THE PROGNOSIS

If you’ve observed Congress for any length of time, you know this to be true: Behind nearly every big piece of legislation is a bitter fight over how to pay for it.

That’s the case with a sweeping measure overhauling medical care for veterans that President Trump signed into law yesterday – but this time, the funding fight is between his White House and members of his own party.

Two Republicans heading powerful Senate committees and their Democratic counterparts want to pay for the $50 billion VA Mission Act by lifting existing spending caps within a large funding bill being considered in the Senate Appropriations Committee today.

The foursome – which includes Sens. Richard Shelby (R-Ala.), Patrick Leahy (D-Vt.), Johnny Isakson (R-Ga.) and Jon Tester (D-Mont.) – argue their approach would shield other veterans' benefits from being cut in order to pay for the pricey new law, which makes it easier for veterans to access private health care (read our latest explainer on the bill here).

But the White House is trying to hamper their efforts, my colleagues Erica Werner and Lisa Rein reported yesterday. Instead, administration officials are pressuring Congress to pay for the veterans' programs by cutting spending elsewhere.

“In a memo circulated privately to Republican senators this week, White House officials slammed the leading veterans funding proposal as ‘anathema to responsible spending’ and that predicts it would lead to ballooning costs and ‘virtually unlimited increases’ in veterans’ spending on private health care,” Erica and Lisa write.

“Without subjecting the program to any budgetary constraint, there is no incentive to continue to serve veterans with innovative, streamlined and efficient quality of care,” the administration says in a memo obtained by my colleagues.

It would be one thing if Trump consistently tried to be Republicans’ conscience in forcing them to hold true to their stated principles of fiscal responsibility. But he’s not exactly consistent when it comes to opening the country's checkbook and growing the deficit. On some issues, most prominently last year’s $1.5 trillion tax bill, the president has signed off on legislation projected to massively increase the deficit, Erica and Lisa note.

It’s also an interesting fight for the White House to pick because the military and veterans affairs are an area where Democrats and Republicans can frequently most easily agree to ramp up spending. For weeks, the four senators — whose committees hold jurisdiction in the matter — have been allied on their approach to funding the Mission Act.

The process could go something like this: Once the 2019 Military Construction, Veterans Affairs and Related Agencies Appropriations bill passes committee – a markup is scheduled for today – the sweeping appropriations bill would go to the full Senate. At that point, the senators intend to offer an amendment to provide the $10 billion needed to fund the Mission Act over the next year.

The senators previewed their approach during joint floor speeches on May 22, the day before the Senate passed the bill and sent it to the president's desk. Without lifting budget caps, funding for the Mission Act “could come at the expense of existing programs, including those at the VA,” Shelby said at the time.

“As we provide the tools and authorities necessary for veterans to get the care they need, I agree that we also need to secure the resources necessary to achieve the goals of this legislation without shortchanging other domestic priorities,” Tester added.

But as of this week, the White House says it won’t accept new spending on the veterans' bill above the overall domestic spending levels already negotiated with Congress, arguing enough money can be found to fund it within existing limits, my colleagues report.

There were no hints of this behind-the-scenes fight yesterday, as Trump signed the veterans' legislation into law and showered praise on members of Congress who helped to pass it. The legislation is aimed at easing the burden on military hospitals and clinics, which lack capacity to treat a huge influx of aging Vietnam-era veterans and younger service members returning from the wars in Iraq and Afghanistan.

Besides making it easier for veterans to access outside, private care, the new law expands the Veterans Affairs Department's popular caregiver program by extending stipends to all veterans and requiring the agency to do a review of all its underused hospitals.

“If the VA can’t meet the needs of a veteran in a timely manner, that veteran will have the right to go right outside to a private doctor,” Trump said yesterday before signing the bill. “So simple and so complex. ... These are sweeping, historic changes. There’s never been anything like this in the history of the VA – never been anything close.”

AHH, OOF and OUCH

AHH: What would you prefer to call the Department of Health and Human Services? Politico reports the Trump administration is seeking to rename HHS as part of a sweeping plan for reorganizing the federal government to be released by the White House Office of Management and Budget. The report includes a major consolidation of welfare programs, including moving the food stamp program into HHS, Helena Bottemiller Evich and Andrew Restuccia write. It would also propose cuts at the U.S. Agency for International Development and the State Department.

"The report, which is expected to recommend big changes at many federal agencies, is almost complete and is expected to be introduced this month," Helena and Andrew write. "Sources in and outside the government have been told the rollout will happen in late June. The plan is still being finalized and some of the details could change, but one of the people familiar with the report said the proposal to reorganize HHS has widespread buy-in at OMB."

"It’s unclear exactly how HHS would be reshuffled, but sources said its new name would emphasize programs that provide assistance to low-income Americans, potentially restoring the term 'welfare' to the title of the department," Helena and Andrew continue. The Health 202 is wondering whether the "Department of Be Best" is on the shortlist.

OOF: Switzerland’s top prosecutor won't pursue criminal charges against Swiss pharmaceutical giant Novartis over $1.2 million in payments the company made to Trump’s personal attorney Michael Cohen. The Swiss attorney general said there was “insufficient” reason to pursue charges of bribery, Stat News’s Ed Silverman reports. “Swiss law does not recognize an offence of trading in influence, whether within Switzerland or internationally,"  the prosecutor also noted.

Several U.S. lawmakers are pursuing their own investigation. A spokesperson for Sen. Ron Wyden (D-Ore.) told Stat the Senate Finance Committee has received responses from Novartis and from Cohen, who has said he plans to cooperate with the probe. The Health 202 wrote earlier this month about Novartis's attempt to gain access to Trump and influence his policy decisions, a move which doesn't appear to have been fruitful.

OUCH: The number of children in New Hampshire who were taken from their parents' care due to the latter's substance abuse doubled from 2012 to 2016, per a new University of New Hampshire study. The amount of youths removed from parental care overall increased from 358 in 2012 to 547 in 2016. The research also found a 21 percent increase from 2013 to 2016 in the number of child abuse and neglect cases accepted for assessment by the New Hampshire Division for Children, Youth and Families.

“The research showed that having a parent abusing opioids can have negative consequences on child development, including emotional or behavioral problems and increased likelihood of the child using drugs by age 14,” the Concord Monitor reports.

“The opioid epidemic in New Hampshire has strained not only the families coping with addiction but also the service providers who work with children and families,” study author Kristin Smith, family demographer at the Carsey School of Public Policy at the University of New Hampshire said in a statement. “Founded and unfounded cases of child abuse and neglect increasingly involve substance-use-related allegations or a noted risk for substance use.”

TRUMP TEMPERATURE

— Trump lashed out at the news media yesterday, accusing it of falsely reporting “vicious” stories about first lady Melania Trump during a more than three-week stretch in which she didn't hold or attend any official events. The first lady accompanied the president on a visit to the Federal Emergency Management Agency headquarters for a briefing on hurricane preparedness, where reporters were present and the event aired on live television, The Post's John Wagner and Emily Heil report.

The president tweeted this:

Melania Trump had not appeared in public since being hospitalized May 14 for a procedure to treat what the White House described as a benign kidney condition. Trump's right that there was rampant speculation in Washington about alternative explanations for her absence from the public eye. A Rolling Stone writer tweeted this on Sunday:

But most of the rumors the president mentioned in his tweets were never published in the news media, John and Emily note.

— Yesterday, the president commuted the sentence of Alice Marie Johnson -- a 63-year-old woman serving a life term on federal drug and money-laundering charges -- after meeting with reality television star and socialite Kim Kardashian West last week to discuss the case. The action was the latest in a recent string of pardons and other acts of clemency from Trump, and aides haves suggested that more could soon be on the way, The Post's John Wagner and Sari Horwitz report.

Convicted in Tennessee in 1996, Johnson was denied clemency by the Obama administration in January 2017 in one of the administration’s last batches of clemency denials. In a statement, the Trump White House noted that Johnson was a great-grandmother who had served almost 22 years for a first-time offense.

“Ms. Johnson has accepted responsibility for her past behavior and has been a model prisoner over the past two decades,” the White House said. “While this Administration will always be very tough on crime, it believes that those who have paid their debt to society and worked hard to better themselves while in prison deserve a second chance.”

— It's a somewhat surprising move coming from Trump, a president who has publicly called for executing drug dealers, my colleague Chris Ingraham writes. But Jordan's case underscores how many nonviolent drug offenders are serving life terms in federal prison; as of 2016 1,907 federal inmates were serving life sentences for drug offenses, which are by definition nonviolent. An additional 103 offenders found guilty of those crimes were serving “virtual life sentences,” defined as sentences of 50 years or more, Chris explains. Under federal law, there is no possibility of parole for crimes committed after Nov. 1, 1987.

MEDICAL MISSIVES

— Researchers are hoping for at least one silver lining from the recent Ebola outbreak: the chance to evaluate experimental drugs that could cure it. Five experimental medicines are being used at treatments centers throughout remote areas of the Democratic Republic of Congo, including hundreds of drug vials being sent or that are already being used.

“Some have only been tested on animals and a handful of healthy volunteers, and none have been proven to work against the severe viral disease in a standard clinical test,” Bloomberg’s Marthe Fourcade  and Naomi Kresge report. “Now, scientists are seeking a way to offer compassionate treatment for patients with few options while doing painstaking data collection to evaluate the drugs.” Health officials are also trying an experimental vaccine, developed and donated by U.S. drugmaker Merck.

There are looming challenges to such experimental use and data retrieval. Normally, researchers would test a drug against a placebo, but that won't be the case in this outbreak. “Carrying out a trial that pits multiple untested medicines against one another would be challenging in the best of conditions,” Marthe and Naomi explain. “This one would take place in an impoverished, equatorial nation of 78 million that’s home to the river that gave Ebola its name and much of the world’s second-largest tropical forest.”

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

On Tuesdays, 18-month-old Joaquim Santos spends an hour sitting by himself in a corner of a special needs classroom in this small city in northeast Brazil, one of the country’s poorest regions and one hit hard by the Zika virus.
Associated Press
The husband and business partner of designer Kate Spade, who died in an apparent suicide, said she suffered from depression and anxiety for many years.
AP
INDUSTRY RX
A lawsuit by 22 ovarian cancer patients against Johnson & Johnson went to trial on Wednesday in Missouri state court, marking the largest case the company has faced over allegations its talc-based products contain cancer-causing asbestos.
Reuters
STATE SCAN
More than 500,000 able-bodied, nonelderly adults in Michigan’s Medicaid expansion program would have to work or meet related requirements to keep qualifying for government health insurance under a revised bill that cleared a major legislative hurdle on Wednesday and is expected to become law.
REPRODUCTIVE WARS
A clinic in Kiev, Ukraine, stirs controversy by making babies with DNA from three different people to help women who are infertile bear children. It's the only clinic known to be doing this right now.
NPR
DAYBOOK

Today

  • The House Small Business Subcommittee on Investigations, Oversight, and Regulations will hold a hearing titled “Vets First? An Examination of VA’s Resources for Veteran-Owned Small Businesses.”
  • The House Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs holds a hearing on memorializing veterans.
  • The House Veterans Affairs Subcommittee on Health holds a hearing on the “Potential Health Effects of Burn Pit Exposure among Veterans.”
  • The American Enterprise Institute holds an event on the opioid crisis and foster care families.
  • Axios hosts an event on “The Innovation Impact on Health Care.”

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on prescription drug costs on June 12.
SUGAR RUSH
Trump hosts his first dinner for theMuslim holiday of Ramadan:

At a meeting with his Cabinet members, President Trump praised everyone at the table, except Attorney General Jeff Sessions:

Will 2018 be a leap forward for women or just another small step?: