Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.

The deal would repeal a cost-control measure in “Obamacare” known as the Cadillac Tax, an unpopular levy on benefit-rich health insurance plans scheduled to take effect in 2022. That means Congress is upsetting the balance between expanding access and controlling costs that former President Barack Obama tried to strike in his signature law, said Kathleen Sebelius, who served as his health secretary. “President Obama thought it was very important to have additional access paid for,” said Sebelius. “This just takes a big step backwards.” The deal was reached in late stage negotiations between congressional leaders and Treasury Secretary Steven Mnuchin as part of a broader agreement to keep the government operating past this weekend. As part of the package, the Trump administration would be barred from using its rule-making authority to take certain actions that would destabilize the ACA’s health insurance markets. But it punts on the two biggest consumer health care issues this year: curbing prescription drug costs and ending surprise medical bills. Lawmakers will try again early next year — when another round of budget legislation is due. The Cadillac Tax was intended as a levy on the most generous plans, pegged at 40% of the value above a certain threshold. In 2022 that threshold would have been $11,200 for single coverage and $30,100 for a family plan, according to the nonpartisan Kaiser Family Foundation. One in five employers would have been affected. The tax was widely supported by economists and health policy experts, who argued it would help confront the problem of high U.S. health care spending. That’s because employers were expected to scale back their plans or shift costs to workers to avoid paying. Many employers and labor unions opposed it from the beginning. “It could have meant higher deductibles for employees or less choice,” said Cynthia Cox, who leads research on the Obama health law at the Kaiser Foundation. Repeal will “have a positive effect on a lot of people with health insurance coverage.” But critics said taxpayers will be on the hook for more debt, since repeal of the Cadillac tax and two other unpopular “Obamacare” levies is estimated to add about $400 billion to the federal deficit over 10 years. “The Cadillac tax may have resulted in some modest cost increases when it took effect, but what it was actually going to do is reduce health care costs, which would have raised wages,” said Marc Goldwein, of the nonpartisan Committee for a Responsible Federal Budget, which advocates for reining in the nation’s $1-trillion deficit. Here’s an overview of some of the other major health care components of the budget deal: — Also repeals the health law’s health insurance tax and its sales tax on medical devices. These taxes were intended to help pay for the cost of expanding coverage under the health law, which currently provides insurance to about 20 million people. Even without these taxes, most of the law’s financing stays in place. —Blocks the Trump administration from issuing regulations that would end the health law’s automatic re-enrollment provision, or from shutting down a state-level workaround called “silver loading,” which has helped stabilize “Obamacare”premiums. —Extends and increases Medicaid funding for U.S. territories, including Puerto Rico.
Budget deal puts access to health care above curbing costs.

LGBT advocates praised the new recommendations for giving attention to a community that is often left out of sex education policies. But some parents and conservative groups assailed the more than 700-page document as an assault on parental rights, arguing it exposes children to ideas about sexuality and gender that should be taught at home. The guidance approved Wednesday by the California State Board of Education does not require educators to teach anything. It is designed as a guide for teachers to meet state standards on health education, such as nutrition, physical activity and combating alcohol and drug abuse. But it’s the parts about sex that got the most attention during a public hearing on Wednesday. The framework tells teachers that students in kindergarten can identify as transgender and offers tips for how to talk about that, adding “the goal is not to cause confusion about the gender of the child but to develop an awareness that other expressions exist.” It gives tips for discussing masturbation with middle-schoolers, including telling them it is not physically harmful, and for discussing puberty with transgender teens that creates “an environment that is inclusive and challenges binary concepts about gender.” “As the parent of three kids, we’re on a careful trajectory here not to be introducing things as though they are endorsed in some way,” board president Linda Darling-Hammond said. But Patricia Reyes, a 45-year-old mother of six, doesn’t believe that. She traveled more than 400 miles (about 644 kilometers) from her home in Southern California to attend Wednesday’s hearing, bringing along her 4-year-old daughter, Angeline, who held a sign that read: “Protect my innocence and childhood.” “It’s just scary what they are going to be teaching. It’s pornography,” she said. “If this continues, I’m not sending them to school.” Much of the pushback focused not on the framework, but on the books it recommends students read. An earlier draft of the document suggested high schoolers read the book: “S.E.X. : The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties.” It includes descriptions of anal sex, bondage and other sexual activity. Several parents read from the book and held it up so board members could see the pictures, which many described as “obscene.” The board responded by removing the book, plus a few others, from the guidance. “It’s important to know the board is not trying to ban books. We’re not saying that the books are bad,” board member Feliza I. Ortiz-Licon said. “But the removal will help avoid the misunderstanding that California is mandating the use of these books.” More than 200 people signed up to speak during a public hearing on Wednesday that lasted for several hours. Supporters and opponents mingled together in the lobby of the California Department of Education, where parents handed out snacks to appease their young children while waiting for their number to appear on dry-erase board telling them it was their turn to get one minute of time at the microphone. Speakers included 16-year-old Phoenix Ali Rajah, a transgender boy who said he is rarely taught information for people like him during sex education classes at his Los Angeles area high school. “I’m never taught about how to be in a relationship with gay men,” he said, adding that the “conversation with sex starts from a different place.” Michele McNutt, 49, focused on the framework’s attention to healthy relationships and consent, something she said is never too soon to teach her two daughters in public school, ages 11 and 9. “Withholding medically accurate, scientific information from them actually causes more harm and does not actually protect innocence,” she said while wearing a purple T-shirt that read “protect trans students. “If you don’t give kids accurate information about their own body ... how are they able to make good choices?” The guidance was developed with input from teachers across the state, and several spoke in favor of the recommendations on Wednesday. But not Tatyana Dzyubak, an elementary school teacher in the Sacramento area. “I shouldn’t be teaching that stuff,” she said. “That’s for parents to do.”
California overhauls sex education guidance for teachers.

They say government policies are partly to blame for a system in which doctors and other staff expect to be paid extra fees to perform operations and take kickbacks from pharmaceutical firms and medical-equipment suppliers. The profession’s ugly underbelly was exposed last week when police accused British drugmaker GlaxoSmithKline of bribing officials and doctors for six years to boost sales and the price of its medicines. GSK has called the developments “shameful” and on Monday said some of its Chinese executives appeared to have broken the law. China is an appealing market for pharmaceutical firms and medical-equipment makers, with spending in the industry expected to nearly triple to $1 trillion by 2020 from $357 billion in 2011, according to consulting firm McKinsey. The corruption stems largely from doctors’ low base salaries, which are set in line with a pay scale for government workers. Hospitals can pay bonuses but, given public hospitals are strapped for cash, compensation is usually low, say doctors and industry experts. A doctor fresh out of medical school in Beijing earns about 3,000 yuan ($490) a month including bonuses — roughly the same as a taxi driver. A doctor with 10 years experience makes around 10,000 yuan a month, according to Peter Chen, chief executive of privately run Oasis International Hospital in Beijing. “Without the grey income, doctors would not have the incentive to practice,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York. Over the past 30 years the Chinese government has made its healthcare sector more market-oriented. That means the country’s 13,500 public hospitals have to balance their own books. Medical services accounted for just over 50 percent of public hospital revenue in 2011, according to Health Ministry data. About 40 percent came from prescribing drugs while the rest was from other income as well as government subsidies, which have fallen steadily since the 1980s. Hospital administrators can set fees for in-patient care, nursing and laboratory tests. But the state fixes the cost of operations to make surgery affordable to ordinary Chinese. And it effectively caps the cost of many prescribed medicines by setting a suggested price. That leaves hospitals little room to top up wages. One Chinese doctor who used to hold a senior position at a prominent hospital in Beijing said 80 percent of his income came from bribes. Without it, he would have earned less than $600 a month, said the doctor, who left China five years ago to live in Britain where he continues practicing medicine. “These sums (bribes) are essential. You cannot survive on your salary,” said the 50-year-old physician, who spoke on condition of anonymity due to the sensitivity of the issue. An industry executive who has worked in China’s medical sector for more than 15 years said bribery and corruption permeated every level of a public hospital. “They are seen as necessities in the current healthcare system,” said the executive, who also declined to be identified. The Health Ministry did not respond to a request for comment. Officials at the National Development and Reform Commission, which sets the prices of prescribed medicines, also declined to comment. Low base salaries are a legacy of China’s planned economy, said Jia Xijin, associate professor at the School of Public Policy and Management at Tsinghua University in Beijing, explaining the dilemma faced by the government. China has also committed to making health care affordable for its 1.37 billion people. The government has spent 2.2 trillion yuan ($358 billion) on the system since 2009, of which more than 680 billion yuan was to provide universal health insurance coverage, state media quoted the Finance Ministry as saying earlier this year. Public hospitals say recruiting new doctors is getting harder as many physicians are turned off by the wages at a time when patient numbers are growing. Health Ministry data showed the overall number of doctors rose 13 percent from 2008 to 2011, while patient visits jumped 28 percent. “There will be no doctors left to treat the current doctors when they retire,” said the accounting director at a Shanghai hospital who declined to be identified because she was not authorized to speak to the media. Low salaries have also spawned a system of under-the-table payments from patients. The payments are known as “hongbao” — a reference to the cash-filled red envelopes given as presents during Lunar New Year festivities — and cover various services from jumping the queue for appointments to extra surgical fees. Bob Wang, a 35-year-old businessman in Beijing, said he gave the main surgeon who operated on his aunt’s femur bone transplant last year 5,000 yuan in “hongbao” on top of the 100,000 yuan he paid to the hospital because he was worried the doctor would not take the operation seriously otherwise. There was unstated “hongbao” guidance for each type of surgery, he said. “If my family or myself get sick ... we won’t just go to the hospital. Everything will take forever — from registration to waiting for a bed, to getting seen by a doctor to queuing for surgery,” he said. According to the doctor now living in Britain, patients and their families could sometimes spend two to three times more than the actual fee in “hongbao”. Critics doubt that an anti-corruption campaign by President Xi Jinping will have much impact. Indeed, a former doctor at a major heart hospital in Beijing said eradicating corruption would be nearly impossible. “It would be easy to find out who was taking money if the government wanted to,” said the cardiologist, who has been working in the United States since 2009. “But everyone would be found guilty. How could the hospitals survive?” ($1 = 6.1413 Chinese yuan)

Bribery serves as life-support for Chinese hospitals.