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Michigan’s Debbie Stabenow says apparent defeat of Republicans’ health care effort in the Senate is “great news,” but notes that earlier attempts have been forsaken and rebooted.

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It wasn’t old age, or disease: A “bluish foreign body” that was found in an English woman’s eye turned out to be a mass of contact lenses, surprising medical staff who were preparing the woman, 65, for routine cataract surgery. They report pulling 27 lenses from the woman’s eye.

“She was quite shocked,” specialist trainee ophthalmologist Rupal Morjaria tells Britain’s Optometry Today.

Morjaria says she and her colleagues were startled to find 17 contact lenses clumped together as they were injecting anesthesia into the woman’s eye at Solihull Hospital, southeast of Birmingham. They then recovered another 10 lenses. Part of their surprise, she said, was because the patient hadn’t complained of any irritation.

“When she was seen two weeks after I removed the lenses she said her eyes felt a lot more comfortable,” Morjaria tells Optometry Today. “She thought her previous discomfort was just part of old age and dry eye.”

The woman had not complained about problems other than cataracts, according to the report Morjaria and others published in the British Medical Journal. The patient had been wearing monthly disposable contact lenses for some 35 years, she said.

Morjaria said she hopes the episode, which occurred last winter, raises awareness for patients who wear contacts but might go long periods without getting an eye exam — perhaps because they order them online rather than in person. The incident should also raise issues for optometrists, she said, noting that the mass of contact lenses hadn’t triggered an obvious infection.

Their BMJ article prompted one physician to remark in the comment section, “It does make one wonder about the appropriateness and completeness of the examination of the referring clinician!”

As for the surgery that had been planned — it was postponed, in part to allow bacteria that had accumulated to clear from the area of the eye.

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The Senate will postpone its consideration of the GOP bill to repeal and replace the Affordable Care Act until Sen. John McCain returns to Washington.

The Republican senator from Arizona is recovering from brain surgery performed Friday to remove a nearly 2-inch blood clot from above his left eye. The surgery was described as a “minimally invasive craniotomy with an eyebrow incision.”

“The Senator is resting comfortably at home and is in good condition,” according to his doctors at the Mayo Clinic Hospital in Phoenix, relayed in a statement from McCain’s office. He’s in “good spirits” after the “surgery went ‘very well.’ “

The tissue that was removed is undergoing analysis, and McCain’s office says results should be available within the next several days.

Shortly after McCain’s office released the statement, Senate Majority Leader Mitch McConnell clarified what the news meant for the vote on the Republican health care bill planned for next week.

“While John is recovering, the Senate will continue our work on legislative items and nominations, and will defer consideration of the Better Care Act,” McConnell said in a statement he posted to Twitter.

McConnell had been in a rush to get the bill to a vote, in part because it was thought more time wouldn’t help and could hurt the chance for passage.

And the Republican senator’s absence from the Capitol next week would have complicated the already tight math surrounding a planned Senate health care vote to repeal and replace the Affordable Care Act.

Two Republican senators have already announced opposition to the measure, Sen. Rand Paul of Kentucky and Sen. Susan Collins of Maine. With McCain away, unless one of those two senators changes their mind, Senate Republican leaders are unlikely to meet the 50-vote threshold needed to begin debate on the bill.

A chorus of senators weighed in on McCain’s recovery via Twitter, including the Democratic leader Chuck Schumer.

Sen. Jeff Flake, also from Arizona, put out a statement, saying he and his wife were praying for a speedy recovery.

“I have never known a man more tenacious and resilient than John McCain,” Sen. Flake said. “I look forward to seeing him back at work soon.”

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For Heather Gijanto, going to the doctor means taking a day off work and driving at least 60 miles round-trip from her home in McNeil, Ariz., to the town of Bisbee. And that’s assuming there’s a primary care doctor available in Bisbee to get her in.

“You select one doctor and then you find out a few months later that that doctor is no longer going to be available,” Gijanto says. “So then you have to start the whole process over again. And then you find that doctor and, for whatever reason, that doctor leaves as well.”

Gijanto is frustrated, and says she and her husband and their two young kids have had to change family doctors four times recently. Ideally, she says, the family would have one doctor who knew each member’s medical history, so “I didn’t have to explain my chart every single time, or have to go over medications all the time with each new physician.”

It’s long been hard to recruit new doctors to rural America. They can make a lot more money in metropolitan areas as specialists, and many choose to do that, especially if they’re saddled with mounting debt from student loans.

But the shortage, especially of primary care providers, has gotten steadily worse in recent years. According to the National Rural Health Association, rural areas could be short 45,000 doctors by 2020. And other trade groups warn those numbers of unfilled positions could loom even larger. Since 2010, more than 70 rural hospitals have closed.

The fallout is felt most acutely in small towns like Bisbee, which has a population of 5,400. The Victorian-era town has struggled since the 1970s, when the copper mines closed. Much of its economy now depends on tourists, who come to see the town’s well-preserved old West architecture and scenery, and to enjoy the local arts and music. But that income is largely seasonal. Bisbee’s full-time population has been steadily declining.

Today, says Mayor David Smith, a lot of Bisbee residents are uninsured, or rely on Medicaid. And this region has only about half the doctors it needs.

“Because of the lack of doctors, they actually end up using the emergency room for their normal needs,” Smith says. “They get a bad cold and they end up in the emergency room.”

Located in the mountains about 5 miles north of the border between the U.S. and Mexico, Bisbee is remote. Smith says they’ve worked hard to improve the town’s amenities. Among other things, this summer the public pool is finally reopening.

Still, there is no movie theater. There is only one grocery store left in town, no soccer fields. Little things like these can be a deal breaker when it comes to recruiting new doctors and other professionals.

And though the shortage of doctors all across rural America is a crisis affecting some 90 million Americans, the problem is not even part of the health care debate in Washington right now.

“Rural America is a forgotten America,” says Bisbee’s mayor, who believes the doctor shortage is just part of a broader story of rural neglect.

Smith points to the problem of student loan debt. Leaders in towns like this have long called for more generous debt-forgiveness programs for medical students, so that young doctors actually could afford to come out to underserved areas and work.

The mayor says there’s no sign this is being addressed by national politicians. They talk about rural America, he says, but when they get here they realize it’s complicated, and they leave and wait until the next election.

“Copper from Bisbee, Ariz., is what helped win World War I,” Smith says. “And yet, when we are in need, we are forgotten because it’s not convenient — and because it’s not a whole bunch of people here that are voters.”

Over at Bisbee’s Copper Queen Community Hospital, CEO James Dickson goes further.

He sees the doctor shortage as the latest example of why people in towns like this are feeling left behind, untouched by the economic booms in many American cities. It’s a likely contributor to the country’s growing economic and cultural divide, Dickson says.

“They’re starting to call the rural areas ‘the new inner city’ because we have the same shortages and lack of access to care,” he says.

How do you have a thriving economy if you don’t have access to health care?

“They can’t export a health care system like you all have in [Los Angeles] and other places,” Dickson says. “Doctors don’t come here. Doctors want a reasonable income, and I don’t blame them.”

Dickson’s 14-bed hospital and health clinic sit at the base of a mountain of old mine tailings — a legacy, if a somewhat bitter reminder, of better economic times. Copper Queen is often held up as a success for its low-cost model of high quality, especially when so many other rural hospitals are closing, or facing the threat of closure.

For now, Copper Queen has been able to get around the shortage of family doctors by incorporating telemedicine into its practice. Patients in need of specialty care or other emergency services can get consultations in real time from physicians at the Mayo Clinic. The hospital also has been able to hire more nurse practitioners and physician assistants.

But no one knows if these coping strategies are sustainable. Dickson thinks there’s another big problem, beyond the student loan issue, that’s being ignored: a shifting immigration policy that’s squeezing off the supply of young physicians from outside the U.S.

“They cap the number of visas and we can’t get doctors down here,” Dickson says.

Rural hospitals have relied heavily on foreign-born doctors who do residencies in underserved towns, in exchange for green cards. The cap means Dickson hasn’t been able to recruit a doctor to his hospital or clinic for 18 months.

No one is counting on a more liberal immigration policy under the Trump administration. And there’s a pervasive sense, in Bisbee anyway, that even if the national government weren’t divided, there’s only so much national leaders can do to solve the crisis.

Just as much of the responsibility lies within the local community, the mayor believes. Small towns like Bisbee that used to be wholly dependent on natural resources have struggled to reinvent themselves. Smith foresees some tough conversations.

“A lot of people still think that the mines are going to come back and resurrect this town. And of course that’s not going to happen,” he says. The mining industry has increasingly focused its business in South America. “Business practices have changed.”

It’s been hard for the economy to diversify, especially in a remote border region like this, Smith says. “And that hurts small towns with vision.”

Heather Gijanto, the mother of two who drives many miles to Bisbee for medical care, figures one of the solutions to breathing life into the region is to attract more private investment. She’s had the same job at a local Safeway for 14 years because she hasn’t been able to find much else.

“There’s not that much for people here,” Gijanto says. “There needs to be more options.”

More options, she says — and then maybe the doctors will come.

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The GOP’s latest proposal to repeal and replace the Affordable Care Act hews closely to the earlier bill that didn’t win enough support among lawmakers to bring to a vote.

Perhaps the biggest change in the document released Thursday is that it leaves in place the Affordable Care Act taxes on wealthy individuals. It uses that money to reduce the number of people left without insurance coverage by the law’s changes. This latest version adds $70 billion to a fund for states — bringing the total to $132 billion — to help support coverage of low-income people.

It also would allow insurance companies to offer health plans without the consumer protections included in the Affordable Care Act, or Obamacare. That means insurers could sell stripped-down policies that cover fewer conditions and offer fewer benefits than currently allowed under the law.

Those plans would very likely be cheaper than the policies currently offered on the Obamacare exchanges. But for people who would like to purchase plans that cover the essential health benefits mandated by the Affordable Care Act, including mental health coverage, addiction treatment, maternity care and prescription drug coverage, costs could go way up.

The nonpartisan Congressional Budget Office hasn’t yet analyzed the new bill. It weighed in on the earlier Senate bill, saying that proposal would result in 22 million fewer people having health coverage in the next 10 years, compared with under the Affordable Care Act. Of those, 15 million would lose Medicaid coverage. That version was projected to lower the deficit by billions over 10 years — but that may have changed as the latest version offers billions more for state grants and also doesn’t repeal as many of the Obamacare taxes.

Yet this new variant is the same as its predecessor when it comes to subsidies to help individuals pay for insurance. It would mostly reduce subsidies and cause out-of-pocket costs to rise, as the CBO said about the previous bill. It’s not yet clear how the state grants would alter that dynamic.

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Michael McBrayer of St. Paul, Minn., needs to pay a lot attention to his health.

“I give myself shots multiple times a day, as well as controlling my diet and exercise,” he says.

Ten years ago, McBrayer learned he has Type 1 diabetes. Now he knows he faces dire consequences if he fails to control his blood sugar.

“Kidney failure, blindness, heart disease — all those things are looming out there,” he says.

McBrayer has health insurance through his wife’s employer, the state of Minnesota. It’s a HealthPartners health insurance plan that charges extra to employers — in this case, the state — to cover diabetes care. So for the past several years, McBrayer’s plan has paid for everything he needs to keep his diabetes in check. He doesn’t spend a dime on supplies.

Diabetes, high blood pressure and other chronic conditions account for the vast majority of health spending in the U.S., according to the Centers for Disease Control and Prevention. Almost half of American adults have one or more chronic physical or mental health conditions, and spending on them adds up to some $2.3 trillion a year.

Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot money in the long run.

“We’ve been trying change the health care conversation in the United States from how much we spend to how well we spend,” says Dr. Mark Fendrick, head of the University of Michigan’s Center for Value-Based Insurance Design.

He says it makes both medical and economic sense to make properly managing chronic conditions affordable.

“I want the health insurance plan my patients have to charge my patients the least for the services that are going to make them healthier,” he says. “Let’s allow those to be covered on a pre-deductible basis; you’re not leaving the patients paying 100 percent of the cost.”

That may seem like common sense, but health plans have been running hard in the opposite direction. Consumers are on the hook for a rapidly increasing amount of their health costs — in large part to try to curb health costs.

But corporate buyers of health insurance are starting to realize that people may be putting off necessary care, says Mike Thompson, who runs the National Alliance of Healthcare Purchaser Coalitions. The organization advises around 12,000 organizations that buy health plans for tens of millions of Americans. He says those who provide insurance need to take a thoughtful look at what they pay for and what consumers should pay for.

“So that people are more prudent on discretionary care but are more compliant with the care they need and certainly the case they need to stay healthy,” Thompson says.

If people have to pay out-of-pocket for care they might not need, they may think twice, but their day-to-day health needs are taken care of.

One major obstacle to this approach, known as “value-based health insurance,” is an IRS rule that does not allow free maintenance care for chronic conditions for the 20 million Americans with health savings account-qualified, high-deductible insurance.

The enhanced insurance benefit that pays for all McBrayer’s Type 1 diabetes maintenance is paying off for state taxpayers, according to HealthPartners, his provider.

That program has helped quadruple the number of diabetes patients with optimal care, saving the state about $1 million on medical services since its inception almost 10 years ago, says Dan Rehrauer, a program manager at HealthPartners.

“We’ve shown that we’ve reduced hospitalization and emergency department utilization, which is exactly what we want to see,” Rehrauer says. “You’ve got a healthy employee and that results in not ending up in the hospital and saving money.”

This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.

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Senate Majority Leader Mitch McConnell, R-Ky., plans to release an updated Republican health care bill on Thursday and is delaying the body’s annual August recess by two weeks in an effort to generate momentum for the beleaguered legislation.

“In order to provide more time to complete action on important legislative items and process nominees that have been stalled by a lack of cooperation from our friends across the aisle, the Senate will delay the start of the August recess until the third week of August,” McConnell said in a statement. Originally senators were supposed to head home at the end of July.

The GOP will also release an updated version of their Better Care Reconciliation Act, which so far has drawn opposition from both moderate Republicans who say it goes too far in reducing Medicaid funding and conservatives who argued the bill doesn’t go far enough to fully repeal regulations and subsidies in the Affordable Care Act, or Obamacare.

McConnell had wanted to have a vote on the bill before the July 4th recess, but he didn’t have the votes he needed to pass it after at least five GOP lawmakers came out against the current version. There are currently 52 Republicans in the Senate and 50 need to support it to pass.

A revised Congressional Budget Office score, showing the costs and impact on coverage of the new version of the bill, is expected on Monday or Tuesday of next week. The CBO score of the first version found that the BCRA would leave 22 million more people uninsured by 2026.

A vote on a motion to proceed on the revised bill is expected by the end of next week. If that preliminary procedural measure passes, there will be debate on the bill that could go on for days.

Some Senators have already begun offering alternatives which could make it into the revised bill. Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, have an amendment which would let insurance companies sell any health insurance plan they wish as long as they also offer at least one plan that is compliant with all of the coverage mandates outlined in Obamacare.

That would allow insurers to offer plans that do not comply with ACA regulations, like providing so-called “essential health benefits,” and would therefore provide less robust coverage and cost less. Critics say it will cause costs for people with pre-existing conditions who need more services to rise sharply, undermining protections in place for them.

The White House supports the amendment, and Cruz told reporters on Tuesday that he believes that plan is the key to a deal.

“I think the reason is that it is the necessary ingredient to getting the votes that we have to have to follow through on our commitment to repeal Obamacare,” Cruz said. “I believe we can get there. It remains challenging. More work remains to be done. But there is a path forward.”

GOP senators are already warning that failure to uphold their seven-year campaign promise to repeal and replace Obamacare could have reverberations with their base.

“We should not be surprised if people are irritated with the Republican majority when we have been promising, and we do not deliver,” Sen. Chuck Grassley, R-Iowa, said on Fox News Tuesday. “I am very pessimistic.”

However, the bill overall has little support with the American public. An NPR/PBS NewsHour/Marist poll earlier this month found just 17 percent support the Senate GOP bill, and that even GOP support for it is soft.

Ultimately, if this doesn’t work, Republicans may need to find a way to bring Democrats to the table, and Sen. Lindsey Graham, R-S.C., has hinted he’s working on a way to do just that in the coming days.

“We’re not there yet, but we’re working with governors, and we may be taking some of the critics of the current bill and converting them to supporters,” Graham told reporters on Tuesday.

NPR’s Susan Davis contributed to this report.

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