THE PROGNOSIS

There were already serious doubts about whether Veterans Affairs secretary nominee Ronny Jackson was equipped to manage a 375,000-person agency. Now real questions are emerging about whether he can even oversee a medical team of 70.

Jackson’s prospects of getting confirmed as the new VA head went from shaky to bleak yesterday amid mounting allegations that he overprescribed medications, became intoxicated while on duty and created a toxic environment at the White House Medical Unit he leads.

As things stand now (and they could quickly change), the White House is rallying behind President Trump’s official doctor, even after Trump earlier suggested that Jackson should consider pulling out because of the “abuse” he was facing, my colleagues Josh Dawsey, Seung Min Kim, Lisa Rein and John Wagner report. By late afternoon, Trump had huddled with Jackson, and White House aides vowed to fight the charges.

But within hours, the AP highlighted a 2012 report that said Jackson exhibited “unprofessional behavior” (though it did not mention allegations of drunkenness or improper drug prescribing).  The Post reported that the 2012 report recommended removing Jackson.

“There is a severe and pervasive lack of trust in the leadership that has deteriorated to the point that staff walk on ‘eggshells,’ ” the report found, according to Josh, Seung Min, Lisa and John. "It described morale under his leadership as in the doldrums and said the office was beset by fighting between Jackson and Jeffrey Kuhlman, President Barack Obama’s doctor at the time."

Earlier in the day, Jackson had denied such a report existed, per NBC News's Frank Thorp: 

The Post's Philip Rucker: 

Jackson demonstrated unprofessional behavior in other ways, too, according to four sources who told CNN that during an overseas trip in 2015, he noisily banged on the hotel room door of a female employee while intoxicated. That’s just one example of several allegations from more than 20 military employees who worked with the Navy doctor, mainly apparently made to members of the Senate Veterans Affairs Committee charged with vetting Jackson's nomination.

The Daily Beast's Sam Stein: 

It’s hard to see exactly how Jackson rides this out, considering what he’s coming from and where he’s trying to go.

The medical team certainly plays an important role at the White House – ensuring the president is within range of a medical facility when he travels, enjoying close access to his living quarters, and also caring for the vice president and his family, White House staffers and even guests at state functions. Jackson has cited his experience leading that team when queried about why he’s qualified to lead the VA.

But regardless of Jackson's leadership bona fides at the medical unit – and it now appears many people feel they aren't up to snuff  – that job pales in comparison to the responsibilities that the doctor would take on as head of the VA, the federal government’s second-largest federal agency that oversees a sprawling network of 1,300 hospitals and clinics that care for more than 9 million veterans.

Those considerations are top of mind for members of the Veterans Affairs Committee, who would have to confirm Jackson before his nomination could move forward. Top panel Democrat Jon Tester (Mont.) is appearing increasingly skeptical, telling CNN’s Anderson Cooper yesterday that Jackson had been nicknamed “the candy man” for handing out prescription drugs indiscriminately.

In an interview with NPR, Tester said the committee heard complaints from more than 20 current and former military members that Jackson had improperly dispensed drugs, became drunk on professional trips and belittled staff members.

“We were told stories where he was repeatedly drunk while on duty, where his main job was to take care of the most powerful man in the world,” Tester said. “That’s not acceptable.”

Tester and his Republican counterpart, Sen. Johnny Isakson (R-Ga.), canceled Jackson’s confirmation hearing originally planned for today, saying they’re looking into the allegations. A spokeswoman for Isakson said the senator remained undecided about the nomination but continued to harbor serious concerns. 

In a great play-by-play of how Jackson’s nomination started spiraling downward, my colleagues Amy Gardner, Seung Min and Lisa Rein report that the chaos has triggered bewilderment in Congress, with some Republicans expressing concern about the vetting in the Trump White House.

“Obviously, you want to make sure that when you get these nominees and their qualifications that a lot of this, the background, has been done,” Sen. John Thune (R-S.D.) told my colleagues. “And it sounds like maybe in this case, it wasn’t quite ready to send up here.”

Senate Majority Leader Mitch McConnell (R-Ky.) said he would take cues from the White House and the VA committee. “I’m going to wait and see what the president recommends and what Chairman Isakson recommends,” McConnell said, adding that he was “waiting for a signal” from the White House on whether the nomination will be pulled.

The Post's Josh Dawsey: 

NYT's Maggie Haberman: 

Vox's Matt Yglesias: 

HuffPost's Ashley Feinberg gets Best Tweet of the Day award:

AHH, OOF and OUCH

AHH: Yesterday, the Department of Health and Human Services proposed to rewrite rules on Medicare payments to hospitals, making it easier for patients to see the prices of procedures and care, The Post's Amy Goldstein reports. The nearly 1,900-page proposed rule calls on hospitals to publish their standard charges online in a machine-readable form that will help insurers and other organizations analyze them. It would also revamp the federal program that encourages hospitals to improve electronic health records, requiring them to share the data in a form that patients can take to their doctors or other health-care facilities.

Seema Verma, administrator for the Centers for Medicare and Medicaid Services, said the changes would improve the transparency of hospital prices, empowering patients to choose where to go for treatment. She said the aim is to move away from a system that reimburses providers for the number of services they provide to one that rewards them for the value of their care -- one of four overarching goals HHS has said it's pursuing. 

Federal health officials also want to add $1.5 billion for the coming year to the funds for so-called disproportionate share payments that help buffer hospitals from the expense of treating patients who cannot pay their bills, signaling the government expects an influx of uninsured patients.

OOF: Our colleague Lena H. Sun takes you inside a commercial warehouse about the size of two super Walmarts that houses a massive resource of drugs and supplies. They're kept in case of a bioterrorism or nuclear attack, or an infectious disease outbreak with pandemic potential, one of many warehouses across the country that are part of the $7 billion Strategic National Stockpile. Inside, there are antibiotics, vaccines for smallpox and anthrax, and antivirals for a deadly flu pandemic.

For two decades the repository has been managed by the CDC, but the Trump administration is planning to shift oversight of the program to another part of HHS, which proponents say will streamline management. But some public health officials and lawmakers on both sides of the aisle worry it will disrupt a complex system already in place to oversee the program.

Some also worry the move will “politicize decision-making about products bought for the stockpile,” Lena writes. Starting in October, the office of the assistant secretary for preparedness and response will be in charge of choosing and purchasing products for the stockpile, which critics argue could allow companies to lobby for more specialized drugs and products to be included. Georges Benjamin, executive director of the American Public Health Association, told Lena the stockpile should contain “the stuff we need for the disasters we know we’re going to have — like gloves, syringes, Cipro, penicillin, antibiotics, and influenza vaccines — versus the newest, sexiest version of the anthrax vaccine.”

OUCH: Yesterday the FDA announced a nationwide undercover “blitz” to  crack down on retailers' sale of e-cigarettes to children and teenagers, The Post's Laurie McGinley reports.The agency says it has uncovered dozens of violations of the law and issued 40 warning letters since starting the effort on April 6.

“Let me be clear to retailers,” FDA Commissioner Scott Gottlieb said in a statement. “This blitz, and resulting actions, should serve as notice that we will not tolerate the sale of any tobacco products to youth.”

The agency is particularly targeting e-cigarettes made by Juul, which resemble a USB flash drive but contain high levels of nicotine. Their emissions can be virtually invisible, which has made it difficult for teachers and school officials to spot and prevent use of the product, Laurie notes. The FDA also has asked Juul Labs for information that might indicate why the product is so appealing to young people. Other brands, such as myblu and KandyPens, have similar characteristics.

HEALTH ON THE HILL

— Sen. John McCain (R-Ariz.) has been discharged from the hospital more than a week after surgery for an intestinal infection related to diverticulitis. The Arizona Republican is back home in Sedona, Ariz. his wife Cindy tweeted yesterday. The 81-year-old’s family said he came out of the surgery in stable condition, our colleague John Wagner reports. He has been in Arizona for the last few months for therapy and recovery following cancer treatment. It's unclear when McCain may return to the Senate.

BRAIN WAVES

— Is health care the No. 1 issue in America? That's what Sen. Chris Murphy (D-Conn.) claimed in an April 18 Vox article, where he was quoted as saying: "There is no question we’ll have to act [on health care]. It’s the No. 1 issue in America. The polls are clear.” Good thing for us that Post fact-checker Glenn Kessler examined Murphy's statement.

The Facts: Three polls from Bloomberg News, Morning Consult and an NBC News exit poll from the Virginia governor’s race seem to back up Murphy's assertion -- but they were all from 2017, taken as Republicans were trying to repeal and replace the Affordable Care Act.

A fourth poll from HuffPost/YouGov poll and conducted in April, was more on target. Asked to choose their two top issues from a list, 30 percent of registered voters picked health care. But gun policies and immigration were close behind, at 25 percent each, with the economy at 24 percent. There was a clearly partisan divide on some of these issues — 43 percent of Republicans picked immigration compared with 10 percent of Democrats — but both Democrats and Republicans rated health care highly.

And then there's a Gallup poll that asked Americans about their “top worry.” In that survey, 55 percent of respondents said they worry “a great deal” about the availability and affordability of health care, more than 14 other issues that Gallup asked about. However, "top worry" isn't the same as "top issue," Glenn writes, citing other polls from Gallup, Pew and Quinnipac showing health-care ranks only slightly ahead or even behind other concerns.

The conclusion: "Rather than the polls being clear, it’s actually quite murky," Glenn writes. "Murphy can point to a poll that shows health care at the top of the list. But other polls — including Gallup’s monthly open-ended question that is widely cited for identifying the top problem — show that health care is lower on the list of concerns....Murphy may be convinced that health care is what will motivate voters in the coming year. But based the polls, he might be fooling himself."

MEDICAL MISSIVES

— For the first time in more than three decades, new groups may bid to run the country's organ transplant system. The United Network for Organ Sharing has had the federal contract for 32 years, but it's up for renewal this year and other groups are exploring a bid against the nonprofit. Two groups looking to best UNOS have “criticized the organization as inefficient and slow to change — two reasons why nearly 115,000 people are on waiting lists for organs,” The Post’s Lenny Bernstein reports. “Some patients have been seeking kidneys, livers, lungs and other organs for years.”

But there have been obstacles for the challengers. The government gave outside groups only 31 days to respond to requests for bids, a deadline which was later extended to just 35 days. The federal Health Resources and Services Administration also requires bidders to have three years of experience managing transplants projects of similar complexity -- but that description fits only UNOS, according to one bidder. A HRSA spokesman said the agency is “not considering altering those requirements.”

Lenny writes UNOS isn't gnoring the potential competition. UNOS spokeswoman Anne Paschke told him “we are working hard to put together a confidential bid that satisfies the conditions of the [Organ Procurement and Transplant Network]. UNOS is proud to have served as the OPTN and of the increase in deceased donor organs transplanted for each of the past five years.”

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

One in three older Americans with Medicare drug coverage is prescribed opioid painkillers, but for those who develop a dangerous addiction there is one treatment Medicare won’t cover: methadone.
AP
In the decades since the first genetically modified foods reached the market, no adverse health effects among consumers have been found.
New York Times
To Your Health
"The doctor came out and said 'You have to find the nearest emergency room. You need to pick the closest one. Just go.'"
Cleve R. Wootson Jr.
INDUSTRY RX
Barriers to entering the pharmaceutical industry are too high even for Amazon, says billionaire investor.
CNBC
OPIOID OPTICS
To deter opioid abuse, Michigan lawmakers say it's time to rethink the child-resistant prescription vial.
AP
DAYBOOK

Today

  • The House Ways and Means Subcommittee on Trade holds a hearing on the opioid crisis.
  • The Centers for Medicare & Medicaid Services Office of Minority Health and Substance Abuse and Mental Health Administration’s Office of Behavioral Health Equity host a forum on the opioid crisis.
  • Roll Call hosts an event on patient-focused health.

Coming Up

  • The House Ways and Means Subcommittee on Health holds a hearing on health care innovation on Thursday.
  • HHS Secretary Alex Azar speaks at the 2018 Health Datapalooza, which will be held on Thursday and Friday.
SUGAR RUSH

Fact Check: Do countries that punish drug offenses by death not have "much of a drug problem?:"

Stephen Colbert takes on the allegations against VA nominee Ronny Jackson: 

All the times President Trump and French President Emmanuel Macron held hands yesterday: