Health Policy Reporter

THE PROGNOSIS

Here’s what Democrats — and some Republicans — will want to know about  Ronny Jackson, President Trump’s nominee to lead the Department of Veterans Affairs: How does Jackson feel about a bipartisan, middle-of-the-road approach making it easier for veterans to get care outside the VA system?

Given VA’s systemic problems with providing timely, quality care, there’s a raging political debate over whether its 20 million veterans should be able to visit private providers instead. And the recent ouster of VA chief David Shulkin is further inflaming the controversy.

At Jackson’s upcoming Senate confirmation hearing — which Capitol Hill staffers told me will be scheduled as soon as the White House submits the necessary paperwork — expect Democrats to probe the longtime White House physician on whether he supports a bipartisan bill the Veterans' Affairs Committee passed 14 to 1 late last year.

This legislation, hammered out by Chairman Johnny Isakson (R-Ga.) and ranking Democrat Jon Tester (Mont.), tries to appease conservatives who want to ease restrictions on private care while reassuring liberals that private care won’t replace 1,700 VA hospitals and clinics across the country.

Dubbed the Caring for Our Veterans Act, the bill eliminates requirements that veterans must have waited longer than 30 days for an appointment or live farther than 40 miles from a VA facility to seek private care. Instead, it opens that door directly if veterans and their providers decide together that community care is the best option.

There is major backing for the legislation. All the major veterans services organizations are behind it, including the American Legion and the Veterans of Foreign Wars, and Shulkin had indicated he was a fan if you read between the lines of his outgoing New York Times op-ed last week.

“Working with community providers to adequately ensure that veterans’ needs are met is a good practice,” Shulkin wrote. “But privatization leading to the dismantling of the department’s extensive health care system is a terrible idea.”

So why hasn't the measure become law? The bill lacks backing from the Koch-backed group Concerned Veterans for America — which has lobbied hard against it — and, perhaps for similar reasons, the White House. Advocates had hoped to get the bill included in the massive spending measure Congress passed last month, but in the end didn't succeed.

Shulkin’s moderate views on privatizing VA were among several differences he had with Trump, who said last week that Shulkin was dispatched because he wanted to give veterans more choices. Now Jackson’s nomination could mean the privatization legislation will be pushed further back on the shelf, depending on how loyal the White House doctor is to the president in his likely new job. (For their part, a White House spokeswoman said following Shulkin's exit that "no one is talking about privatizing the VA," per Politico).

These are among the indications that Jackson’s confirmation process could be an unusually controversial one for the Veterans' Affairs committee, which has historically confirmed nominees by wide margins and in a biparrisan manner. Democrats feel the White House wants to go too far in privatizing VA, and they’ll be suspicious of Jackson if he’s a strong proponent of that view.

Most Democrats, including Tester, haven’t yet drawn a hard line on what it would take for them to reject Jackson, but they appear wary of him so far.

“Moving forward, the VA needs a strong leader at the top who will listen to veterans, strengthen the VA, and work with Congress to implement bipartisan reforms,” Tester said in a statement last week. “I look forward to meeting Admiral Jackson soon and seeing if he is up to the job.” 

Americans also appear uncertain about giving U.S. veterans more access to private medical care. Thirty-nine percent of likely voters feel privatizing VA would be bad for veterans, while just one-third say it would good to do so, according to a Rasmussen poll released yesterday. Smaller shares of respondents said either privatization would have no impact or weren’t sure whether it would.

Sen. Bernie Sanders, the liberal Vermont independent who used to lead the Senate Veterans' Affairs panel, is dead set against turning over more VA medical care to the private sector and warned he’d oppose Jackson’s nomination if he doesn’t come out against privatization.

“Without exception, the major veterans organizations say we have got to strengthen VA, not dismember it, not privatize it,” Sanders said Sunday on CNN. “And I will do everything I can as a member of the veterans committee not to approve any nominee who is not going to strengthen VA and who will oppose privatization.”

Sen. Sherrod Brown (D-Ohio), also a member of the Veterans' Affairs committee, said Monday he’ll be asking Jackson at his confirmation hearing how the physician feels about privatization.

“I will fight any effort to use America’s veterans to line the pockets of wealthy corporations,” Brown said in a statement. “Any nominee to head the VA must oppose efforts to abandon that responsibility by privatizing the VA.”

AHH, OOF and OUCH

AHH: Final enrollment numbers for the Affordable Care Act marketplaces were only slightly lower this year, despite the Trump administration's move to slash most advertising and outreach funding. About 11.8 million customers actively selected or were automatically re-enrolled in coverage, down from 12.2 million who signed up last year, according to figures released yesterday afternoon by the Centers for Medicare and Medicaid Services.

The agency reported that enrollment was slightly up among those ages 55 and older — making up 29 percent of all enrollees compared to 27 percent last year — and slightly down among those 34 and younger. While 83 percent of consumers nationwide were eligible for subsidies to reduce their monthly premiums, those who weren't eligible chose plans that were 18 percent less expensive on average.

CMS Administrator Seema Verma called it the most “cost-effective” enrollment season ever, saying CMS spent just over $1 per each Healthcare.gov enrollee compared to $11 per enrollee during the final year of the Obama administration. She posted a few tweets:

OOF: Grindr, a popular dating app for gay men, said yesterday it will stop sharing users’ HIV data with third-party companies that analyze mobile and Web apps, The Post's Kristine Phillips reports. BuzzFeed had reported Monday that Grindr, which has 3.6 million daily active users worldwide, has been providing their HIV status and “last tested date” to two analytics companies, prompting a backlash of criticism that the app breached users’ trust.

Bryce Case, Grindr’s head of security, said sharing information with Apptimize and Localytics is “standard industry practice for rolling out and debugging software” and was done securely to test and optimize the app’s features, such as HIV testing reminders.

“Any information we provide to our software vendors including HIV status information is encrypted and at no point did we share sensitive information like HIV status with advertisers,” Case said in a statement. “As the testing of our feature is completed, any information related to HIV status has been removed from Apptimize and we are in the process of discussing removal of this data from Localytics.”

OUCH: The FDA ordered a mandatory recall of a Las Vegas-based company’s kratom products that were contaminated with salmonella, marking the first time the agency has used a mandatory recall for a food product. The recall came after the company failed to cooperate with a voluntary recall. It involves powdered kratom, an herbal supplement used as a pain remedy, that was manufactured, packed and processed by Triangle Pharmanaturals, our colleague Laurie McGinley reports.

“This action is based on the imminent health risk posed by the contamination of this product with salmonella, and the refusal of this company to voluntarily act to protect its customers and issue a recall, despite our repeated requests and actions,” FDA Commissioner Scott Gottlieb said in a statement.

It’s the latest development in a brewing controversy around the supplement. Advocates have hailed kratom as a pain remedy that is safer than opioids, but the FDA warns it is a dangerous and unregulated drug “that can result in a opioid-like abuse and death.” Laurie and Katie Zezima reported in February that the DEA was weighing whether to add kratom to the same category of illegal drugs as heroin.

REPRODUCTIVE WARS

—Cecile Richards, the Planned Parenthood president who is stepping down this spring, writes in a new memoir that Jared Kushner told her Planned Parenthood could get more federal funding if it agreed to stop providing abortions. The conversation occurred during a previously reported meeting last January between Richards, Kushner and Ivanka Trump. At the time, Republicans in Congress were determined to strip Planned Parenthood clinics of Medicaid funding as part of an Obamacare repeal bill.

“If it wasn’t crystal clear before, it was now," Richards wrote, per People Magazine. "Jared and Ivanka were there for one reason: to deliver a political win. In their eyes, if they could stop Planned Parenthood from providing abortions, it would confirm their reputation as savvy dealmakers. It was surreal, essentially being asked to barter away women’s rights for more money. It takes a lot to get Kirk mad, but it looked like his head was about to explode.”

How much political sway Kushner holds in Congress is questionable, but Richards said it still felt like a "bribe." Richards also wrote that Kushner told her Planned Parenthood “had made a big mistake by becoming ‘political.’" Richards' memoir "Make Trouble: Standing Up, Speaking Out, and Finding the Courage to Lead" was released yesterday.

OPIOID OPTICS

—A new team of federal agents, computer experts and analysts are targeting online opioid  sales, which law enforcement warns “can be more persistent and vexing than more traditional trafficking by cartels," the Associated Press reports.

Part of the difficulty stems from the anonymity of online drug traffickers. Buyers can access stores on private web browsers, can use encrypted channels to make purchases and use virtual currency such as bitcoin to pay for the drugs. This year, Attorney General Jeff Sessions doubled the number of federal agents working on drug cases by these “darknet" vendors, the AP writes.

In its first operation, the new Joint Criminal Opioid Darknet Enforcement team arrested a 28-year-old Euclid, Ohio-based online dealer, as well as seven others, and seized weapons, computer equipment and 2,000 lethal doses of fentanyl. “Before the team’s formation, federal agents would dive into complicated investigations largely on their own, sometimes without realizing others were already on the case,” the AP's Sadie Gurman writes. “But the team has forged a new level of cooperation that its members say is critical in increasingly sophisticated darknet cases that combine tech savvy with old-fashioned drug dealing.”

—As part of its effort to tackle the opioid epidemic, the Justice Department has requested to join settlement talks in federal court involving hundreds of lawsuits against drug manufacturers and distributors. The government requested to join as a “friend of the court” in a filing Monday before U.S. District Judge Dan Polster in Cleveland, Reuters reports. “We are determined to see that justice is done in this case and that ultimately we end this nation’s unprecedented drug crisis,” Attorney General Jeff Sessions said in a statement.

“President Donald Trump has called for litigation against companies over their roles in the opioid epidemic,” reporter Nate Raymond writes. “But Monday’s brief signaled that the Justice Department would not be seeking to participate as an active litigant in the litigation before Polster, who is overseeing at least 433 opioid-related lawsuits brought primarily by cities and counties...The lawsuits generally accuse drugmakers of deceptively marketing opioids and allege distributors ignored red flags indicating the painkillers were being diverted for improper uses. The defendants have denied wrongdoing."

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

HEALTH ON THE HILL
PowerPost
The Arizona senator has been absent from the Capitol since December as he receives treatment for brain cancer.
Sean Sullivan
MEDICAL MISSIVES
Wonkblog
Heartbreaking media reports abound regarding how pregnant women who use opioids allegedly “pass down addiction to unborn children.” But news stories that describe any baby as “born addicted” not only misunderstand addiction but also foster hysteria that can have unintended negative consequences.
Keith Humphreys
To Your Health
Kelli Rowlette is suing her mother's fertility doctor, alleging that he had secretly used his own semen during insemination.
Lindsey Bever
STATE SCAN
D.C. Politics
Reports outline the vision of a replacement for the District’s troubled public facility.
Peter Jamison
Penn State research says the real number is closer to 1,085, compared to the government's estimate of 64.
Axios
To Your Health
Synthetic cannabinoids, also known as K2 or Spice, has been linked to 56 cases in Illinois in which people have experienced severe bleeding.
Lindsey Bever
DAYBOOK

Today

  • The Bipartisan Policy Center holds an event on “Advancing Innovation, Competition, and Access for Biologics Through Patent Policy.”

Coming Up

  • MedPAC holds a public meeting on Thursday and Friday.
  • The Advisory Committee to the Director of the National Institutes of Health will host a meeting on an opioid report on Friday.
  • Harvard School of Public Health holds an event on the gun violence epidemic on Friday.
SUGAR RUSH

Fifty years after the Rev. Martin Luther King Jr.'s death, Rep. John Lewis (D-Ga.) spoke about his legacy and the work left to do:

President Trump said "nobody’s been tougher on Russia than Donald Trump:"

Trump is a 'subject' of Special counsel Robert Mueller's probe. Here's what that means: