THE PROGNOSIS

Republicans have long targeted Planned Parenthood at both the federal and state level as a punching bag, trying to strip taxpayer funding from the nation's largest abortion provider. But the chain of women's reproductive health centers -- and their political representatives -- are now punching back at the state level. 

Planned Parenthood leaders announced yesterday they’re working with lawmakers in more than a dozen states to introduce bills expanding access to abortion or pulling back on existing measures that limit it. They include a bill to repeal Missouri’s 72-hour waiting period before a woman can obtain an abortion; Maine legislation allowing nurse practitioners to prescribe abortion pills and a bill restoring family planning funding that former New Jersey governor Chris Christie (R) had cut from the budget.

“We’re trying to work in every state — even in the toughest places to expand access,” the group’s Executive Vice President Dawn Laguens told reporters. “By the end of this year, we will take this offensive fight to all 50 states.”

Planned Parenthood, which is losing its longtime head Cecile Richards (who held the reins of the organization for 12 years and will retire in May), is also pushing measures in three states with Democratic-led legislatures — California, Hawaii and Rhode Island — and in seven more states where Republican majorities might make it hard for the group to gain traction, including Alaska, Arizona, Kansas, Michigan, Oklahoma, Tennessee and West Virginia.

It is true that Planned Parenthood recently weathered a major onslaught by Congress to strip it of Medicaid dollars, a GOP effort that died alongside several bills to repeal and replace the Affordable Care Act. It looks unlikely that Republicans will be able to defund Planned Parenthood anytime soon, despite their long promises to do so and strong backing of President Trump and Vice President Pence.

But that doesn't mean it will be easy, by any means, for Planned Parenthood to expand and ease access to abortion. Republicans, many of whom oppose abortion, have complete control over a quarter of state governments — including the governorships and state legislatures. And the group has also been shuttering dozens of clinics and providing fewer health-care services over the past several years.

According to the annual 2016-2017 report Planned Parenthood released last month, the group provided less contraception, fewer cancer screenings, fewer prenatal services and less miscarriage care compared to the year prior. While the numbers ticked slightly upward on well-women exams and sexually transmitted-disease testing, the group’s clinics are providing significantly fewer health services in nearly every category compared to five years ago.

For example, Planned Parenthood provided 28,674 prenatal services during its 2011-2012 fiscal year, but now provides fewer than 8,000 similar services. It provides a little more than half the breast exams it did five years ago. Its performed abortions are also down, but by less — in the most recent year, the group provided 321,384 abortion procedures compared to 333,964 in the 2011-2012 year.

Some of this stems from the fact that Planned Parenthood has less real estate than it used to. The latest report says the network operates more than 600 clinics around the United States, compared to 860 clinics 13 years ago.

Laguens also pointed to historically low rates of unintended pregnancy, teenage pregnancy and abortion as good reasons demand is down, and noted that women are using long-acting, reversible contraception more than ever, meaning they don’t need to visit clinics as frequently to get birth-control refills. There’s also the fact that some services provided by Planned Parenthood, such as pap tests, aren’t recommended as frequently for women anymore.

“When the CDC or NIH or any of the medical groups come out and say women don’t have to have a pap test every other day – that they need to come every two years or whatever the guidance is – Planned Parenthood is often the very first large-scale women’s reproductive care provider to implement those things,” Laguens said.

Then there are the ongoing actions by states to restrict abortions in various ways, a trend that has been going strong for several years and continued in 2017. Last year, 19 states adopted 63 new restrictions on abortion rights and access, according to the Guttmacher Institute, a pro-abortion rights research group.

Additionally, Iowa, Kentucky and South Carolina moved to restrict family planning funding for abortion providers, making 15 states to try to cut these providers out of the federal Title X program. They’ve got strong support from Trump, who signed a bill last year reversing Obama-era guidance saying states couldn’t restrict Title X funds in that way.

“There are attacks that absolutely have negative impacts, there are gains that we are making and there are changes that are good for women that would actually be reflected in those numbers,” Laguens said.

AHH, OOF and OUCH

AHH: The Centers for Medicare and Medicaid Services is still working on a "scorecard" for states to report how well their Medicaid programs are working, the agency confirmed yesterday to the Washington Examiner. CMS Administrator Seema Verma had mentioned such a scorecard in a speech last fall, when she said it would use state data to track whether positive outcomes from Medicaid and measure items such as the effectiveness of children's health care and treatment and prevention policies. 

"The scorecard is still in development and is a priority for CMS," an agency official told reporter Kimberly Leonard. "We have been working with states on its development to ensure it’s a collaborative process and isn’t a 'federal government knows best' approach to providing greater transparency and accountability of the Medicaid program." The official didn't provide a specific timeline, but the document is expected later this year, Kimberly writes.

OOF: As the nation grapples with the ongoing opioid crisis, crystal meth has crept back too. The New York Times’s Frances Robles reports methamphetamine “has never been purer, cheaper or more lethal.” Nationwide, about 6,000 people died from the use of stimulants, mostly meth, in 2015. That’s a 255 percent increase from a decade prior, according to the Centers for Disease Control and Prevention.

Meth use decreased after 2005 when Congress passed the Combat Methamphetamine Act, limiting sales to 7.5 grams for every 30 days. Some states required a prescription for pseudoephedrine, the nasal decongestant used to make it. And as a result, the use of prescription drugs and opiates spiked to fill the void. But the stimulant has returned, in part because as the ingredients became more difficult to acquire in the United States, Mexican drug cartels took over to fill the market with pure, low-cost meth, Frances reports.

OUCH: Two health-care juggernauts are locked in a battle for patients in western Pennsylvania that could foretell the future of American health care, The Post's Carolyn Y. Johnson reports. On one side is UPMC, a health system that built its brand on cutting-edge research and university-affiliated hospitals. On the other is Highmark Health, best known as one of the country’s biggest health insurers.

"They could be mirror images of each other, flipped upside down. UPMC started out in the hospital business, then created its own health insurance plan and built a $20 billion-a-year enterprise. Highmark, which reported $18.2 billion in revenue last year, announced in 2011 that it would branch from insurance into hospitals, Carolyn writes. "In response, UPMC threatened to stop accepting Highmark insurance at its doctors and hospitals."

"Agreements and state intervention smoothed over the divorce, which won’t be complete until next year, but people have had to pick sides: Highmark patients with UPMC doctors have had to switch plans, or switch doctors. UPMC health plan members have to pay out-of-network prices at Highmark’s facilities. In the meantime, people have been bombarded by dueling ad campaigns and endless local news stories about the rift....The competitive clash has turned Pittsburgh into a testing ground for forces that are transforming health care nationally, as waves of consolidation blur traditional boundaries in the $3.3 trillion health-care system."

HEALTH ON THE HILL

--If your name is Alex Azar, hopefully you're well-caffeinated. This morning the secretary of Health and Human Services is scheduled to testify about the White House budget request before the House Ways and Means Committee. Tomorrow, Azar is headed to the Senate Finance Committee in the morning, and then to the House Energy and Commerce Committee in the afternoon, to do the same.

First in The Health 202: The pro-ACA group Save My Care will concurrently run an ad urging Azar to reject Idaho's recent move to allow health insurers to sell plans that aren't compliant with Obamacare regulations. The state has issued a bulletin saying plans could decide not to cover benefits the Affordable Care Act mandates or could choose to put lifetime caps on benefits (also banned under the ACA).

Save My Care said it will air its ad on cable news during Azar's 10 a.m. testimony today, as part of a five-figure campaign to pressure Idaho into complying with the ACA. The ads will air in Boise, Idaho and the District of Columbia:

--Yesterday House Speaker Paul Ryan (R-Wis.) said he's aiming for "incremental" reforms to health care this year instead of full Obamacare repeal, an effort that failed dramatically in the Senate last year. “I think the best chance we have is going after incremental entitlement reform since the fact the Senate couldn't pass it,” Ryan said on Fox Business.

Ryan also took a jab at Sen. John McCain, the Arizona Republican who famously stymied the Senate bill with a thumb-down gesture. “What we tried to do was do it all in the House bill with repeal and replace,” Ryan said. “Like I said, we passed it. And that bill — one guy in the Senate did this instead of that, and that went down. That would have been the biggest entitlement reform bill ever passed by Congress.”

“So what are we doing?” Ryan added. “We're going back and doing it incrementally. Going back at incremental health-care reform and other entitlement reforms so we can chip away at this problem."

Ryan also expressed some wishful thinking about his hopes of reforming entitlement programs like Medicare and Medicaid, although that's politically challenging for Congress to do because it involves cutting government spending:

INDUSTRY RX

--Amazon.com has already made moves into the health-care business as it looks to become a major medical supplier, recently inviting hospital executives to its Seattle headquarters to brainstorm about expanding Amazon Business into a hospital resource. Yesterday, after the Wall Street Journal first reported on Amazon’s push into the industry, stocks for health-care distributors tumbled. The company already sells some medical supplies through the Amazon Business marketplace, but is looking to expand its efforts to compete with distributors of more specialized medical products and simplify purchasing for hospitals in the process, reporters Melanie Evans and Laura Stevens write

Our colleague Carolyn notes Amazon has been more upfront about this particular initiative unlike its plans to shake up the prescription-drug industry and develop ways to cut health costs for employees. “In an earnings call in October, an executive mentioned hospitals first on a laundry list of institutions Amazon was targeting with its Amazon Business offering, along with schools, labs and government agencies,” Carolyn writes. (Amazon founder and chief executive Jeffrey P. Bezos owns The Washington Post.)

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

IWasPoisoned.com, which lets users submit anonymous reports of food poisoning, has become a controversial powerhouse in the restaurant industry.
The New York Times
MEDICAL MISSIVES
Wonkblog
Over one-quarter of American workers have no paid sick leave, and it's making us all sick.
Christopher Ingraham
Medical schools aren’t good at keeping women professors. Could better leave help?
Bloomberg
STATE SCAN
Virginia Politics
Republicans have killed most Democratic priorities, but Medicaid expansion remains on the table.
Laura Vozzella
OPIOID OPTICS
Economists tracking federal mortality data say the opioid crisis is undercutting the productivity of people in their prime working years — 30s and 40s.
NPR
DAYBOOK

Today

  • The Hill, Faces & Voices of Recovery and Indivior hold an event on the opioid crisis and supporting recovery.
  • The Alzheimer’s Association hosts an event this morning on dementia care practice recommendations, and will be joined by lawmakers including Sen. Susan Collins (R-Maine) and Sen. Catherine Cortez Masto (D-Nev.).

Coming Up

  • The USC-Brookings Schaeffer Initiative for Health Policy holds an event on patient cost sharing for prescription drugs on Friday.
SUGAR RUSH

Yesterday, Sarah Huckabee Sanders faced repeated questions from reporters about the White House’s response to allegations of abuse against Rob Porter:

In the spirit of Valentine's Day, watch some of the elaborate courtship rituals that male birds use to attract females during mating season:

Stephen Colbert shares President Trump's Valentine's Day card to Melania: 

And on Jimmy Kimmel, White House-themed Valentine's Day cards: