THE PROGNOSIS

Sen. Joe Manchin (D-W.Va.) pauses during a television news interview on Capitol Hill in Washington. (AP Photo/J. Scott Applewhite)

The middle ground on abortion rights is narrow and politically treacherous, and senators trying to inhabit it risk wrath from both sides in 2018.

Another big fight over taxpayer funding for abortion providers is brewing in the Senate, which may soon take a vote on whether to deny Medicaid reimbursements for one year to Planned Parenthood. Such a provision was included in the House’s Obamacare overhaul bill, and Republicans are under heavy pressure from conservative groups to include it in a Senate version.

The abortion issue is a deeply polarizing one, and has become so closely aligned with partisan identity that just a handful of antiabortion Democrats and an equally small number of Republicans supportive of abortion rights remain in Congress. Democrats have been forced to grapple with the issue lately. After Democratic National Committee Chairman Tom Perez suggested supporting abortion rights is “nonnegotiable” for Democratic candidates, House Minority Leader Nancy Pelosi (D-Calif.) appeared to push back, telling The Washington Post the Democratic Party is not a “rubber-stamp party.” Now Perez has confirmed he plans to meet with the antiabortion group Democrats for Life of America.

Yet as fractious as the issue of abortion rights is, a few senators appear malleable -- or at least deeply conflicted about which side of the fence they should pitch their tent. Consider two moderate senators facing tough reelections next year: West Virginia Democrat Joe Manchin III and Nevada Republican Dean Heller.

Manchin recently appeared in two contrasting photographs: One with a sign supporting Planned Parenthood and another with a sign opposing the group (Axios first placed the photos side-by-side):

And last month, Heller told a town hall crowd he has no problems with federal funding for Planned Parenthood and said he would “protect” the women’s health and abortion provider:

The next day, Heller’s office quickly walked back the comments, saying that Heller is “opposed to providing federal funding to any organization that performs abortions.”

Manchin’s vote matters to antiabortion advocates because he’s one of the few remaining Senate Democrats they have any hope of keeping on their side. Both he and Heller describe themselves as “pro-life,” although as Nevada's secretary of state, Heller once said he backed a woman's right to choose abortion.

These juxtapositions reflect the conundrum before the lawmakers -- both of whom are defending their seats in purple states next year. In order to win, the Republican and Democratic incumbents need to appeal to a broader spectrum of voters while still luring their base. And while there are moderate positions to be had on a whole host of issues, it’s difficult-to-impossible to find a politician who will articulate a nuanced position on abortion rights.

It’s not that you can’t take a moderate position on abortion. Many Americans do. Fifty percent of registered voters in the most recent Gallup poll said abortion should be legal only under certain circumstances (29 percent said it should always be legal and 19 percent said it should never be legal).

But the activist groups who pour millions of dollars into campaigns don’t occupy that middle ground. They’re on opposite ends of the spectrum, and they’re ready and waiting to pounce on candidates who don’t toe the line. Planned Parenthood is targeting Heller with television ads, using footage from that town hall meeting:

Susan B. Anthony List, a nonpartisan group focused on electing antiabortion women to office, put Manchin on its hit list after he opposed a GOP-led bill allowing states to ban Planned Parenthood from getting Title X reimbursements for family-planning services.

“With that Planned Parenthood vote, he put himself on our election map,” Dannenfelser told me this week.

Manchin recently told Politico he will continue to support federal funding for Planned Parenthood as long as it can’t use the money for abortions. Yet Dannenfelser met with Manchin for about 40 minutes last Wednesday, hoping to persuade him otherwise.

What gives her hope is that Manchin bucked his party and voted to defund Planned Parenthood back in 2015, after undercover videos showed some of its clinics supplied aborted fetal tissue for medical research purposes. Manchin was also one of three Democrats in 2015 who voted to advance a bill to ban abortions halfway through pregnancy (the other two were Joe Donnelly of Indiana and Bob Casey of Pennsylvania).

“We do not want to lose a pro-life senator, and we certainly would like to take him off our target list,” Dannenfelser said.

Manchin has already said he’d oppose a bill repealing Obamacare. But should it include a provision defunding Planned Parenthood, a moderate Republican like Sen. Susan Collins (R-Maine) may offer an amendment to strip that part out. In that case, abortion foes would be watching to see how Manchin votes on that language.

The 2010 fight over the Affordable Care Act made antiabortion Democrats virtually extinct. Nearly two dozen in the House and Senate retired or lost their seats after voting for the law that allows federally subsidized health plans to cover abortions (although there’s also a requirement for insurers to use only non-taxpayer funds for the procedure). Donnelly and Casey, along with Manchin, voted to advance the 20-week abortion ban back in 2015, but those two didn't go along on Planned Parenthood defunding -- signaling they're not likely to buck their party now.

The bench is also thin when it comes to Republicans who back abortion rights. With Illinois Sen. Mark Kirk’s loss last year to Democrat Tammy Duckworth, just two supportive Senate Republicans remain: Collins and Lisa Murkowski of Alaska. Those two will almost certainly vote against any health-care plan that targets Planned Parenthood.

But the thorniness of the issue almost guarantees that no matter which way other moderates swing, they will almost certainly be targeted when they're up for reelection by outside groups who care deeply about abortion.

AHH, OOF and OUCH
President Trump listens as Turkish President Recep Tayyip Erdogan speaks in the White House on May 16, 2017. (AP Photo/Evan Vucci)

AHH: President Trump said something mostly accurate last month, when he was talking about health care for veterans. At a rally in Harrisburg, the president said the number of vets able to get care outside the limited VA health-care system has jumped by 42 percent. Trump was referring to the Choice program, which allows vets to get care at a private medical center if they face a long wait time or live far away from a VA medical center. One of our fact-checkers, Michelle Ye Hee Lee, researched Trump's claim and concluded this

"Trump gets into technically problematic territory by citing a 42 percent figure that applies to all community-care programs for veterans, while citing one specific (“Choice”) program, which has seen a 35 percent increase. Politicians have often conflated the two, and there is an effort to consolidate all programs into one label to eliminate this confusion...We prefer the president use more precise language, either by specifying that the 42 percent increase applies to all community care including Choice, or using the 35 percent specifically for the Choice program ... While this technical difference means Trump’s statements do not qualify for a Geppetto Checkmark, he is close enough to being right that we won’t issue any Pinocchios."

OOF: It's never a good idea to make fun of a kid in public, for many reasons. A Fox News contributor learned that the hard way, after she mocked a 10-year-old boy who appeared to overreact when he asked for an apology after Vice President Pence accidentally bumped his nose. Turns out the boy has autism and sometimes struggles with social interactions. The contributor ultimately apologized, after the boy's mother appeared on CNN to set the record straight, saying her son Michael was trying to follow manners he'd been taught in therapy. See the video below:

OUCH: Addiction experts are not pleased that Health and Human Services Secretary Tom Price questioned the effectiveness of drugs used to help people stop misusing prescription drugs or illicit opioids. Nearly 700 of them wrote to Price on Monday, arguing that there's loads of research supporting the use of such treatments and urging him to "set the record straight," NPR reportsThe letter also notes that Price's own agency displays information online that contradicts his comments. If you missed Price's comments, he said last week that using medication to treat drug abuse is "substituting one opioid for another."

HEALTH ON THE HILL
Senate Majority Leader Mitch McConnell (R-Ky.) pauses while meeting with the media to discuss health care on May 9 in Washington. (AP Photo/Jacquelyn Martin)

--The Health 202 feels Senate Majority Leader Mitch McConnell (R-Ky.) made a bit of an understatement when he told Bloomberg News yesterday that passing a health-care bill in the Senate “won't be any easier" than getting one passed in the House. It will actually be even harder -- way harder. But McConnell said the working group of 13 senators are “devoting" Tuesdays, Wednesdays and Thursdays to trying to hammer out a compromise measure. He wouldn't disclose any details of what the lawmakers are discussing, saying he doesn't want to “handicap" the effort.

--Remember how Sens. Patrick J. Toomey of Pennsylvania and Rob Portman of Ohio are trying to craft an agreement on what to do with Medicaid expansion? Toomey, who is representing the views of more conservative members, has signaled he may be open to a smoother transition out of Medicaid expansion than the House bill provided. But whether more conservative senators (like Ted Cruz (Texas) and Mike Lee (Utah)) might agree to that is another question.

--The Senate's second-in-command Democrat, Richard J. Durbin (Ill.), has said he's fine with some Democrats discussing health care with Republicans Susan Collins (Maine) and Bill Cassidy (La.), since the discussions are focused on a broader debate on the topic than just repealing Obamacare. “I think Collins and Cassidy have shown good faith when it comes to that issue … I've talked to both of them privately and I want to continue that dialogue," Durbin told The Hill.

--What does the drama playing out at the White House mean for efforts to repeal and replace Obamacare (and other major projects Republicans want to get done)? Republicans desperately wanted a mutually beneficial relationship with President Trump, as they saw their first chance in a long time to advance a big policy agenda, our own Dan Balz writes. But the events of the last eight days have robbed the GOP of that luxury.

“The White House is now in perpetual crisis mode, scrambling to keep up with the mercurial president, consumed by talk of a possible staff shake-up, with officials pointing fingers at one another as things spiral away from them," Dan writes. “All that also affects the legislative process. It’s not that congressional committees cannot go about doing basic business, but in a 24/7 media environment, coupled with the power of social media to accelerate events, elected leaders have not had the ability to avoid responding. The big story saps the energies of everyone."

--The Health 202 sends our best wishes to Sen. Mazie Hirono (D) of Hawaii, who has announced she'll undergo surgery for kidney cancer but says her doctor expects a full recovery. Here's her tweet: 

BRAIN WAVES
Protesters in Brooklyn bear bitter cold temperatures to voice their opposition to plans hatched by House Republicans to repeal and replace the Affordable Care Act. (Reuters)

Protesters are holding "die-ins" at the district offices of House Republicans who voted last month to overhaul Obamacare, partially to highlight how the bill could result in huge premiums hikes for people with preexisting conditions. While the GOP-passed measure would allow states to waive a ban on insurers from charging people with preexisting conditions more, it's not totally clear how many states would seek that waiver and therefore how many people would be affected. But the Kaiser Family Foundation provides some helpful analysis. Here's what it found:

--People with preexisting conditions could only be charged more if they have a lapse in coverage of several months. About 6.3 million people fit that bill in 2015.

--For any of those people to get charged more, they'd also have to live in a state that gets a waiver from the federal government to lift the ACA's so-called "community rating" banning insurers from basing rates on health status. And it's unclear how many states will do so.

--The Republican health-care bill also provides incentives for patients, including those with preexisting conditions, to maintain continuous coverage because if they don't, insurers can charge them 30 percent more for one year.

--Therefore, it's hard to say exactly how many people might face higher rates because of their health condition, but the number is likely to be less than 6.3 million.

INDUSTRY RX
Another year of big premium increases and dwindling choice is looking like a distinct possibility for many consumers who buy their own health insurance — but why, and who’s to blame?
Former FDA commissioner Robert Califf is in talks with Google's life sciences arm Verily for a leadership role.
The global WannaCry cyber attack highlights a frightening reality.
STATE SCAN
Amid increasing calls for curbs on U.S. drug pricing, some of the most aggressive legislative action is happening at the state level—and industry lobbyists are fanning out to fight back.
Democrats in the New York Assembly are relaunching a push for a statewide single-payer health-care program in hopes that the national debate over health care will give their legislation new momentum.
REPRODUCTIVE WARS
A study published in the BMJ involved data on about 1,000 women in the Republic of Ireland and Northern Ireland.
A state House committee is poised to begin consideration of a bill to ensure abortion remains legal in Delaware if the U.S. Supreme Court ruling in Roe v. Wade is ever overturned.
SUGAR RUSH

See why this British McDonald's ad has people outraged:

See Sen. Kamala Harris (D-Calif.) call for the decriminalization of cannabis:

And finally, Stephen Colbert says White House staffers have gone into hiding: