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    America's Health Insurance Plans, the lobbying group representing insurers, said Wednesday it opposes a Republican bill to overhaul Obamacare, in part because the bill could pave the way for states to implement their own single-payer healthcare systems. The overhaul bill "would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single-payer healthcare to grow," wrote Marilyn Tavenner, president and CEO of AHIP, in a letter to Senate leaders. John Kennedy, R-La., has asked Republicans to add an amendment to the bill that would prohibit states from implementing a state-run health insurance system, but GOP Sen. Lindsey Graham of South Carolina, one of the bill's authors, has said states could try to implement such a system if they wanted. California and Vermont tried to implement single-payer proposals under Obamacare but failed, largely because of cost. A single-payer proposal would remove customers from private coverage, a move that insurers oppose. "To best serve every American, we need both a strong private market and an effective role for and partnerships with government," Tavenner wrote. "Building on the choice, competition and innovation of the private sector and the strength, security and dependability of public programs is a far more effective solution than allowing states to eliminate private insurance." AHIP joins the association of 36 independent Blue Cross Blue Shield insurers in opposing the bill, along with the American Medical Association, the American Hospital Association and a group of 10 bipartisan governors. The most common side effects include: headache, dyspepsia (i.e., pain or an uncomfortable feeling in the upper middle part of your stomach), back pain, myalgia (i.e., muscle pain), nasal congestion, flushing, and pain in limb. When Taken As Needed: The starting dose is usually 10 mg as needed prior to sexual activity but it depends on the individual. It has been shown to improve erectile function, compared to placebo, up to 36 hours post dose. When Taken Daily: The starting dose is 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity. Based on effectiveness and tolerability, your physician may recommend an increase to 5 mg. Cialis has been shown to take effect in as little as 30 minutes. After single oral-dose administration, the maximum observed plasma concentration (Cmax) of tadalafil is achieved between 30 minutes and 6 hours (median time of 2 hours). Absolute bioavailability of tadalafil following oral dosing has not been determined.

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