Senate Majority Leader Mitch McConnell on Monday suggested President Donald Trump is getting impatient with Congress because he hasn't "been in this line of work before."

During a speech to members of a northern Kentucky Rotary Club, McConnell said Trump had "excessive expectations" about the inner workings of legislative dealmaking, according to local CNN affiliate WCPO.

"Our new president, of course, has not been in this line of work before,"McConnell said."I think he had excessive expectations about how quickly things happen in the democratic process."

McConnell also said the public should give lawmakers have more time to work out issues.

"Part of the reason I think people think we're under-performing is because of too many artificial deadlines unrelated to the reality of the legislature which may have not been understood,"the majority leader said.

According to The Washington Post, the Senate has held fewer than 10 votes in which a roll call was needed, a low historical number. With the failure of the Republican healthcare push, Trump has no major legislative victory to point to 200 days into his tenure.

Even McConnell himself, asked after an apparent defeat of the healthcare push in mid-July, only listed confirming Supreme Court Justice Neil Gorsuch and passing simple de-regulation measures when asked about the Senate's accomplishments.

Over the past few weeks, Trump has channeled his discontent through Twitter, repeatedly attacking members of his own party for not passing the healthcare bill or enacting other major legislation. McConnell told the Rotary Club meeting that he is not a fan of the president's social media habit.

"I've been, and I will be again today, not a fan of tweeting, and I've said that to him privately. I think it would be helpful if the president would be a little more on message,"McConnell said.

Congress struggled to pass major legislation prior to departing for its August vacation, and now it faces a busy September that includes the need to pass a budget, raise the debt ceiling, authorize funding for a variety of federal programs, and start work on a major tax overhaul. 

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WASHINGTON (AP) — Message to President Donald Trump and congressional Republicans: It’s time to make the Obama health care law more effective. Stop trying to scuttle it.

That’s the resounding word from a national poll released Friday by the nonpartisan Kaiser Family Foundation. The survey was taken following last month’s Senate derailment of the GOP drive to supplant much of President Barack Obama’s statute with a diminished federal role in health care.

Around 4 in 5 want the Trump administration to take actions that help Obama’s law function properly, rather than trying to undermine it. Trump has suggested steps like halting subsidies to insurers who reduce out-of-pockets health costs for millions of consumers. His administration has discussed other moves like curbing outreach programs that persuade people to buy coverage and not enforcing the tax penalty the statute imposes on those who remain uninsured.

Just 3 in 10 want Trump and Republicans to continue their drive to repeal and replace the statute. Most prefer that they instead move to shore up the law’s marketplaces, which are seeing rising premiums and in some areas few insurers willing to sell policies.

Ominously for the GOP, 6 in 10 say Trump and congressional Republicans are responsible for any upcoming health care problems since they control government. That could be a bad sign for Republicans as they prepare to defend their House and Senate majorities in the 2018 elections.

And by nearly 2-to-1, most say it’s good that the Senate rejected the GOP repeal-and-replace bill last month.

Trump has been publicly browbeating Senate Majority Leader Mitch McConnell, R-Ky., to continue trying to pass legislation tearing down Obama’s 2010 overhaul. After using Twitter to blame McConnell for last month’s Senate failure despite years of GOP vows to repeal it, Trump suggested Thursday that McConnell should perhaps step aside if he can’t push that and other legislation through his chamber.

On three separate attempts in late July, McConnell fell short of the 50 GOP votes he needed to pass legislation scrapping Obama’s law. With a 52-48 GOP majority and Vice President Mike Pence available to cast a tie-breaking vote, McConnell has said he’s moving onto other matters unless “people can show me 50 votes for anything that would make progress.”

With the Kaiser survey consistently showing clear overall public support for retaining Obama’s law, the numbers help explain why some centrist Republicans who rely on moderate voters’ support opposed repeal or backed it only after winning some concessions.

Strikingly, while large majorities of Democrats and independents back efforts to sustain the statute, even Republicans and Trump supporters lean toward saying the administration should try making the law work, not take steps to hinder it.

But in other instances, Republicans and Trump supporters part company with Democrats and independents and strongly back the president’s views. For a White House that often seems more concerned with cementing support from Trump’s loyalists than embracing the political center, that might help explain Trump’s persistence on the issue.

For example, 6 in 10 Republicans and Trump backers want the GOP to continue its repeal and replace drive in Congress.

And around two-thirds from those groups want Trump to stop enforcing the tax penalty Obama’s law levies on people who don’t buy coverage. Analysts say that would roil insurance markets because fewer healthy people would buy policies, leaving them with greater proportions of expensive, seriously ill customers.

Trump has frequently tried pressuring Democrats to negotiate on health care by threatening to halt federal subsidies to insurers. While around 6 in 10 overall say Trump should not use such disruptive tactics, a majority of Republicans back that approach.

The companies use the money to trim out-of-pocket costs for deductibles and copayments for around 7 million low- and middle-income people. Since insurers are legally required to reduce those costs, they say blocking the subsidies would force them to increase premiums for millions who buy private insurance, including those whose expenses aren’t being reduced.

The poll found that 52 percent have a positive view of Obama’s law, a 9 percentage point increase since Trump was elected last November.

The Kaiser Health Tracking Poll was conducted Aug. 1-6 and involved random calls to the cell phones and landlines of 1,211 adults. The margin of sampling error for all respondents is plus or minus 3 percentage points.

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Sixty percent of Americans say it's a "good thing" that President Donald Trump and Republican lawmakers failed to pass legislation repealing and replacing Obamacare, according to the August Kaiser Health Tracking Poll. 

A large majority of the public disapproves of Trump's suggestion that Republicans "let Obamacare implode" and move on to other policy priorities — 78% of those polled said Trump should do what he can to make the law work.

A majority — 57% — say they want Republicans to work across the aisle to make fixes to former President Barack Obama's signature healthcare law, also known as the Affordable Care Act. And equal shares of respondents (21%) said they want the GOP to continue working on its own replacement bill or to abandon their efforts altogether. 

Of the 78% who said the Trump administration should do what it can to sustain Obamacare, 51% were Trump supporters. Just 17% said the Trump administration should undermine Obamacare or let it fail. Notably, a large majority believe that Trump and the GOP are responsible for any problems with Obamacare going forward. 

The survey was conducted between August 1 and 6 and has a margin of error of plus or minus three percentage points.

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"This hospital wasn't always like this," says Douglas Jablon, the senior vice president of patient relations at Maimonides Medical Center.

Today, when he walks around this Brooklyn hospital, he hears as many as 70 languages. When he arrived 41 years ago, diversity meant having Orthodox Jews and other Jews in the same space. Jablon, who is Jewish, said his main job was to get them all to get along.

Then the hospital decided to encourage people from outside the Jewish community to come through its doors, and Jablon took on the challenge. At his first stop — St. Finbar's, a Catholic church in Brooklyn with a heavily Italian-American congregation — he was met with questions like "why should I come to that Jewish hospital?" Jablon recalls.

That's all changed. Maimonides is located Brooklyn's Borough Park, a neighborhood that's still home one of the largest Orthodox and Hasidic Jewish populations in the US, but also new immigrants from China and the Arab world. Adjacent communities served by the hospital are predominantly Latino or home to European immigrants.

I went to Maimonides to learn about how ethnic and religious diversity affects healthcare and what doctors and hospital administrators need to think about as the populations they serve change.

It's not just about dealing with language barriers. Our cultural backdrop affects how we talk about illness and death, and our ethnicity can make us more prone to develop diseases like diabetes or certain cancers, and the doctors at Maimonides have to think about every way they engage with new or different communities — all the way down to how they decorate.

I also learned about a concept called community-based healthcare, the whole point of which is to consider a person's individual circumstances — whether you're talking about ethnicity or language barriers or poverty.

New York, of course, is unique in its degree of diversity, but the lessons here will be relevant nationally one day as the US undergoes a massive demographic shift. In 50 years, the country is expected to have no majority population. By then, the Pew Research Center estimates, 24% of the US population will be Hispanic, while 14% will be of Asian descent, compared with 18% and 6% as of 2015.

Right now, most of the country is getting it wrong, says Keith Chan, a professor of social welfare at the University at Albany who focuses on immigrant health, particularly among the Asian-American community.

Minority populations are disproportionately hurt because they're more likely to delay going in for care, waiting until their conditions progress to a point that can make them harder to treat.

And while it's true, as one surgeon told me, that once patients are on the operating table the doctors don't see any difference in them, people like Chan are focused on changes that will keep them off the table in the first place. Those efforts, he said, could make everyone's health better — not just minority populations'.

The case of breast cancer in Chinese-American women

Even what's on the walls can matter. One problem Maimonides encountered at its cancer center — about a mile from the main hospital — was the huge "four" painted on the wall outside an operating room.

"Four" in Chinese sounds similar to the word for "death," and — sort of like the number 13 in the West — it's an ominous sign. That had to go.

That is low-hanging fruit, though, compared with the medical challenges doctors encountered as they treated more Chinese patients. They're seeing cancers that aren't normally common in the US and tumor sizes that are different — both of which can affect proper diagnoses.

"Tumors that are supposed to be rare we see frequently," Dr. Patrick Borgen, the chief of surgery at Maimonides, said.

According to a 2012 study of breast-cancer patients from China and the US, as well as Chinese-Americans, Chinese-American patients with stage 1 cancer tended to have bigger tumors than patients from the US but smaller ones than patients in China. Women in China on average also tend to get breast cancer 13 years earlier than women in the US.

And the very diagnosis is viewed differently between the two cultures. Dr. Yiqing Xu, the associate director of hematology oncology at Maimonides, said communication was especially important, as some Chinese patients, if not given prompt guidance over treatment options, would opt to fly to China to get a mastectomy, a procedure in which the whole breast is removed.

"They come back with horrible mastectomy down to the bones," Xu said. The procedures in China often use older techniques that remove more of the breast than American doctors would consider necessary.

Building communities

While a hospital built for the future American population may have the added challenge of navigating different backgrounds, religions, and languages, there are some basic principles that will remain unchanged. Those in the hospital are there with a singular purpose: to get better.

That removes divisions that may be prominent outside the hospital.

During a group conversation of breast-cancer patients and their family members, Fatema Khatun, a Bengali woman who learned she had breast cancer in February, broke down when discussing the experience of going through treatment while losing her mother and caring for a child.

The other women nodded along sympathetically and handed her tissues. "You are so strong," the sister of an Arab-American patient named Amal Omar told Khatun. "If you can face this alone, that means you are strong."

"I don't know how people who don't have faith ... survive," said an Orthodox Jewish woman who declined to tell me her name because she hasn't shared her diagnosis with many people.

"We are a community, and we serve people who elsewhere on the planet today are killing each other literally. Here, they're not," Maimonides CEO Kenneth Gibbs told Business Insider. "I think part of that is about the moment at which we come together is those who need and those who provide healthcare. It's about that service that vulnerability and that sense of purpose that allows for humanity to emerge rather than all the things that we can find to disagree about."

What others can learn

When I asked what other hospitals could learn from Maimonides and its work expanding into other areas culturally, Gibbs spoke of the hospital's position as one piece of what's called a community-based healthcare system— an approach that makes health and prevention an important conversation outside traditional healthcare settings like the doctor's office or a hospital.

The hospital is there for an emergency or extreme situation, he said, and very good at handling those situations.

But the real point of understanding diversifying communities is to do a better job of keeping people out of the hospital in the first place.

That's still where the healthcare disparities happen, Chan said. That's in part because outreach to minority communities hasn't historically worked as well.

Community-based healthcare, though, considers what's going on in patients' everyday life, such as whether patients have access to food or childcare. It can change the way doctors approach patients. It could lead to more preventive actions, like heart-health screenings or setting up new dietary habits because of a higher risk of diabetes.

Chan said there had been a shift in the conversation toward setting up community-based healthcare systems, though hospitals have yet to do it fully. If that transition were to happen, it would benefit all Americans, not just minority populations.

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Gov. Brian Sandoval of Nevada on Tuesday announced that Centene, a low-cost health insurer, would enter the private health-insurance markets in 14 rural Nevada counties that previously had no insurer for 2018.

"Today we are going to announce that there will be no counties without health insurance options in the great state of Nevada," Sandoval said at a rural hospital in Silver Springs.

The news was first reported by The Nevada Independent.

The void in Nevada was created after the health insurer Anthem pulled out of the 14 counties on August 7, citing uncertainty surrounding the future of the markets established by the Affordable Care Act, the law better known as Obamacare.

At Tuesday's press conference, Sandoval said he called Centene CEO Michael Neidorff after Anthem's exit to ask whether Centene would expand its Obamacare footprint.

Health-policy experts describe empty counties as the worst-case scenario for Obamacare's individual insurance markets. Based on data from the Kaiser Family Foundation, a nonpartisan health-policy think tank, 8,048 Nevadans in the 14 counties were in danger of having no insurer in 2018 based on plan selections for this year.

Tuesday's decision leaves one county in Wisconsin and one county in Ohio as the only remaining empty counties for next year. Data from the Kaiser Family Foundation suggests that 381 people currently enrolled in plans in those counties are at risk of being left without an insurer in 2018.

Centene is a relative success story in the Obamacare markets, using its slimmed-down Medicaid-like plans to achieve profits in the exchange business. Centene has expanded its Obamacare footprint in multiple states, including previously bare counties in Kansas.

Tuesday's announcement from Centene comes as uncertainty surrounding the 2018 plan year is reaching a fever pitch.

President Donald Trump has contributed to the uncertainty by not committing to follow through on two key parts of Obamacare: subsidizing insurers for providing affordable health insurance to poor people and enforcing penalties on some Americans who do not purchase health insurance. Insurers have made it clear there will be negative consequences for consumers on the exchanges if Trump backs away from either of those obligations.

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The Congressional Budget Office released its report on the impact of President Donald Trump ending Obamacare's cost-sharing reduction (CSR) payments on Tuesday.

CSR payments help to offset the cost to insurers that offer plans with low out-of-pocket costs to poorer Americans.

The payments became the subject of a lawsuit between the Obama administration and the Republican-controlled House in 2015. The House argued the way the CSRs were paid through the executive branch was illegal, and a judged ruled in their favor in 2016.

The Obama administration appealed the ruling, allowing the payments to continue. Trump has threatened to drop the appeal and cut off the payments repeatedly over the past few months.

Insurers have warned that without CSRs, they would likely have to dramatically raise premiums for 2018, well above their current planned increases.

Now, the CBO's nonpartisan analysis found that many of the insurers would follow through on their warnings. Here's a breakdown of the key findings:

• Premiums would increase more than originally projected: Premiums for 2018 would increase by 20% over the CBO's current baseline and by 25% over the 2020 projection. This would happen because in order to qualify for the Obamacare markets, insurers would still have to provide low-income enrollees with the same level of care without those costs being offset. "Because they would still be required to bear the costs of CSRs even without payments from the government, participating insurers would raise premiums of 'silver' plans to cover the costs," said the CBO.
• The federal deficit would increase as more people relied on subsidies to access insurance: The federal deficit would increase by $194 billion between 2018 and 2026 compared to the current baseline. "Because the tax credits would increase when premiums for silver plans rose, the agencies estimate that the average subsidy per person receiving premium tax credits to purchase nongroup health insurance would increase," said the CBO report. Put another way, since premiums would increase with no CSRs, Americans would need more help paying the higher costs through subsidies. The increased cost of subsidies, said the CBO, would be greater than simply funding the CSRs.
• Some insurers would pull out of the Obamacare markets, but not enough to cause a collapse: According to the CBO, if Trump ended CSRs, insurers would exit some of the Obamacare exchanges due to the higher costs. The exits, said the report, would impact areas where only 5% of the US population lives. By 2020, "almost all areas" would have at least one option for insurance according to the report. Health policy experts have previously warned that ending CSRs could lead to a mass exodus of insurers from the market; however, the CBO does not expect this to be the case.

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The Trump administration will continue to fund critical Obamacare payments for the month of August despite the president's repeated threat to yank them.

The White House confirmed on Wednesday that the cost sharing reduction (CSR) payments would continue to go to insurers to help offset the cost of providing poorer Americans with lower out-of-pocket costs.

The payments became the subject of a lawsuit between the Obama administration and the Republican-controlled House in 2015. The House argued the way the CSRs were paid through the executive branch was illegal, and a judge ruled in their favor in 2016.

The Obama administration appealed the ruling, allowing the payments to continue.

Trump has dangled the possibility of cutting off CSRs in numerous tweets, calling them "bailouts" for insurers and threatening to let Obamacare "collapse."

The Congressional Budget Office released a report on Tuesday that projected gross premiums would increase for people in the Obamacare exchanges by 20% more than its baseline projection in 2018 if the CSRs are cut off. While this would be offset by subsides for most consumers in the marketplaces, there is a possibility premiums for some would rise.

The larger impact, according to the CBO, is that the federal deficit would balloon by $194 billion by 2026 compared to the baseline projection due to increased subsidy payments.

Other health policy experts have projected a larger impact on the future of the market.

A substantial number of insurers offering plans in the exchanges around the country warned that they would increase their premiums for 2018 if the payments are stopped, but what that would mean for consumers is unclear.

The White House has said the CSR payments will be paid on a month-by-month basis going foward.

The Senate Health, Education, Labor, and Pensions committee plans to consider a bipartisan bill when it returns after the August recess that would, in part, fund the CSRs for two years.

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One county in Ohio is the only in the US at risk of being without a health insurer for 2018 on the exchanges established by the Affordable Care Act.

After Wisconsin said on Monday that all of its counties would have insurers for 2018, Paulding County in northwest Ohio became the only county in the country that doesn't have a health plan available through the exchanges.

The county covers just 334 enrollees.

It's a positive development for Obamacare, the law formally known as the Affordable Care Act, at a time when the future stability of the law remains uncertain. On August 15, the insurer Centene stepped in and covered 14 rural Nevada counties that had previously not had insurers for 2018. 

Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health-policy think tank, tweeted out a timelapse of how the number of counties that were at risk of not having insurance plans on the marketplace in 2018 has changed over time. 

Health insurers have until late September to finalize their coverage areas.  

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The last potentially empty county on the Affordable Care Act's insurance exchanges has landed an insurer, the Ohio Department of Insurance said Thursday.

CareSource, an Ohio-based insurer with a background in Medicaid, will offer plans on the ACA's individual insurance exchange in Paulding County, which was the last remaining county in danger of having no insurer in next year's marketplace.

The prospect of empty counties has long been a serious concern of health-policy experts, since there was no backup plan for those with coverage if counties went bare. This year, 334 people signed up for health insurance in Paulding County in the individual exchange established by the ACA, the healthcare law better known as Obamacare. Those people were at risk of losing their insurance next year if no insurer entered the market.

"There is a lot of uncertainty facing consumers when it comes to health insurance and these announcements will provide important relief," Jillian Froment, the Ohio Department of Insurance director, said in a statement Thursday.

Cynthia Cox, an associate director at the Kaiser Family Foundation, a nonpartisan health-policy think tank, said the concern was exacerbated in rural counties like Paulding because of the exit of Anthem and other Blue Cross Blue Shield providers.

"The majority of these counties were at risk of being bare at least in part because Anthem or the state’s Blue Cross Blue Shield plan left the market," Cox told Business Insider in an email. "These exits raised the question as to whether any company would have the ability or desire to come in and cover these counties. Not every insurer has a statewide provider network in place, and a lot of these counties are rural."

Many of the insurers that have entered bare counties in places like Nevada, Wisconsin, and Indiana over the past two months, Cox said, have been Medicaid-focused companies like CareSource and Centene that have experience serving populations that are more similar to exchange participants.

"At the end of the day, this is a business decision, and it appears Centene and several other companies see this market as profitable," Cox said. "First-quarter insurer financial data suggests that companies in the individual market are on a path to be profitable this year."

Kansas, Tennessee, and Washington were also among states recently in danger of having bare counties but eventually saw them filled.

Since President Donald Trump took office, the Department of Health and Human Services and Republican politicians consistently cited the bare counties as evidence that Obamacare was failing.

For Cox, however, this was an example of their deficiency — but also their resiliency.

"The exchange markets have not been without problems, but they aren't collapsing," Cox said.

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Steve Bannon is setting his sights on Senate Majority Leader Mitch McConnell upon his return to the website Breitbart.

Bannon, who last week left his post as White House chief strategist, told the Economist in an interview two days after departing the Trump administration that he plans to go after the Republican leader.

"Mitch McConnell, I’m going to light him up," Bannon told the Economist.

McConnell has been caught up in an ongoing feud with President Donald Trump and is seen by far-right outlets like Breitbart as an impediment to Trump's populist agenda.

Trump has attacked McConnell repeatedly over the past few weeks on his handling of issues like the debt ceiling and the repeal of the Affordable Care Act.

While McConnell has remained relatively quiet on Trump's attacks, a recent New York Times report indicated that the majority leader has expressed private frustration over Trump's grasp on policy and Senate rules. The report also said McConnell has questioned whether Trump can salvage his presidency.

The two sides attempted to put out the fire with twin statements on Wednesday, but on Thursday the president once again attacked McConnell on Twitter.

Bannon's comments seem to confirm that pro-Trump media like Breitbart are unlikely to ease up on McConnell over the coming weeks as he attempts to address the debt ceiling, funding the government, and rolling out the GOP tax reform plan.

Bannon suggested he would have a bigger voice at Breitbart than he did in the administration.

"In the White House I had influence," he said during the interview. "At Breitbart, I had power."

In the interview, Bannon also said that Silicon Valley and Wall Street consist of "a bunch of globalists who have forgotten their fellow Americans" and said that Breitbart will "will never turn on" Trump. And Bannon said he wants to ruin China's plan known as "One Belt, One Road" to connect its infrastructure to the rest of Asia and Europe.

Read the full Economist interview here »

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Eight US governors on Thursday unveiled a plan to fix the Affordable Care Act, the law also known as Obamacare.

A letter from two Republican governors — John Kasich of Ohio and Brian Sandoval of Nevada — five Democrats, and one independent urged congressional leaders to do everything in their power to help the people on the individual insurance exchanges created by the law and to stabilize the program.

"As Congress considers reforms to strengthen our nation's health insurance system, we ask you to take immediate steps to make coverage more stable and affordable,"the letter said. "The current state of our individual market is unsustainable and we can all agree this is a problem that needs to be fixed."

The letter called on the Trump administration to try to make the law work by increasing outreach to get people to sign up for plans.

The governors also suggested a few concrete policy steps. Here's a quick rundown:

• Fund cost-sharing-reduction payments. CSR payments help to offset the cost to insurers for offering poorer Americans plans with low out-of-pocket costs. These payments have been the subject of a lawsuit under the Obama administration. Trump has repeatedly threatened to cut them off. The governors urged the leaders to fund them for at least two years.
• Create a fund to help states address rising premiums. The governors said they wanted Congress to create a $15 billion-a-year stability fund that would allow states to create programs to lower premiums for people in the exchanges. They also suggested offsetting the move by cutting spending in other areas.
• Exempt insurers from the federal health-insurance tax for plans in underserved counties. The governors' plan would exempt insurers from the federal tax on plans provided to people in counties with only one insurer on their exchanges. Such a move, they say, would help encourage insurers to enter rural counties that may be in danger of going without coverage on the exchanges.
• Allow people in underserved counties to buy into government benefits. The plan would let people in counties with one insurer on their exchanges buy into the Federal Employee Health Benefits Program. In essence, that would create a so-called public option for underserved counties.
• Re-create the federal reinsurance program. That program helped to stem losses by insurers and spur their participation in the exchanges. The program was phased out, but the plan would reinstate it.

The plan would also encourage open enrollment and institute other programs to allow states more flexibility in addressing their needs.

The proposal comes after Republican attempts to repeal and replace Obamacare — which were roundly criticized by many governors in both parties — fell through at the end of July.

A bipartisan solution is scheduled to be discussed by the Senate Health, Education, Labor, and Pensions Committee in September, once Congress returns from its monthlong recess.

Here's a full list of signatories:

• John Kasich, Ohio Republican
• John Hickenlooper, Colorado Democrat
• Brian Sandoval, Nevada Republican
• Tom Wolf, Pennsylvania Democrat
• Bill Walker, Alaska independent
• Terry McAuliffe, Virginia Democrat
• John Bel Edwards, Louisiana Democrat
• Steve Bullock, Montana Democrat

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The Trump administration is taking a big step toward undermining the Obamacare exchanges for 2018.

The budget for outreach to encourage people to sign up for 2018 insurance through the Obamacare exchanges will be sliced by a total of $116.5 million, according to the Department of Health and Human Services.

Typically the Obama administration poured money into outreach during the open enrollment period — the few months out of the year that people could sign up for health insurance for the coming year — to help get as many people covered as possible.

But the budget for advertisements encouraging enrollment will be reduced dramatically this year — to $10 million, down from $100 million in 2016, according to HHS. Additionally, the budget for the Navigator program, which trains people to assist others in signing up for coverage, will be cut to $36 million from $62.5 million last year.

A release from the Centers for Medicare and Medicaid Services said that new funding levels were determined "based on previous evaluation of past Exchange outreach efforts."

Increasing enrollment is a big step to ensure that younger, healthy people sign up for coverage. This not only provides them with insurance, but it helps balance out the risk pool, keeps costs down for all enrollees, and mitigates losses for insurers participating in the exchanges.

If enrollment declines, it could lead to higher costs for Americans and an uptick in the uninsured rate according to Larry Levitt, a senior vice president at The Kaiser Family Foundation, a nonpartisan health policy think tank.

"There's little question that cutting back on outreach and advertising will result in more people uninsured," said Levitt. "Those who fail to sign up will be healthier than average, which will cause the risk pool to deteriorate and premiums to rise. This is not a signal that the administration is trying to make the law succeed."

The moves come after the Trump administration already slashed the length of open enrollment in half. It is now from November 1 to December 15. In past years, open enrollment ran from the start of November to the end of January.

The move was swiftly condemned by Senate Minority Leader Chuck Schumer.

"The Trump administration is deliberately attempting to sabotage our health care system," Schumer said in a statement. "When the number of people with health insurance declines and costs skyrocket, the American people will know who's to blame."

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Republicans have only one month to pass legislation to repeal and replace Obamacare through the process by which they tried and failed earlier this summer.

According to a Friday ruling from the Senate parliamentarian, the window to pass an Obamacare-repeal bill through the process known as budget reconciliation will close at the end of September.

Reconciliation allows a bill to pass with a simple majority of votes and bypass a potential filibuster in the Senate as long as it lowers the federal budget deficit. Since Republicans have only a 52-seat majority in the Senate, any repeal bill needs to proceed through reconciliation — or get Democrats to come on board.

The parliamentarian, who settles debates on Senate rules and procedure, ruled that the current reconciliation resolution used during the previous Republican attempt to repeal and replace Obamacare will expire when the fiscal year 2017 budget expires at the end of the month.

Given the struggle to pass the previous Obamacare repeal-and-replace bill and the slew of other must-pass legislation scheduled for September, it seems unlikely the GOP could mount a successful effort.

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It will be a wild and woolly September on Capitol Hill as Congress faces a massive number of legislative deadlines and initiative launches.

There's must-pass legislation — like a bill to raise the debt ceiling and a bill to fund the government — and some long-gestating projects like the Republican plan to overhaul the tax code and a bipartisan effort to stabilize the individual health-insurance exchanges.

Throw in unexpected issues like funding for the Hurricane Harvey recovery effort and it will most likely make September the most jam-packed month of the year.

We've got a breakdown of all the major legislative events Congress will address in the coming weeks, along with the current state of negotiations and the worst-case scenario if lawmakers come up short.

Here's everything Congress needs to do in checklist form

Pass a bill for Hurricane Harvey recovery

Deadline: ASAP.

What it means: The federal government typically shoulders a massive amount of the financial load in response to a major disaster, and the aid needed for Harvey recovery could have a price tag as high as $100 billion.

State of negotiations: The House drafted and posted a $7.85 billion bill on Sunday, and another larger aid bill will most likely sail through. The only hiccup could come if the bill is attached to a must-pass piece of legislation like the debt ceiling or a funding bill, but even then the chances are extraordinary high it gets through.

If it doesn't pass: There's a slim-to-none chance that a bill for disaster relief won't pass, despite the argument over Hurricane Sandy relief in 2013. But in the worst-case scenario, it would most likely mean state agencies and nonprofits would need to shoulder a monumental financial burden.

Fund the government

Deadline: Midnight between September 30 and October 1.

What it means: Fiscal-year 2017 is ending this month, and the government needs to pass a bill to continue to fund the federal government.

State of negotiations: A six-month continuing resolution is all but guaranteed on this one, which would fund the government at existing levels through December. Numerous issues must be ironed out, but the path appears to be much easier after reports that President Donald Trump will not demand funding for a wall along the border with Mexico as part of a bill.

If it doesn't pass: Nonessential federal resources would be shut down, so things like national parks and some federal offices would be closed. Federal employees at these offices would be furloughed, meaning they would not go to work or receive paychecks for the duration of the shutdown.

Optima — a Virginia-based health insurer — will exit a slew of Obamacare exchanges in the state for 2018, the company announced  Wednesday. 

The insurer said it would leave many rural areas of the state, following the exits of large insurers like Anthem from the same areas. The company cited the other insurer exits as well as "uncertainty in Washington" as reasons for the exit.

"The decisions we made were challenging ones given the recent changes and ambiguities in the marketplace," Optima CEO Michael Dudley said in a statement. "Our most recent filing with the state reflects these dynamic changes, as would be expected in these circumstances."

According to The Kaiser Family Foundation, a nonpartisan health policy think tank, the exit will leave 63 counties in the state with no insurer. Just over 70,000 people enrolled in Obamacare exchange plans in 2017 in these counties, per Kaiser, leaving them at risk of having no coverage next year.

Optima's exit also brings back the possibility of empty coverage areas in 2018 after states like Nevada, Indiana, and Ohio found insurers to fill their potentially barren counties.

The possibility of counties going without an insurer has long been one of the biggest potential setbacks for the Obamacare exchanges, since there is no back up option for individuals in areas without an insurer.

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One top Republican lawmaker has become worried that the party is running out of time to enact its agenda.

Rep. Mark Meadows, the chair of the influential conservative House Freedom Caucus, said during a Bloomberg event on Thursday that the GOP needs to accomplish a legislative agenda item by the end of the year or face serious blowback.

"If we get to December and we’ve not repealed and replaced Obamacare, we’ve not built the wall, we’ve not done tax reform, let me just tell you it’s not going to be pretty some eight or nine months after that in terms of reelection," Meadows said.

The North Carolina lawmaker said that unless Republicans get something done, "there’s going to be rebellion against everybody."

As it stands, Republicans have so far failed to pass a bill repealing and replacing the Affordable Care Act. Many of their other legislative priorities are in early stages.

The big push for the rest of the year will come on tax reform. But Meadows said there are few details on that plan and little time with which to get the effort passed.

"At some point you’re going to have to call the play,"Meadows said. "You’re going to have to get specific."

Meadows added at the event it's time to "get on with it" and that a tax-code overhaul "needs to happen by Thanksgiving." December is stacked with several key deadlines associated with government funding, the debt ceiling, and more after President Donald Trump's deal on Wednesday with Democrats.

As it stands now, a slew of unanswered questions remain on the tax reform plan — such as what the corporate rate would be and whether the cuts would be permanent or temporary.

In a speech on Wednesday in North Dakota, Trump said that details would come "in two weeks."

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President Donald Trump started Friday with a series of tweets on one of his most frequent topics of criticism: the legislative filibuster.

The president once again attacked Republicans for failing to repeal and replace the Affordable Care Act and implored the Senate to scrap the legislative filibuster as a way to pass more legislation.

"Republicans, sorry, but I've been hearing about Repeal & Replace for 7 years, didn't happen!" Trump tweeted. "Even worse, the Senate Filibuster Rule will never allow the Republicans to pass even great legislation. 8 Dems control - will rarely get 60 (vs. 51) votes. It is a Repub Death Wish!"

To avoid a filibuster, which allows Democrats to hold the floor and block legislation from advancing in the chamber, Republicans need 60 votes, but there are only 52 GOP senators.

To avoid a filibuster in their attempt to repeal the ACA, the healthcare law better known as Obamacare, Senate Republicans crafted legislation through the process known as budget reconciliation, which allows a bill to pass with only a simple majority. Despite needing only 50 votes (with Vice President Mike Pence in line to be the tiebreaker), the GOP efforts still failed, most recently with three Republican defections.

Trump also said Republicans needed to begin working to overhaul the US tax system.

"Republicans must start the Tax Reform/Tax Cut legislation ASAP," Trump said. "Don't wait until the end of September. Needed now more than ever. Hurry!"

Trump's team has repeatedly said it has been working with Republican leaders on a tax plan since the election in November. Administration officials have said recently that they turned formal legislative drafting efforts over to the relevant committees in Congress. During a speech in North Dakota on Wednesday, Trump promised more details within "two weeks."

The president's tweets came two days after Trump bucked Republican leaders and cut a deal with Democrats to suspend the debt ceiling for just three months. GOP leaders Paul Ryan, Mitch McConnell, and Kevin McCarthy all favored a longer extension during an Oval Office meeting, but Trump sided with Democrats Chuck Schumer and Nancy Pelosi and agreed to a shorter suspension.

One of the factors that have contributed to the fractured relationship between Trump and McConnell, the Senate majority leader, has been Trump's flaunting of Senate procedure, including his tweets on the legislative filibuster.

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Republican Sens. Lindsey Graham and Bill Cassidy on Monday were set to roll out a last ditch effort repeal and replace the Affordable Care Act in the near-term.

The Graham-Cassidy bill would maintain a significant portion of the structure of previous GOP attempts at a healthcare overhaul in the first half of the year. But it contains some notable differences in an attempt to appeal to more moderate members of the party.

The bill, however, faces an uphill battle and a short window in which it could be passed.

A ruling by the Senate parliamentarian earlier this month said Republicans can't continue after September 30 to use the process of reconciliation, which allows bills to be passed with a simple majority in the Senate if they decrease the deficit.

That leaves a little under three weeks for Republicans to attempt to push the bill through Congress. President Donald Trump has reportedly urged a vote on the bill before the option for budget reconciliation runs out. But given the minuscule window and competing healthcare-related pushes, there is little hope for the effort on Capitol Hill.

With that in mind, here's a breakdown of what's expected in the plan:

• Shift Medicaid funding and insurance subsidies to a block-grant system: Instead of determining the federal government's share of funding for Obamacare's Medicaid expansion and individual insurance subsidies through a formula, states would receive large chunks of money up front — and then determine what to do with it. About $1.2 trillion would be allocated for this purpose from 2020 through 2026. Funding would be cut off by 2027.
• Eliminate the individual and employer mandate: People who do not sign up for insurance would not face a tax under the plan, and companies would not be compelled to offer coverage. States could pass their own mandates, however.
• State reinsurance fund: A certain amount will likely be allocated to insurers to offset greater losses from insuring a sicker pool of people.
• Adjust the essential health benefits: States could determine what qualifies as an essential health benefit. Currently, the federal government mandates that all plans sold on the Obamacare exchanges cover 10 basic types of care, including emergency-room visits and prescription drugs.

The legislation still needs to be evaluated by lawmakers and scored by the Congressional Budget Office, complicating the already tight window for potential passage.

Additionally, the Senate Health, Education, Labor, and Pensions (HELP) Committee has already been moving forward with hearings focused on bipartisan healthcare fixes that would be smaller in scope but possibly garner more support.

Sen. John McCain — who cast a deciding vote that killed the previous round of Obamacare repeal efforts — has indicated that he would possibly vote for the package.

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Bernie Sanders is getting some serious support in his push to reform the US healthcare system.

Sanders on Wednesday will roll out a Medicare-for-all bill, which aims to extend the Medicare program, federally funded insurance for people over the age of 65, to all Americans.

A single-payer healthcare push has previously been well outside the mainstream for most Democrats. But Sanders' legislation has picked up support from high-profile Democrats.

The latest Democratic senator offering support is Kirsten Gillibrand of New York.

"Health care is a right, not a privilege," Gillibrand tweeted Tuesday. "This week, I'll proudly join Senator @BernieSanders to co-sponsor Medicare for All."

Sen. Cory Booker of New Jersey also offered support for Sanders' legislation this week.

"I'm signing onto Medicare-for-all, which I'm excited to do this week," Booker said in an interview with NJTV on Monday. "Sen. Sanders, myself, and some others are going to be announcing some legislation this week along with some of my other colleagues."

Booker, who has been floated as a possible contender for the Democratic presidential nomination in 2020, said Obamacare was just a "first step" in securing healthcare for all Americans.

"What we have right now is a country where just because of your wealth, it will depend on whether you have healthcare or not," Booker continued. "You should not be punished because you are working-class or poor and be denied healthcare. I think healthcare should be a right to all."

Booker's announcement comes after other high-profile Democrats said they would cosponsor the bill.

Sen. Kamala Harris, who also has been floated as a 2020 contender, said at a town hall late last month that she would also co-sponsor the bill.

"This is about understanding, again, that healthcare should be a right, not a privilege. And it's also about being smart," Harris said.

Sen. Elizabeth Warren, another senator popular with the progressive wing of the Democratic Party, announced her support on Thursday in an email to supporters.

"I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans?"Warren wrote. "Everything should be on the table — and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month."

The movement on Sanders bill comes as single-payer healthcare has become much more popular among the American public in polling. Even business titans like Warren Buffett have backed the idea.

The bill still faces almost impossible odds of passage, given that Republicans control Congress and the White House. But Sanders' move signals it will be a policy fight Democrats are willing to pick for the foreseeable future.

Sanders, along with the cosponsors, will roll out the legislation at a large event featuring doctors, hospital workers, and more on Wednesday.

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A group of Senate Republicans on Wednesday rolled out a last-ditch effort to repeal and replace the Affordable Care Act, but it is almost certain to face a legislative roadblock.

The bill, written by Sens. Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson, would primarily allocate federal funding for healthcare in block grants to states — a change from the current system, which allocates money based on a percentage of what states spend.

In a statement announcing the release of the bill — named after the senators— Graham touted the idea as a way to give states flexibility on healthcare spending.

"Our bill takes money and power out of Washington and gives it back to patients and states," Graham said. "It takes us off the path to single payer healthcare — which would be a disaster — and puts us on a path toward local control."

The bill has the support of some prominent Republicans, including Sen. John McCain, who cast the pivotal vote that killed the first push by the GOP to repeal the ACA, the law also known as Obamacare. But it does not appear to have the necessary support to pass the Senate.

Sen. Ted Cruz said the bill had the support of about 45 members of the GOP conference. Senate Majority Leader Mitch McConnell reportedly said the bill would get a vote if the senators could persuade 50 Republicans to support it. Typically, leadership tries to find votes for a bill it supports.

The process by which Republicans would have to move the bill, known as budget reconciliation, also presents the biggest challenge, as it stamps a serious time crunch on their effort. The rules that would allow the bill to pass the Senate with a simple majority and avoid a Democratic filibuster are set to expire at the end of the month.

Sen. John Thune, the third-ranking Republican member of the Senate, told reporters that the bill would need a "double-double bank shot" to pass.

The bill does have the support of President Donald Trump, who applauded it in a statement after its release, though he did not explicitly tell other senators to vote for the bill.

"As I have continued to say, inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis," Trump's statement said.

Another sticking point is whether key provisions of the proposal would qualify for budget reconciliation under what is known as the Byrd rule, which dictates that any part of a bill that does not affect the budget is stripped out.

Here's a quick rundown of what the proposal would do:

• Shift Medicaid funding and insurance subsidies to a block-grant system. Instead of determining the federal government's share of funding for Obamacare's Medicaid expansion and individual insurance subsidies, states would receive large chunks of money up front based on how many people with certain health statuses are living there — part of a complex formula that could cause a significant shift in federal funding among states. Just under $1.2 trillion would be allocated for this from 2020 through 2026.
• Pay cost-sharing subsidies through 2019. Such a move would help the insurance exchanges established by Obamacare stay stable in the short term — something Democrats have urged. When the block grants kick in, however, these payments would end.
• Maintain many Obamacare taxes. To avoid adding too much to the federal deficit — and being disqualified from the reconciliation process — the bill would preserve many major taxes created under Obamacare, such as the tax on net investment income.
• Eliminate the individual and employer mandates. People who do not sign up for insurance would not face a tax under the plan, and companies would not be compelled to offer coverage, though states could pass their own mandates.
• Include a state stability fund. The bill would allocate $10 billion in 2019 and $15 billion in 2020 for states to help bring down premiums and set up programs to get people coverage.
• Cut off money to abortion providers. None of the money allocated by the bill could go toward healthcare providers that offer abortion services.

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