10. R. Milton Johnson, Chairman and CEO of HCA Healthcare

Under Johnson's helm, Nashville-based HCA Healthcare has been on a buying spree. In April, the for-profit hospital company struck a $710 million deal to purchase 604-bed Memorial University Medical Center in Savannah, Ga., one of eight hospital acquisition deals that HCA has made this year.

According to Stock News Journal, HCA currently has $705 million of cash on the books, which is offset by $213 million current liabilities.

"You can get a sense of how sustainable that is by a levered free cash flow of $2.7 billion over the past twelve months," Stock News Journal writes. "Generally speaking, earnings are expected to grow in coming quarters."

In the company's most recent earnings call, Johnson said that HCA is in position to take advantage of acquisition opportunities as they arise, according to TheStreet.com.

"Our balance sheet and cash flow give us the financial flexibility to invest in our existing markets of quality hospitals and to continue to execute our share repurchase plan," he said.

9. Rick Pollack, President and CEO of the American Hospital Association

Pollack and the American Hospital Association strongly lobbied against the GOP's repeal effort. In June, BenefitsPRO reported that the AHA and other trade groups were spending at least $1 million on television ads opposing Senate Republicans' plan to repeal and replace Obamacare.

The ads asked viewers to consider whether they'll be among the millions of Americans projected to lose their health coverage under the Senate proposal, Pollak had told reporters at the time.

The AHA is also against mandatory participation in federal bundled-payment initiatives.

In its "Bundled Payment – AHA Research Synthesis Report," the group contends that even though the concept of bundled payment is "appealing," implementation is "complex." "Further advancement of bundled payment will depend on the will of payers and providers to collaborate in a new way and to address several challenging operational issues," according to the report.

8. Mark Bertolini, Chairman and CEO of Aetna

Bertolini strongly opposed the GOP repeal effort, urging lawmakers instead to find bipartisan ways to fix the current law.

He is also in the process of moving Aetna down a more holistic road beyond just physical rehabilitation, aiming toward the 1948 definition of health defined by the World Health Organization as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," Bertolini recently said.

Some of the Bertolini-led initiatives at the company include gathering data on the communities in which patients lived, building programs that spanned urban farms in an effort to eliminate food deserts, and teaching yoga-mindfulness in inner city schools to help students focus on their studies.

Bertolini is also a big advocate for in-home monitoring via wearable devices, he said.

Specific data provided by wearables, he said, will allow the insurer to know what kind of help patients need once they're back home in their own communities, so that it can better provide that help—not just to the patient, but to the community supporting that patient.

7. President Donald Trump

Even though the GOP repeal effort failed in Congress, the Trump administration can still find ways to stymie the ACA, as well as include spending cuts to several Health and Human Services programs in the president's 2018 budget proposal.

"There's no question" that the Trump administration and Republicans in Congress are actively sabotaging the Affordable Care Act, former Health and Human Services Secretary Kathleen Sebelius said in a recent interview with Kansas public radio station KCUR. 

At the beginning of his presidency, Trump instructed the Internal Revenue Service to back off enforcement of the individual mandate, she said. The administration also cut funding for advertising to educate consumers on when and how to purchase coverage. 

Now, Trump's threat of ending cost-sharing reduction payments to insurers is creating uncertainty in the individual marketplace, Sebelius said.

Some large insurers, including Aetna and Humana, have already said they will not participate in the health exchange market in 2018 due to the uncertainty. Blue Cross and Blue Shield of Kansas City has also pulled out.

6. Rep. Paul Ryan (R-Wis.), Speaker of the U.S. House of Representatives

For years, Ryan has been one of the loudest critics of the ACA, and has introduced legislation in many sessions calling for deep reductions in Medicaid and a total restructuring of Medicare under voucher system.

He was successful this year in getting the House to pass its repeal-and-replace proposal, the American Health Care Act.

While Ryan has vowed to revisit the ACA repeal effort, for now he and Senate leader Mitch McConnell say they are moving on to tax legislation, which they feel offers a better chance of success, according to The National Memo.

5. Anthony Tersigni, President and CEO of Ascension

The nation's largest Catholic health system under Tersigni's lead is getting even bigger. The $21 billion organization has 141 Catholic hospitals in 24 states and the District of Columbia, with 150,000 employees over 2,500 care sites.

Last week, Chicago-based Presence Health — the largest Catholic-sponsored health care system in Illinois — signed a letter of intent to merge into Ascension, according to Modern Healthcare.

This is Ascension's largest deal since acquiring Wheaton Franciscan Healthcare of Milwaukee in March 2016. In numerous interviews with the magazine, Tersigni has stressed his personal commitment to strengthening and expanding Catholic health care wherever Ascension is needed.

4. Bernard Tyson, Chairman and CEO of Kaiser Permanente

Under the helm of Tyson, Kaiser Permanente posted a $1 billion operating gain in the first quarter and $772 million in the second quarter of 2017. Tyson's signature initiatives involve integrating mental health services into Kaiser's primary-care settings, as a way of promoting the total health of the individuals and communities it serves.

Tyson is also leading the effort of instilling more consumer-facing technology into Kaiser's systems. 

"He is the most influential national leader for the development of patient-friendly technology," Mitchell Katz, MD, director of the Los Angeles County Health Agency, tells Managed Care. "He recognizes that only by embracing modern technologies—such as patient portals, text messaging, and electronic consultations—can we make health care both more effective and more affordable."

1. Sen. John McCain (R-Ariz.) (tie)

Days after being diagnosed with brain cancer. McCain flew back to Washington D.C. from Arizona and in the early morning hours on July 28, cast the final and decisive no vote — effectively killing the GOP's "skinny" repeal act. During floor debate, McCain urged his colleagues to return to a spirit of bipartisanship, and after his deciding vote, Senate Minority Leader Chuck Schumer was moved to near tears, according to Business Insider.

"All of us were so inspired by the speech and the life of the senator from Arizona," Schumer said. "And he asked us to go back to regular order, to bring back the Senate that some of us who've been here a while remember."

Despite his aggressive cancer, McCain is not done with Washington just yet. "To my Democrat friends and some of my Republican friends, I am coming back," McCain quipped laughingly in a video message posted to his Facebook page on Aug. 9. "Even those who want me to die don't want me to die right away, and that's good."

1. Lisa Murkowski (R-Alaska) (tie)

Murkowski rejected all versions of the GOP repeal and replacement efforts, stating that she was particularly concerned over the number of Alaskans who stood to lose coverage under Medicaid, as well as the GOP leadership's closed-door writing of the bills without public debate.

Modern Healthcare writes that Murkowski reportedly was infuriated when the Trump administration threatened to punish her state economically if she didn't support the health care bill.

Now, the U.S. Department of the Interior has confirmed that it's investigating reports that Interior Secretary Ryan Zinke attempted to pressure Murkowski and fellow Alaska Republican Senator Dan Sullivan following their votes on health care last month, according to the Huffington Post.

1. Sen. Susan Collins (R-Maine) (tie)

Not only did Collins also vote no on all of the GOP's repeal and replacement efforts, but throughout her 21 years in the Senate, she has consistently supported programs to expand access to and improve health care delivery, particularly in underserved areas and for the most vulnerable, according to Modern Healthcare.

When asked on CNN's "State of the Union" about the Trump administration's threat to withhold cost-sharing reduction payments to insurers as a way to further destabilize the individual markets after the GOP repeal effort failed, Collins said "I certainly hope the administration does not do anything in the meantime to hasten that collapse." 

Instead, she said, the Senate, through committee action, should produce a series of bills aimed at addressing pressing issues in health care — with the most immediate priority being to stabilize the insurance markets.  "The ball is really in our court right now," Collins said. "Our job is not done."