Health Policy Reporter

THE PROGNOSIS

President Trump has given Democrats the political gift that Capitol Hill Republicans were too smart to grant them last year. And Republicans know all too well it could be disastrous.

Yep, the debate over protecting Americans with preexisting conditions such as diabetes, asthma or cancer is back in the limelight, with last week’s announcement from the Justice Department that it won’t defend in court the Affordable Care Act’s bans on denying coverage (called “guaranteed issue”) or charging more to these patients (called “community rating”). Texas is leading a group of states making yet another attempt to get these parts of the ACA — and the rest of the law — struck down as unconstitutional.

Dismayed, top Republicans have been moving quickly to put space between themselves and the administration on the matter, anxious to distance themselves from such popular consumer protections. (Our fact-checking colleagues Glenn Kessler and Meg Kelly explain Trump's flip-flop on preexisting conditions here.)

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, called it a “far-fetched” legal argument. Senate Majority Whip John Cornyn (R-Tex.) told Axios he hasn’t contemplated “what some creative lawyer might come up with in terms of another idea to sue” over the ACA. Senate Majority Leader Mitch McConnell (R-Ky.) said “everybody I know in the Senate — everybody — is in favor of maintaining coverage for preexisting conditions.”

And Trump’s own health-care chief, Health and Human Services Secretary Alex Azar, sidestepped the question during a committee hearing on Tuesday, saying the Justice Department is taking a “constitutional position … not a policy position.”

And some Republican senators didn't know -- or said they didn't know -- about the administration's move. Per Politico's Jennifer Haberkorn: 

Politicians and policymakers are well aware that preexisting protections poll extremely well with Americans. Seventy percent of respondents to a Kaiser Family Foundation poll last year — including 59 percent of Republicans — said the federal government should continue prohibiting insurers from charging these folks more for coverage.

Now, it’s true that Republicans hotly debated whether to retain the preexisting condition measures in their bills to repeal and replace Obamacare. But in the end, both the House and Senate health-care bills (which never became law) mostly kept the protections, although the House version opened the door for states to weaken them.

Let’s review those bills for just a minute:

—The House’s American Health Care Act would have allowed states to request waivers from the federal government to charge higher premiums based on health status to people who lacked coverage for at least 63 days in a year. But it fully maintained the ACA’s "guaranteed issue" provision.

—The Senate’s Better Health Care Reconciliation Act also provided waivers for states to opt out of some of the ACA’s insurance regulations, which could weaken coverage for people with preexisting conditions. But it didn’t allow for states to duck either "guaranteed issue" or "community rating."

Don’t expect Democrats to acknowledge that, however. Instead, you’ll hear this line from them a lot — that Republicans are just continuing their 2017 efforts to destroy insurance for the country’s most vulnerable patients.

As Democrats seek to regain control of the House and avoid losing ground in the Senate in November, they could hardly be more gleeful about the turn of events. After all, it fits perfectly into their Republicans-want-to-erase-your-health-care story line (some of this played out in Azar's grilling on Capitol Hill this week as my colleague Colby Itkowitz noted).

They’re full throttle ahead with the message that Republicans want to strip insurance protections from people who struggled to gain coverage in pre-ACA years. Yesterday, top House Democrats sent indignant letters to the Justice Department and the Department of Health and Human Services demanding explanations for why the administration isn’t defending the ACA as the law of the land.

“Last week, Republicans renewed their effort to destroy those vital protections, this time trying to fulfill the cruel vision of Trumpcare through the courts,” House Minority Leader Nancy Pelosi (D-Calif.) said during a news conference yesterday, where she displayed a photo of President Trump and GOP leaders celebrating in the Rose Garden after the House measure’s passage in May 2017.

Senate Democrats took to the floor in the afternoon to bash the Justice Department announcement and argue that it was just the administration’s latest move to sabotage President Barack Obama’s health-care law.

“A new assault came just days ago in which the president … issues an order and says we’re not going to defend the requirement that people with preexisting conditions can get health care at the same price as everyone else,” said Sen. Jeff Merkley (D-Ore.). “What is this called? This is called a sellout, this is called a deception, this is called a whopper.”

Democratic super PAC American Bridge:

From Sen. Angus King (I-Maine):

Sen. Bill Nelson (D-Fla.): 

The administration’s move is also heightening tensions between Republicans and the White House — and even within the Justice Department. My colleagues Devlin Barrett and Matt Zapotosky reported this week on the resignation of senior official Joel McElvain, who had worked for years under the Obama administration to defend the ACA in court.

And expect to see lots of friend-of-the-court briefs filed today by outside groups worried that the ACA’s preexisting condition protections could become extinct (although the challenge’s legal road ahead is long and uncertain). Several patient groups, including the American Cancer Society, the American Diabetes Association and the American Heart Association, have banded together to urge the court to preserve the ACA.

AHH, OOF and OUCH

AHH: White House officials were in serious discussions with Sen. Joe Manchin this spring to gauge his interest in joining Trump’s Cabinet as Veterans Affairs secretary after presidential physician Ronny Jackson’s nomination imploded, The Post's Lisa Rein, Seung Min Kim and Josh Dawsey scoop. Their goal in wooing the 70-year-old West Virginian Democrat? Clearing the way for Republicans to win his seat in the heavily pro-Trump state this November over concerns that Manchin is popular enough back home to win reelection.

Manchin acknowledged speaking with the White House, as well as with Bob McDonald, President Barack Obama’s second-term VA secretary, about the vacancy generally, telling our colleagues he viewed the discussions as being about how to find the best person for the VA post — not filling the position himself.

"But White House officials said they specifically asked Manchin about leading VA himself and believed he was interested," Lisa, Seung Min and Josh write. "The discussions with him went on for several days and began after Jackson withdrew his nomination in late April, but Manchin backed out once he saw a poll suggesting he could win his race and heard from others the job was too difficult, White House officials said."

OOF: More than 60 percent of American children -- about 46.3 million kids -- were enrolled in either Medicaid or the Children’s Health Insurance Program last year, per new data from the Centers for Medicare and Medicaid Services, our colleague Philip Bump reports.

“In 38 states and the District of Columbia, more than half of the children in the state were enrolled in either CHIP or Medicaid at some point during the year,” he writes. In only one state, North Dakota, was less than a quarter of the population of people under the age of 18 enrolled in either program at some point. The state with the highest percentage of enrollment was New Mexico, where more than 80 percent of children were enrolled in one of the two programs at some point.”

OUCH: Do you typically grab a morning doughnut in the break room or an afternoon sugar pick-me-up from the vending machine? These workplace indulgences can add nearly 1,300 extra calories to your diet each week, CDC research says. 

The Post's Lindsey Bever reports that researchers found nearly one-quarter of working adults obtain food and beverages from work at least once during their workweeks -- and “work foods are high in empty calories, sodium, and refined grains and low in whole grains and fruit.” Of course, they could have just asked The Health 202 for evidence; all we'd have to do is forward along all the work emails notifying us of "cakings" whenever a colleague retires, leaves or gets a promotion.

HEALTH ON THE HILL

— Yesterday, your Health 202 author sat down with Sens. Brian Schatz (D-Hawaii) and Thom Tillis (R-N.C.) to discuss mental health-care in the U.S. and how lawmakers might address the growing problem of suicide and untreated mental illness. We talked about underserved populations -- including the homeless, rural-dwelling Americans and veterans -- how telehealth and cultivating more providers could make inroads and the possibility of replacing some opioid use with medical marijuana. 

A few interesting moments in our discussion, in case you missed it:

On Medicaid expansion:

On mental-health stigma:

On what Congress can do:

TRUMP TEMPERATURE

— Trump’s top economic adviser Larry Kudlow was discharged from the hospital yesterday after suffering what officials called a very mild heart attack. “Doctors say Larry’s recovery is going very well,” White House press secretary Sarah Huckabee Sanders said, our colleague John Wagner reports. “The president and the administration are happy Larry is back home and look forward to seeing him back to work soon.”

Kudlow, 70, was admitted Monday to Walter Reed National Military Medical Center following the heart attack. He had traveled with the president over the weekend for the Group of Seven meeting in Canada.

INDUSTRY RX

— CVS Health seems to be one indirect winner of a federal judge’s decision to allow the mega merger between AT&T and Time Warner. The decision, considered a green light for potential other major corporate mergers, could pave the way for CVS’s planned $69 billion merger with health insurer Aetna, CNBC’s Thomas Franck reports. Shares of CVS health and Aetna both spiked 3 percent yesterday as a result of the AT&T-Time Warner ruling. CVA expects the deal to close in the second half of this year.

"U.S. District Court Judge Richard Leon ruled that AT&T's acquisition of Time Warner is legal and did not impose conditions on the merger's approval, which we think bodes well for CVS' pending acquisition of Aetna," Cowen analyst Charles Rhyee wrote in a note on Tuesday, per CNBC.

OPIOID OPTICS

— Kaiser Health News’s Fred Schulte has published a look at how Purdue Pharma, the maker of opioid painkiller OxyContin, spent hundreds of millions of dollars to promote the drug despite risks of addiction. “From 1996 to 2002, Purdue pursued nearly every avenue in the drug supply and prescription sales chain — a strategy now cast as reckless and illegal in more than 1,500 federal civil lawsuits from communities in Florida to Wisconsin to California that allege the drug has fueled a national epidemic of addiction,” Fred writes.

Fred's piece includes a link to years of documents revealing Purdue’s internal budget and other records, writing that the documents “offer readers a chance to evaluate how the privately held Connecticut company spent hundreds of millions of dollars to launch and promote the drug.” A Purdue spokesman appeared to dismiss parts of the story. “Suggesting activities that last occurred more than 16 years ago, for which the company accepted responsibility, helped contribute to today’s complex and multi-faceted opioid crisis is deeply flawed,” spokesman Robert Josephson said.

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

MEDICAL MISSIVES
National
With his voice silenced and body ravaged, Rahul Desikan's research gives him a 'reason to live.'
Laurie McGinley, Nick Otto and Sam Schumacher
To Your Health
The child is recovering at home and “doing well” after being treated with antibiotics at an Idaho hospital, a health official said.
Lindsey Bever
A highly publicized trial in Spain found that the Mediterranean diet protects against heart disease. Now the original work has been retracted and re-analyzed, with the same result.
New York Times
STATE SCAN
Nearly 4,300 Californians killed themselves in 2016, a 50 percent increase from 2001, according to the latest figures from the U.S. Centers for Disease Control.
The Sacramento Bee
Newly released data from Puerto Rico’s government bolsters a conclusion reached by several studies that the death toll from last September’s Hurricane Maria vastly exceeds the official figure of 64.
Wall Street Journal
DAYBOOK

Coming Up

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on public health biopreparedness on Friday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Pricing Program on June 19.
SUGAR RUSH
From The Fact Checker: Trump's flip-flop on insurance coverage for pre-existing conditions
How California's independent commission learned redistricting is harder than it looks