THE PROGNOSIS

By hating on Obamacare, the Trump administration and Republicans may have inadvertently helped it.

A lot of people are still puzzling over why the 2018 marketplace enrollment season went so amazingly well, with 8.8 million Americans – a whopping 96 percent of last year’s total – signing up for Affordable Care Act coverage despite the halved timeframe to do so and much-reduced advertising effort by the Department of Health and Human Services. 

We’ve already written extensively at The Health 202 about how more consumer access to cheaper plans – due to a weird phenomenon caused by cutting off extra subsidy payments to insurers – could have sparked signups. But perhaps we in the press can claim some credit, too.

A new report, commissioned by Covered California, finds a significant increase in media coverage of enrollment nationwide during the sign-up period that ran from November through mid-December, compared to the year prior. There was more news coverage involving the terms “enrollment,” “enrollment period” and “deadline” – 53%, 125% and 129% percent more coverage for each term, respectively – for the 2018 period compared to the 2017 period, the firm Ogilvy & Mather found.

Why was this the case? As a reporter, that’s an easy question to answer. For better or worse, we reporters gravitate toward the unexpected and the out-of-the-ordinary, as well as a dramatic storyline. When the ACA marketplaces were ticking along just fine at the end of 2016 – the Obama administration was heavily promoting them and the Healthcare.gov was working well – there was less “news” to report.

But following Trump's election, there were bigger questions about how the GOP president and his appointees would approach implementing a law that many were vehemently against. The will-they-or-won't-they-enforce-it narrative was intriguing because suddenly there was a Republican administration forced to carry out a law it had railed against. Plus, the whole sign-up period came at the end of a year where Congress was laser-focused on trying to upend the health-care law as we know it, which only increased the drama quotient.

After the GOP Congress failed to overhaul Obamacare, the storyline became even more interesting as the Trump administration had to open the ACA marketplaces to consumers once again, despite spending a lot less money on promoting them. And that seems to have meant more people watching or reading the news heard about opportunities to sign up for marketplace plans.

For example, the Ogilvy report found a 17 percent increase in the volume of news coverage related to ACA enrollment during the 2018 sign-up period, compared to the year prior.

Much of this was driven by President Trump himself. There was a particularly sizable spike in coverage on Oct. 13, when the president announced he was cutting off extra cost-sharing reduction payments to insurers, and on Oct. 18, when he tweeted opposition to the bipartisan plan from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to fund them again.

The takeaway? Maybe ACA advocates should be thanking the power of the press for helping keep the system intact -- for now.

AHH, OOF and OUCH

AHH: All the drama around repealing and replacing the ACA has definitely stressed us out at times -- but at the most it means we eat a little more ice cream. Apparently not so for Rep. Pat Meehan (R-Pa.), who blamed stress around high-pressure health-care votes last year for his alleged sexual harassment of a younger aide. Following a weekend report that Meehan used thousands of taxpayer dollars to quietly settlement the harassment claims, the Pennsylvania Republican told the Philadelphia Inquirer he had "deep affection" for the aide but never pursued a relationship with her.

"Meehan ...  also said that he initially reacted 'poorly' when he found out that the longtime aide, decades younger, had begun a serious relationship with another man and might leave his office. He released a heartfelt letter he wrote to her in May in which he wished her well, thanked God “for putting you into my life,” and signed it, 'With all my heart, Patrick.' The congressman went on to recount that "any hostility he may have exhibited stemmed from stress around high-pressure votes last year over the Affordable Care Act. " The Inquirer has a copy of the congressman's full hand-written letter to the former aide, which really deserves a read.

OOF: New York City is joining the growing list of cities and states suing drug companies over the opioid crisis. Yesterday, New York City Mayor Bill de Blasio announced the city has filed a lawsuit against Allergan, Endo International, Johnson & Johnson, Purdue Pharma and Teva Pharmaceutical, and distributors AmerisourceBergen, Cardinal Health and McKesson, blaming them for contributing to the deadly nationwide opioid epidemic.

De Blasio said the lawsuit seeks $500 million of damages to help fight the crisis, Reuters’s Jonathan Stempel and Nate Raymond report. "Big Pharma helped to fuel this epidemic by deceptively peddling these dangerous drugs and hooking millions of Americans in exchange for profit," de Blasio said. "It's time for hold the companies accountable for what they've done to our city and help save more lives."

The latest complaint comes nearly three months after Trump declared the opioid crisis a public health emergency.

OUCH: A member of the opioid commission Trump commissioned last March says the GOP-led Congress is turning the panel into a "sham" by its unwillingness to put money toward the crisis. "Everyone is willing to tolerate the intolerable -- and not do anything about it," former Democratic Rep. Patrick Kennedy (R.I.), a leading mental health advocate, told CNN. "I'm as cynical as I've ever been about this stuff."

While Trump declared opioid abuse a public health emergency last fall -- and recently renewed the declaration -- there's no new funding available for the crisis, which killed about 64,000 people in 2016. Democrats are pushing for more opioid funding in a spending bill three weeks from now, but it's unclear whether Senate Majority Leader Mitch McConnell (R-Ky.) will uphold the alleged commitment he made toward that end.

Kennedy is one of six members of Trump's opioid commission, led by former New Jersey Gov. Chris Christie (R), which issued a report with 56 recommendations for combating opioid addiction in the United States. But Kennedy told CNN the administration's response so far is "tantamount to reshuffling chairs on the Titanic."

"The emergency declaration has accomplished little because there’s no funding behind it," Kennedy said. "You can’t expect to stem the tide of a public health crisis that is claiming over 64,000 lives per year without putting your money where your mouth is."

AGENCY ALERT

--HHS is poised to get a boss. Today's probably going to be a very good day for Alex Azar, Trump's nominee to lead HHS. Six Democrats joined with Republicans yesterday on a procedural vote to start considering Azar on the floor, setting up a likely confirmation vote today around 2:15p.m.. The former Eli Lilly executive would replace former HHS Secretary Tom Price, who resigned last fall under fire for his repeated flights on private charter planes at taxpayer expense. Azar's nomination has been considerably less controversial than Price's, and sources at HHS tell us they believe he'll bring better management to the agency.

Nonetheless, two top Democrats -- Sen. Patty Murray (D-Wash.), ranking member om the Health, Education, Labor and Pensions panel, and Sen. Ron Wyden (D-Ore.), ranking member of the Finance Committee -- will not be among the Democrats voting for Azar today. In a floor speech provided in advance to The Health 202, Murray plans to criticize Azar for a number of items, including supporting ACA repeal efforts, not backing more opioid funding (at least publicly) and the increase in insulin prices at Lilly while Azar was working there.

“As a nominee Mr. Azar may try to assure us that he will fight for patients and protect the health of our communities, but after looking at his record, after reading his past statements, after discussing these issues with him, I am alarmed that he might not stand up for women and families," the speech says. "I am alarmed that he might not stand up to the pharmaceutical industry. And I am alarmed that he might not stand up to President Trump’s agenda driven by sabotage and ideology."

HEALTH ON THE HILL

--It's still looking extremely difficult for the House to ever pass two bills aimed at stabilizing the Obamacare marketplaces. Several House Republicans told the Washington Examiner this week that they'd have to include more Obamacare "reforms" in order for members to get behind them. Both measures -- one to authorize cost-sharing reduction payments and the other to fund reinsurance for marketplace insurers -- appear to be stuck in limbo, even though GOP Senate leaders had allegedly promised to move them forward.

“So far the only thing I have seen is additional flexibility at the state level. For me, it is not enough,” said Rep. Tom Cole (R-Okla.). “I want something substantial to justify a vote for that.”

Two conservative leaders also indicated their respective groups won't go for funding the CSR subsidies, which help insurers discount things like co-payments for the lowest-income marketplace enrollees. “The CSRs] are still something that most of the guys I am talking with are saying I can’t get there,” said Rep. Mark Walker (R-N.C.), chairman of the 170-member Republican Study Committee. “I don’t know that there is a whole lot of support for it here,” said Rep. Mark Meadows (R-N.C.), who leads the conservative House Freedom Caucus.

Sen. Susan Collins (R-Maine), who is co-sponsoring the reinsurance bill, told Axios she's working with the House on potential changes to that measure, to which Republicans have indicated they're more open than cost-sharing payments. "Reinsurance was part of the House's repeal and replace efforts, so there's no reason why Republicans would be philosophically against it right off the bat. Depends on the details of the package," a House GOP aide told Caitlin Owens.

--The Health 202 congratulates Sen. Tammy Duckworth (D-Ill.), who announced yesterday she's pregnant with her second child. The arrival of Duckworth's child in April would make her the first sitting senator to give birth while in office, my colleague Paul Kane reports.

Duckworth told Lynn Sweet of the Chicago Sun-Times she is six months along and, just six weeks shy of turning 50, that she felt “great” about motherhood and the demanding role of being a senator. “As tough as it’s been to juggle motherhood and the demands of being in the House and now the Senate, it’s made me more committed to doing this job,” she told Sweet.

Duckworth also opened up to Sweet about her struggles to conceive again. “I’ve had multiple IVF cycles and a miscarriage trying to conceive again, so we’re very grateful,” she said.

TRUMP TEMPERATURE

--More than eight in 10 Americans feel the U.S. president should be required to take an annual physical exam, while more than seven in 10 think the president should also undergo a mental-health exam, according to a new CNN poll released yesterday. Those findings pretty much line up with how Americans felt back during George W. Bush's presidency.

But public opinion has shifted away from privacy for the president, the poll found. Respondents were divided evenly on whether a president should be required to release his health information or whether he should be allowed to withhold it. In a 2004 survey, 61 percent of Americans favored presidential privacy while 38 percent thought the president should release all medical information that might affect his or her ability to serve.

OPIOID OPTICS

--Legendary musician Tom Petty, who recently died of an accidental drug overdose, had a host of risk factors associated with opioid addiction: Chronic pain from a fractured hip, an ongoing battle with severe depression and a long history of substance abuse. Over at Stat News, Lipi Roy, an addiction medicine doctor, lays out a few science-backed ideas that could perhaps have prevented Petty's death.

1. Medication-assisted treatment. Medications like methadone and buprenorphine not only reduce withdrawal symptoms but also reduce the risk of relapse and overdose. "Medication-assisted therapy saves lives," Lipi writes. "Yet of the 23 million Americans with substance use disorders, only 1 in 10 get access to this treatment. This egregious treatment gap is driven by stigma, as well as lack of patient and clinician knowledge, legislative obstacles, and the like."

2. Prescription drug monitoring programs. Petty was receiving multiple medications that heightened his risk of overdosing. "This dangerous concoction probably didn’t come from a single doctor but from multiple providers," Lipi writes. "A statewide — ideally nationwide — prescription drug monitoring program could have alerted clinicians about Petty’s list of medications."

3. Addressing the root causes of addiction. Like many patients, Petty survived several traumatizing events including beatings by his father, a painful divorce and substance abuse. "We must identify and address the underlying pain and suffering," Lipi writes. "We must show a lot more compassion and a lot less judgment toward people with addiction."

--A few more good reads from The Post and beyond:

PowerPost
The Vermont senator and nine guests discussed the need to bring about single-payer health care, its benefits to business and its implementation around the world.
David Weigel
MEDICAL MISSIVES
A report from the National Academy of Sciences said that e-cigarettes are safer than smoking, but not quite safe, and may cause teens to take up tobacco.
New York Times
INDUSTRY RX
Wonkblog
The surprise winners from a three-day government shutdown.
Carolyn Y. Johnson
STATE SCAN
Virginia Politics
Republican senator from Southwest Virginia wins a do-over vote.
Laura Vozzella
Local
A surge in reported cases in D.C., Maryland and Virginia echoes a national trend.
Rachel Chason and Paul Schwartzman
DAYBOOK

Today

  • The Families USA Health Action Conference begins.

Coming Up

  • The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.
  • The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.
  • The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday. 
  • Tivity Health sponsors an event on “Aging in Rural America: The Growing Crisis, a Movement for Change” with remarks from Sen. Chuck Grassley (R-Iowa) on Thursday
SUGAR RUSH

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