One official argued that the damage inflicted on Iran had increased the chances of securing a deal and said President Donald Trump still has "tools in his arsenal" if diplomatic efforts fail, according to the report.
He said Hezbollah’s power in Lebanon had not been fully revealed, adding: “No one can stand against Hezbollah in Lebanon, and everything you have seen from Hezbollah in Lebanon is only the tip of the iceberg.”
Qaani also described the Bab al-Mandab Strait as one of the strategic assets of the so-called “Resistance Front.”
“Bab al-Mandab is one of the winning cards of the Resistance Front, and if necessary, other cards will also be revealed,” he said.
Addressing the United States and Israel, Qaani warned: “Do not get involved with the Resistance Front. Wherever you confronted the resistance, you were left with no dignity.”
The FDA issued a drug safety communication approving a label change that warns about the risk of kidney stones or kidney injury with the over-the-counter (OTC) weight loss drug orlistat (Alli), the agency said Wednesday.
The label now recommends that consumers with a history of kidney disease or kidney stones consult a healthcare provider before using the drug.
The FDA advised clinicians to inform patients about reports of acute kidney injury (AKI), hyperoxaluria, calcium oxalate nephrolithiasis, or oxalate nephropathy linked to orlistat. Patients should also stop taking the drug if they develop symptoms like back or groin pain, painful urination, blood in urine, feet or leg swelling, or less frequent urination.
These events are rare, the agency noted. Mild cases of AKI may be reversible, but untreated severe cases can be fatal.
"The risk of renal injury is now described consistently across the labeling for all FDA-approved orlistat products, including those available OTC and those available in a higher strength by prescription," the FDA stated.
Orlistat is the only FDA-approved OTC weight-loss aid and is available in 60 mg capsules. A 120 mg version (Xenical) is available by prescription and is indicated for obesity management. The drug works as a lipase inhibitor that binds to enzymes to break down fats, leading to less dietary fat being absorbed in the digestive tract.
After receiving reports of AKI from orlistat users, the FDA reviewed its Adverse Event Monitoring System (AEMS) and medical literature for cases of AKI, oxalate nephropathy, hyperoxaluria, and calcium oxalate kidney stones spanning the drug's approval date in February 2007 through December 2023. The review identified 12 cases of kidney complications linked to orlistat, nine from AEMS and three from medical literature.
Patients in these cases had a median age of 61. Seven cases were reported in females, and five were in males. Median exposure to orlistat was 2.5 months before kidney injury. Eight cases involved AKI, two reported acute kidney injury with oxalate nephropathy, and two had hyperoxaluria with calcium oxalate kidney stones.
Eight patients required hospitalization and five required dialysis. Seven patients improved; one had not improved when the report was made, and four reports did not describe outcomes.
Among the four patients who had available dosing information, all were taking 60 mg or 120 mg of orlistat three times daily.
"Our data analysis also suggests that orlistat-associated oxalate nephropathy and kidney injury may not be dose-dependent, as the difference in dietary fat absorption inhibition between the 120 mg (Xenical) and 60 mg (Alli) doses is 5%, indicating the risk exists at both prescription and nonprescription doses," the FDA noted.
The actual number of cases involving kidney problems after orlistat use may be higher, the FDA pointed out, as consumers and healthcare professionals don't always report side effects to the agency.
The reports also were often incomplete, lacking details like kidney stone composition and patient medical history. Several patients had pre-existing conditions including obesity, diabetes, high blood pressure, and a history of kidney disease or kidney stones that may have contributed to kidney problems.
The FDA urged consumers and healthcare professionals to report side effects involving orlistat or other medicines to the FDA MedWatch program.
https://www.medpagetoday.com/primarycare/obesity/121703
Year after year, Ross and Rebecca Tobiassen saw their healthcare costs rise, having relied on the Affordable Care Act for federally subsidized health insurance since its start in 2014. Year after year, the couple in western North Carolina kept their coverage, believing the peace of mind was worth the cost.
But in December, that changed. The Tobiassens decided to cancel their insurance when Rebecca saw the cost of their monthly premiums would jump from $130 to more than $550.
"It makes no sense," she said. "It's not worth it anymore."
The couple own and are the only employees of a small auto shop just west of Appalachian State University in the North Carolina mountains. Rebecca worries about her husband, whose work as a mechanic can be dangerous. A spring once shot a metal ball joint into their garage wall like a gun. A heavy object crushed Ross' thumb. In 2020, Ross became mostly blind in one eye after repeatedly getting metal shards in it and developing an infection in his cornea.
The Tobiassens are among the Americans who canceled their ACA coverage after Congress allowed enhanced tax credits that helped pay for insurance plans to expire at the end of 2025. The Tobiassens benefited from those tax credits -- like millions of other enrollees expected to drop or be dropped from their coverage as the year progresses, unable to keep up with the higher costs.
Established by the Biden administration's American Rescue Plan Act during the COVID pandemic, the expanded subsidies reduced monthly premiums for many families and prompted a tidal wave of new sign-ups, doubling ACA enrollment to about 24 million.
The Centers for Medicare & Medicaid Services is expected to soon release complete data on how many people are no longer covered under the ACA, but an early analysis from KFF, citing Wakely Consulting Group research, showed enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026.
In North Carolina, individual ACA sign-ups for 2026 were down 22% compared with the year before, a greater drop than any other state, amounting to a decrease of more than 213,000 people, according to enrollment data. While the Tobiassens' two teenage daughters remain on Medicaid, Rebecca said the new prices showed that the federal government doesn't care about families like hers.
"We've known that you don't care about us," she said, "but you're making it plain and simple now."
The couple's insurance hadn't helped them cover all their medical needs. When the pain from Ross' eye infection worsened 5 years ago, Rebecca insisted he go to a specialist, who told them that fixing the eye through cornea replacement surgery would cost them up to $30,000 and require Ross to take 6 months off.
Ross chose a less expensive treatment to kill nerves in the eye instead.
The couple know they're taking a risk by not being insured. If something were to happen, they could face an enormous medical bill.
Ross, 47, said the blindness in the one eye doesn't significantly affect his job. He works long hours, sometimes into the night to keep up with demand.
"I try not to think about it too much," he said. "I just work."
Katie Alexander oversees volunteers for Pisgah Legal Services, a western North Carolina nonprofit that helps low-income people secure health insurance. Alexander has helped North Carolina and Tennessee residents try to get ACA marketplace plans since Obamacare's launch. She said she's never seen anything like this year.
Nearly 100 Pisgah clients, out of about 700 that Alexander's team worked with during open enrollment, decided to drop insurance this year, and many others chose cheaper ACA plans with less coverage, Alexander said.
Alexander said the people who have dropped their coverage include Lyft and Uber drivers. They're trying to start their own businesses. They are artists and people who can work only part-time, because they're chronically ill. Some are unable to get insurance through their employers, or they make too much to be on Medicaid.
"Even for folks who don't have chronic illnesses," Alexander said, "there's just this nagging at the back of your mind, kind of constantly, of: 'Don't get hurt. Don't get sick. Because you can't afford that.'"
ACA premiums and deductibles steadily increased for years starting in 2022, then spiked during the enrollment period for 2026 plans, according to data analyzed by KFF. The Tobiassens have seen every dip and rise in plan costs since 2014 when the plans launched. They joined immediately and paid about $30 a month, Rebecca Tobiassen said.
"You actually felt like you were benefiting," she said.
But through the years as the marketplace became more expensive, the couple made concessions, switching at one point from a silver plan -- historically the most popular -- to a bronze. The plan mostly provided for the couple's basic needs.
As they saw their deductibles and premiums rise over more than a decade, Rebecca feared the day would come when they could no longer afford even the cheapest plan.
"Plans are unaffordable, no matter how you cut it," said Risha Gidwani, DrPH, a healthcare policy researcher at the University of Colorado Anschutz School of Medicine in Aurora. "It's just who is shouldering the unaffordability."
Gidwani and health economist Cheryl Damberg, PhD, of RAND Health Care in Santa Monica, California, in a study published earlier this year, found that most bronze plans, the cheapest ACA options for many, would be unaffordable without subsidies for the average person using the federal healthcare coverage.
Without subsidies, many families using these plans don't make enough to afford premiums or deductibles, Gidwani's research shows.
People who drop health insurance also change what's known as the "risk pool," Gidwani said, when a group of people share financial hazards.
If healthier people drop out of the risk pool, fewer people subsidize the people who get sick, Gidwani said. That means premiums for the people who get sick will increase again in the future, she added.
"That becomes what we call a death spiral," Gidwani said.
Even if the subsidies hadn't expired, taxpayers would have borne an estimated $350 billion burden over the next decade to cover them, Gidwani's study noted.
After dropping coverage they'd relied on for 11 years, the Tobiassens have no plans to return to the ACA marketplace. They looked into alternative options through a faith-based healthcare organization but decided to go without.
For now, they don't have a plan B. They've set aside some money for a medical emergency. And if their savings run out, Rebecca Tobiassen said, they have a couple of last resorts to lean on: credit cards or family members.
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/121759
The Medicare Physician Fee Schedule should increase each year tied to the rate of medical inflation, while payments for inpatient rehabilitation and home healthcare should be cut, the Medicare Payment Advisory Commission (MedPAC) reiterated Monday in its June report to Congress.
"To bring fee-for-service Medicare's overall payment levels closer in line with providers' costs, the commission ... recommends slightly increasing (above current law) payment rates for the hospital outpatient and inpatient prospective payment systems and the Physician Fee Schedule, modestly decreasing payment rates for outpatient dialysis services and hospice services, and substantially decreasing payment rates for post-acute care providers (i.e., skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities, which have high Medicare profit margins of 24%, 21%, and 17%, respectively)," the authors wrote, hearkening back to recommendations from MedPAC's March 2026 report.
"We also recommend collecting cost-report data from ambulatory surgical centers to help inform decisions about annual updates to the payment rates for these facilities," they added.
For Medicare Advantage (MA) plans, "the commission has recommended using geographic market areas" to better evaluate quality of care, the commissioners noted, adding that the CMS should "take additional steps to ensure that MA plans submit accurate and complete encounter data for services provided to MA enrollees."
The commissioners also looked at payment levels in Medicare's alternative payment models (APMs), a payment approach that gives practices added incentive payments to provide high-quality and cost-efficient care. Accountable care organizations (ACOs) are one of the more popular forms of alternative payment.
Commissioners applauded CMS for acting on some of the commission's prior recommendations. Previously, "the commission has expressed concerns about spending targets that are periodically ratcheted down when ACOs become more efficient," the authors wrote, referring to a 2022 MedPAC report recommendation. "CMS has taken steps toward addressing this concern by introducing a prospective growth rate for ACO spending targets for all ACO models."
At a briefing with reporters last week, Paul Masi, MPP, MedPAC's executive director, responded to a question from MedPage Today by discussing how the commission's prior recommendations fit into the new report. Masi reiterated the commission's suggestion that for fee-for-service Medicare, CMS should "move to something more like MEI [Medicare Economic Index, a level of medical inflation] minus 1%," he said.
"Separately, the commission ... highlighted its past recommendations to move towards site-neutral payments" and put a cap on out-of-pocket spending, while allowing the HHS secretary "flexibility to vary cost-sharing based on whether services are relatively higher or relatively lower value," he said. Site-neutral payments would allow Medicare to pay the same amount for a service no matter where it was provided, an idea that hospitals have pushed back on.
The MedPAC report comes at a time when Congress has been trying to implement some of the commission's ideas. A bill to tie Medicare physician payments to the MEI was approved in May by the House Ways & Means Committee but has yet to be considered by the full House.
The site-neutral payment issue also continues to bubble up. The Congressional Research Service issued a report on the topic in May, noting that "A December 2024 Congressional Budget Office analysis estimated that expanding site-neutral payment rates ... could save more than $170 billion" from 2025 to 2034, with most of those savings -- $157 billion -- coming from applying site-neutral payments to all hospital outpatient departments and much of the rest coming from applying site-neutral rates for drug administration services and imaging services. In addition, implementing site-neutral payments would also reduce Medicare beneficiary copayments, since they are tied to the total amount Medicare pays for a particular service, the report said.
https://www.medpagetoday.com/publichealthpolicy/medicare/121750
Ukrainian President Volodymyr Zelensky claimed on Monday that he offered to meet his Russian counterpart in the United States during a phone call with US President Donald Trump yesterday.
"Yesterday, we discussed with President Trump that such a meeting could be organized in the U.S. – in a format where Putin would find it much harder to refuse at least to President Trump," Zelensky said in a video posted on X. He emphasized that "additional pressure will be needed" in case Moscow refuses this offer.
Previously, Trump said that both Zelensky and Putin seem willing to pursue a negotiated settlement of the conflict.
https://breakingthenews.net/Article/Zelensky-offers-to-meet-Putin-in-US/66509314
Iranian President Masoud Pezeshkian said on Monday that although the memorandum of understanding reached between Iran and the United States is an "important step" towards peace, the final agreement between the two countries has "yet to take shape."
"What has been agreed upon is an important step toward stopping the war and beginning negotiations, and a final agreement has yet to take shape. The Islamic Republic of Iran has prepared itself for all options, and the government's focus, with or without an agreement, is sincere service to the people. The Iranian nation has learned from its martyred Imam not to submit to humiliation," Pezeshkian said in a post on X.
Meanwhile, US President Donald Trump previously revealed that a deal with Iran has been signed already, and that the details of the agreement will be revealed after the official signing ceremony, which is expected to take place in Geneva on Friday.
https://breakingthenews.net/Article/Iran's-Pezeshkian:-Final-deal-has-yet-to-take-shape/66509249
