washington Examiner in an interview Monday. “We did eliminate the [individual] mandate. We did get some of the taxes. I did push back and postpone the Cadillac tax and some of those issues, but we made the big mistake of trying to do that first and it was too heavy of a lift.” The incumbent Republican said that he does not expect GOP leadership to push for a repeal of the law before the November elections because there are not enough votes in the GOP caucus.

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Single-payer, state-run healthcare coverage takes center stage at primaries. The Democratic gubernatorial primary in Michigan tonight features progressive insurgent Abdul el-Sayed, who has vowed to bring “Medicare for All” to the state. Other gubernatorial candidates – including Gavin Newsom of California, Kerri Harris of Delaware, Ben Jealous of Maryland, Cynthia Nixon of New York, and Jay Gonzalez of Massachusetts – have called for similar measures.  Medicare is a federally funded program, and any move to have a fully state-funded system in any state would require a large increase in taxes as well as price controls that the healthcare sector will battle, all without additional help from the federal government. Previous efforts at single-payer in California, Colorado, and Vermont have failed. California’s single-payer program was estimated to cost $400 billion to implement.

Trump looking to limit citizenship for legal immigrants who use public welfare programs: Report. The Trump administration is working on a proposal that would make it harder for legal immigrants to obtain citizenship or acquire green cards if they’ve used public welfare programs, including Obamacare, according to a new report. A draft of the plan described to NBC News shows the administration could prevent immigrants living legally in the U.S. who have used Obamacare, children’s health insurance, and food stamps, among other benefits, from obtaining citizenship.

White House backs revamp of child support enforcement to demand more from parents. The White House has called for an overhaul of federal child support enforcement to shift more responsibility for children’s welfare from the government to parents, part of the administration’s larger welfare reform agenda. White House officials favor requiring parents to cooperate with child support enforcement in order to be eligible for government benefits, including for programs that do not currently have such requirements, such as food stamps and housing aid. The idea is to save taxpayer money and “demonstrate that parents, rather than the government, should be the primary source of economic support for children and families,” the officials said in a draft of welfare reform recommendations sent by the White House to congressional Republicans obtained by the Washington Examiner. The recommendations also call for redirecting funds to work training for absent parents who owe child support.

Abortion, Obamacare defenders ramp up August recess opposition to Brett Kavanaugh. Organizations defending abortion rights and Obamacare are teaming up for a series of events in August to rally voter opposition to Judge Brett Kavanaugh’s nomination to the Supreme Court. Planned Parenthood and state advocates will host more than 80 events from Aug. 6-10 across the U.S., including in Chicago, St. Louis, Pittsburgh, and Seattle, holding phone banks and writing postcards to send to voters. They plan to put pressure on senators while they are back in town for the summer recess. “If all the Americans who care about these issues make their voices heard we can and we will win this fight,” Kelley Robinson, national organizing director of Planned Parenthood Action Fund, said in a call with reporters. The organizations are putting pressure on centrist GOP Sens. Lisa Murkowski of Alaska and Susan Collins of Maine. Democratic Sens. Joe Manchin of West Virginia, Joe Donnelly of Indiana, and Heidi Heitkamp of North Dakota all voted for Trump’s former nominee, Neil Gorsuch, and are running re-election in states that that voted for Trump. They are facing pressure to side with Democrats, but could still confirm Kavanaugh if Murkowski and Collins defect. “The name of the game is clear: We have to get to 51 votes,” Robinson said. “To be honest with you, I’ll take any 51. We have to get there.”

Pentagon restricts GPS fitness apps after sensitive data leaks. The Pentagon on Monday barred the use of GPS features used on popular fitness apps and other devices among its deployed forces after the data exposed sensitive information about troops and bases. “These geolocation capabilities can expose personal information, locations, routines, and numbers of department personnel, and potentially create unintended security consequences and increased risk to the joint force and mission,” Maj. Audricia Harris, a Pentagon spokeswoman, said in a statement.

Congo’s death toll from Ebola rises to 34. At least 43 cases of Ebola are suspected in the Democratic Republic of the Congo, where 34 people have already died. Officials from the World Health Organization said this morning that they expect the cost of responding to the outbreak, which is in a war-torn region, to be “significant.” So far 30 staff have arrived, and they have been isolating and caring for patients, and getting in touch with others who may have been infected.

Carl Icahn urges Cigna investors to block $60 billion Express Scripts deal. Weeks before a shareholder vote on Cigna’s takeover of Express Scripts, activist Carl Icahn is urging the insurer’s investors to block the transaction. In an open letter on Tuesday, Icahn said Cigna is “dramatically overpaying for a highly challenged Express Scripts that is facing existential risks on several fronts.” The business model employed by the pharmacy benefit manager and its peers — which act as middlemen between drug companies and insurers during negotiations on treatment prices — has become a focal point in the Trump administration’s quest to reduce medication costs. Health and Human Services Secretary Alex Azar and others have voiced support for ending the lucrative drug rebate program, a system under which benefit managers often receive a sizable percentage of the subsidy they are negotiating. The industry argues that drug rebates ultimately lower drug costs for consumers. Icahn told Cigna shareholders that opposition to the current system is likely to lower Express Scripts’ profitability. He also highlighted Amazon’s acquisition of online pharmacy PillPack as another obstacle.

Low competition reason for high Obamacare rates, study says. Recent years of premium hikes on Obamacare’s insurance marketplaces are likely due to fewer insurers competing for customers, a new study claims. The study was published Monday in the journal Health Affairs. It looked at 2017 and 2018 price hikes on the marketplaces, which serve the individual insurance market for people who don’t have insurance through a job or the government. The study helps Republican claims that Obamacare is collapsing and that insurers are fleeing the exchanges, a frequent political point from the past few years. However, Democrats believe they have the upper hand for proposed rates for the 2019 coverage year because of moves by the Trump administration and Congress that they claim are acts of “sabotage” of Obamacare. The study looked at rates for states that use the federally run healthcare.gov, which residents in 38 states use to sign up for Obamacare plans. In 2018, marketplace premiums were 50 percent higher on average in rating areas that had only one insurer, compared to those with more than two insurers, the study said.

Top oversight Democrat presses Trump administration on scrubbing Obamacare references. Rep. Elijah Cummings, D-Md., is demanding the Trump administration answer questions surrounding the potential scrubbing of Obamacare content on federal websites. Cummings, the top Democrat on the House Oversight Committee, sent a letter on Tuesday to the Trump administration for documents surrounding the deletion of references to Obamacare on Medicare.gov. Cummings’ letter refers to a report from the nonprofit Sunlight Foundation that found that the Department of Health and Human Services deleted an entire page on the relationship between Affordable Care Act and Medicare. HHS also deleted links and references to “The Affordable Care Act & Medicare” and other pages that previously appeared on Medicare.gov’s primary “About Us” page, Cummings wrote.

RUNDOWN

Axios Average insurance deductibles keep rising

Associated Press Nevada health exchange rates expect to see lowest rise yet

New York Times Trump’s short-term health insurance policies quickly run into headwinds

Kaiser Health News Once its greatest foes, doctors are embracing single-payer

Washington Post Democrats seize on cherry-picked claim that ‘Medicare-for-all’ would save $2 trillion

STAT News Congress requests Sackler deposition that Purdue Pharma is trying to keep hidden

Cleveland Plain Dealer Future of opioid lawsuit becomes an issue in Ohio’s attorney general race

Bloomberg Express Scripts to drop big sellers from AbbVie, Gilead