THE PROGNOSIS

The Prognosis is guest hosted today by The Fix's Amber Phillips. Paige will return next week.

“Dreamers” may soon lose their security to go about their daily lives and not be deported. But these 800,000 young adults who came here illegally as children have never had health-care security.

When it protected them from deportations, the Obama administration blocked dreamers from participating in the health-care marketplaces established under the Affordable Care Act, to the dismay of immigration rights advocates.

And dreamers' health-care insecurity is a microcosm of all immigrants' health-care problems. The 23 million immigrants who aren't citizens — which includes the 11 million who are undocumented — are significantly more likely to be uninsured than U.S. citizens.

That's according to a July Kaiser Family Foundation report that found immigrants in the country legally are twice as likely to be uninsured than U.S. citizens. Undocumented immigrants are four times as likely to be uninsured than U.S. citizens.

In short, immigrants play a big role in driving up the nation's uninsured rate. And immigration advocates fear that Trump's decision Tuesday to limit dreamers' rights by ending the Deferred Action for Childhood Arrivals program is only going to exacerbate immigrants’ insurance problem.

“It's not easy to overstate the level of fear and anxiety among immigrants and their families right now,” said Matthew Lopas, a health policy attorney with the National Immigration Law Center, which advocates for immigrant rights. "Some people are afraid to leave their homes, some people are afraid to provide information to the government.”

The irony for immigrant rights advocates is that Obamacare was just starting to take hold in the immigrant community. It took awhile for people to learn how the 2010 law worked, let alone realize they were eligible for the exchanges. Most lawful immigrants aren't immediately eligible for public health insurance programs such as Medicaid.

Immigrants are also more likely to work in low-wage jobs and industries that don't offer health coverage, said health policy expert Samantha Artiga, who wrote the report for the Kaiser Family Foundation, which means they rely on the exchanges more.

“They face a range of challenges, both in terms of more limited access in coverage and greater challenges to enrolling in coverage even when they are eligible,” she said.

The language barrier has been another major hurdle for immigrants — and another example of how the Trump administration is undoing the gains the Affordable Care Act had made for immigrants’ insurance rates. The Obama administration invested heavily in government assistance to help immigrants (and, really, everyone) understand the exchanges. The Trump administration is doing a 180.

On Thursday, the Trump administration announced that it was slashing the advertising and promotion budget for Obamacare by about 90 percent, weeks before the 2018 open-enrollment session. Grants to nonprofits that help people navigate health insurance exchanges will be cut nearly in half, from $63 million to $36 million.

The hit will immediately be felt by immigrant communities who were already suspicious of giving the government their information, Lopas said.

The unsuccessful Republican health-care plan would have narrowed immigrants' health-care coverage options even further, by making certain legal immigrants ineligible to use the exchanges and receive tax credits — and blocking illegal immigrants from those same tax credits. (Immigration crackdown groups were concerned that Republicans' proposals didn't go far enough to make sure illegal immigrants couldn't get taxpayer money for health care.)

Why does any of this matter? For one, research on DACA recipients suggests that immigrants who are threatened by deportation have more mental-health struggles, such as adjustment or anxiety disorder. Research suggests that children who struggle with mental health can struggle later in life, too. And research suggests that children who don't have health insurance are more likely to miss school than those who do.

What happens to one immigrant, documented or not, can have a wavelike effect on their communities and on other immigrants. Rarely is one household one immigration status. Children can be legalized, while parents aren't. Or one partner can be in the United States lawfully while another isn't. The broader message to this community as a result of the Trump administration's decision? Trusting the government isn't safe.

“Denying people insurance is a really bad long-term investment in communities,” Lopas said. “We made this decision under the ACA that communities were better when people were insured, and the same is the case for immigrant members of these communities.”

One more thing: 

On Thursday, a bipartisan group of governors will come to Washington and offer their ideas for doing what Congress couldn’t: changing Obamacare. Actually, two prominent governors have already put together a proposal.

This summer, Govs. John Kasich (R-Ohio) and John Hickenlooper (D-Colo.) introduced a plan to tweak Obamacare around the edges, by keeping the individual mandate in place but doing more comprehensive verification for people who want to enroll outside the open enrollment period, to prevent sick people from getting health insurance only when they need it.

The Washington Post's graphics team has the full breakdown of their plan, which six other governors have signed onto.

AHH, OOF and OUCH

--AHH: A Democratic group, Protect Our Care, is drawing up plans to go on the offensive against Republican efforts to overhaul the Affordable Care Act -- the group's plan includes a major digital ad buy and a website that will target Health and Human Services Secretary Tom Price.

Protect Our Care planned to spend $1 million in digital ads across the country and will hold rallies and protests in ten states accusing GOP lawmakers and Trump administration officials with attempting to sabotage Obamacare, the New York Times reported.

Brad Woodhouse, a Democratic operative working with the group, told the Times that “Putting Tom Price in charge of the health care law is no different than putting the Cookie Monster in charge of dessert rationing. He doesn’t want to support the health care law. He wants to get rid of it.”

--OOF: Democrats "believe that the GOP will take a political hit if Congress fails to produce an agreement to improve the marketplaces," write Amy Goldstein and Juliet Eilperin.

Amy and Juliet preview the first of four scheduled Senate Health, Education and Labor Committee hearings today that will focus on finding some bipartisan fixes to stabilize the ACA marketplaces. More from them: "According to senators, their aides and outside health-policy experts close to the negotiations, both Chairman Lamar Alexander (R-Tenn.) and Patty Murray (Wash.), the panel’s ranking Democrat, are eager to write into law federal funding of 'cost-sharing reduction' subsidies ... 

The committee’s leaders agree that preserving the payments is important, but they differ on their duration. Alexander said in a statement that the government should promise to continue them “for another year,” while Murray said she is seeking 'a multiyear agreement.'"

 

 

--OUCH: The federal government has delivered a grim set of data regarding the sweeping opioid crisis: There were more than 64,000 drug overdose deaths in 2016, according to preliminary data released from the National Center for Health Statistics. And synthetic opioids like fentanyl had a higher rate of overdose deaths than heroin and prescription painkillers combined, Vox reported.

The center found that opioid painkillers were involved in about 14,420 overdose deaths last year, heroin was involved in more than 15,440 and non-methadone synthetic opioids were associated with more than 20,140 overdose deaths.

The findings show that overall, overdose deaths are increasing at a rate faster than anticipated. The 64,000 deaths marks a more than 20 percent increase over the 52,898 drug overdose deaths recorded in 2015.

The new data emerges weeks after President Trump announced his intention to declare the opioid epidemic a "national emergency."

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency," Trump said during an appearance last month at his golf club in New Jersey. “We’re going to draw it up, and we’re going to make it a national emergency.”

TRUMP TEMPERATURE

--The door may not be all the way shut on Obamacare repeal this year. President Trump and his staff have been working with GOP Sens. Lindsey O. Graham (R-S.C.) and Bill Cassidy (R-La.), Politico reports, on a last-ditch effort to push through a rewrite of the bill that failed dramatically in July, even with an already-crowded agenda before Republican lawmakers.

And with the parliamentarian’s ruling that the GOP can only use budget reconciliation procedures before the end of this month, a deadline for any action is looming.

“He wants to do it, the president does. He loves the block grants. But we’ve got to have political support outside Washington,” Graham told Politico, adding the bill would need a “majority of the Republican governors behind the idea” to have any movement in the Senate.

Cassidy, according to Politico, wants to have a bill rewrite finalized this week.

“Trump berated McConnell and the Senate GOP over the summer for falling one vote short of sending repeal into conference with the House in July, when Sen. John McCain of Arizona voted down the GOP’s ‘skinny’ repeal bill. So the White House has continued to work on the Graham-Cassidy bill behind the scenes, seeing it as the best option to make progress, according to several administration officials,” Politico’s Burgess Everett and Josh Dawsey report.

They continue: “The bill would keep most of Obamacare's taxes and devolve many spending decisions to the states. It was submitted as an amendment to the repeal bill in July but did not receive a vote; aides say it could not pass the Senate in its current form.”

Graham told the publication it was “possible” if they “do it quickly.”

“Introduce it this week, have a hearing soon about the bill, then the process is set to actually take it to the floor and vote,” he said. “Everything has to fall in place.” 

HEALTH ON THE HILL

And as the HELP committee meets today on extending subsidies, Freedom Partners, the Koch network’s funding arm, released a new digital ad warning against premium increases.

“It’s time for real solutions,” the ad reads. “Not more subsidies to prop up Obamacare.”

The ad, which will be geo-targeted online near the Capitol today, highlights proposed premium percentage hikes in Maryland, Nevada, Tennessee and Wyoming.

“The billions in taxpayer handouts that have propped up Obamacare for years have resulted in fewer choices and an average individual premium increase of 105 percent,”  Freedom Partners Vice President of Policy Nathan Nascimento said in a statement. “Squeezing more money out of Americans to continue subsidizing a law that’s hurting them is indefensible – it’s time for real solutions that provide real relief.”

STATE SCAN

Several states are bucking Trump administration limitations on signup periods for the ACA.

Some of the states that run their own exchanges, including California, Colorado, Minnesota, Washington, Massachusetts as well as the District of Columbia will allow consumers extra time to make choices about purchasing insurance, Kaiser Health News reported.

A new Trump administration rule allows just 45 days for people to purchase individual insurance plans on the federal exchange via open enrollment, which will run from Nov. 1 to Dec. 15.

But in California for example, people will have three months to shop on the "Covered California" exchange. And the state is working to solidify the three-month enrollment period beyond 2018. 

MEDICAL MISSIVES

--Planned Parenthood and two National Cancer Institute researchers who worked on vaccine development for cervical cancer were awarded the Lasker Awards on Wednesday, considered one of the most prestigious awards in medicine.

“In announcing the awards, sometimes referred to as “America’s Nobels,” the foundation lauded the recipients’ efforts to protect and enhance women’s health,” The Post’s Laurie McGinley writes. “Its praise of Planned Parenthood seemed designed to counter attacks on the nonprofit by President Trump and top congressional Republicans, who want to end all federal funding to the organization. Planned Parenthood, the nation’s biggest abortion provider, already is barred from using federal dollars for abortions.

— Meanwhile, the Trump administration is interested in rolling back an ACA rule preventing federal funds programs from discriminating based on sex.

Under President Obama, Medicaid was required to cover transgender care, but STAT news reported Tuesday that HHS Secretary Price said he’s working to change that.

The changes could allow states to deny coverage for hormone treatment, counseling and surgery for transgender men and women.

STAT’s Usha Lee McFarling writes: “Price’s stated goal: to strike down rules that cause “regulatory or economic burdens.” The administration has made it clear that it views transgender surgeries as a heavy burden; in July, Trump cited the cost of that care as a primary reason for barring transgender people from serving in the military.”

Although some states have gone against the Obama-era order to exclude transgender care from their Medicaid coverage, STAT notes that 12 states and Washington have written rules to ensure coverage.

The group said research at the VA has helped improve the lives of veterans with heart disease and diabetes, and has helped treat post trauma...
One in 10 rural counties lost a hospital maternity ward over a decade
Carolyn Y. Johnson
Plaintiffs in the lawsuit by Equality California include a 27-year-old soldier and two transgender people who are hoping to enlist in the mi...
Washington Examiner
The detective was fired from his job as a paramedic and is on administrative leave from the department.
Fred Barbash and Derek Hawkins
INDUSTRY RX

— Industry groups are lobbying to repeal or delay two Obamacare taxes on medical devices and on health-insurance plans before they take effect in 2018, the Wall Street Journal reported.

The taxes were delayed in 2015, a signal that such a move had bipartisan support two years ago.

“The medical-device tax levies a 2.3% charge on the sale of many medical devices, and is paid by manufacturers and importers. Device makers say the tax would stifle innovation, while their critics say they want an unfair exemption to the taxes the ACA imposes on many parts of the health-care industry,” the Journal reports. “The health-insurance tax, in turn, functions as a sales tax on coverage, paid by insurance companies. Insurers say this tax would sharply accelerate premium increases, but critics say it is a reasonable levy given the benefits insurers get from the ACA, including many new customers.”

Industry officials have reportedly suggested combining Alexander and Murray's efforts to stabilize the marketplaces with action on ACA taxes.

But the Journal notes that Alexander is concerned that such a strategy would encourage Republicans to request that the bill repeal other elements of Obamacare, which would likely only lead to a dead end.

Here are a few more good reads for today:

Health regulators in St. Kitts and Nevis are probing the 2016 clinical trial, which they said was conducted without prior official approval.
CNBC
Vaccine giant Sanofi Pasteur has pulled the plug on its Zika vaccine project, a move that underscores the difficulty of the effort.
STAT News
The original researchers say they stand by their paper and will publish a point-by-point response soon.
Ariana Eunjung Cha
SECOND OPINION
I’m happy Trumpcare failed. But now Congress has to act.
Sen. Patty Murray (D-Wash.)
DAYBOOK

Today

  • House lawmakers are scheduled to consider the Harvey relief bill.
  • The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies holds a markup on the HHS spending bill.
  • The CATO Institute holds an event on the “Long-term effect of health insurance on near-elderly health and mortality.”
  • The Senate Committee on Health, Education, Labor and Pensions holds hearings on how to stabilize the insurance marketplaces  today and Thursday, and on Sept. 12 and 14.

Coming Up

  • The Senate Finance Committee is scheduled to hold a hearing on the Children’s Health Insurance Program on Thursday.
  • Colorado Gov. John Hickenlooper (D) and Ohio Gov. John Kasich (R) discuss their bipartisan health care proposal at an American Enterprise Institute eventon Friday.
  • The National Institute for Health Care Management holds a webinar on cancer care on Friday.

 

SUGAR RUSH

President Trump seeks the reduction of 'crushing' tax burden:

Late-night laughs: President Trump ending DACA:

Stephen Colbert says 'North Korea Is In The News' is never a good thing: