THE PROGNOSIS

Republicans are once again stuck between a rock and a hard place on Obamacare. They could significantly lower 2019 premiums by making extra payments to insurers. But their base is protesting loudly against such a move.

Passing two measures aimed at stabilizing the Affordable Care Act marketplaces by infusing insurers with more funds would lower monthly premiums by 20 to 40 percent and prompt an additional 3.2 million people to get covered, says an attention-grabbing independent analysis released yesterday by the firm Oliver Wyman.

These measures – which would pay insurers for extra cost-sharing discounts for the low-income and reimburse them for their most expensive customers – are currently stuck in political limbo as leaders on Capitol Hill consider whether to include them in a massive, must-pass spending bill next week.

The bills have become emblematic of inter and intraparty disputes over how to approach a world with most of the ACA still in place. Democrats are bitter that Republicans are still chipping away at parts of the law by repealing its individual mandate and changing other provisions through the executive branch. Their lead negotiator on the matter, Sen. Patty Murray (D-Wash.), is insisting any stabilization bills should also include beefier premium subsidies and cost-sharing payments to lower costs further for consumers.

And Republicans can’t even agree among themselves how to handle the law now that they’ve failed to entirely wipe it from the books.

Republican moderates, who feel they’ve got a responsibility to try to improve the marketplaces for customers, pointed to the Wyman report as more evidence that this is the right route. They say insurers need more incentive to stay in the system and halt massive rate hikes, which plagued the exchanges this year.

“This analysis…further demonstrates that our bipartisan proposals will help drive down premiums in the individual market and make health insurance more affordable for millions of Americans,” GOP Sens. Lamar Alexander (Tenn.) and Susan Collins (Maine), the measures’ GOP sponsors, said in a joint statement.

But 14 leading conservative groups are sticking with their characterization of the payouts as a “bailout” of the health-insurance industry – a term they started using to criticize the Obama administration, which made the payments without approval from Congress.

The cost-sharing reductions and reinsurance payments “do nothing to address the real reasons premiums and deductibles are rising,” Heritage Action, Americans for Prosperity, FreedomWorks and other groups wrote in a letter to leadership yesterday, adding tthose problems are caused by “the law’s regulations, mandates and subsidy structure.”

“Lawmakers should not be fooled by ludicrous claims that spending new federal money on Obamacare bailouts will save the federal government money,” they wrote. “The same insurers who are lobbying for bailout money this year will be back again when funding expires, threatening to withdraw from the exchanges or raise premiums if bailouts aren’t extended.”

Those “ludicrous claims” the groups were referring to are actually from the Congressional Budget Office, the official nonpartisan scorekeeper for Congress that both parties typically trust to estimate the cost and impact of legislation.

The CBO said last August that withholding the payments to insurance companies would actually cause the government to spend more money on subsidies for monthly premiums, which a wider swath of Americans can access.

If the conservative groups don’t have those facts on their side, it appears they don’t have public support for their position either. Nearly 60 percent of voters around the country favor making the payments to insurers, compared to just 33 percent who don’t want them made. And that’s according to a poll commissioned by the American Action Forum, a conservative group led by former CBO director Doug Holtz Eakin.

Plus, industry is of course on the side of making the payments. “Immediate action is necessary to reduce premiums for individual and families that purchase coverage on their own,” America’s Health Insurance Plans, the American Medical Association, the American Hospital Association, the U.S. Chamber of Commerce and several other groups wrote to congressional leaders earlier this month.

AHH, OOF and OUCH

AHH: Today the House is scheduled to vote on a "Right to Try" bill  allowing patients with life-threatening illnesses to try experimental treatments if agreed to by their physician and the drug maker. But yesterday a leading Democrat, Rep. Frank Pallone, announced his opposition to the measure his colleagues had hoped would be bipartisan, calling it risky, unneeded and saying it "provides false hope to patients."

Pallone, who is the top Democrat on the House Energy and Commerce Committee, echoed arguments by some opponents that Right to Try is unnecessary because the FDA already approves most similar access requests. He noted the legislation doesn't require drugmakers to provide these treatments to patients.

"It also provides false hope to patients and their families, who will assume they will have access to investigational therapies even though the bill does nothing to require manufacturers to provide these therapies to the patient," Pallone said.

Pallone’s opposition is notable because if GOP leaders want to rush the legislation through the House using a process normally reserved for noncontroversial measures, that could require a two-thirds majority, the AP's Alan Fram points out. Even if all Republicans vote yes on the bill, they’d still need help from at least 50 Democrats to pass it, Alan writes.

OOF: Now that the Trump administration has poured cold water on Idaho's plans to let insurers duck the ACA, the Republican vying to be the state's next governor is on the defense. Lt. Gov. Brad Little -- who spent months campaigning on a plan the Centers for Medicare and Medicaid Services said last week probably violates the ACA -- downplayed the agency's warning, the AP reports.

"I believe Idaho is following the intent of the law by offering quality health insurance," Little said in a prepared statement. "We want to offer more choices and affordability to all Idahoans."

Gov. C.L. "Butch" Otter (R) invited insurers earlier this year to submit plans that don't comply with the ACA's coverage requirements. But it now appears that won't fly with the administration. Democratic gubernatorial candidate A.J. Balukoff said Friday he was thrilled that "Otter's 'crazypants illegal' plan to sell skimpy health care coverage to Idahoans is dead." Balukoff aslo said he hoped the CMS letter meant that Little's "taxpayer-funded campaign trips to sell these illegal plans are over."

Little had made this "state-based" health plan one of his top campaign issues. "Idaho certainly doesn't need D.C. liberals telling us how to run health care, so I decided to do something about it," Little said in a recent television ad. "This January, Gov. Otter and I ended Obamacare's monopoly in Idaho."

OUCH: An Ohio couple who lost both their frozen embryos when a fertility clinic’s storage tank overheated last week are the first in a wave of patients heading to court to hold the facility accountable for dashing their dreams of future children, the Post's Amy Goldstein and Ariana Eunjung Cha report.

Two Cleveland attorneys said they have been inundated ever since the University Hospitals Ahuja Medical Center’s Fertility Center disclosed late last week that it was notifying 700 patients that their eggs or embryos may have been damaged. A second clinic, the Pacific Fertility Center in San Francisco, disclosed to The Post on Sunday it also had suffered a malfunction last week in a steel tank where hundreds of patients’ eggs and embryos were stored. Members of the American Academy of Assisted Reproductive Technology Attorneys said Monday they were not aware of legal action against the California clinic but expected filings soon.

"The impulse of couples to translate their anger or grief into legal action represents a new consumer activism in a realm of medical technology that has been proliferating and remains unevenly regulated," Amy and Ariana write. "The number of embryos in cold storage has skyrocketed since the turn of the century. A 2002 survey estimated the number to be almost 400,000. By 2011, it was 600,000. Fertility experts say it is probably well over 1 million today — more than the population of Austin."

HEALTH ON THE HILL

—Senate Democrats running for reelection in states that went for Trump in 2016 may be well-positioned when it comes to the topic of health-care policy. A new poll from Axios and Survey Monkey finds that in 10 states Trump won, most voters would prefer modifying the ACA or letting it stand rather than trying to repeal it.

In Wisconsin, for example, 60 percent of respondents were in favor of modifying the ACA, compared with 24 percent who said they wanted the law repealed. Of all 10 states surveyed, Indiana and Missouri had the lowest percentage of voters – 49 percent – who preferred to modify the health care law, compared with 33 percent and 32 percent respectively who wanted to repeal it. Most of the Senate Democrats in these states have already taken a moderate position on the law, opposing its repeal but not joining more liberal members of their party in supporting a single-payer system.

OPIOID OPTICS

—The opioid crisis may be even worse than we thought. The federal government has been undercounting opioid overdose deaths by as much as 35 percent, Keith Humphreys writes for The Post.

Keith highlights startling research from University of Virginia professor Christopher Ruhm, who examined one source of federal data on national opioid overdose trends: coroner reports. The CDC aggregates data from more than 3,000 coroner’s offices nationwide, but sometimes coroners don’t record the specific drug involved in a fatal overdose. That means some opioid overdose deaths may not have been included in official counts.

“According to Ruhm’s research, if all coroners accurately reported opioid overdose deaths, official counts would be substantially higher,” Keith writes. “For example, the CDC figure for 2016 was 42,249 opioid overdose deaths nationwide, but with accurate data the count would have been 49,562.”

And while it’s up to states and counties to work with local coroners to improve the reporting practices of overdoses, their incentive for doing so is complicated, Keith notes. If more resources are provided to better record overdose deaths, a county may end up looking like its opioid problem is only getting worse.

—Kentucky Attorney General Andy Beshear is suing yet another distributor of prescription opioids. Last week, Beshear announced a case against AmerisourceBergen, which the suit claims engaged in “unfair, misleading and deceptive business practices for excessively distributing opioids in Kentucky,” per CNHI News Service reporter Ronnie Ellis.

Beshear estimated that Pennsylvania-based AmerisourceBergen supplied almost a third of the opioid drugs in his state, which has some of the highest overdose and death rates from opioids in the country. Ronnie writes that 54 counties in Kentucky have been cited by the CDC as being at a risk for Hepatitis C and HIV outbreaks. This lawsuit is just the latest in the effort by states to hold drugmakers accountable for the ongoing opioid crisis. The Health 202 wrote last month about the litigation led by Beshear, who has filed three other lawsuits against Endo Pharmaceuticals, Cardinal Health and McKesson Corporation.

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

AGENCY ALERT
A bipartisan law was supposed to make it easier to fire bad actors at the Department of Veterans Affairs. But it’s targeting the wrong people.
Politico
MEDICAL MISSIVES
To Your Health
Scientists are eager to examine whether the upheaval of the Trump era could have a similar impact.
William Wan
INDUSTRY RX
STATE SCAN
D.C. Politics
Public hospital leaders will no longer fight ruling that they violated Open Meetings Act
Peter Jamison
DAYBOOK

Today

  • The American Enterprise Institute holds an event on the opioid crisis with Sen. Mike Lee (R-Utah).

Coming Up

  • The Senate Indian Affairs Committee holds an oversight hearing on opioid in the Indian community on Wednesday.
  • The Patient-Centered Outcomes Research Institute and the American Heart Association hold a briefing on cardiovascular disease on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Discount Program on Thursday.
  • VA Secretary David Shulkin testifies before the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies on Thursday.
  • HHS Secretary Alex Azar testifies before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on Thursday.
SUGAR RUSH

What you need to know about Trump’s plan to prevent mass shootings:

Sen. John Cornyn (R-Tex.) describes several provisions of a bill that would aim to improve the background-check system for gun purchases:

Education Secretary Betsy DeVos’s stumbling "60 Minutes" interview, annotated: