Axios

The Centers for Medicare and Medicaid Services released its annual report Friday that details how health insurance companies fared in 2016 with two Affordable Care Act programs, called risk adjustment and reinsurance.

The takeaway: Several Blue Cross Blue Shield insurers gained a lot of money through risk adjustment — the permanent program where health plans with less costly, healthier members pay into a pool to offset companies that have sicker, more expensive patients. That implies many Blues plans had sicker enrollees in the ACA's exchanges, or they were more aggressive in coding their members' medical conditions.

A group of 10 senators is sending a letter to Senate Majority Leader Mitch McConnell Friday asking him to shorten their August recess, or cancel it altogether, if the GOP fails to make progress on their legislative agenda in July, reports Politico.

Why it matters: It's the latest example of the Republicans' increasing frustration with the GOP's delayed legislative agenda and how long it is taking them to pass policies that their constituents depend on, like health care and tax reform.

Who signed it: Sens. Mike Lee (UT) — who is one of five GOP senators against the Senate's health bill — David Perdue (GA), Steve Daines (MT), Joni Ernst (IA), John Kennedy of (LA), James Lankford (OK), Mike Rounds (SD), Luther Strange (AL), Thom Tillis (NC), and Dan Sullivan (AK).

Women in the United States continue to have fewer children, and when they do, they are usually in their 30s instead of their 20s. New data from the Centers for Disease Control and Prevention show the U.S. fertility rate in 2016 was a historically low 62 births per 1,000 women, down from the 62.5 rate in 2015.

Telling stat: "Birth rates declined to record lows for women in all age groups under 30 years in 2016."

Why it matters: The CDC did not say why the birth rate is declining. But research and surveys have shown several reasons, including wider availability of birth control, personal economic instability from student loans or other debt, women focused on launching a career before starting a family, and a growing acceptance that not everyone wants to have children.

An investor uprising is starting to bubble over at Mylan, which has been under fire for hiking the prices of EpiPens and other drugs. Mylan released the vote tallies from its June 22 shareholder meeting, and the picture wasn't pretty.

Why it matters: It's a prime example of the megaphone that activist investors have today, and of the tone deafness that some in the pharmaceutical industry have toward their business operations.

A Republican Senator told the New York Times on Tuesday that President Trump gave the impression that he "did not have a grasp of some basic elements of the Senate plan" and that he was "especially confused" by the idea of opponents calling the bill "a massive tax break for the wealthy." More aides described Trump as uninterested in the particulars of health care.

"There would be times when he would describe what was clearly Medicare...but say Medicaid, and when we pointed that out, he would say, 'That's what I said, Medicare and Medicaid."