<div class="KonaFilter image-container display-table float_right"><div><div class="image">Joshua Lott/Getty ImagesOld tires rest near the abandoned Packard Automotive Plant December 13, 2013 in Detroit, Michigan. </div></div></div>The city of Detroit has seen a steady decline over the past few decades. A combination of factors, including a dwindling population, high crime rates and widespread unemployment, have earned it the title of one of the nation's <a href="http://www.businessinsider.com/most-dangerous-cities-in-america-2013-6">Most Dangerous Cities</a>.
Now, the city has also gained the reputation as one of the worst places to be born.
The infant mortality rate in Detroit is now worse than that of some developing countries. Bloomberg recently <a href="http://www.bloomberg.com/news/2014-06-11/babies-pay-for-detroit-s-fall-with-mortality-above-mexico.html">reported</a> that in 2012, Detroit "saw a greater proportion of babies die before their first birthdays than any American city, a rate higher than in China, Mexico and Thailand."
According to an investigation published in January by <a href="http://www.detroitnews.com/article/20140130/LIFESTYLE03/301300005">The Detroit News</a>, "Infant mortality is the No. 1 killer of Detroit children; violence is second. In 2011 alone, 130 of the 208 Detroit children who died that year had not yet marked their first birthday."
The numbers are bleak, and to make matters worse, the Michigan Department of Human Services just saw $287.6 million in cuts to public assistance for poor and unemployed individuals and families, the <a href="http://www.freep.com/article/20140610/NEWS06/306100175/State-s-health-budget-trims-funding-infant-mortality-public-aid">Detroit Free Press</a> reported.
The Detroit News investigation prompted Detroit Mayor Mike Duggan to launch a campaign to fight preterm births, the number one driver behind Detroit's sky-high infant mortality rate. A preterm birth is <a href="http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm">defined</a> as a baby that is born prior to 37 weeks of pregnancy, and such babies - so-called "preemies" - are at high risk for health problems and complications.
Stress, poor nutrition, smoking, injury, and being over- or under-weight are all <a href="http://www.mayoclinic.org/diseases-conditions/premature-birth/basics/risk-factors/con-20020050" target="_blank">risk factors</a> for preterm birth, and access to appropriate prenatal care can help mitigate some of those risks.
The "<a href="http://www.makeyourdate.org/about/">Make Your Date</a>" campaign, announced in May, offers free prenatal care, including cervical screenings, to pregnant women in Detroit regardless of insurance coverage or ability to pay.

Babies Are More Likely To Die In Detroit Than In Mexico Or Thailand

<div class="KonaFilter image-container float_right"><div class="image on-image"></div></div>We went overboard with the Purell.Public health experts call it <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841828/">the hygiene hypothesis</a>: While you might think cleaner is always better, research suggests that a little grit is good for you.The hypothesis was coined by <a href="http://www.ncbi.nlm.nih.gov/pubmed/2513902/">British epidemiologist David Strachan in 1989</a>. He noticed kids in larger families were more likely to get hay fever, reasoning that the more exposure to allergies the kids had, the greater tolerance they could build. Since then, the hypothesis has provided an explanation for the rise in auto-immune disorders in developed countries, like type 1 diabetes, multiple sclerosis, inflammatory bowel diseases, and, most popularly, asthma and allergies, which <a href="http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx">have been on the uptick</a> in the U.S. for years.The researchers who study the hygiene hypothesis propose our over-sanitized, germ-free lives are to blame. We've replaced overtly nasty ailments like gout and ringworm, found in our poorly stored and undercooked food, with less obvious conditions that we carry for the long-haul.Purell and hand washing <a href="http://www.who.int/gpsc/country_work/en/">may make hospitals safer</a>, but those oh-so-helpful clinical rituals may backfire in everyday life.Like with with raising kids, for instance.Yale University immunologist Dr. Christina Price points to <a href="http://www.ncbi.nlm.nih.gov/pubmed/18678343">research done on farms </a>to suggest a sort of prenatal protection from bacteria that sticks with kids later in life. Moms, then, might do well to limit their sanitary practices. "Encouraging kids to play outside is wonderful," Price tells Business Insider. "But even that may be too late if you are already 'sensitized.'"Post-delivery, the benefits seem to compound the initial set of conditions.A <a href="http://pediatrics.aappublications.org/content/early/2015/02/17/peds.2014-2968.full.pdf">study</a> published recently in the journal "Pediatrics" found families that washed their dishes by hand suffered fewer allergies than their dishwasher-using counterparts. The explanation? Dirt actually boosted immunity.The practice has also found its way into the place where kids get the sickest: school. One example is Gever Tulley's radical approach to pedagogy, <a href="http://www.sfbrightworks.org/how-we-learn/program-components/">Brightworks</a>.The San Francisco-based school gets kids learning by doing. They take apart home appliances. They superglue their fingers together. And they also happen to play in the dirt, exposing their immune systems to the very things most of us try to eliminate.Improving public health isn't necessarily a goal of Brightworks, but it could easily be an unintended virtue. And for a generation whose idea of playtime comes built-in with screens of all sizes, <a href="http://www.businessinsider.com/r-screen-time-tied-to-poor-wellbeing-among-kids-2014-18">just getting outside could end up reaping the greatest rewards</a>. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/waterfall-climbing-fish-goby-evolution-hawaii-2015-5">Scientists are astonished by these Goby fish that can climb 300-foot waterfalls</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="djMXJkdTpXxb0FwhBHlUoNNT3m6RuJH9" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

Here's proof that being too clean is actually harming our kids

<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div></div></div><ul><li> The House of Representatives will vote on the American Health Care Act on Friday after an ultimatum to GOP lawmakers from President Donald Trump.</li><li>The House will go through four hours of debate on the bill. The final vote is expected soon after 4 p.m. ET.</li><li>Only 22 Republicans can vote against the bill, but conservatives and moderates have come out against the AHCA. Passage of the bill is in serious doubt.</li></ul>Friday is judgment day for the Republican Party's opening bid to repeal and replace the Affordable Care Act.After President Donald Trump issued an ultimatum to Republicans on Thursday, the House has begun to debate the healthcare bill to repeal and replace Obamacare in the early hours of Friday morning.The GOP leadership originally wanted to vote on the AHCA on Thursday, the seventh anniversary of the Affordable Care Act being signed into law. But leaders were unable to garner enough support for the bill and delayed the vote.Office of Management and Budget Director Mick Mulvaney told a group of Republicans on Thursday night that they had to pass the AHCA on Friday - or Trump would move on from the bill and leave them stuck with Obamacare.This has put the onus on House GOP members. But given reservations from conservatives who do not think the bill goes far enough in its repeal of Obamacare and moderates who think the AHCA does not solve the problems of the healthcare system, the outcome of the vote is unclear.House Speaker Paul Ryan went to the White House early Friday afternoon to brief Trump on the latest with the healthcare bill.<h2>The final offer</h2>The American Health Care Act has been altered considerably from its introduction on March 6.In an effort to win over conservative members of the House GOP, the final bill will have a provision that would do away with the ACA's "essential health benefits." Those mandate that insurance companies cover certain types of care, such as prenatal care and preventive screenings like mammograms.(<a href="http://www.businessinsider.com/ahca-essential-health-benefits-ehb-2017-3">Read more on the impact of repealing essential health benefits »</a>)The effect of these changes on things like the federal budget, health insurance marketplace, and premiums are unknown, since the nonpartisan Congressional Budget Office has not had the time to score the updated bill. Some health policy experts have warned that <a href="http://theincidentaleconomist.com/wordpress/confusion-over-essential-health-benefits/">the recent changes will likely cause a further deterioration</a> of the individual health insurance marketplace.In fact, despite attacking Democrats for the process in which they passed the ACA, Republicans will likely introduce the completed bill and take a final vote on it in the same day. The vote will come less than <a href="http://www.businessinsider.com/obamacare-repeal-replace-bill-text-2017-3">three weeks after the introduction</a> of the original AHCA. By contrast, the ACA was <a href="https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca">introduced</a> five months before the House passed the bill in 2009.<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div><h2>Losing support on both sides</h2>The problem facing the AHCA on its crucial day: Even with the concessions, both moderates and conservative Republicans have taken issue with parts of the bill.Conservative members of the House Freedom Caucus have said the bill does not go far enough in its repeal of Obamacare's insurance regulations, even with the end of essential health benefits.Freedom Caucus members want to see more of the so-called Title 1 regulations stripped, <a href="http://www.businessinsider.com/freedom-caucus-trumpcare-ahca-pre-existing-conditions-obamacare-2017-3">including provisions preventing insurance companies</a> from denying coverage based on a preexisting conditions and the ability for a child to stay on their parents health insurance until they are 26 years old. Both of these provisions have proved incredibly popular with the American public.The White House has balked at these demands, which has left Freedom Caucus members at large decidedly against the bill. According to reports, the Freedom Caucus held a meeting on Friday morning and many of its approximately 35-member caucus were still strongly in the "no" camp.(<a href="http://www.businessinsider.com/conservative-freedom-caucus-against-trumpcare-ahca-before-house-vote-2017-3">Read more on the conservative pushback »</a>)At the same time conservatives are asking for more parts of the ACA to be repealed, moderates have been coming out against the bill for going too far in potentially disrupting the healthcare system.One high-profile moderate defector was Rep. Rodney Frelinghuysen of New Jersey. Frelinghuysen, the chair of the House Appropriations Committee, wrote in a Facebook post that the changes to the essential health benefits convinced him to vote "no" on the bill."Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey," <a href="https://www.facebook.com/rfrelinghuysen/posts/816598255160874">Frelinghuysen wrote.</a> "In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues."Other moderates <a href="http://www.businessinsider.com/trumpcare-ahca-obamacare-house-vote-trump-paul-ryan-freedom-caucus-2017-3">have said that the changes to Medicaid</a> will prevent them for voting for the bill.As of 11:30 a.m., <a href="https://www.nytimes.com/interactive/2017/03/20/us/politics/health-care-whip-count.html?smid=tw-share&amp;_r=3">The New York Times estimated</a> that 32 Republicans have come out against the bill and 10 others are leaning against it.<h2>What to expect</h2>The White House and GOP leadership will continue to wrangle votes as debate on the AHCA continues for four hours, per the rules set down by the House Rules Committee on Friday morning. The Democrats and Republicans will have two hours apiece to debate the bill, in which House lawmakers can make their closing arguments about the proposal.After the debate, the plan is for a final vote to be taken. A Republican source close to the process told Business Insider that the GOP leadership expects a final vote on the bill just after 4 p.m. ET. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/former-head-of-the-cia-says-obama-never-tapped-trumps-phones-2017-3">Here's why the former head of the CIA says Obama never tapped Trump's phones</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="g4dnA2YTE6ivUGsvNlsch-EJAqduVXjB" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

'TRUMPCARE' JUDGMENT DAY: The GOP's Obamacare replacement is in danger

<div class="KonaFilter image-container float_right"><div class="image"></div></div>It's called a "marriage squeeze." It's what happens when cultural norms and state policies combine in places like China and India to make the birthrates of boys greatly outpace those of girls.Then, when those boys come of age, there aren't enough would-be brides to go around. This is a huge problem for at least two reasons: Historically, heterosexual marriage is seen as a necessary part of being included in society in these two countries As the New York Times <a href="http://india.blogs.nytimes.com/2013/01/16/indias-man-problem/" target="_blank">reports</a>, having "a shortage of marriageable women, results in higher rates of crime, including rape, committed by young unmarried men."<a href="http://www.economist.com/news/asia/21648715-distorted-sex-ratios-birth-generation-ago-are-changing-marriage-and-damaging-societies-asias?fsrc=scn/tw/te/pe/ed/barebranchesredundantmales" target="_blank"> </a>The squeeze stems largely from years of sex-selective abortions, first in China as a result of the one-child policy and, in India, as a result of the increasing availability of prenatal screening and a preference for boys. Where there isn't sex-selective abortion,<a href="http://www.epw.in/special-articles/female-foeticide-rural-haryana.html" target="_blank"> infant girls are killed</a>.Today, the imbalance is pretty profound: According to <a href="http://www.bbc.com/news/magazine-21320560" target="_blank">a 2013 BBC report</a>, there are 20 million more men in China then there are women. According to <a href="http://www.bbc.com/news/magazine-21320560" target="_blank">that same report</a>, more than 33% of men aged 25 to 29 in China are unmarried, and about 20% of women are unwed. According to <a href="http://www.censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter5.pdf" target="_blank">2011 census data</a>, there are 37 million more men than women in India.And <a href="http://www.economist.com/news/asia/21648715-distorted-sex-ratios-birth-generation-ago-are-changing-marriage-and-damaging-societies-asias?fsrc=scn/tw/te/pe/ed/barebranchesredundantmales" target="_blank">as data collected by the Economist shows</a>, the imbalance is getting even more extreme: From 2010 to 2015, China's birth ratio was 116 boys to 100 girls, India's was 111 to 100. The natural rate is 105 to 100. If births rates were normal, China would have 66 million more girls born in 2010. For India, it would have been 43 million. In 2050, India will have an estimated 30% more men looking to marry than single women. In 2055, it will be the same. In China in 2050, there will be an estimated 186 single men looking to marry for every 100 single women. For India in 2060, there will be 191 single men looking to marry for every 100 women.Because of this imbalance, a "marriage queue" starts to develop.Again, the Economist <a href="http://www.economist.com/news/asia/21648715-distorted-sex-ratios-birth-generation-ago-are-changing-marriage-and-damaging-societies-asias?fsrc=scn/tw/te/pe/ed/barebranchesredundantmales" target="_blank">explains</a>: At stage one, a cohort of women reaches marriageable age (say, 20-24); they marry among the cohort of men aged 25-29. But there are slightly more men than women, so some members of the male cohort remain on the shelf. Later, two new cohorts reach marriageable age. This time, the men left over from the previous round (who are now in their early thirties) are still looking for wives and compete with the cohort of younger men. The women choose husbands from among this larger group. So after the second round even more men are left on the shelf. And so on. A backlog of unmarried men starts to pile up.Since men in India and China tend to marry women who are younger than them or have less education, professional, educated women in Mumbai and Shanghai <a href="http://www.economist.com/news/asia/21648715-distorted-sex-ratios-birth-generation-ago-are-changing-marriage-and-damaging-societies-asias?fsrc=scn/tw/te/pe/ed/barebranchesredundantmales" target="_blank">have more trouble finding a husband</a> - provided that they're interested in such a thing. That creates an increase in the number of single women age 27 or older, who in China are unhelpfully called <a href="http://www.ibtimes.co.uk/single-educated-problem-chinas-leftover-women-1434671" target="_blank">sheng nu</a>, or leftover women. The increase of women's status in society pushes the trend even further. As can be seen across the globe, the more educated and higher status women become, the more likely they are to put off marriage or avoid getting hitched at all. In the United States, <a href="http://douthat.blogs.nytimes.com/2013/03/22/late-marriage-and-its-consequences/?_r=0" target="_blank">the average age of marriage for women is 27 and 29 for men, both all-time highs</a>. In Europe, the average age of marriage for women is even higher: <a href="http://www.citylab.com/politics/2013/10/these-countries-have-oldest-and-youngest-first-marriages/7313/" target="_blank">32 years old in Sweden, 31 in France and Ireland, and 30 in Italy</a>. In the richest parts of Asia, <a href="http://www.economist.com/node/21526329" target="_blank">the average age of marriage is going up, too: In Japan, South Korea, and Hong Kong, the average age of first marriage for women is 29 to 30</a>. With all these trends combining, marriage in China and India is becoming ever-so-slowly more <a href="http://www.businessinsider.com/difference-between-single-men-and-women-2015-4">like marriage in the United States - optional</a>. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/barack-obama-body-man-reggie-love-2015-2">Here's what it takes to be President Obama's right-hand man</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="g1N2NwczpXSDrnuf4uTcS7BnUmwlMLeM" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

India and China are in the middle of one of the greatest gender imbalances in history - and it's making for an unprecedented 'marriage squeeze'

At one of the largest hospitals in Delhi, a patient was suspected to have <keyword id="525231" type="UNKNOWN" weightage="100" keywordseo="septicemia">Septicemia</keyword> infection; however the detection needed to be confirmed. The doctor contacted <keyword id="3029563" type="UNKNOWN" weightage="100" keywordseo="iGenetic-Diagnostics">iGenetic Diagnostics</keyword>, the newly launched diagnostics lab focused on high-end tests. iGenetic was able to complete the detection in 24 hours. What is unique about iGenetic’s offering is that they have managed to reduce the detection time of this extremely fatal disease (Septicemia is an extremely fatal disease, where there is a pathogen in the blood, that needs immediate diagnosis and treatment) from 3 days to 24 hours. In addition to a rapid detection, iGenetic is also able to identify the causant pathogen so that the correct line of treatment can be initiated immediately. 
 “Previously sample testing would either take significantly longer or the pathogen would go undetected due to lack of testing methods. Now with our in-house designed tests we can detect the pathogen much faster. Our test has got extremely high specificity and sensitivity as we have a deep understanding of <keyword id="117841" type="ORGANIZATION" weightage="100" keywordseo="molecular-biology">molecular biology</keyword> ” said Dr. Archana Krishnan, a lead scientist and Co-Founder at iGenetic. 
 
With a team of 10-12 scientists and three years of research, iGenetic Diagnostics launched this unique test and thus significantly increased the survival rate for patients having Sepsis. They are also one of the two labs in the country with the capability to detect Septicemia. 
 
“It is difficult to give definite amount of money invested for this test as we have made significant investments, both from a financial as well as intellectual perspective in order to build our unique menu of diagnostic tests. Hypothetically, if we start from scratch today, it would cost around Rs. 4-5 crores said Siddharth Patodia, co-founder of iGenetic. 
 
The main purpose of iGenetic is to bring high-end tests at affordable prices for the Indian population to tier II and tier III towns where there are good consultants but dearth of good diagnosis. They have launched tests which are available at lower prices than its global competitors (mainly European and American companies). 
 
“For example, the tests available for Pre-implantation-Genetic Screening (PGS) from international players costs around Rs. 1 lakh per sample. Our test of the same quality costs around Rs. 60,000” said Arunima Patel, co-founder of iGenetic. 
 i<keyword id="49685" type="UNKNOWN" weightage="100" keywordseo="Genetic">Genetic</keyword> is also on the way to validate another breakthrough technology - Non-Invasive Pre-natal testing (NIPT) for screening of downs’ syndrome and other serious genetic disorders in the early weeks of pregnancy. The current method (Amniocentesis) is risky as it can potentially lead to injury to the foetus; NIPT is completely safe for the mother and baby as it is done on the mother’s blood. NIPT is currently available only in the US and Hong Kong; iGenetic is in the process of launching it now in India as one of the first players in the market. 
 
“The test is currently under validation. We have already validated several samples and after regulatory approvals, we will launch it in the Indian market in the next few months,” she said. 
 
Archana said they are targeting 50 samples of which they are already half way through. 
 
This is only the beginning of the journey. They are looking to design one of the most advanced forms of molecular biology in India, Micro-arrays. 
 
“This is relevant especially for African markets, where there is a lot of demand and currently the solution is constrained due to logistics.. If we can provide the answers quickly through a chip base solution such as micro-arrays, then we can target those markets effectively,” she said. 
 In the field of <keyword id="6355291" type="ORGANIZATION" weightage="100" keywordseo="Cancer">cancer</keyword> detection, iGenetic has launched Next Generation Sequencing (NGS). NGS is the latest technology globally and facilitates personalised medicine. This means that for each individual patient, the treatment can be tailor made so as to have the highest efficacy. This is also known as personalised medicine. In the US and Europe, personalised medicine for cancer treatment is now becoming standard. iGenetic is making the same tests available for the Indian population. 
 
Investment plan 
 
With an investment of over US$10 million this fiscal year, they plan to add 2-3 cities each month to their locations of operations. 
 
In the last six months, they have launched their operations in 10 cities. 
 
“We plan to add 2-3 cities every month. Next month we are going to add Kolkata, Pune and Bangalore. We will open up three more locations in Maharashtra and Gujarat. We will shortly start our operations in international markets including the Middle East and SAARC countries as well. We are also looking to license some of our unique offerings to the markets in the Western countries,” said Arunima. 
 
What gives them an edge over their foreign competitors in the Indian market is that they can customise their tests to be targeted and affordable. 
 
Challenges 
 
In the western markets, high end tests constitute about 40 per cent of the total pathology market. In India, it is limited to only 10-15 per cent. Cost and availability of these tests in India are the key constraint. 
 
“The diagnostics space industry is completely unregulated. What it has led to is lots and lots of unregulated players. Anybody can open a lab. It becomes a challenge for a patient to determine the quality of the test results. Some regulation in this space to maintain quality standards would be a welcome step,” said Siddharth. 
 
The next big challenge is awareness. Though these tests are highly accurate and faster, awareness of genetic tests still remains limited. 
 
And yes, affordability comes next. The high-priced tests cannot be afforded by all. With more indigenous R&amp;D the tests can be made affordable. 
 
The third difficulty faced by the players in the diagnostics space is the poor logistics system of our country. 
 
“It should be improved so that we receive samples from places like Vizag on time and in intact condition,” said Arunima. 
 
iGenetic Diagnostics is a young and fast growing Company in the high-end diagnostics space with a focus on genetic testing. The company is positioned to solve difficult to diagnose cases especially in the field of Cancer, critical care and IVF. We are a research oriented company which has developed several tests in-house. 
 
They have successfully launched several unique tests, saving lives across Delhi, Maharashtra, Gujarat, Andhra Pradesh, Bihar. 
 
(Image credits: 1zoom.net)

This diagnostics lab in India has come up with a unique test
to treat Septicemia

<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div></div></div>Paul Ryan strode to the lectern, looking solemn. It was hard to imagine in November, after Donald Trump shocked the world to win the presidency and Republicans gained even bigger majorities in the House and Senate."Obamacare is the law of the land. It will remain the law of the land until it is replaced," <a href="http://www.businessinsider.com/paul-ryan-ahca-vote-obamacare-repeal-2017-3" target="_blank">Ryan said</a>. "We will be living with Obamacare for the foreseeable future."Just 64 days into his presidency, the first major legislative item on the Republican agenda was dead.Ryan called Trump around 3 p.m. Friday to say what Republican leaders knew all week - they didn't have the votes to pass the American Health Care Act. Trump told him to pull the bill.The collapse of the AHCA, which became colloquially known as "Trumpcare" and "Ryancare" through the process, capped off a wild 18 days in which the bill was introduced, went through four committees, was amended multiple times, and ultimately failed to garner enough support from House Republicans.The defeat of the legislation represents not only is a short-term failure for one of the biggest parts of Trump's legislative agenda, but also an ominous sign for Republican efforts going forward.<h2>'We came up short'</h2>Ultimately, the AHCA fell flat because Republicans wre not able to unite the two disparate wings of the party. On the one hand, the conservative wing - primarily the House Freedom Caucus a 35-member, more conservative-leaning group - <a href="http://www.businessinsider.com/conservative-freedom-caucus-against-trumpcare-ahca-before-house-vote-2017-3">felt the AHCA did not go far enough in its repeal of Obamacare</a>.The Freedom Caucus had enough ammunition to hold out for a variety of reasons. The caucus was just big enough to block the GOP from obtaining a majority to pass the legislation. They are mostly safe in their districts. And conservative action groups like Heritage Action and Club for Growth were on their side. Part of the problem came from the GOP leadership, which gave the caucus the ammunition to hold out nearly two years ago.Then, Republicans passed a "clean" Obamacare repeal bill in 2015, through both the House and Senate. The bill stripped all of Obamacare' taxes, like the AHCA, but also its protections for patients and popular regulations like the ability for a child to stay on their parents' insurance until age 26.Freedom Caucus members who turned against the AHCA repeatedly brought up the 2015 bill as an example of what repeal could look like. And since every member voted to pass that bill, for the Freedom Caucus, it became a question of why they would not simply do that again."There's one thing that has united Republicans in when we won the House, in 2014 when we won the Senate, and in 2016 when we won the White House. This doesn't divide Republicans, this brings us together, and that is complete repeal, clean repeal," <a href="http://www.businessinsider.com/jim-jordan-obamacare-repeal-bill-press-conference-rand-paul-2017-3" target="_blank">Sen. Rand Paul said on March 7</a>.On the other end, moderate Republicans like the so-called Tuesday Group thought the bill went too far in its changes to the healthcare system.Facing the prospect of thousands of voters in their district losing their healthcare and seeing backlash from constituents at a variety of town-hall meetings, the AHCA was not palatable to this group.The issue was exacerbated as the White House and GOP leaders gave concessions to the conservative wing of the party in the final days. Tweaks like the repeal of the ACA's essential health benefits - which compel insurers to provide basic coverage for things like prenatal care and preventive screenings - made moderate Republicans reject the bill.Additionally, the changes to Medicaid funding in the AHCA - including ending the Medicaid expansion that allowed 11 million Americans to get coverage since the ACA - made moderates move off of the plan.Republican Rep. Rodney Frelinghuysen of New Jersey, chair of the House Appropriations Committee, <a href="http://www.businessinsider.com/house-appropriations-chair-comes-out-against-trumpcare-2017-3" target="_blank">cited those tweaks when he made a stunning decision</a> to oppose the bill Friday. "In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues," Frelinghuysen said. "I remain hopeful that the American Health Care Act will be further modified. We need to get this right for all Americans."The further the bill moved to the conservative edge, the more moderates the GOP would lose - and vice versa. The dynamic made it near impossible for Ryan and the House leadership to find enough votes to pass the AHCA.<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div><h2>High-speed crash and a failed sell</h2>Another factor that contributed to the demise of the AHCA was the speed at which the bill was pushed through the House.While Ryan and Republican leaders said the bill was going through "regular order," there were few opportunities for debate of the bill and little knowledge of its effects.The Congressional Budget Office did not issue a score on the bill until it had already moved through two committees - and the full text of the updated bill only became available on Friday, the same day it was supposed to be voted on. The CBO did not issue a score for the final iteration of the legislation.This speed gave cover for some Republicans who were skeptical of the AHCA. Rep. Mark Sanford of South Carolina, a Freedom Caucus member who wavered between undecided and "no" on the AHCA, even said during the debate on the House Floor on Friday that he questioned the speed at which the bill was being passed.Trump, who initially left the sales pitch to GOP leaders, ended up mounting a furious push in the last few days, meeting with members of the Freedom Caucus a handful of times in the days leading up to the planned vote.But even at large rallies in Tennessee and Kentucky, where Trump was supposed to drum up support for the healthcare bill, he instead focused on other issues for the bulk of his speech. In fact, in Kentucky, Trump said that the bill has to pass "in some form" so that Republicans could "move on" to other issues like tax reform.Conservative media latched on to the seeming lack of support from Trump, as well, with conservative outlets like Breitbart opting to call the bill "Ryancare" and pin its shortcomings on the House speaker rather than the president.Ultimately, Trump decided Thursday night to <a href="http://www.businessinsider.com/trump-healthcare-pass-ahca-obamacare-2017-3" target="_blank">issue an ultimatum to wavering House Republicans</a>: Pass this bill, or Obamacare stays. It ended up staying, for now.<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div><h2>What it means for the future</h2>The inability to pass the AHCA is only one legislative misstep. But it indicates that Trump's desire to pass sweeping overhauls of taxes, immigration, and trade deals - even must-pass legislation like a debt-ceiling increase - is newly in doubt.Ryan and Trump both said on Friday that the GOP would move on from healthcare and focus on other legislative priorities."Now we are going to move on with the rest of our agenda because we have big, ambitious plan," Ryan said at a press conference.The AHCA drama proved, however, that the rest of the agenda may not be as easy as that. The struggles proved the Republican conference is diverse, with competing interests and goals.A push for something controversial like a border adjustment tax, a policy that is favored by House GOP leaders but has drawn fierce resistance from some GOP lawmakers and outside groups, may end up similarly dividing the party. Additionally, Trump has expressed misgivings about the border adjustment tax, similar to his half-hearted approach to the AHCA."The differences between dealmaking in New York City and dealmaking in Washington, DC, have never been more apparent; Trump is like a fish out of water," said Greg Valliere, the chief global strategist at Horizon Investments. "He will have to change the subject, quickly, but soon he will face bruising budget battles." <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/former-head-of-the-cia-says-obama-never-tapped-trumps-phones-2017-3">Here's why the former head of the CIA says Obama never tapped Trump's phones</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="g4dnA2YTE6ivUGsvNlsch-EJAqduVXjB" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

How 'Trumpcare' went up in flames - and why it should worry the GOP about the future

<div class="KonaFilter image-container float_right click-to-enlarge"><div class="image on-image"><a title_source="Andreea Ayers" title_caption="Andreea Ayers." class="zoomin" href="https://static-ssl.businessinsider.com/image/557727d06bb3f7f510e55aeb-960/andreea-ayers-headshot-1.jpg"></a><a href="http://www.launchgrowjoy.com/">Andreea Ayers</a>Andreea Ayers.</div></div>When Andreea Ayers starting looking for jobs after moving with her husband to Boulder, Colorado in 2006, she was five months pregnant with her first child.After a handful of interviews that went nowhere, she realized she might be better off building her own business, where she could have some flexibility with her new baby."I always had side businesses along with full time jobs," the 39-year-old says. "So I thought. 'Let me pick one idea and devote myself full time to it."She decided to launch a tee-shirt company, using her savings to get started. "It was definitely under $1,000," she remembers. "I wanted to start with $1,000 because I figured, 'If I lose $1,000, it's not that bad.'"From whether she should screen print herself (no, she would outsource), to where to buy her blank tee-shirts (she ordered a bunch of samples and chose one that she would want as a customer), to whom she should sell (women), to what she should feature on the shirts (inspirational phrases), there were a lot of choices to make. "I learned as I went along," she says.Ayers placed her first order for 96 shirts in four colors, drove them to a screen printer in Denver who walked her through the process, took her own photos, and set up a website and Etsy shop in April 2007 selling the tees for $28 each to "see what would happen."Orders started to trickle in during that first month, and then, she had an idea. At a prenatal yoga class, she noticed her instructor was wearing a shirt that said "Be present.""I was riding the bus back, thinking that shirt was so inspiring," she remembers. "I thought maybe it makes sense to sell the shirts to yoga studios."That weekend, she spent two days combing through yoga websites and magazines to build an Excel spreadsheet of 3,000 yoga studios in the US and the names of the owners. "I spent the next week emailing every single one individually," she says. She offered the shirts, which cost her under $8 each to make, to the studios at wholesale, around $14 each. Within a week, she had sold out of her initial order and was able not only to reimburse herself the starting costs from her savings, but also make a profit and finance another order of shirts.<div class="KonaFilter image-container float_right click-to-enlarge"><div class="image on-image"><a title_source="Andree Ayers" title_caption="Ayers filming a video for one of her courses." class="zoomin" href="https://static-ssl.businessinsider.com/image/557728186da811c614f682e6-960/andreea-ayers-courses.jpg"></a><a href="http://www.launchgrowjoy.com/">Andree Ayers</a>Ayers filming a video for one of her courses.</div></div>From there, the business snowballed, and that first year it earned about $124,000. As the business continued earning more, up to $160,000 a year, she was able to pay herself at least $3,000 a month - sometimes up to $10,000, depending on whether she needed to buy inventory - until she sold the business in February of 2011, right before her third child was born."I was getting so many emails from people asking questions," Ayers remembers. "I had a lot of success getting in magazines, and people would say, 'How did you do it? Can I hire you?" So she started consulting in April of 2011 and took on five clients for $500 a month each, teaching them how to launch their businesses.But with three young kids, helping five clients was too much. Ayers decided instead to launch an online course, "basically teaching them what I had been teaching them one on one - everyone had the same questions and the same needs."She had been blogging about her experience launching a tee-shirt business, and had started to build an audience and an email list, to whom she offered her course for $47. About 50 people out of her 200-person list signed up. "I thought, 'This is crazy!' Ayers recalls. "Putting this course together, now I can sell to a lot more people than I could ever work with one on one."After another $47 course with similar registration, in January of 2012, she launched a third, higher-end six-week course for $800 and sold 60 spots, creating videos to include and getting affiliate marketers on board.Since then, she's begun offering not only the courses on her website <a href="http://www.launchgrowjoy.com/">LaunchGrowJoy.com</a>, but also a <a href="http://www.getmediahappy.com/">$125/month membership to access media opportunities</a>, and takes regular speaking engagements that pay anywhere from $200 to $10,000.<div class="KonaFilter image-container float_right click-to-enlarge"><div class="image on-image"><a title_source="Andreea Ayers" title_caption="Ayers's business has allowed her to spend more time with her three kids." class="zoomin" href="https://static-ssl.businessinsider.com/image/557729f56bb3f7ba1ae55ae8-960/andree-ayers-colorado-1.jpg"></a><a href="http://www.launchgrowjoy.com/">Andreea Ayers</a>Ayers's business has allowed her to spend more time with her three kids.</div></div>She works about 25 hours a week (unless she's preparing for a project, in which case she might work more) and employs virtual help including an assistant, a designer, a copywriter, and a video producer.Over the last few years, her business's annual revenue has steadied around $220,000-$240,000, and she usually takes home about $10,000 a month."It's had a huge impact on my life and family life," Ayers says. "Having all these businesses has allowed my husband to stay home with our kids, and for me to be home with our kids too, instead of spending my time away at work. If I didn't do this, probably both of us would have to work full time for someone else, and not be able to spend as much time with our kids."And what does she advise someone else who wants to follow a similar career path?"In addition to the type of lifestyle you want, it's important to think about how much you want to pay yourself and make that a priority," she says. "There's always things to spend money on in your business, but if you can make paying yourself a priority, that gives you so much motivation to keep going. If you don't do that, and you're spending so much time and energy and not seeing a return in terms of money, it's easy to get burned out and start resenting your business - and that's one of the worst things you can do." <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/james-altucher-401k-strategy-investing-money-2015-4">JAMES ALTUCHER: Why investing in a 401(k) is a complete waste of money</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="F3MzBodDrTy3quqOY3LWyY_4WpiCHYJo" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

How one woman turned less than $1,000 of savings into a business that earns over $200,000 a year

<div class="image-container float_right" style="width:480px"><div class="image"><a href="http://www.youtube.com/watch?v=HsQHpgSxA1o">YouTube/U Chicago</a></div></div><keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy">Pregnancy</keyword> and childbirth is one of the most consequential and stressful things that most women go through. 
Given the potential dangers, and the fact that people are committing to 9-months of pregnancy followed by 18 or so years of child rearing, anxiety and caution are understandable. 
Understandable caution too often ends up turning into excessive self-denial.
When University of Chicago professor <a href="http://faculty.chicagobooth.edu/emily.oster/">Emily Oster</a> got pregnant, she expected it to be similar to her professional life, a situation where there was good data, plenty of information, and a good basis for herself and her husband (also an economist) to make an informed decision. 
She found a massive set of rules, and a lot of studies and doctors mixing up correlation and causation. Her own research, applying the data literate and occasionally skeptical eye of an economist to pregnancy ended up turning into a book, <a href="http://www.amazon.com/Expecting-Better-Conventional-Pregnancy-Wrong-/dp/1594204756/ref=sr_1_1?s=books&amp;ie=UTF8&amp;qid=1376950574&amp;sr=1-1&amp;keywords=expecting+better">Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong – and What You Really Need to Know</a>, which is coming out tomorrow. 
Here are a few highlights from the book, which is definitely worth picking up for anyone who's considering or having a child for the expanded data and the coverage of pregnancy from conception to birth. 
Alcohol and coffee are fine in moderation
We covered this in more detail <a href="http://www.businessinsider.com/emily-oster-expecting-better-2013-8">in a previous post</a>, but blanket prohibitions on either of the above are misguided. A few cups of coffee a day are fine, Oster finds, and continued her 4 cup a day habit through pregnancy. As much as a glass of wine a day is fine after the first trimester, and a couple a week are fine even then. 
Up to two cups are supported as fine by pretty much all evidence, most evidence supports 3 to 4, and even for larger amounts of coffee, the links to miscarriage may be due to the fact that these women were less nauseous, which can indicate other issues.
And as for alcohol, heavy drinking and binge drinking are very much to be avoided. There's no good evidence that light drinking hurts a baby.
Sushi is fine, and you should eat more, not less fish
The list of prohibited pregnancy foods is vast, and recommendations can be vague and contradictory. Oster took a closer look, and found a few bans don't hold up to scrutiny.
Do avoid raw/rare meat and poultry, deli turkey (other deli meats are ok), unwashed fruits and vegetables, and queso fresco/raw milk cheeses. The first two put you at risk of toxoplasmosis and the latter two, listeria, both potentially very bad for your baby. 
Sushi, though care should be taken to avoid high mercury fish, turns out to be fine. So do raw eggs. They may contain bacteria, but it's not of a type that's worse for pregnant women. Just don't eat suspect discount sushi or a raw eggs from an old carton.
High mercury fish are bad, but many others are not only low in mercury, but high in beneficial omega-3s, which can boost IQ. The effect holds to the point where people that eat tons of fish have smarter kids on average, despite more mercury exposure. Avoiding it all together is a particularly poor outcome.
Skip canned tuna, eat lots of sardines and other little fish. 
You can clean a litterbox and dye your hair, but don't garden
Food bans are only the start. Women are also cautioned against flying, hair dye, hot tubs, gardening, and cleaning a cat's litter box.
The fears over litter boxes focus on toxoplasmosis, but the likelihood of contracting it that way is quite low, especially if the cat is tested. The risk of contracting it from gardening is quite a bit higher. If you're working with soil, consider a mask and use gloves.
Unless you're a hairdresser, or injecting the stuff, hair dye isn't a concern. You don't absorb enough when simply coloring your hair.
The "over-35 rule" for invasive testing is a huge oversimplification
The choice about pre-natal testing is one of hte most consequential and earliest decisions. Invasive tests, like amniocentesis or CVS carry some risk of miscarriage. Noninvasive screening doesn't, but is less accurate in measuring the probability of having a chromosomal anomaly like Down's Syndrome. 
Because these issues are more common for older mothers, invasive screening is often only offered to women over 35.
Women under 35 are rarely even offered the choice of invasive screening because of the relative chances of relative to miscarriage. As Oster puts it, this is "insane." Every woman or family has different opinions on their ability or desire to raise a child that might have developmental issues, compared to the (very low) prospects of miscarriage and they need to be given the opportunity to make that decision. 
The conventional wisdom about weight is wrong
The question of weight gain is particularly stressful, with many doctors giving women a hard time about gaining too much weight. Though the idea that you're "eating for two" is wrong (you need to eat a bit more, but not a ton more) gaining a bit too much weight isn't all that big of a deal, most women manage to take it off. 
Targeting some weight then worrying about being a pound or two over isn't productive. Even 10 or 15 pounds over isn't really important. If you gain more weight, the baby will be slightly larger on average, if you gain less, . Gaining too little weight and having an undersized baby is a larger concern. 
"But mostly chill out," Oster writes.
Exercise doesn't really matter
Some women are encouraged to exercise, mainly due to concerns about weight. On average, women who exercise during pregnancy don't end up changing their end weight all that much, and there's not much evidence that there are other beneficial effects. Basically, most women should just keep doing what they've been doing, avoiding over-strenuous exercise or anything that might result in falling.
Bed rest doesn't prevent premature birth and is bad for you
Preterm birth is fairly common, and can have significant negative impacts. Preterm babies get ill more easily, have lower IQs on average, and occasionally hearing or vision problems, though survival rates are much, much higher than they used to be. 
Bed rest is frequently advised for people that could go into preterm labor, but there's no real evidence that it works. 
Not only that, it has negative consequences, including restricting women from working or doing much of anything to help their families, along with potential bone loss, muscle decay, and possibly decreased birth weight. 
Doctors know this, but still often prescribe bed rest. The conventional wisdom has hung on, against the evidence.
Find Expecting Better <a href="http://www.amazon.com/Expecting-Better-Conventional-Pregnancy-Wrong-/dp/1594204756/ref=sr_1_1?s=books&amp;ie=UTF8&amp;qid=1376950574&amp;sr=1-1&amp;keywords=expecting+better">here</a>

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