THE PROGNOSIS

It’s unclear whether James T. Hodgkinson suffered from mental illness. But his attack yesterday on Republicans practicing baseball in Alexandria, Va., reopened the controversy over gun control. And that issue leads to another hard question: Whether and how the mentally ill should be able to access firearms.

Gun control is a tough issue for Washington lawmakers after Republicans in Congress repeatedly blocked President Obama's push for stricter regulations – something the former president has since said is one of his biggest regrets. Lawmakers responding to yesterday’s shooting, which has left House Majority Whip Steve Scalise (R-La.) in critical condition, mostly stayed away from statements that could be perceived as political.

Many believe it’s too hard to change opinions on the subject anyway. Sen. Chris Murphy (D-Conn.) -- who represents the state where the Sandy Hook massacre took place and is a big gun control proponent -- told my colleague Kelsey Snell that he believes the country is beyond the point where a single instance of gun violence, and subsequent reactions from politicians, changes Americans’ minds on the issue.

“No one incident should ever change somebody’s position of gun violence,” Murphy said. “What happened this morning today was tragic but over the course of the day about 80 people will die from gun violence.”

Sen. Lindsey O. Graham (R-S.C.) told Vox that the aftermath of this latest shooting will have "the same ending as all the other conversations about gun control." “I don’t know how this guy got a gun. I don’t know if he did it legally. I don’t know if he did it illegally. I have an AR-15. I’m not going around shooting people with it. Guns, knives, cars, bombs. That’s the world in which we live," Graham said.

In an unusually thoughtful speech from the White House, Trump avoided mentioning any political issues when he discussed the shooting -- which was instigated by an avid hater of him and his policies.

“We may have our differences, but we do well in times like these to remember that everyone who serves in our nation’s capital is here because, above all, they love our country,” Trump said. “We can all agree that we are blessed to be Americans, that our children deserve to grow up in a nation of safety and peace and that we are strongest when we are unified and when we work together for the common good.”

The differences between Democrats and Republicans on gun control are stark – and Trump has staked out a comfortable position within his party on the issue, showing up at the National Rifle Association convention and promising to do what he could to loosen federal regulations on gun control. “It’s not the guns that pull the trigger, it’s the people who pull the trigger,” Trump said at a Fox Business presidential primary debate in January 2016.

But there is a middle ground on the issue – sort of. In past years, Democrats and Republicans have come together on tightening up policies intended to keep firearms out of the hands of the seriously mentally ill.

In the wake of the 2007 Virginia Tech shooting, Congress passed -- and President George W. Bush signed -- a measure to tighten up the background-check reporting system, called the National Instant Criminal Background Check System, or, NICS, to ensure that states provided all the necessary documents indicating whether someone had a history of severe mental illness or violence that could disqualify them under federal law from being sold a gun.

Even though federal law prohibits the sale of firearms to certain individuals with a history of very serious mental illness, there are lots of loopholes in NICS. States often fail to turn over the necessary records to the NICS, resulting in purchases by people who could prove dangerous to themselves and others. That’s a problem the 2007 legislation was trying to correct.

The measure was bipartisan. But late last year, the Obama administration interpreted it in a way Republicans and civil-rights advocates didn’t like, underlining the fact that even that middle ground is fraught with controversy.

The Obama-era regulation blocked the sale of firearms to people deemed by the Social Security Administration to be so severely mentally ill that they couldn’t hold down a job or cash their own benefit checks. Many Republicans viewed the rule allowing sales to be blocked to people based on their SSA status as violating the constitutional right to bear arms and stigmatizing those with mental illness – and the ACLU and other disability rights groups agreed. In February the GOP-led Congress and Trump quietly did away with it.

“I fully support that if a person has a medical diagnosis that they are not mentally competent, absolutely they should go on the NICS list,” Rep. Tim Murphy (R-Pa.), who opposed that rule, told The Health 202.

“Just because someone has their checks sent to someone else, that is not an affirmative decision by a psychologist,” added Murphy, a psychologist by training who is known as a top mental-health advocate in Congress.

Yet Democrats and gun-control advocates say it’s hypocritical for Republicans to support keeping guns out of the hands of the severely mentally ill, and then do away with regulations advancing that goal.

“I think there’s a certain hypocrisy to the argument that we need to focus on mental health when they’re not willing to talk about guns in that discussion -- when the catalyst for that discussion is a shooting,” said Lindsay Nichols, federal policy director for the Law Center to Prevent Gun Violence.

Details are still emerging about Hodgkinson, who was shot dead by police after opening fire on Scalise and the other Republicans practicing for their annual baseball game against Democrats (which is still planned for tonight). He had a history of arrests, and was known for extreme, leftist rants on social media, but it’s unclear exactly what drove him to go so far as to mount an attack.

And mental-health experts warn against automatically assuming that perpetrators of mass shootings suffer from psychological disorders – some do, but not all of them.

But as long as mass shooting happen, they’ll keep churning the debate in Washington over gun control and mental illness. Virginia Gov. Terry McAuliffe (D) said as much as he spoke near the scene of the shooting shortly after it happened. The Democrat said it wasn’t the day to talk about gun control…and then talked about gun control.

“This is not what today is about — but there are too many guns on the street,” McAuliffe said. “We lose 93 million Americans a day to gun violence.” [He later corrected this to say 93 individuals]

“I have long talked about this,” he said. “Background checks, shutting down gun show loopholes. That’s not for today’s discussion, but it’s not just about politicians.”

That earned McAuliffe some criticism from the political right. From Charlie Kirk, founder of the conservative student group Turning Point USA:

From Townhall editor Katie Pavlich:

Rep. Mo Brooks (R-Ala.), who was among the Republicans at the baseball practice, said the shooting didn’t change his views on the second amendment because there are “adverse aspects” affecting constitutional rights.

“What we just saw here is one of the bad side effects of someone not exercising those rights properly,” the Alabama congressman told reporters when pressed on whether he was reconsidering his position on gun control.

The Daily Beast's Lachlan Markay tweeted Brooks's full remarks:

And House Freedom Caucus Chairman Mark Meadows (R-N.C.) said he sees this as a mental-health issue, not a gun control one.

“I think to default to that would be a missed opportunity to be thankful for every moment we have, be thankful for our law enforcement, and ultimately to understand that the mental health component is an important thing for us to address," Meadows told Vox.

SHOOTING UPDATE: 

--House Majority Whip Steve Scalise (R-La.) was still listed in critical condition Wednesday night following a shooting at a practice for the annual congressional baseball game. MedStar Washington Hospital Center, where Scalise is being treated, said the bullet fractured bones and hit internal organs and that he will require “additional operations.” Law enforcement officials identified 66-year-old James T. Hodgkinson from Illinois​, who appeared to be angry at President Trump,​ as the lone gunman behind Wednesday's attack that injured Scalise and four others. Hodgkinson died from gunshot wounds from an exchange of gunfire with police. Capitol police officer Crystal Griner who was injured in the attack was in "good condition" after being shot in the ankle, and another officer David Bailey was released after being treated for a minor injury. Congressional staffer, Zach Barth, who was shot in the leg was released from the hospital and lobbyist Matt Mika was listed in critical condition after surgery as of Wednesday afternoon. Lawmakers on both sides of the aisle called for unity following the attack. An emotional Rep. Joe Barton (R-Texas) praised the Capitol police for their heroism after the shooting.


--Trump, joined by first lady Melania Trump​, visited Scalise​ at the hospital last night and called ​for prayers for the lawmaker, ​tweeting​ he was “in very tough shape.” But tonight's charity baseball game will still go on --​ Scalise's Louisiana colleague Rep. Cedric L. Richmond (D) said "he absolutely would want the game to continue.” Lawmakers applauded House Speaker Paul D. Ryan's announcement on the floor that the game would continue. "We’re united, not as Republicans and Democrats but as United States representatives," Barton said​ Wednesday evening alongside fellow congressional baseball manager Rep. Mike Doyle (D-Pa.) ​Louisiana State University, Scalise's alma mater, is sending lawmakers hats and t-shirts to wear during the game. CNN reported Thursday morning that the Louisiana Republican was hoping to watch the game from the hospital. The president will not be attending Thursday night's game due to security concerns.

AHH, OOF and OUCH

AHH: The Senate is made up of 100 unique individuals, full of moving parts and often unpredictable. But here's an easy way to understand its continued gridlock on a bill to repeal much of the Affordable Care Act: Each senator is trying to get the best deal for his or her state, my colleague Paul Kane explains.

"The most critical divide sits between Republicans from states that accepted the federal funding to expand Medicaid coverage to millions more Americans, and those from states that declined that expansion....Many of the Republicans from non-Medicaid-expansion states are more conservative, and those from states that accepted the extra federal funding tend to be more moderate. But it’s not a purely ideological breakdown," Paul writes.

Just look at Graham, who is considered key to compromise in the Senate. Yet he's siding with the conservatives on wanting to phase-out Medicaid expansion. "Republicans like Graham take a purely parochial view: that a more costly phaseout of Medicaid expansion is a federal giveaway to states that made a bad decision to begin with when the ACA was first enacted," Paul writes.

"All of this is making the final weeks of negotiation a bit more difficult because neither side in this standoff is giving a full signal of their bottom line — what they’re willing to live with. Doing so gives away a leverage point, potentially leading to a little bit worse of a deal and thus endangering the entire negotiations," Paul concludes.

OOF: Does the Department of Health and Human Services cross a line by retweeting its leader Tom Price advocating directly for the House GOP health-care legislation?

That's what some congressional Democrats want to know, The Hill reports. They are requesting an investigation from the Government Accountability Office of whether HHS under President Trump has been violating the law by advocating for the passage of legislation on its Twitter accounts. 

“In recent months, at least two of the Department’s official Twitter accounts have promoted the American Health Care Act (“AHCA”) — legislation that is now pending before the Congress,” Sens. Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) and Reps. Frank Pallone Jr. (D-N.J.) and Richard E. Neal (D-Mass.) wrote to the GAO. “These actions appear to violate restrictions on the use of the department’s appropriations for supporting the enactment of legislation pending before Congress, in this case, a legislative proposal that would repeal the Affordable Care Act ("ACA") and leave 23 million Americans without health insurance."

OUCH: The director of Michigan's health department has been charged by the state attorney general with involuntary manslaughter for his role in the Flint water crisis. Nick Lyon, director of the Michigan Department of Health and Human Services, also faces a felony count of misconduct in office, the Post's Brady Dennis reports.

"While much of the attention in Flint has focused on the lead-tainted water that exposed thousands of young children to potential long-term health risks, the crisis also has been linked to an outbreak of Legionnaires’ disease that contributed to at least a dozen deaths," Brady writes. "Lyon was aware of the Legionnaires’ disease outbreak by early 2015 but 'did not notify the public until a year later,' according to charging documents filed in court and reviewed by the Detroit Free Press. According to the documents, he 'willfully disregarded the deadly nature of the Legionnaires’ disease outbreak,” later saying “[we] can’t save everyone,” and “everyone has to die of something.'"

HEALTH ON THE HILL

--Congress is returning to some of its regular activity today, even as Scalise remains in critical condition and members continue to process yesterday's events. Rep. Murphy, a psychologist from Pittsburgh and a leading advocate for mental-health reform, told The Health 202 he'll be speaking at the GOP conference meeting this morning about dealing with trauma.

"I plan on telling them about the importance of understanding trauma, how to talk to their kids about these things, seeking support and help for it -- trying to help them understand this is a normal reaction," Murphy told me. 

Murphy said he happened to be walking up to the Capitol yesterday when some members and aides present at the shooting arrived, so he offered them counseling. "The mood among my colleagues is -- people are under a lot of distress as expected, and it’s important we are supportive of each other on both sides of the aisle," Murphy said.

Here are some more reads about the Senate's effort to produce a health-care bill:

President Donald Trump's labeling of a House-passed health care bill as "mean" is aggravating some of the conservatives he pressed to back it, even as Senate attempts to reshape the measure increasingly threaten to spill into July.
New York Times
The Senate’s secret deliberation on the health bill overhaul is part of a long, slow slide away from transparency. And I’m a witness.
Kaiser Health News
New estimates show that Republicans have stumbled upon the rare thing that unites red and blue states: opposition to the health care bill.
New York Times
REPRODUCTIVE WARS

--Emily’s List, one of the most influential women’s groups in national politics, has hired a Washington outsider to help elect scores of abortion rights-supporting women next year, the Post's Philip Rucker reports.

"Emily Cain, who helped lead fellow Democrats to the majority in the Maine House of Representatives in 2012, has been tapped to try to do the same for Democrats nationally at the helm of Emily’s List...Stephanie Schriock, the president of Emily’s List, said that the election of President Trump has spurred scores of women around the country to run for office and that she thinks Cain will be able to help novice candidates develop winning strategies, as she did in Maine," Phil writes.

“There is an incredible wave of women’s energy and leadership on the ground to stop Trump,” Schriock said. “We’re watching women resist across the country, whether in town halls or phone calls or marching and now running...Emily brings with her something that’s so incredibly important, which is a real understanding of what it is to be a candidate.”

--The above video shows a Missouri state Rep. Mike Moon beheading a chicken while talking about abortion. Why? Moon, who owns a 125-acre farm, was frustrated that a bill to be reviewed in a special legislative session added restrictions to abortion clinics in Missouri but none of them attempted to ban the practice entirely. That’s when he decided to film a video, the Post's Peter Holley reports.

“'God gave us man dominion over life,' Moon said on camera moments after he sliced a bird’s head off with a knife, causing the animal’s wings to flap erratically. 'He allows us to raise animals properly and care for them and then process them for food so we can sustain life. And that’s what I’m doing here with this chicken. So we’ve been called back to this special session for the primary purpose of supporting life, protecting the unborn specifically.'"

"'I think we need to get to the heart of the matter here,' he added before pulling the bird’s heart out of its body," Peter writes.

INDUSTRY RX
Bringing down the rate of HIV infection in one of the United States’ great public health triumphs of the past quarter-century. Now, thanks to the opioid economic, some of those hard-won gains may be reversed.
Keith Humphreys
DAYBOOK

 Today

  • The Senate Appropriations' subcommittee on Labor, Health and Human Services, Education and Related Agencies will hold a hearing with HHS Secretary Tom Price on the department's 2018 fiscal year budget request.
  • Bloomberg Law is hosting an event on the future of the Affordable Care Act.
  • The annual Congressional Baseball Game is scheduled to go on tonight starting just after 7 p.m. at Nationals Park, one day after an attack on Republican lawmakers at a practice in Alexandria, Va. 

Coming Up

  • Mylan, the company that makes the EpiPen, is scheduled to have its annual shareholder meeting on June 22
SUGAR RUSH

My colleagues Devlin Barrett, Adam Entous, Ellen Nakashima and Sari Horwitz reported last night that the special counsel overseeing the Russia probe is now investigating Trump for possible obstruction of justice:

Lawmakers recall details from the shooting at a practice for the Congressional Baseball Game: 

Who is Rep. Steve Scalise, the Louisiana Republican lawmaker who was shot at a baseball practice?

Seth Meyers addresses Wednesday's shooting at a congressional baseball practice, wishing the victims a "full and speedy recovery" and praising the actions of the Capitol police: 

And Jimmy Kimmel puts together a birthday video for President Trump, who turned 71 on Wednesday: