Doubts grow about GOP health care bill, but...

Congress has returned from its July 4 recess even less enthusiastic about the GOP health care bill, according to multiple news reports. Moderate Republicans Sen. Bill Cassidy and Sen. John McCain essentially pronounced the current draft dead; Cassidy suggested turning to a different bill that he drafted with Sen. Susan Collins of Maine. Kaiser Health News offers a wrap up of the coverage. ( Kaiser Health News)

...McConnell delays the recess to get it done
The Senate will delay its annual August recess so it can work on “important legislative issues,” including the GOP health care bill, Majority Leader Mitch McConnell said Tuesday. The announcement came on the heels of a call from several Senate Republicans to consider canceling the month-long break. “I don’t see any reason why we need to be leaving this town in August,” said Sen. Steve Daines, R-Mont. “If you were going to school and you were getting failing grades in your spring semester, you better … go to summer school.” ( Washington Times)

Centene, others step up to fill the exchange gaps

St. Louis-based Centene will sell individual exchange plans in 40 Missouri counties next year, including in those that were at risk of having no options in 2018. Centene is one of a small handful of insurers entering markets other insurers have abandoned. New York-based startup Oscar Health also plans to expand its footprint on the ACA marketplace in 2018. Others, including Molina Healthcare and Highmark Health, indicate they’ll continue to sell coverage in each of the states where they currently operate, Modern Healthcare reports. ( Modern Healthcare)

Vermont all-payer ACO moves closer to reality
Six months ago, Vermont got federal approval to form an all-payer ACO. Now, it’s almost ready to launch. According to Health Leaders Media, four of the state’s 14 acute-care hospitals have signed on, contracts have been inked with Medicaid and Medicare, and negotiations are underway with BlueCross BlueShield. ( HealthLeaders Media)

FQHCs face unique PCMH struggles, study finds
Federally qualified health centers that implemented the patient-centered medical home concept improved access to care, but didn’t reduce the use of specialty care, acute care or Medicare expenditures, according to a RAND Corp. study published in the New England Journal of Medicine. The problem isn’t the PCMH model itself, but the unique challenges faced by FQHCs, including patients’ long-standing disease burdens, substantial social service needs and limited English proficiency or health literacy. (Becker’s Hospital Review; NEJM)

A simpler solution? Direct primary care
In a commentary for Forbes, Ripley Hollister, MD, of the Physicians Foundation, makes the case for direct primary care. It is “a practical solution that supplants the craziness in the current debate and, in a simple way, provides a clear path for patients to beat all the rhetoric with something valuable, practical, coherent and concrete--the physician-patient relationship.” Legislation has been introduced that would allow patients to use their health savings accounts to purchase direct primary care. ( Forbes; Background on legislation)