THE PROGNOSIS

Fourteen House Republicans took a big risk last year in voting for a bill repealing much of Obamacare. Now, in the middle of the campaign season, Democrats have not forgotten.

It was hazardous for these GOP members to vote for the unpopular American Health Care Act because they’re from politically purple districts that went not for President Trump in 2016 but for his opponent, Hillary Clinton. Now their names are inextricably tied to a health-care bill that would probably have resulted in millions fewer Americans having insurance.

And Democrats are practically salivating over the situation.

“Many of these incumbents would be extremely vulnerable without some of their votes,” said Tyler Law, a spokesman for the Democratic Congressional Campaign Committee. “But the fact that they voted for health care in districts trending away from them that already rejected the president is just political suicide.”

The sad irony for these Republicans is they ultimately stuck out their political necks for…pretty much nothing. Even though the House managed to scrape its bill through, the effort to repeal and replace the Affordable Care Act crashed and burned in the Senate and is now widely presumed to be over -- for now, anyway.

Two of the 14 – California Reps. Ed Royce and Darrell Issa – are retiring. A third, Rep. Martha McSally (R-Ariz.), is running for Senate. The rest face an uphill battle to hold on to their seats in November, as Democrats seek the 24 seats they need to regain the House majority. They include:

  • Rep. Carlos Curbelo of Florida
  • Reps. Steve Knight, Mimi Walters, Jeff Denham and Dana Rohrabacher and David Valadao of California
  • Rep. Erik Paulsen of Minnesota
  • Rep. Peter Roskam of Illinois
  • Reps. Pete Sessions and John Culberson of Texas
  • Rep. Kevin Yoder of Kansas

How some of these members defended their votes at the time:

All but one of these races are rated “toss-ups” by the politics website RealClearPolitics and one of them, Florida’s 26th Congressional District, represented by Curbelo, is in the website’s “leans Democrat” category.

Valadao’s race is rated “likely Republican," according to RCP (it rates a "leans Republican," according to the Cook Political Report) but the Democratic Congressional Campaign Committee also has made a pass at him. The House campaign arm targeted Valadao, Denham, Yoder and eight of their GOP colleagues in radio ads last October, accusing them of supporting legislation that would make insurance more expensive and end guaranteed coverage for those with preexisting conditions.

And early in the year, shortly after the House passed its AHCA in May, the group launched a six-figure digital-ad campaign against McSally, Denham, Valadao, Curbelo, Yoder and five other Republicans who voted for the measure. The buy included 15-second web videos and display ads that appeared whenever the names of these lawmakers were Googled.

“The passage of this repeal and rip-off bill was a defining moment for every single House Republican,” Tyler told my colleague James Hohmann at the time.

Democrats are well aware health care could be a winning issue with their base this year. In a flip from recent elections, Democratic-leaning voters now rank the topic as higher in importance than their GOP-voting counterparts.

In a Kaiser Family Foundation poll released last week, 31 percent of Democrats said health care is the No. 1 issue they want to hear about from congressional candidates vs. just 10 percent of Republicans. While larger shares of Republicans said they’re worried about health-care costs, more Democrats said universal coverage and quality of care are top concerns for them.

These “health-care voters” are a “liberal-leaning, Democratic group of voters who say a candidate’s position on health care will be ‘the most important factor’ in their 2018 congressional vote choice,” Kaiser researchers wrote.

Just look at Curbelo's Florida district to see how Democrats are going after these voters. Last election, Curbelo managed to win reelection by 12 percentage points even though his district went for Clinton over Trump by 16 points. But Democrats are now so sure they can leverage Cubelo's AHCA vote against him that top House Democrat, Nancy Pelosi, traveled to South Miami-Dade on May 4 to campaign with his opponent and slam Curbelo for his health-care vote, as McClatchy reported.

"Today we’re talking about the one-year anniversary of a very destructive bill that the congressman from this area, Mr. Curbelo, voted for to the detriment of people in this district,” Pelosi said.

Curbelo told McClatchy he welcomed the attention on health care. "We need to keep the good in the law," he said. "And we need to replace the bad with something that works better. A year later I still get some complaints in my office about the Affordable Care Act."

REPRODUCTIVE WARS

— Administration officials have confirmed they'll be announcing a policy change today restricting recipients of federal family planning dollars from providing abortions or referring patients to clinics that do, the New York Times reports. Health providers already can't use these "Title X" dollars for abortions, but under the new policy they would need to have a "physical separation" and "separate personnel" from any abortion services being rendered, Julie Hirschfeld Davis and Maggie Haberman write. It's a return to a 1988 policy under President Ronald Reagan, in which caregivers at facilities getting family planning dollars couldn't provide information to patients about abortion or where to get one.

Expect lots of enraged back-and-forth over this move for weeks to come. Planned Parenthood, which says it serves four in 10 patients who get care under Title X, argues the move is censoring health providers. “People have a right to access unbiased, essential reproductive health care, regardless of where they live, how much money they make, what their background is, or whether or not they have health insurance," said Dana Singiser, Planned Parenthood's vice president of public policy and government relations.

Abortion opponents characterized the shift as putting up necessary walls between taxpayer funds and abortion. “We thank President Trump for taking action to disentangle taxpayers from the abortion business,” said Susan B. Anthony List President Marjorie Dannenfelser. "The Protect Life Rule doesn’t cut a single dime from family planning. It instead directs tax dollars to Title X centers that do not promote or perform abortions, such as the growing number of community and rural health centers that far outnumber Planned Parenthood facilities."

AHH, OOF and OUCH

AHH: There's a striking association between population density — the concentration of people in a given area — and happiness, The Post's Christopher Ingraham reports. When a team of happiness researchers at the Vancouver School of Economics and McGill University ranked 1,215 communities in Canada by average happiness, they found that average population density in the 20 percent most miserable communities was more than eight times greater than in the happiest 20 percent of communities.

To get the massive new data set, the researchers compiled 400,000 responses to a pair of national Canadian surveys. "They were able to cross-reference the well-being responses with other survey data, as well as figures from the Canadian census, to see what sorts of characteristics were associated with happiness at the community level: Are happier communities richer, for instance? Are the people there more educated? Do they spend more time in church?," Christopher writes.

“Life is significantly less happy in urban areas,” the paper concluded.

OOF: This deep dive from U.S News & World Report’s Gaby Galvin explores what health care looks like for the almost 1.4 million people who live in the Rio Grande Valley. It’s the busiest area in the nation for illegal border crossings, the location for Trump’s proposed border wall with Mexico -- and a “hotbed for poverty, health and environmental issues," Gaby writes. 

“Indeed, the Rio Grande Valley is easy to point to as a region where the so-called social determinants of health have not weighed in residents' favor: Only between half and two-thirds of adults in each of the four counties have graduated from high school, and area unemployment rates are high,” she reports. “Poverty rates sit between 30 percent and 40 percent, and obesity, diabetes and other chronic health conditions are prevalent.”

OUCH: The U.S. fertility rate fell to a record low for the second straight year, according to the National Center for Health Statistics. The rate of births fell to 60.2 per 1,000 women of childbearing age, a 3 percent drop since 2016. “The country has been living through one of the longest declines in fertility in decades and demographers are trying to figure out what is driving it,” the New York Times’s Sabrina Tavernise reports. “Rates tend to drop during difficult economic times as people put off having babies, and then rise once the economy rebounds.”

“But the rate has not recovered since the Great Recession,” Sabrina adds. “A brief uptick in 2014 did not last. The number of births has also declined, and last year was its lowest level since 1987. The fertility rate is the number of births per 1,000 women ages 15 to 44.”

AGENCY ALERT

— As FDA Commissioner Scott Gottlieb had promised earlier this week, his agency published a list yesterday showing brand-name pharmaceutical companies that could be using "gaming tactics" to delay generic competition. It's an effort by the Trump administration to shame drugmakers who try to game a drug safety system in order to stymie genetic companies from developing generic versions of their medicines. The list includes the brand-name drugs and their makers for which the FDA has received complaints from generic companies that they've not been able to access enough samples to create equivalent products.

"Today, we’re making public a list of companies that have potentially been blocking access to the samples of their branded products," Gottlieb said in a statement announcing the public list. "We hope that this increased transparency will help reduce unnecessary hurdles to generic drug development and approval."

— Talk about good luck. When the crew on a Delta flight asked if there was a doctor on board, they got U.S. Surgeon General Jerome Adams:

Prior to takeoff, Delta flight 1827 from Fort Lauderdale to Atlanta returned to the gate due to a customer illness, Delta spokesman Trebor Banstetter told our colleague Herman Wong in an email. The surgeon general, responding to a call for emergency help, worked with the flight crew and two nurses to provide medical assistance. The passenger’s condition isn't known, but Adams tweeted Wednesday “patient doing well" and Delta tweeted its appreciation. 

— The National Institutes of Health has halted a $100 million study of moderate drinking being funded in large part by the alcohol industry. Yesterday’s announcement by NIH Director Francis Collins “reflects the seriousness of allegations that surfaced in news reports in recent months," The Post’s Joel Achenbach reports. A story in March in the New York Times described two scientists and a federal health official pitching the idea for the study to liquor company executives at a 2014 gathering.

Collins has ordered two reviews of the study, Joel writes. One review by the Office of Management Assessment will “determine if any process or conduct irregularities occurred with grants associated with the MACH Trial" and the other will examine the scientific merit of the study. NIH's memo gave no additional details about the reasons for the study’s pause. “NIH has requested that the grantee, Beth Israel Deaconess Medical Center, pause all study activities until the reviews are completed,” the agency said in the brief announcement.

HEALTH ON THE HILL

— House Republican leaders say they'll hold a vote next week on the Right to Try Act, which would allow terminally ill patients to try experimental medicine not yet fully approved by the FDA. The House passed a nearly identical version of the measure nearly two months ago, but couldn't get it through the Senate.

“Families across the country receive the devastating news of a diagnosis every day and next week the House will vote to give seriously ill patients the right to try experimental treatments when there are no other options left," House Majority Leader Kevin McCarthy (R-Calif.) said in a statement. "This will not only offer a chance for the patient to possibly find treatment but could open possibilities to help others do the same."

INDUSTRY RX

— One of the world’s most renowned heart transplant programs has had some of the worst transplant outcomes in the country, ProPublica’s Charles Ornstein and the Houston Chronicle’s Mike Hixenbaugh report in an investigation.

Baylor St. Luke’s Medical Center in Houston, “has long held itself out as one of the best in the world for heart surgery,” they write. “But in recent years, the famed program has performed an outsized number of transplants resulting in deaths or unusual complications, has lost several top physicians and has scaled back its ambition for treating high-risk patients, all the while marketing itself based on its storied past.”

The medical center's heart transplant survival rate ranks near the bottom in the nation. Just 85 percent of the patients who received a new heart between summer 2014 and the end of 2016 survived at least a year. That’s compared with 91.4 percent nationally. The Centers for Medicare and Medicaid Services cited the program in January for its poor outcome rate, and threatened to cut off its Medicare funding, Charles and Mike report. But the program submitted a plan of correction and avoided losing the federal funds.

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

TRUMP TEMPERATURE
"I was able to, uhh, explain that those are rarely confused with each other," Gates recalled.
BuzzFeed News
President Trump's first-quarter salary of $100,000 will go toward the Department of Veterans Affairs, the White House announced Thursday, one day after the House passed a major VA reform bill.
Washington Examiner
MEDICAL MISSIVES
To Your Health
There may be a link between mental health and fertility for both women and men.
Ariana Eunjung Cha
Federal health officials say the tainted lettuce is no longer on the shelves or on restaurant menus, because the harvesting season in the Yuma, Ariz., region ended more than a month ago.
New York Times
OPIOID OPTICS
The impact of the opioid crisis on regional labor markets has been "large and statistically robust" but the share of individuals abusing opioids didn't increase due to the last recession, Cleveland Fed paper finds.
Wall Street Journal
DAYBOOK

Coming Up

  • The Brookings Institution holds an event on opioids on May 24.
  • The Brookings Institution holds an event on medical marijuana in the United States on May 29.
SUGAR RUSH

A bipartisan group of senators paid tribute to Sen. John McCain (R-Ariz.) at the premiere of a documentary about his life:

Bill Gates says Trump confused HIV with HPV

White House weighs in on "Yanny or Laurel:"