THE PROGNOSIS

He’s already a thorn in the side of the Trump administration. But California Attorney General Xavier Becerra is getting even more aggressive in challenging how the president and his appointees are tackling a range of health-related controversies.

The former chairman of the House Democratic Caucus — who has since forged a reputation as perhaps this administration’s  most persistent legal hound — said in a meeting with a group of Washington Post reporters yesterday that he is launching a  strike force aimed at enforcing federal health-care laws around access and delivery in California. It’s a necessary project, Becerra said, considering how massive and far-reaching the health-care industry has grown.

“The health-care market’s roughly one-sixth of our economy and there’s a growing need to enforce laws in this area — the team we’re building will focus on tackling this,” Becerra said.

The new strike force, staffed so far by five attorneys and one supervisor, will keep working on several health-related lawsuits filed by the the Golden State while also homing in on a few newer issues, including a possible challenge to President Trump’s recent move to expand association health plans.

The strike force is also looking into how it could get involved in several other pressing health-care issues, including price fixing of generic drugs, consolidation in the health-care market, protecting medical privacy and going after opioid makers.

It’s not a terribly surprising move by one of the country’s most activist attorney general. In the year he has served as California’s top lawyer, Becerra has gone after the GOP-led administration tooth and nail, filing 28 lawsuits on issues from the environment to immigration to health care, and joining other states on several more.

Recall last October. When the Department of Health and Human Services issued rules to broaden exemptions to the Affordable Care Act’s requirement for employers to cover contraception, Becerra was one of several state officials and interest groups to swiftly file complaints in federal court. Several courts have ruled against the Trump administration as the dispute works its way through the legal system.

Just a few days later, when the White House cut off extra Obamacare subsidy payments, Becerra led 17 other state attorneys general in challenging the move, which represents another major way the administration has been trying to undermine the ACA even as Congress has failed to repeal most of it.

The payments compensate marketplace insurers for extra discounts, known as cost-sharing reductions, they must provide to the lowest-income enrollees to help them afford costs such as deductibles and co-payments. Becerra and his colleagues initially requested a preliminary injunction (which a federal judge rejected), citing concerns insurers would be forced to hike premiums to compensate for the loss of the payments.

Becerra said he’s filed a motion for summary judgment in the case, which is before the U.S. District Court of Northern California.

“California wants [insurers] to be able to continue to do what they’re doing,” Becerra said.

And it’s not just federal policy Becerra has his eye on. Just a few weeks from now, his office will defend before the U.S. Supreme Court a California law requiring antiabortion “crisis pregnancy centers” to publicly post or notify patients of the availability of low-cost or free abortions.

The centers bringing the lawsuit say the state is violating their free-speech protections, while California says it’s simply ensuring that basic health information is provided to women. I wrote about the case in this Health 202, if you want to read more about it.

A spokeswoman for Becerra said the strike force is also weighing in on cases against two Alabama laws. One outlaws “dilation and evacuation” abortions — the most common second-trimester abortion procedure — and the other bans abortion clinics from being located within 2,000 feet of public elementary and middle schools.

The attorney general appears to embrace his new role, one that holds fresh opportunity at a time when the Trump administration is seeking to reverse many of the policies advanced during the prior eight years under President Barack Obama.

“It’s an opportunity to enforce the law,” Becerra said.

AHH, OOF and OUCH

AHH: Apple is launching health clinics for its employees this spring. The program, called AC Wellness, will serve employees and their families at the company’s headquarters in Cupertino, Calif. to start. The company has quietly launched the website acwellness.com, which lists job openings including for a primary care physician, acute care physician, medical assistant, nurse practitioner and nurse coordinator, CNBC reports.

Apple's move toward a primary care program for employees comes as other major companies are also exploring ways to enter the health-care space. Amazon, Berkshire Hathaway and JP Morgan Chase announced last month they're partnering on a joint effort aimed at reining in health-care costs.

OOF: The Washington Post's Amy Goldstein takes a look back at how Idaho’s rebellion against the ACA began, leading to its move to allow individual market insurers to sell non-ACA-compliant plans. With his executive order #2018-02, Gov. C.L. "Butch" Otter told his state insurance department to allow “creative options” in health coverage, unfettered from “the overreaching, intrusive nature of Obamacare and its infringement on Idahoans’ freedoms.”

"Within a matter of weeks, the department decreed that insurance companies have substantial wiggle room as long as they offer at least one health plan that meets the Affordable Care Act’s rules," Amy writes. "They can sell policies that lack maternity care and charge older residents more than permitted under the 2010 law. They can impose yearly coverage limits and block coverage of customers’ prior medical conditions ... In the nearly eight years of the ACA, this order by a lame-duck Republican governor is a singular act of audacity — the first time any state has stepped out on its own to foster a parallel insurance universe."

"As events move swiftly on the ground — with Blue Cross of Idaho announcing that it hopes to start selling alternative “Freedom Blue” plans in March — the state’s maneuver has sparked a tempest that has spread to Washington," she continues. "Dispute is raging over whether Idaho’s maneuver is legal, and whether it is a clever balm for broken insurance markets or a slide back to shoddy, unfair insurance practices that the ACA had fixed."

OUCH: Yesterday, Attorney General Jeff Sessions announced the creation of a new task force focused specifically on targeting opioid manufacturers and distributors, and holding them accountable for unlawful practices, The Post's Lenny Bernstein, Katie Zezima and Sari Horwitz report. The Justice Department has also filed a statement of interest in a case involving hundreds of city and county lawsuits against opioid manufacturers and distributors; Sessions says it will argue that the federal government has borne substantial costs from the opioid epidemic and it seeks reimbursement.

“Opioid abuse is driving the deadliest drug crisis in American history,” Sessions said at a news conference with several U.S. attorneys. “It has strained our public health and law enforcement resources and bankrupted countless families across this country.”

“Sessions’s announcement is part of a flurry of activity this week at the White House, on Capitol Hill, in a U.S. courthouse and elsewhere that may mark the beginning of an intensified federal effort to address the uncontrolled drug epidemic sweeping the country,” Lenny, Katie and Sari write. “This week, the White House is holding a summit on the drug crisis, hearings on eight House bills are beginning on Capitol Hill and the Secretary of Health and Human Services has embraced the expansion of medically assisted drug treatment — in contrast to his predecessor.”

OPIOID OPTICS

--Sessions is also trying to go after illegal drug sales online, but that's a tall order, FiveThirtyEight reports. Last month, DOJ announced the creation of the Joint Criminal Opioid Darknet Enforcement (J-CODE) team to pursue drugs on the dark web, a network of web internet sites that can be accessed anonymously. FBI officials said the team will focus on “disrupting the sale of drugs via the darknet and dismantling criminal enterprises that facilitate this trafficking," Kathryn Casteel writes.

The dark web consists of Internet services -- mostly sales of illegal weapons, stolen identities, child pornography and large amounts of deadly drugs -- that can be accessed with anonymity using special networks. "But some experts warn that, depending on the approach the Justice Department takes, the disrupted sites could simply resurface elsewhere or thrive internationally — and its tactics could raise privacy concerns," Kathryn writes. "Much as with crackdowns on traditional drug markets, shutting online marketplaces and arresting their operators have resulted in other marketplaces replacing them."

HEALTH ON THE HILL

--House Republican leaders may have closed the door yesterday on any kind of swift response to this month’s shooting at a Florida high school, our colleagues Mike DeBonis and Seung Min Kim report. House Speaker Paul Ryan and other Republican leaders wouldn't commit to bringing up even gun-related measures with broad bipartisan support.

Their hesitation may in part be due to mixed signals from the White House. While Trump initially floated a number of gun-related proposals, including banning “bump stocks,” arming teachers, raising the minimum wage for rifle purchases and expanding background checks, the White House has not endorsed any particular course of action. “Lawmakers...have no real idea what Trump wants from them on gun policy in the wake of the massacre at a South Florida high school,” Seung Min and Mike write.

"Since the shooting, students have called for new gun restrictions as part of any legislative response, including a new age limit of 21 for buyers of long guns, matching the federal limit for handgun buyers," they continue. "But Republican lawmakers have sought to turn the discussion toward law enforcement failures, mental health and school security."

“Of course we want to listen to these kids, but we also want to make sure that we protect people’s due process rights and legal, constitutional rights while making sure that people who should not get guns don’t get them,” Ryan said, before turning to “bigger questions of our culture.”

--The alleged Parkland shooter Nikolas Cruz refused mental health and other services from his school once he turned 18, the Sun Sentinel reported. Once he was considered an adult, Cruz chose to stay at Marjory Stoneman Douglas High even though specialists recommended in November 2016 he be transferred to Cross Creek, a school for students with emotional and behavioral issues, reporter Scott Travis writes.

Considered a special needs student, Cruz had been transferred to Cross Creek in eighth grade but two years later, the district allowed him to split his days between the two schools. After that transition, a report was made to the Broward Sheriff’s Office, claiming Cruz threatened on Instagram “to shoot up the school.” According to Broward Schools Superintendent Robert Runcie, the situation "had deteriorated" by November 2016, with "a lot of incidents."

While it was recommended Cruz return to Cross Creek full time, Cruz had already turned 18 and was able to refuse, along with turning down services available for special needs students. Then in February 2017, about a year before the shooting, Stoneman Douglas finally removed Cruz from the school for unspecified behavior problems.

--A bipartisan group of eight senators led by Ohio Republican Rob Portman and Rhode Island Democrat Sheldon Whitehouse have introduced a second iteration of a bill responding to the opioid crisis, a sequel of sorts to the Comprehensive Addiction and Recovery Act of late 2016. If passed, it would be the most substantive action Congress has taken to address the opioid epidemic since Trump took office. The measure would place three-day prescription limits on doctors’ ability to hand out opioids prescriptions, exempting only cancer, chronic pain, and hospice treatment.

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

MEDICAL MISSIVES
The Switch
However, the study did turn up a few troubling indicators.
Eli Rosenberg
They're not slumped over in alleyways. They haven't lost everything. They are the heroin addicts living next door and fooling their families.
CNN
INDUSTRY RX
The CEOs of both companies recently met to discuss a deal, amid industrywide disruption.
CNBC
America's healthcare system is, simultaneously, the best and the worst, says JPMorgan Chase CEO Jamie Dimon.
Washington Examiner
STATE SCAN
Morning Mix
Christopher Bathum also is charged in a $175 million fraudulent health-care billing scheme.
Samantha Schmidt
DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Health will hold a hearing on combating the opioid crisis.
  • The Senate Health, Education, Labor and Pensions Committee holds an executive session on various bills.

Coming Up

  • The U.S. Chamber of Commerce holds an event on combating the opioid crisis on Thursday.
SUGAR RUSH

During an announcement with the Justice Department to combat the opioid crisis, Arkansas Attorney General Leslie Rutledge said, "The face of the drug dealer has changed:"

Seth Meyers checks in on the opioid epidemic: 

Senate Majority Leader Mitch McConnell said Congress should enact changes to the background-check system for gun purchases to “at least show some progress:"

Senate Minority Leader Chuck Schumer said Senate Democrats want a “full debate” on legislation to curb gun violence: