THE PROGNOSIS

About this time last year, we were scrutinizing how the two Senate Republicans who favor abortion rights might vote on an Obamacare overhaul.

Now, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska are back in the spotlight as the Senate gears up to confirm a new Supreme Court justice. Along with three Democratic senators from red states -- Joe Donnelly (Ind.), Heidi Heitkamp (N.D.) and Joe Manchin (D-W.Va.), all of whom are up for reelection this year -- they make up the five senators whose votes will most aggressively be courted in the knockdown fight over President Trump's nominee to replace retiring Supreme Court Justice Anthony Kennedy.

Republicans are eager to replace Kennedy with a justice who would more consistently oppose abortion rights from the bench. And their best chance to do so is keeping Collins and Murkowski in their camp on a confirmation vote -- that is, unless they’re able to win over a few moderate Democrats like the ones above.

Assuming Sen. John McCain of Arizona, who is undergoing treatment for brain cancer, can’t make it to Capitol Hill, Senate Majority Leader Mitch McConnell (R-Ky.) will have a one-vote margin to confirm Trump's nominee for the high court, who is expected to move the court significantly rightward on a host of issues from abortion, to gay rights to voting issues. So McConnell either needs all 50 Republicans on board with his plan — with a tie-breaking vote from Vice President Pence — or he'll be depending on the support of two Democrats if Collins and Murkowski defect.

Both women did vote to confirm Justice Neil M. Gorsuch last year — but the stakes were significantly different then. Gorsuch replaced the late conservative Justice Antonin Scalia, while Trump’s next nominee will replace Kennedy, the court’s longtime swing vote.

You can bet this time around that both Collins and Murkowski will be facing immense pressure from abortion-rights activists to duck their party. So will Sens. Joe Manchin of West Virginia, Joe Donnelly of Indiana and Heidi Heitkamp of North Dakota — the three moderate Democrats who joined Republicans to confirm Gorsuch who are running this year (Collins isn't up for reelection until 2020; and Murkowski doesn't face voters until 2022).

“I don’t know who of these people — if any — are going to hold out, because this is such a different situation,” Yale law professor Priscilla Smith told me. “This is a very different situation than when Gorsuch was replacing Scalia.”

Yesterday, NARAL Pro-Choice America announced a 50-state campaign to pressure senators into opposing any Trump high court nominee who opposes abortion rights. The group held a media call along with Planned Parenthood, the National Women’s Law Center and Trump resistance group Indivisible, where leaders said they’ll focus on keeping Democrats unified against a nominee and picking up some GOP support as well.

NARAL President Ilyse Hogue said her group’s activists made three times the number of calls to Senate offices in the 24 hours after Kennedy’s retirement announcement than they did after Gorsuch was nominated in January 2017 to replace Scalia.

“Sens. Murkowski and Collins have already laid down the marker saying that they stand by Roe, they believe in legal access to abortion,” Hogue said. “It’s about upholding their word through this vote, and we’re going to make sure that the public support is there for them in their states and that there will be a lot of frustration and anger if they don’t.”

Collins and Murkowski are trying to downplay their influence as the frenzy over the Supreme Court opening grows and the pressure on them builds, my colleague Seung Min Kim reports. They're both "rare elected Republicans in Washington who support abortion rights and voted against repealing the Obama-era Affordable Care Act — issues Democrats are using to frame the battle over the Supreme Court nominee," Seung Min writes.

“It’s been kind of interesting in this firestorm. Afterward, everyone is focused on Lisa and Susan,” Murkowski told Seung Min yesterday. “If I were John or Jerry or Bill, I’d say, ‘Wait a minute. How come I’m not being viewed as an important voice in this process?’"

The Alaskan Republican made clear Roe wouldn't be her only consideration in making a decision, Seung Min reports.

"Murkowski called the future of Roe v. Wade — the 1973 decision that legalized abortion nationwide — a 'significant factor,' but she stressed that in no way will that landmark ruling be the sole factor for her. 'And I don’t think it should be the only factor for anybody,' Murkowski said. 'It’s not as if those are the only matters that come before the Supreme Court.'"

Collins said she wouldn’t ask Trump’s pick how he or she would rule on specific issues -- but stressed that she always presses judicial nominees about their views on legal precedent. “I do get a sense from them on whether or not they respect precedent,” Collins told Seung Min. “And from my perspective, Roe v. Wade is an important precedent and it is settled law.”

Murkowski tweeted on Wednesday that she’d “carefully scrutinize” whoever Trump nominates:

Both Republicans and the three Democrats who voted in favor of Gorsuch met with Trump Wednesday evening at the White House to discuss the vacancy, White House press secretary Sarah Huckabee Sanders said.

Abortion rights activists could face an uphill battle, because even if they hold Collins and Murkowski, it would take only two Democratic defectors for Republicans to confirm the nominee. Because Senate Republicans voted last year to eliminate the 60-vote requirement for Supreme Court nominees, Democrats have little recourse when it comes to blocking consideration of a nominee as confirming a justice only takes 50 votes, my colleagues Seung Min Kim and Josh Dawsey note.

It's no small matter that the three Democratic defectors on the Gorsuch vote — Heitkamp, Manchin and Donnelly — are up for reelection in November in states Trump won in 2016. “On Wednesday, none of them gave any indication of being interested in a fight over Kennedy’s replacement, even as other Democratic senators and party activists ratcheted up pressure to oppose the pick,” Seung Min and Josh write.

“Part of my job as a United States Senator is to carefully consider the president’s judicial nominees, including for the Supreme Court, and I will thoroughly review the record and qualifications of any nominee presented to the Senate,” Donnelly said in a statement.

Americans tend to support moderate limits on abortion rights but don't want to see Roe v. Wade overturned entirely. A new Kaiser Family Foundation poll published this morning found two-thirds of respondents want Roe to remain, compared with 29 percent who want see the high court overturn the law. Among Republicans, 53 percent want Roe overturned, compared with 81 percent of Democrats and 73 percent of independents who would not like to see it overturned.

AHH, OOF and OUCH

AAH: The Department of Health and Human Services says in the past week, following Trump’s executive order to keep migrant families together, the number of children taken in by its Office of Refugee Resettlement has decreased by nearly half.

An HHS official told the Washington Examiner’s Anna Giaritelli that 914 children were taken in by the ORR from June 21 to June 27, an average of about 130 children per day. The agency was previously taking in about 250 children per day. Trump signed his executive order June 20.

"Honestly, our referrals have been decreasing recently...it has not been nearly as high lately," Kenneth Wolfe, deputy director for the Office of Communications at the Administration for Children and Families, told Anna.

BUT: NBC reported this morning the administration (seems like both Obama's and Trump's) rolled out a "pilot program" last fall that separated migrant children from their parents: "... Numbers provided to NBC News by the Department of Homeland Security show that another 1,768 were separated from their parents between October 2016 and February 2018, bringing the total number of separated kids to more than 4,100. More than 1,000 children were separated between October 2016 and September 2017, and 703 were separated between October 2017 and February 2018, according to DHS."

OOF: Online retail giant Amazon is entering the pharmacy business after months of speculation that the company could disrupt how prescription drugs are sold the same way it upended bricks-and-mortar retail, The Post's Carolyn Y. Johnson reports. Amazon announced yesterday that it would acquire PillPack, an online pharmacy that seeks to simplify medication for people who take multiple drugs, by delivering packets with presorted doses. (Amazon founder and CEO Jeffrey P. Bezos owns The Washington Post.)

“The PillPack acquisition gives Amazon a foothold in the regulated pharmacy business,” Carolyn writes. “Experts said buying the company outright will allow Amazon to develop and scale a mail-order pharmacy business more quickly than if it had to develop the expertise from scratch. PillPack has also developed expertise in battling with payers and pharmacy benefit managers to have its services covered, and Amazon will bring new clout to those negotiations.”

“I think this is a fundamental step for Amazon, to begin to attack the pharmacy industry,” Adam Fein, president of Pembroke Consulting and an expert on the drug supply chain, told Carolyn. “This is the beginning of the pharmacy industry shakeout . . . I think everyone right now is scrambling to figure out what this means for their business model.”

OUCH: Go ahead and order that caesar salad this weekend -- romaine lettuce is no longer a threat to your health. More than 200 people were sickened and five people died after an E. coli outbreak linked to lettuce grown in Arizona's Yuma region, but the Food and Drug Administration announced Thursday that water samples from a canal in Yuma matched the strain of bacteria that caused the outbreak, our colleague Lena Sun reports. The harvest season in that region is over, so lettuce consumed around the country is no longer a threat.

The illnesses struck all over the country, in the largest E. coli outbreak in more than a decade. FDA officials said they're still investigating how the bacteria got into the water and whether in fact that water was used to irrigate the affected farms. 

TRUMP TEMPERATURE

— Yesterday, the first lady made her second trip to an immigration facility, traveling to Tucson nearly a week after she first made a surprise visit to a facility in McAllen, Tex. “The border family separation crisis has compelled the first lady to get a firsthand look at what families, and especially children, are faced with as they cross the border,” CNN's Kate Bennet reports. “She's advocating for quality care for these children, as they're in a difficult situation,” Melania's spokeswoman Stephanie Grisham said.

At the Arizona facility, the first lady held a briefing with local officials and local ranchers and toured the site, per Kate. She met with some of the 55 children who were at the facility, about 10 percent of whom had been separated from their parents at an intake facility at the U.S.-Mexico border, Kate reports.

No word of any controversy-inspiring outer wear.

— Ivanka Trump’s top adviser on paid family leave has left her role at the White House. There are no plans to replace Maggie Cordish, who is also a close friend of the first daughter, Politico’s Ian Kullgren reports. A White House official insisted to Ian the move doesn't mean the administration will stop working on a paid family leave bill, saying staffers on the Domestic Policy Council and the Office of Legislative Affairs who have “always been involved on this issue” will continue to work on paid leave and report to Ivanka Trump.

“Maggie Cordish’s departure comes as Republicans — and Ivanka Trump — struggle to get paid leave legislation off the ground,” Ian writes. “Sens. Marco Rubio (R-Fla.), Mike Lee (R-Utah) and Joni Ernst (R-Iowa) have been working on a bill that would let people borrow from Social Security to fund paid leave. The idea has received praise in some conservative circles, but Democrats and even many Republicans are wary of putting Social Security in more financial jeopardy. The trio has yet to introduce a bill.”

HEALTH ON THE HILL

— A massive farm bill package that covers issues from farm subsidies to conservation to nutrition is headed for a bicameral battle over work requirements for able-bodied Americans on food stamps. 

The Senate passed a bipartisan version yesterday that made no changes to the food stamp program, but the House has included language requiring most adults to work a minimum of 20 hours per week or participate in a state-run training program to receive benefits under the Supplemental Nutrition Assistance Program (SNAP), our colleagues Caitlin Dewey and Erica Werner report. The White House supports the House Republican effort to add this requirement for many of the 42.3 million low-income Americans who receive the average food stamp payment of $125 per month. 

OPIOID OPTICS

— Yesterday, the Justice Department announced it has charged 601 people including doctors, nurses and other health-care professionals for their alleged involvement in alleged opioid-related schemes that resulted in $2 billion in fraudulent billing. HHS said it would exclude 2,700 individuals from participating in Medicare, Medicaid or other federal health-care programs because of their conduct “related to opioid diversion and abuse,” according to a news release.

The Justice Department called it the largest health-care fraud takedown in its history, which included plans related to billing Medicare, Medicare, Tricare and private insurance companies. “Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” Attorney General Jeff Sessions said in a statement.  “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes.”

HHS Secretary Alex Azar said investigators found individuals who had set up fake pharmacies, “harvesting seniors’ Medicare information and coming up with new ways every day to steal from program beneficiaries and taxpayers,” as our colleague Sari Horwitz reports.

Azar tweeted yesterday: 

— There was a marked drop in the amount of money drug manufacturers spent to market opioids in 2016, according to an investigation by ProPublica’s Charles Ornstein and Ryann Grochowski Jones. Purdue Pharma, the maker of OxyContin, has been accused of aggressively marketing the powerful narcotic despite its knowledge the drug was being abused. The founder of Insys Therapeutics and several of the company’s sales representatives and executives have also been charged for allegedly conspiring to bribe doctors to use the company's fentanyl spray improperly.

But payments to physicians for marketing dropped off in 2016, Charles and Ryann found. Opioid makers spent $15.8 million to pay doctors that year, including fees for speaking and consulting, as well as for meals and travel. That’s compared with payments totaling $23.7 million in 2015 and $19.9 million in 2014, a 33 percent and 21 percent decrease, respectively. The biggest decreases in spending were for fentanyl spray Subsys and Hysingla ER, Purdue's extended-release version of hydrocodone.

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

Fact Checker
The senator said more people are in prison for marijuana possession than for all violent crimes. But that's not the case.
Salvador Rizzo
MEDICAL MISSIVES
To Your Health
Student-run groups are associated with increased awareness of mental health issues, reduced stigma and a rise in “helping behaviors,” a new study finds.
Amy Ellis Nutt
Speaking of Science
But good luck living to 105.
Ben Guarino
Jahi McMath, who suffered from brain damage after routine surgery, died on June 22.
The Associated Press
INDUSTRY RX
The Swiss drugmaker will focus on developing new medicines for cancer and other diseases.
By Bloomberg News
STATE SCAN
The state will be the first approved by the Trump administration to mandate work for many low-income Americans enrolled in the entitlement program.
By CNN
DAYBOOK

Today

  • The Alliance for Health Policy holds its 2018 Signature Series Congressional Briefing on Health Care Costs in America.
SUGAR RUSH

Trump suggests a “Keep America Great” 2020 campaign slogan and green campaign hats to represent money: 

Five killed and several injured at a shooting at the Capital Gazette newsroom in Annapolis, Md. on Thursday:

House Minority Leader Nancy Pelosi said the Supreme Court’s public union decision “does violence” to the First Amendment and “working families”: