Good morning, Vitals crew. Today's newsletter is 924 words or a 3.5-minute read.

Nearly 12 million people would lose their health insurance under President Trump's "big, beautiful bill," an erosion of the social safety net that would lead to more unmanaged chronic illnesses, higher medical debt and overcrowding of hospital emergency departments.

Why it matters: The changes in the Senate version of the bill could wipe out most of the health coverage gains made under the Affordable Care Act and slash state support for Medicaid and SNAP.

The big picture: The stakes are huge for low-income and working-class Americans who depend on Medicaid and subsidized ACA coverage.

• Without health coverage, more people with diabetes, heart disease, asthma and other chronic conditions will likely go without checkups and medication to keep their ailments in check.
• Those who try to keep up will pay more out of pocket, driving up medical debt and increasing the risk of eviction, food insecurity and depleted savings.
• Uninsured patients have worse cancer survival outcomes and are less likely to get prenatal care. Medicaid also is a major payer of behavioral health counseling and crisis intervention.

Zoom out: The Medicaid and ACA changes will also affect people who keep their coverage.

• The anticipated drop-off in preventive care means the uninsured will be more likely to go to the emergency room when they get sick. That could further crowd ERs, resulting in even longer wait times.

The other side: The White House and GOP proponents of the bill say the health care changes will address fraud, waste and abuse, and argue that coverage loss projections are overblown.

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Congressional Republicans continue to race toward a July 4 deadline to pass the sweeping bill, with the House GOP trying to squeeze some final changes into the Senate's version of the package.

• The Senate is trying to jam the House to accept its version after an all-night vote-a-rama that began Monday. There is no time left for a House-Senate conference before President Trump's deadline.
• But House Speaker Mike Johnson (R-La.) raised the possibility of going past the deadline, saying some Senate provisions could force the House to make revisions.

Zoom in: Johnson held a call yesterday with Republicans concerned about the Senate's Medicaid cuts, Axios has confirmed.

Meanwhile, Senate Republicans turned back Democratic efforts to strip health-related and other provisions from their version of the bill.

• The chamber rejected a Democratic effort to remove language in the bill that would effectively defund Planned Parenthood on a mostly party-line vote of 51-49.
• It means that Planned Parenthood and other large organizations that offer abortions would be shut out of federal Medicaid funding for one year.

Senators also overwhelmingly voted down an amendment from Sen. Susan Collins (R-Maine) to double the size of a rural hospital fund, to $50 billion.

Federal officials yesterday said they busted a series of health fraud schemes spanning medical supply, telehealth and genetic testing companies, as well as opioid trafficking, that involved more than $14.6 billion in improper charges.

Why it matters: As part of the record-breaking operation, CMS announced it also prevented $4 billion in fraudulent claims from being paid.

Zoom in: Officials seized over $245 million in cash, luxury vehicles, cryptocurrency and other assets as part of the "takedown."

• The alleged fraud took place in 50 federal districts across the U.S. and resulted in criminal charges against 324 individuals, including nearly 100 health providers. Indictments were unsealed in federal courts across the country last week.
• Civil charges were also brought against 20 defendants for $14.2 million in alleged fraud, as well as civil settlements with 106 defendants totaling $34.3 million.

Between the lines: The activity included Operation Gold Rush, a nationwide investigation begun in 2023 that encompassed the largest loss ever recorded in a health fraud case, officials said.

• A transnational organization used a network of foreign straw owners who bought medical supply companies and quickly submitted $10.6 billion in fraudulent health care claims to Medicare, they said.

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Millions of Americans rely on their provider’s advice and choose to be vaccinated. Advisory Committee on Immunization Practices (ACIP) recommendations ensure they are covered by insurance. Don’t put millions of Americans’ vaccine coverage at risk.

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Most K-12 public students in the biggest U.S. cities attend schools in extreme urban heat zones, a new analysis finds.

Why it matters: The heat island effect can make some neighborhoods notably warmer than others, especially during heat waves like the one that recently struck much of the country.

• Many schools lack adequate air conditioning, jeopardizing students' health and learning abilities in periods of extreme heat while class is in session.

Driving the news: About 76% of public K-12 students in the 65 most populous U.S. cities attend schools where the heat island effect increases temperatures by at least 8°F, per a new analysis from Climate Central, a climate research group.

• Among the included cities, Louisville, Kentucky (98%), Orlando, Florida (97%) and Wilkes-Barre, Pennsylvania (97%) have the largest shares of public K-12 students enrolled at schools in extreme urban heat zones.
• Boston (36%), Providence, Rhode Island (42%), and Richmond, Virginia (49%) have the smallest.

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