Republican senators are trying to revive their health care bill. While voters weren’t fond of the the original version, but they’re not always clear about what they want when it comes to health care.

LAKSHMI SINGH, HOST:

With Congress back in Washington this week, we wanted to take a look at a Word You’ll Hear. And in this case, the word is actually letters – BCRA. That’s the acronym for the Better Care Reconciliation Act. It’s the proposed Senate bill to repeal and replace the Affordable Care Act. So far, this GOP draft is very unpopular, with just 17 percent of Americans supporting it according to an NPR “PBS NewsHour” Marist Poll. With so many people unhappy with this proposal, we were curious what they do want to change about the Affordable Care Act. NPR political reporter Danielle Kurtzleben has been looking into that. Hi, Danielle.

DANIELLE KURTZLEBEN, BYLINE: Hello.

SINGH: So we know Republicans are working on different options for how to approach their repeal and replacement of the Affordable Care Act. What are some of the ways the system could change?

KURTZLEBEN: So Obamacare, of course, expanded Medicaid. What the Senate bill would do would be to rollback that Medicaid expansion. Plus, it would cap Medicaid spending further. Aside from that, it would provide less generous subsidies for people to buy insurance on those individual markets. And it would get rid of a lot of the taxes that Obamacare imposed to help pay for itself.

SINGH: What did you see when you looked more closely into what people might actually want to see in health care reform?

KURTZLEBEN: You know, it’s hard to say. For example, right now, a majority of Americans – about 60 percent according to the Pew Research Center – say it’s the government’s responsibility to make sure people have health care. OK, so that’s cut and dried, 60 percent. And that was true before Obama took office, as well. But while Obama was in office, there was no clear majority on either side of that. So clearly people’s opinions on this can vacillate one way or the other pretty quickly depending on what’s going on.

Likewise, a growing share of Americans – right now it’s 53 percent – they say that they want single-payer health care. Once again, that sounds cut and dried. But what the Kaiser Family Foundation found out is if you present people with an argument for or an argument against, you can swing public opinion in a massive way on single-payer. So it’s not really clear how much people do like that idea.

SINGH: So it can depend a lot on how this is actually framed.

KURTZLEBEN: Right. Absolutely. And one way to think of this is, you know, you can say, yeah, Americans are just squishy on this, but if you really think about it, health care is just a very personal, really kind of scary issue for people. It could be a life-or-death issue for many of us at some point. So the idea of massively overhauling, it you can understand how that would make people feel in conflicting ways about it.

SINGH: What about this current system? We’ve seen figures that indicate Obamacare is getting consistently more popular, right? So what does this mean? Are people generally satisfied to keep things the way they are?

KURTZLEBEN: Sort of. I mean, Gallup did find in late 2016 – I mean, even before the election – that around two-thirds of Americans say they’re satisfied with the health care system. And Gallup also found that right now, for the first time this year, Obamacare had majority approval. But certain parts of Obamacare are very popular in certain parts, namely the individual mandates are not popular at all.

The individual mandates, that provision that says you have to have insurance or pay a penalty, that’s the only one that a majority of Americans didn’t approve of. Only 30 percent of people like that. The irony, of course, is that you need the individual mandate to make the rest of Obamacare work.

SINGH: What might congressional leaders keep in mind then if they’re looking to please as many Americans as possible, if not all Americans?

KURTZLEBEN: Right. Well, I mean, of course, you can’t please all Americans. You know what? You might not even be able to please everyone in your own party fully. It’s a very unforgiving topic to try to create legislation on just because it is such a complicated topic. This is not repealing or imposing a tax. This is making a whole massive system for a whole bunch of Americans work correctly.

SINGH: That’s NPR’s Danielle Kurtzleben. Thanks, Danielle.

KURTZLEBEN: Thank you.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Doctors Julie Gunter, Rob Stone and Gary Sobelson talk with Scott Simon about the problems with American health care and what they think of the current Republican health care plan.

SCOTT SIMON, HOST:

The United States spends about $9,000 per person per year on health care, the highest in the world. But our life expectancy is still lower than France, Switzerland, Japan, the United Kingdom, all of which spend less. With the Republican health care bill still on the Senate docket, we thought it would be a good time to hear from U.S. doctors. We have three with us now, Dr. Julie Gunther, a family doctor in Idaho, Rob Stone, an ER turned palliative care doctor in Indiana, and Dr. Gary Sobelson, a primary care doctor in New Hampshire. Thanks so much for being with us.

GARY SOBELSON: Thank you.

ROB STONE: Thank you.

JULIE GUNTHER: Thank you.

SIMON: Let me begin, if we can, with you, Dr. Gary Sobelson there in New Hampshire. Seven years since the Affordable Care Act – three since most of the changes went into effect. How is health care different? Is it better, worse?

SOBELSON: Much better coverage for our patients, particularly, in my case as a family doctor, for the working poor. I have people coming in for preventive services, for hypertension management, for cardiovascular disease prevention, for cancer screening who really had not been coming in except for the most acute needs. And that’s been meaningfully different.

SIMON: Dr. Rob Stone in Indiana, you were an ER doctor. You must have seen patients who who came to the ER because they didn’t have insurance to cover primary care visits. Has that changed under the Affordable Care Act for you?

STONE: It’s changed very noticeably. And a far smaller percentage of people are coming in uninsured, although we still continue to take care of those folks, too. Our hospital’s also affiliated with some very small-town hospitals in Bedford, Ind., Paoli, Ind. And in those areas in particular, I think the Medicaid expansion part of the Affordable Care Act has helped to solidify the financial standing of those hospitals, which was somewhat questionable earlier.

So I would say that’s all good. The downside – and this started before the Affordable Care Act – before Obamacare – is that co-pays and deductibles and premiums keep going up for the people who aren’t on Medicaid. And so people coming into the ER find themselves underinsured too often when they realize they can’t afford their co-pays or their deductibles.

SIMON: Dr. Julie Gunther, you’re a family doctor in Idaho. And I gather you’ve kind of opted out of the typical model and you have your own direct primary care practice.

GUNTHER: Yes, I have. I was a system-employed outpatient physician until 2014. And then I left and started a solo, independent, cash-based practice. So I no longer bill insurance.

SIMON: And why did you take that step?

GUNTHER: The simple answer is I had to leave the system to save myself to be the doctor I wanted to be. It’s valuable for me to hear Dr. Sobelson and Dr. Stone’s experiences. My experience was very, very different. Even before the Affordable Care Act – but especially after – the progressive amount of regulations made it almost impossible for me to serve people the way I was originally called to serve them as an outpatient family doctor.

And so I have built a rather successful cash-based practice that charges very, very little per month. The majority of my patients are either uninsured, underinsured or so frustrated with the current system and its barriers that they would rather pay a small amount out of pocket every month for more direct care.

SIMON: Well – and so I’m going to bring Dr. Rob Stone into this conversation because I’ve been told you’re an advocate for a single-payer system. Is Dr. Gunther onto something?

STONE: Well, I don’t know how generalizable it is widely – and particularly not to very poor areas like the inner city. But my feeling is that we have a good model for how to take care of everybody, which some people still think is kind of a pie-in-the-sky dream. But I’m still going to push for it. And I think that is expanding Medicare, which already takes care of everybody over 65. And I happened to turn 65 a couple months ago. And I’m on Medicare now. And I’m pretty happy with that.

SIMON: Dr. Gary Sobelson, are the high costs of health care unavoidable? Can’t we, after all, just do more for people – a lot more – than we could even 10 and 20 years ago?

SOBELSON: While there are many things that we can do, the high costs are things that the system itself brings about. We’ve designed a system that rewards high-reimbursement procedures, surgeries and undervalues the things that are cost-effective. And it doesn’t really matter how much we research this or prove this to ourselves within our profession. We don’t seem to move in that direction. We don’t have the political will.

Dr. Stone’s comments about Medicare for all are not isolated to small groups of the population. We’ve studied this in New Hampshire, and over 80 percent of our primary care physicians are in favor of a system that some would call single-payer – and the majority of our overall doctors, even including specialists. And that’s been replicated across the country, too. We as Americans seem to value our independent decision-making over collective wisdom, though I would argue that when simple procedures like common arthroscopic knee surgery, something that takes 15 to 30 minutes, is costing $15,000 to $25,000 in community hospitals around our country – that no one has the freedom to make that decision.

GUNTHER: I was just going to say I normally talk about a single payer system. And we use Medicare as a model. My patients who have Medicare say that it works. My mother and father who are economically well off pay $150 a month towards their health care. My Americans who are age 30 to 60 are dropping their health care plans. And they come in, and they tell me, I can choose between putting food on the table, paying for my kid to go to college or getting a health plan that I can’t afford.

So it’s not that I oppose a broader solution. But I would contend we have a system that is completely crumbling and unsustainable. And in my opinion and experience, I don’t think Medicare is working all that well, especially not in a way that we could roll it out to our whole country in any sort of sustainable way. And the heart of it in my opinion is we talk a lot about who’s going to pay for health care. But what we should be talking about is the price of health care.

SIMON: Do we have an unrealistic expectation that health care costs can be reduced when we expect health care to do more and more?

GUNTHER: I think there’s great examples that current health care prices are upwards of a thousand times more than anywhere close to true cost. My patients can get a CAT scan – cash price for $300. If they go into the local ER, it’ll bill out at $2,400. So I think we need to start asking why. Because we keep talking about who should pay or how we should pay for health care.

But if we allow free market forces and competition to create price transparency, then we start to have the opportunity for price control, cost control. And then I think we can completely change the dialogue from who should pay and how should we pay too to what parts of health care do people need help paying for.

SOBELSON: I think Dr. Gunther is describing the problems that we’ve created by more or less – and this is a failing of the ACA – allowing corporate profitability to be the driving force of how we set these so. So, again, if you’re not under Medicare or Medicaid in this country, you’re depending on a private insurance industry to somehow control costs, when, in fact, it’s not really in their interest. They don’t have skin in the game here.

They make their profitability based on how much they collect in revenue. And, in fact, it’s written into the law. So, again, it’s not surprising that we’ve created a model where, in fact, more spending will be encouraged, not discouraged because the only people who really would care about it would be the consumers. And they don’t seem to believe that they can control it.

SIMON: Let me ask this finally, if I could. The Senate bill that’s under consideration right now may or may not be going anywhere. Could each of you give us one idea that you would like to see the government adopt that could improve health care in this country? – or not just the government. What can we do?

STONE: Well, I would say first that the Senate bill is a terrible thing that would set us back and would cost lives. And the people who would be hurt the worst would be children, the disabled and the elderly and nursing homes because of the ravages to Medicaid. So the first thing I would do would be, say, save Medicaid and continue to expand it. And then the second biggest problem in the Senate bill is that it would make health care very expensive for people ages 50 to 65 or 55 to 65 – would be to think about lowering the age of Medicare eligibility to, say, 55 and not cut those people out into the cold.

SIMON: That’s Dr. Rob Stone in Indiana. Dr. Julie Gunther, what would you suggest?

GUNTHER: I would agree with Dr. Stone. I don’t think the Senate bill provides the improvements to the Affordable Care Act or some of our biggest health care problems that we need. If I had one ask it would be that we allow consumers – we allow patients who do have health savings accounts to use those health savings dollars to pay their physician, whether it’s a periodic fee or a direct payment.

And one of my favorite quotes about health care in our country is that we continue to tape wings on a car and call it an airplane. I think we have to radically transform the system at its core if we hope to end up in a different place.

SIMON: And Dr. Gary Sobelson.

SOBELSON: Yeah. From my perspective in New Hampshire, I think the damages to Medicaid that the Senate bill would bring about would be devastating to us and take back so much positive progress we’ve had in terms of access and cost containment.

And if I had to add one thing to it, I think Dr. Stone’s idea of expanding Medicare to populations that traditionally have a hard time buying insurance could be extended into the whole idea of the ability of a public option, the ability of the Medicare and Medicaid programs to work out ways to compete with private insurers so that the public could become more comfortable with them.

SIMON: Doctors Rob Stone, Julie Gunther and Gary Sobelson, thanks so much for joining us.

GUNTHER: Thank you.

STONE: Thank you.

SOBELSON: Thank you.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Dr. Brenda Fitzgerald has been appointed as the new director of the Centers for Disease Control and Prevention in Atlanta. She is an obstetrician-gynecologist who’s led the Georgia state health department for six years. She succeeds Dr. Thomas Frieden.

KELLY MCEVERS, HOST:

Now to someone who is joining the federal government. The Trump administration has named a new director to head the Centers for Disease Control and Prevention. Dr. Brenda Fitzgerald comes from Georgia, where she’s led the state’s public health department and where the CDC is located. She takes the helm at a time when the agency could face budget cuts. Elly Yu of member station WABE in Atlanta has more.

ELLY YU, BYLINE: Fitzgerald replaces Dr. Tom Frieden, who left the CDC in January at the end of the Obama administration. The 70-year-old is an OB-GYN and led Georgia’s Public Health Department for the past six years. There, she’s overseen efforts like preventing Zika and coordinating the state’s response to Ebola. In 2014, several Americans who got the disease were treated at Emory University in Atlanta. Here she is at a press conference about efforts to contain Ebola in the state.

(SOUNDBITE OF ARCHIVED RECORDING)

BRENDA FITZGERALD: We intend that if patients are treated here, we want to absolutely make sure that the medical people treating them are absolutely safe.

YU: During her time as public health commissioner, she’s made early childhood development and tackling childhood obesity priorities. Fitzgerald also has deep political ties. She ran for Congress as a Republican twice in the 1990s and lost and served as health adviser to former House Speaker Newt Gingrich. Tom Frieden, her predecessor, says right now there are a number of public health challenges in the U.S. and globally she’ll face as director. Those include the opioid epidemic and drug-resistant diseases. But his worries are also elsewhere.

TOM FRIEDEN: The biggest challenge Dr. Fitzgerald will face is the budget.

YU: President Trump’s budget proposal cuts funding to the CDC by $1.2 billion in fiscal year 2018. Bills in Congress also call to eliminate the Prevention and Public Health Fund, which helps fund the agency. If that happens, Frieden says…

FRIEDEN: CDC would have to retreat from protecting Americans in this country and around the world. It would leave Americans more vulnerable to infectious diseases and other health threats. It would drive up health care costs. And quite frankly, it would mean avoidable deaths.

YU: Dr. Georges Benjamin leads the American Public Health Association. He, like others in the public health community, praised Fitzgerald’s pick. He says he’s hopeful of her ties with Health and Human Services Secretary Tom Price, who was a congressman from Georgia.

GEORGES BENJAMIN: You know, I hope that trusting relationship will allow her to make a really informed case for improving the CDC’s budget situation.

YU: Fitzgerald says in a statement she’s humbled by the challenges that lie ahead and is confident her experience in Georgia will guide her work at the CDC. Today’s her first day on the job. For NPR News, I’m Elly Yu in Atlanta.

(SOUNDBITE OF JUNGLE SONG, “BUSY EARNIN'”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A new report from the Centers for Disease Control and Prevention says opioid prescriptions are down, but still way too high. While doctors are prescribing lower doses, they are still doing so for longer than CDC guidelines say are safe. NPR’s Robert Siegel talks to Dr. Alan Schwartzstein, who has worked as a family doctor for 28 years in rural Wisconsin, about the issues surrounding prescribing pain medication.

ROBERT SIEGEL, HOST:

Well, as we’ve heard, the last year of data included in the CDC’s report was 2015. Since then, the agency has released guidelines for prescribing opioids. They’re meant for primary care physicians like Dr. Alan Schwartzstein. He’s been a family physician for over 30 years. He works in rural Walworth County, Wis. And he’s a member of the board of the American Academy of Family Physicians. Welcome to the program, Dr. Schwartzstein.

ALAN SCHWARTZSTEIN: Thank you, Robert.

SIEGEL: Are you prescribing fewer opioids than you used to?

SCHWARTZSTEIN: Yes, I am, absolutely.

SIEGEL: And how many opioid prescriptions do you write now as opposed to five, 10 years ago?

SCHWARTZSTEIN: Well, approximately 15 years ago there was a lot of encouragement from patient advocacy groups, people that had chronic pain, as well as some government organizations for us to prescribe more and do a better job of treating chronic pain. It’s just in the last four to six years that we’ve recognized a significant increase in opioid prescribing. And so during that time I prescribe less. I do shorter prescriptions. And in the last year, I’ve actually – am actively working with all my patients who are on this to wean them back off, that or use other modalities.

SIEGEL: Are you at all concerned that the pendulum with regard to painkillers might be swinging too far? That is, that doctors might be overly reluctant right now to prescribe opioids to patients who are dealing with chronic pain?

SCHWARTZSTEIN: It’s possible. Family physicians have to run a thin line between providing adequate treatment for chronic pain and limiting opioids. I don’t think it’s going to go too far, Robert. I’m optimistic.

SIEGEL: I have heard from doctors who practice in rural areas that the question of how many pills you prescribe is a tricky one because if you give too few pills, your patient isn’t like someone in the city who can check back with you in a few days and have another visit with the doctor. The patient may be 60 miles away from your office. Is that a problem for you in Walworth County, Wis., and how do you deal with it?

SCHWARTZSTEIN: For people that I’m treating with opioids for chronic pain, generally the prescriptions I’m giving them and that I’m refilling for them are for a 28-day period. However, for acute pain, I’m beginning to prescribe shorter durations, actually only three days for someone that comes in with a bone injury or some other reason for pain. And they only needed those three days. And after that they relied on acetaminophen and Ibuprofen and the like.

SIEGEL: In addition to seeing patients at your practice, you also hear from patients who are seeking emergency care. Do you hear different kinds of problems related to opioids there?

SCHWARTZSTEIN: Well, I do. Patients don’t generally come in there seeking to get off an opioid. They usually come in on weekends asking for a refill on their medication either because their own physician is out of the office or it’s the weekend and they ran out. Generally we get to understand when we should be prescribing for a few days to get them through and when this probably is not an appropriate prescription. And I’ve had at least three people over the last six months in the urgent care when I declined to write a prescription say, you know, doc, I can go on the street and get heroin or this medicine for cheaper anyway.

SIEGEL: What do you say to someone who says that?

SCHWARTZSTEIN: I hear what you’re saying, but ethically I don’t feel this is the right medication for you. What you do when you leave is up to you. But I also say to them, you know, if this has become an issue with you of overusing the medication or you feel it might be a problem, I’d like to get you connected with somebody that can help you deal with this and control your addiction.

SIEGEL: What is the opioid situation in Walworth County, Wis.? Do you think the county ranks as one of those with a very large problem or in the middle or a small problem?

SCHWARTZSTEIN: I would say we’re probably in the middle. It is a rural county, and we have a large population that is unemployed or underserved. And so opioid addiction and use of opiate medication tends to increase in those areas. And I see that in the area.

SIEGEL: Dr. Schwartzstein, thank you very much for talking with us today.

SCHWARTZSTEIN: Thank you, Robert.

SIEGEL: Alan Schwartzstein is a family physician in southeast Wisconsin.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A joint NPR and ProPublica investigation finds the U.S. medical system can be unprepared when the complications of childbirth turn deadly. NPR reports on healthy mothers who developed one highly treatable complication — preeclampsia — and how it killed them.

KELLY MCEVERS, HOST:

NPR and ProPublica have spent months investigating why it is that the number of mothers dying from complications of pregnancy and childbirth has been rising in the U.S., why that death rate is now higher than any other industrialized nation, why American women are three times likelier to die than women just across the border in Canada.

ROBERT SIEGEL, HOST:

As NPR’s Renee Montagne and ProPublica’s Nina Martin have reported, 60 percent of these deaths could have been prevented. Today we hear about a woman who had a complication unique to pregnancy and childbirth. Renee looks at what her experience tells us about the system that allowed her to die.

RENEE MONTAGNE, BYLINE: This is the story of Lauren Bloomstein. We heard it one rainy day in the New Jersey home of Larry Bloomstein looking onto a child’s playroom filled with princess dresses and a big plush unicorn.

LARRY BLOOMSTEIN: Come here.

MONTAGNE: Hi, cutie.

HAILEY BLOOMSTEIN: Hi.

BLOOMSTEIN: Can you say hi?

HAILEY: Hi.

MONTAGNE: Hi.

BLOOMSTEIN: I have a question for you. Where did you get these beautiful green eyes?

HAILEY: Mommy Lauren.

BLOOMSTEIN: From Mommy Lauren, yeah.

MONTAGNE: Hailey knows Lauren through stories and photographs. A favorite of Larry’s shows Lauren, slender and tan, standing in the foam of a pale blue sea with a barely swelling belly.

BLOOMSTEIN: Lauren loved the beach.

MONTAGNE: Etched in the sand is the name Hailey.

BLOOMSTEIN: She looks, I’d say, like the happiest and most alive the whole time I knew her. I remember her talking to Hailey through her tummy. I remember, like, 28 weeks saying, just don’t come out too soon.

MONTAGNE: As a neonatal nurse at a large medical center near the Jersey Shore, Lauren knew how vulnerable preemies can be.

BLOOMSTEIN: So she made it all the way to 40 weeks, like, really no problem. She was entirely, entirely healthy.

MONTAGNE: What neither she nor Larry, an orthopedic surgeon himself, considered was that Lauren might not survive her own baby’s birth. Yet as we’ve reported, every day in America on average, two or three women die from pregnancy-related causes. Complications include hemorrhage, blood clots, infection, heart failure and the syndrome that killed Lauren Bloomstein, preeclampsia, a disorder of the placenta, the organ that delivers oxygen and nutrients to the fetus. There are an array of symptoms – persistent swelling and headache and dangerously high blood pressure. Preeclampsia affects about 5 percent of all pregnant women in America. It’s highly treatable, but it can turn deadly if that treatment comes too late.

In Lauren Bloomstein’s case, her medical charts during labor record high blood pressure readings, though her nurses did not alert her doctor. And in a home video taken minutes after birth, Lauren is glowing, tearing up in wonder at her tiny newborn. Then Hailey was whisked away to be weighed and measured. Lauren would never see her again.

BLOOMSTEIN: Lauren didn’t touch any of the food that they brought her, and she started describing, like, really one of the worst pains she’s ever felt, and she was pointing with one finger right in the center of, like, the bottom of her sternum. And she didn’t know how to get rid of that pain.

MONTAGNE: Lauren’s blood pressure had begun spiking, and that upper gastric pain – it’s a key symptom of severe preeclampsia. Yet her medical records show her obstetrician ordering a common antacid. Acid reflux, heartburn is a leading misdiagnosis when it comes to preeclampsia.

BLOOMSTEIN: Being around patients in a hospital, you can tell when someone looks sick. And she looked really bad, and I wasn’t sure what to do because the OB seemed confident that this was nothing, and I was not trying to overstep my bounds and assume the system knew what it was doing.

MONTAGNE: Untreated, Lauren’s preeclampsia progressed to a far more dangerous syndrome. Known by the acronym HELLP, it can lead to kidney and liver failure after a breakdown of blood cells and a dramatic loss of the blood’s platelets, which help stem bleeding. Lauren’s medical records show her writhing in agony for hours as the doctors treated her pain but failed to accurately put together her symptoms. Finally this – patient states, quote, “do anything to stop this pain.” Larry was by now frantic that Lauren’s high blood pressure wasn’t being treated. Her obstetrician responded with a call for morphine.

BLOOMSTEIN: I was like, you know, maybe another doctor should see her. But while I’m talking to Lauren, I looked at her face, and I realized that she is not moving her whole face. She just suddenly looks really calm and comfortable. And I’m like, Lauren, smile for me. And when she smiled, only the right side of her face – only the right side went up. So then I actually said to the OB, you have to call a neurosurgeon. And he didn’t know why. He asked me, why? And I was like, ’cause she’s had this blood pressure for so long that’s so high, she now has a stroke. She burst a blood vessel in her brain. She has a huge bleed. It needs to be evacuated.

And the obstetrician was like, you know, she just got morphine; this is going to be some weird, adverse reactions to the morphine. It’s not going to be a stroke. And I was thinking, like, I don’t see how that’s going to be true, but I’ll pray for a miracle here. And I remember watching her CAT scan come up on the screen, and there’s an enormous bleed in her brain. So it’s like – I was like, all right, well, we’ll still have her. She might be paralyzed. She might be partially paralyzed, but we’ll see.

MONTAGNE: Eleni Tsigas has been hearing stories like this for 20 years after she was rushed to the hospital with severe preeclampsia. She survived. Her baby did not.

ELENI TSIGAS: It was a perfectly normal pregnancy until it wasn’t.

MONTAGNE: Tsigas now heads the preeclampsia foundation focused on a complication many say should never lead to the death of a mother. Preeclampsia kills up to 70 women in the U.S. each year. Great Britain once had similar statistics until it instituted a system of uniform responses, the kind of protocols not followed in Lauren’s case. With British medical teams basically on high alert for preeclampsia, Britain brought its numbers down to nearly zero, on average one death a year.

TSIGAS: It’s the disorder of the placenta, right? And when it’s not functioning properly, it’s going to affect both mom and baby. And what a lot of science is really trying to push for now is understanding what is it that’s breaking down in the placenta that causes this to happen?

MONTAGNE: Even though it’s little understood what causes the placenta to become dysfunctional, there are drugs for the high blood pressure and seizures associated with it. Traditionally one important treatment is simply giving birth. But the widely held notion that expelling the placenta is the cure is a myth.

TSIGAS: And the problem with that myth that delivery is the cure is it mentally, emotionally, intellectually – like, it just releases you from, like, anything else that could go wrong is not going to go wrong. And that’s not true.

MONTAGNE: In a 2015 deposition after her death, Lauren Bloomstein’s own obstetrician was asked how to treat or cure preeclampsia. Twice he answered delivery, the third time, quote, “delivery is the only cure.” In fact 80 percent of all deaths from severe preeclampsia occur after birth, as happened with Lauren. It wasn’t until after a code stroke was called that the most basic treatment for severe preeclampsia, magnesium sulfate, was initiated.

Lauren had finally gotten the correct diagnosis, but now she needed surgery to relieve the pressure on her brain caused by the bleed and also a much higher level of platelets. Remember; they help clot the blood. As a surgeon, Larry new platelets could be transfused, and yet…

BLOOMSTEIN: They had none. They were able to call to another hospital and have platelets brought, but that takes all night. And in the meantime, Lauren has this bleed. So we just sat overnight.

MONTAGNE: And by the time the platelets arrived the next morning, it was too late.

BLOOMSTEIN: She did something called doll’s eyes where they – if you take someone’s head and basically turn it side to side and the eyes just move with the head and don’t deviate, it’s the beginning of brain death. And I remember watching him – sorry – do that to her. And so they took her to the operating room, and the neurosurgeon – they operated for I think about four hours, and when he came out, he said that she’s still alive. She’s on – basically on life support, but she’s braindead. So at that point, we decided to withdraw care. And then I brought Hailey in one last time. And I just put Hailey in Lauren’s arms. Then they withdrew care, and she passed away.

MONTAGNE: Days later, Larry held Hailey in his arms when they buried Lauren. He never returned to live in the red brick house they had just bought. When Hailey was nearly three, Larry remarried, and he and his wife Carolyn had another daughter. Yet on a day devoted to Hailey’s birth and Lauren’s death, it’s clear the hurt is always there.

BLOOMSTEIN: I can’t. Like, I literally can’t accept it. The amount of pain she must have experienced in that exact moment when she finally had this little girl – I can’t fathom it. The timing is just so incredibly cruel.

MONTAGNE: NPR and ProPublica found many of the mistakes that lead to maternal death stem from a medical system that bases care on the idea that it’s rare for a woman to die in childbirth. It’s a system where funding and resources are directed mostly at saving babies.

BARBARA LEVY: The assumption is pregnancy and delivery is a normal process, and bad things don’t happen.

MONTAGNE: Dr. Barbara Levy handles health policy at the American College of Obstetrics and Gynecologists.

LEVY: But we worry a lot about vulnerable little babies, and we don’t pay attention I think to those things that can be catastrophic for women.

MONTAGNE: And those catastrophes are not a thing of the past. In May, not far from Larry Bloomstein, Joe Dellavalle watched his wife, Jessica, die in terrible pain nine days after giving birth in an emergency caesarian to their third child, a daughter, stillborn. Doctors told them her placenta had torn away from the womb due to severe preeclampsia HELLP, a syndrome neither Jessica nor Joe had ever heard of.

JOE DELLAVALLE: We were asking a lot of questions. You know, what is happening? Why is she so swollen? And then every single day, either the OB team – each one explained to us that the baby had come out of her system, and you know, that was the cure, and it was just a matter of days until the HELLP syndrome worked its way through her system.

MONTAGNE: Jessica was advised early on to chew gum to get rid of gas. For days she was given pain medication, abdominal surgery, an array of treatments without addressing the syndrome that she would die of.

DELLAVALLE: I was just stunned that we lost her. I can’t – I think that, you know, Jessica and I and the children could have moved on from the baby, so we would have grieved together as a family. But losing my wife is a completely different story. To me, it’s so much more impactful to not only me but my children to lose Jessica.

MONTAGNE: Jessica Dellavalle’s Facebook page is a poignant reminder of what has been lost. A little girl and boy smile shyly out from behind their mother’s pretty profile photo. And her very last post at the end of a seemingly perfect pregnancy – a do-it-yourself video on how to fashion cupcake liners – yellow and pink and lavender – into a bright bouquet for Mother’s Day. Renee Montagne, NPR News.

(SOUNDBITE OF AKIRA KOSEMURA’S “INSIDE RIVER #1”)

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NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Virginia Republican gubernatorial nominee Ed Gillespie is getting questions about health care on the campaign trail. His Democratic rival, Ralph Northam, is also making it a campaign issue.

LULU GARCIA-NAVARRO, HOST:

Republicans in Congress are worried about the political consequences of their proposed health care legislation, but they aren’t the only ones. The Republican running for governor of Virginia is now facing lots of questions about health care, too. Here’s NPR’s Sarah McCammon.

SARAH MCCAMMON, BYLINE: A barbershop in downtown Richmond was the setting for a forum on opioid addiction hosted by a local radio station Friday night. Republican candidate Ed Gillespie, who’s white, addressed a mostly black audience sitting on sofas in salon chairs in a small upstairs loft as men sat for haircuts and beard trims below. Gillespie promised to look for bipartisan solutions to the addiction crisis facing the country.

ED GILLESPIE: I am constantly listening, always looking for new ideas and always looking for them everywhere.

MCCAMMON: Gillespie is running in one of the few high-profile races of 2017. In the governor’s race, he’s up against Virginia’s lieutenant governor, Democrat Ralph Northam. Gillespie won last month’s Republican primary by just a few thousand votes, beating back a surprisingly strong challenger who’d styled himself after President Trump.

He’s now trying to appeal to moderates as well as conservatives in a state that’s become increasingly friendly to Democrats over the past couple of decades. As he was wrapping up his remarks, a woman stepped forward to ask Gillespie about the health care bills before Congress. Lawmakers are still negotiating how to fund treatment for opioid addiction.

GILLESPIE: I look forward to following up. Thank you for letting me join you here this evening.

UNIDENTIFIED WOMAN: Sorry, do you support Donald Trump’s health care repeal, then? Because it guts funding for opioid and addiction problems.

GILLESPIE: A lot of my friends are working to get that fixed.

MCCAMMON: The woman followed up before being cut off by the moderators. The Republicans nationally campaigned on repealing the Affordable Care Act in 2016. Gillespie has been met with pushback on the idea from Virginia voters at campaign events across the state. He’s repeatedly responded by outlining goals like reducing premiums and making sure Virginia doesn’t lose out on federal funding because of its refusal to expand Medicaid under Obamacare.

On Thursday night, Susan Mariner of Virginia Beach was among several protesters who stood outside a Gillespie fundraiser in Norfolk. She says she’s concerned about government estimates that millions of people will lose insurance under the Republican proposals.

SUSAN MARINER: I think that’s unconscionable. And I absolutely want Gillespie to come out and let me know how he stands on this issue. I think that voters need to understand where he stands.

MCCAMMON: At a press conference last week, Democrat Ralph Northam, himself a physician, called on Gillespie to denounce the repeal effort.

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RALPH NORTHAM: It is devastating for the Commonwealth of Virginia. And if he’s not willing to denounce the plan, I would ask, why does he support the current plan?

MCCAMMON: Northam says the Republican plans would cost Virginia more than a billion dollars in lost Medicaid funds over the next decade. Outside the barbershop in Richmond, Gillespie criticized Northam, who said the Affordable Care Act needs improvement, for supporting a system that Gillespie says isn’t working. Asked by reporters about the proposals before Congress, he declined to take a position.

GILLESPIE: And we don’t know what’s in the bill before the Senate right now. Senators don’t know what’s in the bill before the Senate right now. They’re in recess, trying to rework it. So we’ll see what comes out.

MCCAMMON: Stephen Farnsworth, a political scientist at the University of Mary Washington, says the sooner the health care debate is over, the better for Ed Gillespie.

STEPHEN FARNSWORTH: It’s very difficult for any politician to support a plan that takes something away from people.

MCCAMMON: With Republicans in control of Washington, he says, how they handle issues like health care will inevitably reflect on Republicans running for office back home. Sarah McCammon, NPR News, Richmond.

(SOUNDBITE OF TYCHO’S “SPECTRE”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Kaiser Health News Chief Washington Correspondent Julie Rovner gives the latest news on the Senate health care bill.

MICHEL MARTIN, HOST:

Now for an update on the latest Republican effort to repeal and replace the Affordable Care Act. Earlier this week, Senate Majority Leader Mitch McConnell announced that the Senate would not be able to vote on a bill before the July Fourth recess, which means Republicans are still fighting for votes among their own members to pass it since Democrats have made clear that none of them will. On Friday, Republicans began talking about making some big changes.

We wanted to know what those could be, so we called Julie Rovner once again from Kaiser Health News to tell us what she knows. Julie, thanks so much for joining us once again.

JULIE ROVNER: Always a pleasure.

MARTIN: So if you could just set the table for us for people who may not have been following this, what were the objections of the holdouts, the senators who made it clear that they would not vote for the bill that the leadership put forward?

ROVNER: On Monday, the Congressional Budget Office came out with its estimate of the bill. And it found that it would leave 22 million more people without health insurance at the end of 10 years. And I think there were some moderates who were unhappy about some of the cuts in the bill, and that kind of sent them fleeing. At the same time, you have a lot of conservatives who didn’t like the bill from the beginning. They think it didn’t repeal enough of the Affordable Care Act.

So by the time Senator McConnell was thinking he might be able to go to the floor, he was at least nine votes short. So what he said was OK, let’s sort of go back behind closed doors and see if we can work some of this out, get something to the Congressional Budget Office to re-score while everybody’s home on break and vote when we come back. But they left Friday without any obvious progress.

MARTIN: Tell us a bit more, if you would, about the proposals that they seem to be considering.

ROVNER: One of the problems that the moderates were having is the cuts to the Medicaid program for people with low incomes. There are two kinds of cuts to Medicaid. They are a phase-out of the expansion that was in the Affordable Care Act for people who have slightly more money – they’re still poor but slightly more money. Then there is a very deep cut to the base Medicaid program that serves 73 million people.

One of the specific things that the moderates were unhappy about is that about 30 percent of all opioid treatment goes through the Medicaid program. So they were worried that people would be cut off, couldn’t be treated for their substance abuse problems. And so Senator McConnell was looking at putting some more money back for that, but even then, some of the moderates, particularly Shelley Moore Capito of West Virginia, said she still wasn’t very happy.

MARTIN: One of the things you were telling us earlier is that this is a very difficult thing to thread the needle because all the things that bring the moderates on board are exactly the kinds of things that the conservatives don’t want and vice versa. So is there any effort being made to bring more of the conservatives onboard?

ROVNER: What the conservatives really want is to repeal the insurance regulations part of the Affordable Care Act. Which the problem with that is that they’re doing it through a special budget process that lets them pass a bill with only 50 votes, but you’re not allowed to do things in that bill that aren’t directly impacting the federal budget. And most people assume that those are things that you can’t do in this kind of budget bill. So it’s very difficult to give the conservatives what they want because otherwise if they did, they would need Democratic votes, which they’re not going to get.

MARTIN: Well, you know, to that end, is there any indication that Republicans will try to reach out to get Democratic support? I mean, Democrats have been very vocal about the fact that they were kept out of the process. So is there any strategy that includes them?

ROVNER: Well, interestingly, we started to hear sort of Tuesday, Wednesday from Republicans who are actually using what I call the R word which is repair rather than repeal and replace. Those are things that the Democrats would be happy to participate in. And there was a lot of suggestions by a few Republicans that, you know, maybe we should sit down with some of the Democrats. We could find some things that we agree on.

What Democrats have said is that they’re not going to sit down, though, until the Republicans take the repeal off the table and take the big Medicaid cuts off the table. Of course, it’s those big Medicaid cuts that is keeping some of those conservatives on board, so it really is a very difficult needle for the Senate majority leader to thread.

MARTIN: That’s Julie Rovner. She’s the chief Washington correspondent for Kaiser Health News, has been covering health policy for quite some time. Julie Rovner, thank you so much for joining us.

ROVNER: Anytime.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Many Democrats were encouraged that Republicans had to push off their vote on a Senate bill to repeal and replace the Affordable Care Act, in the midst of vocal opposition from the left.

ROBERT SIEGEL, HOST:

Senators are leaving Washington for a week-long recess, but negotiations over a repeal of the Affordable Care Act continue. The attempts to bring more Republican lawmakers onboard include boosting funding to address the opioid crisis and scaling back some of the tax cuts in the latest version of the bill. As all this happens, Democrats are trying to ramp up pressure against the repeal effort. NPR’s Scott Detrow has more.

SCOTT DETROW, BYLINE: When Senate Republican leaders delayed the vote on the Obamacare repeal, Senate Minority Leader Chuck Schumer was quick to not declare victory.

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CHUCK SCHUMER: We’re not resting on any laurels, nor do we feel any sense yet of accomplishment other than we are making progress because the American people are listening to our arguments.

DETROW: Because this bill will pass or fail based on Republican votes, arguing is the most Democrats can do. Perhaps that’s enough.

MEAGHAN SMITH: Health care in general is a complicated policy, but for people to understand what this bill will do to them has been pretty simple.

DETROW: Meaghan Smith is a strategist at PR firm SKDKnickerbocker. She’s helping coordinate messaging for a number of progressive groups trying to block the health care repeal. Smith says activists are focusing on big-picture ideas like that the Republican bill would increase health care costs for many people.

SMITH: You pay increased premiums, or your out-of-pocket health care costs go up dramatically.

DETROW: As outside groups do that, Schumer and other senators are trying as best as they can to bring their arguments down to a scale people can relate to. At an event this week, every Democrat held up a big poster of a constituent facing a health care challenge.

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SCHUMER: And we ask you – those of you from local papers and outlets – to talk to your senators about the person that they are holding up.

DETROW: As the debate has gone on, Democratic lawmakers keep returning to one main attack point. Here’s New Jersey Senator Cory Booker.

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CORY BOOKER: Massive tax cuts for the wealthiest Americans – and to pay for that, we’re taking away health care for millions and millions of Americans. It’s just – it’s as plain as that.

DETROW: Booker orchestrated one of the Democrats’ more viral moments on Monday. He sat down on the Capitol steps with Georgia Congressman John Lewis…

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BOOKER: Let’s take a seat.

JOHN LEWIS: Take a seat?

BOOKER: Yeah. Why don’t we take a seat up here on the on the top here? And it’s a beautiful day.

DETROW: …And began talking about the health care repeal. Other lawmakers joined in, and soon a crowd did, too.

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UNIDENTIFIED WOMAN: What do we want?

UNIDENTIFIED CROWD: Health care.

UNIDENTIFIED WOMAN: When do we want it?

UNIDENTIFIED CROWD: Now.

UNIDENTIFIED WOMAN: What do we want?

DETROW: In the end, the livestream lasted about three and a half hours. That was followed up by another large Capitol rally, this one organized by Planned Parenthood and other groups. The big question is whether any of this matters. The bill has come this far despite low public opinion numbers. And the bill’s fate comes down to a dozen or so Republican senators. That’s why efforts by people like Stephanie Powell may be more important. Powell lives in Anchorage, Ala. And every morning at around 8 a.m., she calls Senator Lisa Murkowski’s office.

STEPHANIE POWELL: I call her Anchorage office, Juneau office, Fairbanks office, her Washington office. I usually try to call the local number so they know I’m from here.

DETROW: Powell says she voted for Murkowski, one of several key swing votes in the Senate. Powell says her family uses Medicaid. She tells staffers that on the rare moments her calls actually go through.

POWELL: They know more about my health history than maybe my own mother (laughter) at this point because I’ve been very upfront with them on what this means to us.

DETROW: This gets at what’s probably Democrats’ best weapon and something Republicans successfully tapped into for several elections in a row. It’s not hard to oppose a complicated legislative effort by focusing on how it could disrupt voters’ lives. Scott Detrow, NPR News.

(SOUNDBITE OF RUBBLEBUCKET SONG, “MY LIFE”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.