Fortune Article

Good morning, readers! This is Sy.

Let’s begin with the big news from last night: At the end of the day, a band of conservative GOP lawmakers thrust the final stake through the heart of the Senate’s health care bill. But the saga of Republicans’ efforts to repeal Obamacare isn’t over yet.

Senate Majority Leader Mitch McConnell on Monday night confirmed what many had suspected—that even a revised version of the Better Care Reconciliation Act (BCRA), which would gut many Obamacare provisions and take a hacksaw to Medicaid, didn’t have the support of the requisite 50 Republicans to pass.

Conservative Senators Jerry Moran of Kansas and Mike Lee of Utah joined with already-declared holdouts Rand Paul of Kentucky and moderate GOP-er Susan Collins of Maine to state their opposition in separate statements Monday. The three conservatives didn’t believe the Senate health bill dismantled enough of Obamacare; Collins expressed concerns about its cuts to Medicaid and other provisions that could potentially roil insurance markets.

But as McConnell made clear in his statement, the Senate is still poised to vote on Obamacare repeal legislation. This time, it’ll take the shape of a 2015 bill that actually reached President Obama’s desk (and was promptly vetoed)—one that’s come to be known as “repeal-and-delay” because it, well, sets a two-year timetable for Obamacare repeal. The theory goes that this “delayed repeal” would give Republicans enough time to craft an alternative to the health law.

That’s easier said than done, as the GOP Congress has learned over the course of the last six months. There are still deep divisions within the party over a rollback of Obamacare’s Medicaid expansion, regulations that could undermine protections for Americans with pre-existing conditions, funding for Planned Parenthood, and numerous other provisions.

It’s unclear whether or not McConnell’s repeal-and-delay gambit would garner 50 votes, either. Previous analyses of that effort suggested it would cost even more losses in health care coverage (to the tune of 32 million fewer insured by 2026, according to the Congressional Budget Office) compared to the Senate’s current bill and foster sharp premium spikes. And while a more straightforward repeal bill may be able to win back some of the conservative defectors, moderates like Sen. Rob Portman of Ohio and West Virginia’s Shelley Moore Capito (in addition to Collins) have already expressed concerns that a repeal-only strategy without a replacement would wreak even more havoc on Obamacare’s individual insurance marketplaces by creating long-lasting uncertainty.

Still, it’s possible the McConnell can cobble up the votes given the mountainous political pressure on the GOP to fulfill its nearly decade-long promise to scuttle the health law. Even if he does, a new round of political wrangling will open up as the Senate will have to proceed to negotiations with the House to iron out the differences between their very different bills.

President Donald Trump, meanwhile, is pressuring the Senate to pass a repeal-and-delay bill. And insurance companies are still in uncertain limbo over what future regulations will hold.

Read on for the day’s other news.

Sy Mukherjee

@the_sy_guy

sayak.mukherjee@fortune.com

DIGITAL HEALTH

Novo Nordisk gets into the digital diabetes arena. Diabetes drug specialist Novo Nordisk and Glooko have joined forces on a smartphone diabetes maintenance platform. The app will be able to take patients' blood glucose and diet data and then match them with advice on the latest trends in blood sugar maintenance. (MobiHealthNews)

Telemedicine firm Doctor on Demand pitches a different view of health care reform. With the seemingly endless debate over Obamacare repeal reaching its latest chapter, digital health companies are pitching themselves as one potential avenue for addressing the U.S. health system's shortcomings. "The American healthcare system requires massive amounts of federal funding, yet remains one of the least-efficient healthcare systems in the world," says Doctor on Demand CEO Hill Ferguson in a statement. "As the government continues to kick the can on the revised health bill, the healthcare system has no choice but to look to new cost-effective alternatives to provide greater access to care. With the relentless pressure to cut federal spending, digital solutions like telemedicine - which expands access to care and reduces costs by up to 90% - will become a key part of that equation."

INDICATIONS

BioMarin, Sarepta settle patent spat. Sarepta Therapeutics, which won a pioneering Food and Drug Administration approval for its Duchenne muscular dystrophy drug last year, has settled a patent dispute with rival BioMarin over the "exon-skipping" technology at heart of the companies' muscular dystrophy treatments. Sarepta will hand over $35 million to BioMarin in an upfront payment and also pay royalties to the firm. (Reuters)

This company may have a less-addictive painkiller on its hands. Shares of Nektar Therapeutics rose 4.5% in Tuesday trading as the company's opioid-modifying painkiller proved to have far less abuse potential than conventional opioids in a clinical study. The treatment, NKTR-181, is designed to reduce the amount of euphoria that patients feel while taking the drug (while still relieving pain symptoms). (TheStreet)

THE BIG PICTURE

The Mediterranean diet and its effect on dementia. A collection of new studies presented at the Alzheimer’s Association International Conference suggest that a Mediterranean diet—one that's rich in lean proteins like fish and chicken, filled with fruits, vegetables, nuts, and legumes, and (moderate amounts of) red wine—may carry yet another benefit: reducing the risk for dementia and Alzheimer's by more than a third. But it's important to note that these results were from observational studies of healthy adults, and there could still be plenty of confounding factors that lead to dementia. Still, the studies add to evidence that such a diet may be associated with real health benefits, including for the heart. (Fortune)