THE PROGNOSIS

The federal law protecting women from violence was set to expire at the end of the month, yet neither the House nor the Senate made renewing it a priority.

Congress didn't actually want the landmark Violence Against Women Act to lapse, so lawmakers did what they do best: They slipped a short-term extension of the existing law into a must-pass continuing resolution that kept the government funded until Dec. 7. 

When VAWA was last reauthorized in 2013, it would still be years before sexual assault allegations against Hollywood mogul Harvey Weinstein inspired the #MeToo movement. Women's stories have since rocked media companies, politics, the restaurant industry, even classical music, and most recently the confirmation process of Supreme Court nominee Brett Kavanuagh, who's been accused of sexually assaulting Christine Blasey Ford when they both were in high school.

"I’m not surprised by much these days, but I’m disappointed we’re at this stage at this late hour," said Rebecca O'Connor, vice president of RAINN, the Rape, Abuse & Incest National Network. 

VAWA was originally passed in 1994, authored by then-Sen. Joe Biden (D-Del.) in the aftermath of the Anita Hill hearings and the subsequent "Year of the Woman," when a record number of women were elected to the Senate. It's noteworthy then that the measure's future hangs in the balance at a time when the country is once again seeing more women than ever run for public office and another woman may testify in Congress about a Supreme Court nominee's alleged misconduct. 

"It really formalized a stream of funding and support for services of victims. It created a more formalized way for agencies to obtain money and it really changed our support across the criminal justice system," said Bethany Backes, director of research for the Institute on Domestic Violence and Sexual Assault at the University of Texas at Austin.

Without these programs, she told me, groups would "do a lot more based on volunteers and a lot of victims would be falling through the cracks."

A task force of organizations dedicated to fighting domestic violence and sexual assault has been working on how to improve the existing law. In July, Rep. Sheila Jackson Lee  (D-Texas) introduced a reauthorization measure that included the recommended updates. It has 163 Democratic cosponsors, including Minority Leader Nancy Pelosi (Calif.), but no Republican supporters. There is no companion measure drafted in the Senate. 

Earlier this week Pelosi sent a letter to Speaker of the House Paul Ryan (Wis.) condemning the decision to temporarily extend VAWA, calling it "an abdication of our responsibilities to women in our country." 

The proposed changes include increased funding for a Rape Prevention & Education Program because demand for such programs has skyrocketed in the #MeToo era, advocates say.  It also increases funding for youth-based prevention education for boys to teach about healthy relationships. 

But the poison pill for Republicans is the Democrats' inclusion of firearms-related provisions. The Democratic proposal closes the so-called "boyfriend loophole," to ensure dating partners under a protective order are prohibited from having a firearm. Currently, that law only applies to couples who are married, live together, or share a child. It also extends the firearm prohibition to people accused of stalking. Finally, it restricts people under temporary restraining orders from possessing a gun. 

The task force offers staggering statistics to back up these requests: Nearly half of women killed by intimate partners are killed by dating partners, and 75 percent of women murdered by intimate partners and 85 percent of women who survived murder attempts were stalked first. A 10-city study cited by the task force found that 20 percent of homicide victims with temporary protective orders were murdered within two days of obtaining the order.

"We’re really hoping Congress takes seriously the importance of reauthorizing it with some key enhancements that we’re collectively asking for and a 3-month extension does not get that work done," said Terri Poore, policy director of the National Alliance to End Sexual Violence.

Some House Republicans last week introduced a  six-month extension of VAWA to give Congress more time to work on a reauthorization. Republicans say the bill doesn't contain any changes and is a straightforward extension, but an examination of it appears to show that some sections of the current law are missing. Rep. Elise Stefanik (R-N.Y.) is sponsor of the GOP effort and her office pointed me to a Congressional Budget Office report of the provisions in the law that are expiring on Sept. 30, and  said those are the only ones included in the GOP reauthorization bill. 

The Health 202 is covering this issue because the Centers for Disease Control and Prevention calls sexual assault "a serious public health problem." Courtnaey Cavanaugh, a psychology professor at Rutgers University, who teaches a Violence Against Women and Women’s Health course, told me that such abuse is associated with numerous health problems from depression to substance abuse to reproductive problems to chronic diseases. 

The general consensus on the task force is that Congress has a rare opportunity to make changes to the law at a time when the American public is focused and concerned with issues of violence against women. 

"It’s been really sad to me and I really hope before it is too late we will see members of Congress who have proclaimed support for survivors connect it to VAWA," said Jess Davidson, executive director of End Rape on Campus. "I think that allowing VAWA to be brought to the brink like this when our country is having such an important national conversation to me really shows that Congress is not as with survivors of sexual assaults as they claim to be."

(Correction: An earlier version said Stefanik's office did not return request for comment, but they never received the email asking for one. This story is also updated to reflect Stefanik's office's explanation of what is included in her VAWA reauthorization bill.)

AHH, OOF and OUCH

AHH: Our Post colleague Amy Goldstein has a deep profile of Alex Azar and how the Health and Human Services secretary has dealt with the fallout from President Trump’s “zero tolerance” immigration policy and the migrant child crisis that followed.

Azar was not consulted on the policy, Amy writes, though his department was enmeshed in handling the result, as it is responsible for housing unaccompanied migrant children. It’s a crisis that has “put on the line [the secretary's] carefully cultivated reputation as an orderly, competent executive who understands how to make government work. With the midterm elections fast approaching and public outrage over the policy an animating issue, Azar also runs a risk of drawing the wrath of Trump, who has publicly humiliated other top officials when he thinks they are hurting his standing.”

Azar's years in government have been “punctuated” by such crises.

Amy also writes of an anecdote from Azar’s first weeks as the general counsel for HHS under President George W. Bush. On September 11, 2001, when the nation’s planes were grounded, then HHS Secretary Tommy Thompson turned to Azar, as Amy describes: “I knew that I needed to get a plane into the air . . . to carry 100,000 masks and 100,000 gloves from a secret medical depot to New York City,” Thompson recalled. The two men and another department lawyer talked of declaring a national health emergency, but no HHS regulation allowed that. Azar came up with a way within an hour.”

OOF: Overdose deaths in the United States have increased markedly in the last 38 years at a near consistent level of about 9 percent per year, according to new research published in the journal Science.

The rise itself is not what’s surprising, it’s the level of consistency in that growth, Axios’s Eileen Drage O’Reilly reports, even with a variation in the type of drug causing the epidemic and the different demographic groups that are impacted. 

“If those issues are not addressed, [study author Donald Burke] says the trend, which has shown about a 99% accuracy in anticipated trajectory so far, will continue even if the current epidemic of prescription opioids, heroin and fentanyl abuse is diminished,” Eileen writes.

OUCH: The United States is the most dangerous place in the developed world to deliver a baby. And USA Today’s Laura Ungar reports it may in part be due to states failing to adequately address the issue.

“At least 30 states have avoided scrutinizing medical care provided to mothers who died, or they haven't been studying deaths at all,” Laura reports in the investigation. “Instead, many state committees emphasized lifestyle choices and societal ills in their reports on maternal deaths. They weighed in on women smoking too much or getting too fat or on their failure to seek prenatal medical care.”

In July, USA Today revealed thousands of women in the United States are injured or die during childbirth because hospitals don’t take basic steps to prevent problems. But many states are not focusing on hospital quality of care and are not pushing for any improvements, Laura reports.

Less than 20 states have panels dedicated to identifying flaws that lead to maternal deaths. Of 10 states with the highest death rates, four had panels that reported on flaws in medical care. More than a third of states aren’t studying maternal deaths at all. 

AGENCY ALERT

— Azar told reporters that HHS has no plans to divert money from key priorities such as efforts on opioids and mental-health funding to funding the detainment of migrant children, responding to a report from Yahoo News.

Yahoo News’ Caitlin Dickson reported the department is set to transfer more than $260 million from various programs including from the Centers for Disease Control and Prevention and the National Institutes of Health in order to fund the oversight of minors who enter the United States. Caitlin reported $80 million of that funding will be moved from other refugee programs, while the rest is coming from other programs “including $16.7 million from Head Start, $5.7 million from the Ryan White HIV/AIDS program and $13.3 million from the National Cancer Institute,” citing a letter sent to Sen. Patty Murray (D-Wash) that Yahoo News obtained. She added the money was also set to come from programs meant for mental and maternal health, women’s shelters and substance abuse programs.

But the Washington Examiner’s Robert King reports HHS will “wall off opioid, mental health, and emergency funding as it cuts 0.2 percent from its overall budget.” “This is very routine with end of the year funding,” Azar told reporters regarding the transfer request, Robert writes. “This was done at least twice in Obama administration.”

HEALTH ON THE HILL

— The attorney for the woman who accused Supreme Court nominee Brett M. Kavanaugh of sexually assaulting her when they were teenagers says it’s “not possible” for her to testify on Monday, but she would be willing to testify later in the week.            

Ford’s attorney said she has requested a call with members of the Senate Judiciary Committee to discuss the conditions under which [Ford] would be prepared to testify next week,” our Post colleagues Seung Min Kim, Josh Dawsey and Emma Brown report.

“As you are aware, she's been receiving death threats which have been reported to the FBI and she and her family have been forced out of their home,” Ford’s attorney wrote to the Senate Judiciary Committee. “She wishes to testify, provided that we can agree on terms that are fair and which ensure her safety. A hearing on Monday is not possible and the committee's insistence that it occur then is arbitrary in any event.”

In a statement, Ford also dismissed a theory from Ed Whelan, a former clerk to the late justice Antonin Scalia and president of the Ethics and Public Policy Center, who publicly identified a high school classmate of Kavanaugh’s as Ford’s possible attacker. “I knew them both, and socialized with” the other individual, Ford said. “There is zero chance that I would confuse them.”

“A handful of pivotal senators have yet to disclose how they will ultimately vote on Kavanaugh’s confirmation, including Republican Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska),” our colleagues point out. “On Thursday, Alaska Gov. Bill Walker and Lt. Gov. Byron Mallott — who are both running as independents — issued a statement opposing Kavanaugh’s nomination.”

 — The dilemma has put Sen. Charles E. Grassley (R-Iowa) in a tough spot. “The famously curmudgeonly Grassley faces competing imperatives as he works through one of the most fraught periods of his 43-year political career,” Politico’s Burgess Everett and Elana Schor report. “Senate Majority Leader Mitch McConnell (R-Ky.) is trying to get Kavanaugh confirmed before the midterm elections, and many of Grassley’s colleagues are arguing there should be no delay."

"But for Democrats and advocates fighting sexual violence, Grassley is in too much of a rush given his long-running history of urging people to come forward on their own terms about malfeasance. They say he needs to stop and assess his place in history before going forward.”

— The pharmaceutical industry is making a last-ditch effort to reverse a move from earlier this year that put drugmakers on the hook for more of seniors' drug costs.  And it's using the popular opioids package to do so.

A provision in a February spending deal required drug companies to cover more of the costs seniors have when they reach the coverage gap, known as the “donut hole” in  Medicare Part D plans. But after that rare loss for the industry, PhRMA, the top trade group for the industry, has been “begging” lawmakers to reverse the policy in opioids legislation, Axios’ Bob Herman and Caitlin Owens report.

In exchange, the industry would accept a version of the CREATES bill, which would block brand-name drugmakers from preventing generic-makers from getting samples needed to make their versions.

“None of this has anything to do with the opioid crisis, which has so far been a rare example of bipartisan agreement,” Caitlin and Bob report. “And there's reason to be highly skeptical Democrats would go along with the industry's latest request… It's also unclear whether Republicans will go along.”

INDUSTRY RX

— The Pharmaceutical Care Management Association, the lobbying organization for pharmacy benefit managers, has named a new chief executive ahead of outgoing CEO Mark Merritt’s departure next month. JC Scott, a medical device industry lobbyist, will be leading the trade group, Axios’s Bob Herman reports.

Scott’s takeover comes as PBMs have been at the center of some of the criticism for the nation’s high prescription drug costs. Merritt announced earlier this year he would be stepping down from the organization. Health 202 author Paige Winfield Cunningham wrote in May that some thought the shuffle was a reflection of members concern over how PBMs have been characterized in the ongoing debate over drug costs.

“I think what you should expect going forward is an industry and PCMA that’s more aggressive, more active in the drug pricing debate at the federal and state levels, which hasn’t necessarily been a strength in the past,” a source familiar with group’s board discussions told Paige then.

MEDICAL MISSIVES

— And here are a few more good reads:

A for-profit venture with exclusive rights to use the center’s vast archive of tissue slides has generated concerns at the nonprofit cancer center.
The New York Times and ProPublica
The Trump administration is developing a drug to protect against the threat of the opioid fentanyl being used in a terrorist attack.
Washington Examiner
In Adams' first year, he issued a rare advisory on naloxone as the Trump administration declared the opioid epidemic a public health emergency.
Stat
Medical insurance generally pays more than dental insurance, so your dentist may be able to bill for services extending beyond tooth care.
New York Times
Mindfulness programs have become popular on K–12 campuses, but in some parts of the country concerns about religious intrusion keep the trend at bay.
The Atlantic
SUGAR RUSH

'Don't mess': Christine Blasey Ford's alma mater rallies support in letter:

Trump’s partisan history of handling sexual misconduct allegations: