THE PROGNOSIS

Democrats have mostly sat helplessly by as Republicans tried to undercut their prized Affordable Care Act, with one exception: Writing letters. Lots of letters.

Demanding answers from the Trump administration about how it’s handling the ACA, and requesting detailed investigations from independent auditors, is the single way Democrats in Congress can try to hit back against the GOP effort to tear down Obamacare – an effort whose nucleus has now moved to the executive branch now that Congress has failed to pass a repeal bill.

When President Obama was in the White House, Republicans could at least conduct oversight from their perch on Capitol Hill – which they did, holding dozens of hearings aimed at pummeling the ACA and highlighting its perceived shortcomings.

But now Democrats can’t even hold their own hearings defending the law because they’re in the minority in both the House and Senate.

Were Democrats still holding the reins of power, you can bet they’d spend this fall hauling top health-care officials – figures like Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Administrator Seema Verma – up to Capitol Hill to explain their plan for the ACA’s marketplaces; Medicaid expansion; the individual mandate to buy coverage; and other key elements of the law.

Stuck on the sidelines, Democrats have tried to dial up pressure on Price and Verma using their pens. For example, they’ve asked the administration to explain why it halted most media advertising in the final weeks of enrollment earlier this year, detail how it will enforce a nondiscrimination provision in the ACA and warned it not to roll back requirements for employer plans to cover birth control.

Most recently, the ranking members of the four leading committees with jurisdiction over health care  – Sen. Ron Wyden (D-Ore.), from the Senate Finance Committee; Sen. Patty Murray (D-Wash.), from the Senate Health, Education, Labor and Pensions panel; Rep. Richard E. Neal (D-Mass.), from House Ways and Means; and Rep. Frank Pallone Jr. (D-N.J.) on House Energy and Commerce – badgered Price to brief them on the administration’s plans for the enrollment season that begins Nov. 1.

“Given the substantial uncertainty resulting from efforts to jam the Republican bill through Congress and the resulting consumer confusion, as well as the administration’s decision to cut the open enrollment period in half, it is critically important that HHS redouble its efforts to ensure that individuals are aware of their enrollment options and eligibility for financial assistance in a timely manner,” they wrote.

Democrats have also tried to harness the power of the Government Accountability Office, the nonpartisan auditing agency that works for Congress.

They’ve asked the GAO to investigate evidence that HHS was improperly lobbying members to support the GOP’s House health-care bill. They’ve also asked the agency to look into whether the administration is refusing to enforce the law’s individual mandate due to Trump’s executive order to undermine the health-care law overall.

Democratic committee leaders have sent more than a dozen such inquiries to federal agencies and the GAO since Trump took office. That’s no guarantee they’ll get answers, and the GAO isn’t able to carry out every request for investigations, but it’s kind of all Democrats can do at this point.

“Tens of millions of Americans are counting on the success of the Affordable Care Act, but the administration is working overtime every day to sabotage it,” Wyden said in a statement provided to The Health 202. “The American people need to know that the administration is making their health care worse and more expensive, and the Congress has an obligation to fight it. That’s why tough oversight is vital.”

STATE SCAN

--At least nine people have died as a result of Hurricane Harvey, which is still battering parts of Texas and Louisiana. Yesterday, rain pelted the Houston area as emergency teams aided by volunteer rescuers slogged through waist-deep water seeking people stranded by the devastating flooding, The Post's Dylan Baddour, Sandhya Somashekhar and Mark Berman report. Authorities expect the death toll to rise as rescue efforts go on and as more rain, rising rivers and surging floodwaters pummel the Gulf Coast.

"First responders and good Samaritans took to boats to rescue stranded residents, with authorities warning that more than 30,000 people across the region could be forced from their homes by the time skies are expected to clear later this week," my colleagues write. "Fears also grew beyond Texas, with particular concern centering on flood-prone Louisiana, where forecasts have called for as much as two feet of rainfall in some areas....[President] Trump on Monday declared 'emergency conditions' in Louisiana, evoking memories of Hurricane Katrina in 2005."

Speaking late in the day yesterday, President Trump pledged swift action by the federal government to provide relief to states affected by Harvey. He's heading to Texas today.

“Recovery will be a long and difficult road, and the federal government stands ready, willing and able to assist in that effort,” he said during a joint news conference with Finnish President Sauli Niinisto.

--Harvey is battering Houston’s world-renowned health-care infrastructure, bringing serious hazards for storm-damaged hospitals, nursing homes, their patients and staff -- and raising question of whether health officials learned lessons from the extreme flooding following Hurricane Katrina in 2005, when dozens of hospital and nursing home patients died, the New York Times reports.

"Most hospitals in Houston continued operating and they reported that they were doing well. But some, ringed by floodwater, were cut off from patients trying to reach them...As of Monday afternoon, 10 to 15 hospitals and various nursing homes, some in rural communities, have evacuated or begun evacuating since the storm made landfall," Sheri Fink and Alan Blinder write. "At one hospital in northwest Houston, CHI St. Luke’s Health — the Vintage, patients were transported by airboat to nearby ambulances due to severe flooding from the Cypress Creek. As displaced residents filled the George R. Brown Convention Center, the city sent out a call for licensed health workers to help people with medical needs there.

Some vulnerable hospitals and nursing homes opted to move their patients out of the region in the hours before the storm. But others 'did not know to necessarily expect this level of chaos,' said Darrell Pile, chief executive of the Southeast Texas Regional Advisory Council. A large coalition of medical providers had drilled and planned regularly for catastrophes, he added, “but honestly, not at this epic level.”

--Doctors at MD Anderson's primary Houston hospital -- one of the world's foremost cancer centers -- were forced to cancel appointments until Wednesday at the earliest, as emergency crews work to restore operations and wait for the floodwaters to recede, Stat News reports.

"Pictures posted on Twitter show muddy water filling a parking garage in the facility and seeping into lobby areas of the Texas Medical Center facility," Casey Ross writes. "The cancer hospital has not been evacuated and MD Anderson administrators said they have maintained continuous care for patients staying in the hospital, even though much of the area around the hospital remains impassable."

From a professor and surgeon at MD Anderson Cancer Center: 

Another hospital, Memorial Hermann First Colony Hospital in Sugar Land, was forced to shut down until further notice, the Houston Chronicle reports.

--By yesterday afternoon, about 3,200 people were at Houston's George R. Brown convention center, and a steady stream of newcomers was arriving in buses, in trucks, in cars and on foot, The Post's Kevin Sullivan, Katie Zezima and Arelis R. Hernandez report.

"From Houston to Austin to San Antonio to Dallas, thousands of people whose lives have been upended by Harvey are living in shelters that range from this hall, one of the nation’s largest convention centers, to churches, gyms, tiny recreation centers — even a furniture store," they write. "Officials say more than 30,000 people may be forced from their homes by Harvey, and many whose homes have been severely damaged or destroyed by deadly winds and astonishing floodwater may need shelter for weeks or months to come."

--The American Red Cross of Michigan has deployed 60 volunteers and seven vehicles to both states to deal with the crisis, according to the group's CEO Kimberly Burton, the Detroit Free Press reports. Burton said at last count 8,000 people have been transported to shelters in the Texas area. She said the group is ready to shelter at least 50,000 homeless individuals and a total of 40 shelters have opened across Texas.

“This is going to be a long, long haul and walk,’’ said Burton. “We’re just trying to get them fed and get them safe."

--Some events don't wait for floods to recede. Particularly, the arrival of the region’s newest and youngest residents, who refused to push back their grand debut for a Category 4 hurricane or the area’s worst flooding in centuries, The Post's Kevin Sullivan and Cleve R. Wootson, Jr. dispatch from Houston. They've got the tale of a pregnant woman who nearly delivered her baby in a Marriott Courtyard hotel before a dump truck arrived to take her through deep water toward Texas Children's Hospital.

No one had made it in or out of the hotel in 24 hours through an obstacle course of deep, impassable floodwaters and abandoned, submerged cars, but a man came running into the hotel shortly after midnight yesterday, telling hotel staff he had picked up a pregnant woman in his truck after her husband tweeted that they couldn't get out of their home.

The baby seemed destined to be born in the hurricane-marooned Marriott, so hotel staff rolled a bed into a ground-floor meeting room and called in three nurses from Louisiana who were staying in the hotel (none of whom had ever delivered a baby). After the mother-to-be lay in the bed in the meeting room for more than an hour, and staff communicated with a 911 operator, a huge city dump truck appeared. Several men helped the woman into the truck, which then headed off into the 4-foot deep water, across the swamped bridge across the bayou and toward the hospital. 

AHH, OOF and OUCH

AHH: It's ready, the bipartisan health-care proposal that Ohio's GOP Gov. John Kasich and Colorado's Democratic Gov. John Hickenlooper had been working on together, according to the Columbus Dispatch. The governors said they'll release details later this week about their plan to stabilize the individual insurance markets (in the absence of the health-care bill Republicans in Congress had promised but failed to pass), after first sharing it with like-minded governors and asking them to sign on.

The proposal is also expected to be discussed before the Senate Health, Education and Labor Committee next week when lawmakers hear testimony from Hickenlooper and some other governors about possible fixes to the ACA marketplaces.

OOF: As Washington prepares for a month of spending deadlines, and as Republicans and business groups try to shift the conversation to a tax-code rewrite, Sen. Bernie Sanders (I-Vt.) is trying to drive a discussion about single-payer health care — a debate that he admits would last for years before any legislative action.

"The campaign will put the Senate’s only democratic socialist in a unique position," my colleague Dave Weigel reports from Detroit. "Republicans have already begun attacking Democrats over 'government-run health care,' daring them to endorse Sanders’s plan. On the left, activists inspired by Sanders’s 2016 presidential bid intend to browbeat Democrats who don’t back Sanders’s...legislation."

Sanders told Dave that he is formulating an “inside/outside strategy,” attracting as much support as possible from his colleagues while expecting most of them to recoil. It would be up to activists to make single-payer politically possible for the holdouts. In the meantime, he'll continue to support colleagues in tough races, even if they reject his bill.

“Is this a litmus test? No, you have to look at where candidates are on many issues,” Sanders said. “But you’re seeing more and more movement toward ‘Medicare for All.’ When the people are saying we need health care for everyone, as more and more Americans come on board, it will become politically possible.”

OUCH: Aetna is facing a class-action lawsuit, which alleges the company violated the privacy of its customers by sending many of them letters through which the phrase “filling prescriptions for HIV” was visible through envelope windows, Stat News reports. The federal suit alleges the breach affected as many as 12,000 Aetna customers living in 23 states.

“For 40 years, HIV-related public health messages have been geared toward assuring people that it’s safe to come forward to get confidential HIV treatment, and now our clients come forward for HIV-related healthcare and Aetna fails to provide confidentiality,” said Ronda B. Goldfein, executive director of the AIDS Law Project of Pennsylvania, which filed the suit with the Legal Action Center and Berger & Montague P.C., in a written statement.

Some more good reads from The Post and beyond:

There are 28 active national emergencies. The opioid crisis isn’t one of them.
New York Times
VA Secretary David Shulkin has proved to be something unique in President Donald Trump's Washington: an Obama appointee nominated by Trump who is beloved by almost everyone and getting stuff done.
Politico
MEDICAL MISSIVES
The agency plans to take action against “unscrupulous” stem-cell clinics while making it easier for responsible players to comply with regulations.
Laurie McGinley
Study finds a new way to reduce risks of heart attack and stroke
Carolyn Y. Johnson
INDUSTRY RX
More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that fau
AP
DAYBOOK

Today

  • President Trump will travel to Corpus Christi and Austin, Tex. following Hurricane Harvey.
  • The Paralyzed Veterans of America holds its Summit and Expo today through Thursday

Coming Up

  • Trump will travel to Missouri on Wednesday to talk tax reform.
  • Sen. Ben Cardin (D-Md.) holds a town hall to discuss the nation’s health care on Thursday.
  • The New York Times hosts its first TimesTalk D.C. series featuring House Speaker Paul D. Ryan on September 7
SUGAR RUSH

President Trump's Pentagon memo reinstates the transgender ban:

Are these Cabinet secretaries distancing themselves from Trump?:

Trump praises 'the spirit and the enthusiasm' of Harvey survivors:

Fact Check: Ted Cruz's claim that two-thirds of the Hurricane Sandy bill 'had nothing to do with Sandy':