THE PROGNOSIS

The nation's highest-ranking health official boasted in a speech Thursday that President Trump saved the Affordable Care Act. 

No, that's not a typo.

Health and Human Services Secretary Alex Azar told health-care professionals at an event in Nashville that Trump deserves credit for the stabilization of the ACA markets. 

"The President who was supposedly trying to sabotage the Affordable Care Act has proven better at managing it than the President who wrote the law," Azar said.

But any casual observer of politics knows Trump was not "supposedly" trying to kill the ACA -- he's been overtly calling for its demise. At a recent rally the president told supporters, "we've done a number on Obamacare." As I reported here at The Health 202 earlier this week, Trump has brought up efforts to repeal the ACA and chip away at its core in every campaign-style speech he's made in the past two months. 

Open enrollment for health coverage on the ACA exchanges begins Nov. 1, and Azar used his speech to officially announce that for the first time since the law was enacted, premiums on average are projected to drop for the popular "silver" plans, mid-range plans with moderate premiums and slightly higher out of pocket costs.

"Insurers have proposed to cut premiums for these benchmark plans by two percent nationally. Meanwhile, the number of federal exchange insurers will grow for the first time since 2015," he said. 

"Let me repeat that: Under President Trump, premiums are dropping and choices are returning," he added. 

But health-care wonks argue the markets are stabilizing now for different reasons. In fact, experts say premiums would likely be going down much more this year if not for the White House casting uncertainty on the ACA's future.  In early August, Brookings Institute's Matt Fielder released an analysis concluding that if Trump and congressional Republicans had allowed the ACA to remain intact, average nationwide premiums for those buying ACA plans would have fallen 4.3 percent next year.  

"Because the experience would be so good this year if policy was stable, the difference between a 4.3 percent decline and what actually happens in 2019 ... we might end up in the single digits [in terms of premium prices falling], but [premiums] are much higher than they could have been," Fielder told me then. 

Larry Levitt, senior vice president of health reform for the independent Kaiser Family Foundation, made a similar point on Twitter yesterday, adding that premium rates for ACA plans are going down next year because insurers are correcting for raising them too high this year before:

Azar ticked off all the changes the administration has made to the ACA -- such as ending "cost-sharing reduction" payments to insurers; allowing states to set up reinsurance programs; allowing businesses to create health association plans and individuals to enroll in short-term duration plans, both of which are cheaper but do not include many consumer benefits required by the ACA. He also chastised "defenders of the Affordable Care Act" for saying that Congress eliminating the individual mandate penalty was a "life or death issue for American issues"

"These architects of the ACA could not have been more wrong," Azar said. "At the same time we’re removing the tax and expanding choices, the market is stabilizing and improving. All the experts, the defenders of the ACA, told us that more choices and more freedom would hurt your access to care. They used that as a reason to wield more control over your healthcare."

But those experts, like Fielder and Levitt, caution that the sum of the Trump administration changes to Obamacare could keep healthy, young people off the exchanges in 2019, leaving insurers with a pool of sicker Americans, which could mean they'll pay out more than they take in and raise rates again for 2020 to compensate for their loss. 

Azar also used his speech to dismiss Democrats who have called for a shift to a nationwide "Medicare for all" program that would operate either as a public option or universal health care. Once an idea reserved only for the most progressive wing of the party, "Medicare for all" has gained traction among even more mainstream Democrats this campaign cycle, 

"It sounds like a nice idea. Medicare is a proud achievement of American healthcare. It provides financial security and quality care for nearly 60 million Americans. Why not just offer it to everybody?" Azar said. "Well, when we were young, our parents taught us a good lesson: If something sounds too good to be true, it probably is. That’s no less true in healthcare than it is anywhere else."

Republicans have pivoted to attacking Democrats on "Medicare for all" as Democrats have spent this campaign cycle criticizing them on the destruction of the ACA. Azar took up a popular GOP line that shifting the entire country to a Medicare-style program would not only be a huge financial burden for the nation, but would divert resources from seniors. 

But advocates for the proposed plan say that the government-run program would have more generous benefits with less out-of-pocket costs for patients and reduce paperwork for providers so they can focus on the care. 

Azar wasn't the only high-ranking Trump administration official to tout its health-care policies Thursday. Centers for Medicare and Medicaid Services Administrator Seema Verma defended the agency's push for states to add work requirements to their Medicaid programs. 

"Community engagement requirements are not some subversive attempt to just kick people off of Medicaid," she said during a speech to  "Instead, their aim is to put beneficiaries in control with the right incentives to live healthier independent lives."

Verma spoke directly about Arkansas, the first state to implement work and community engagement as a requisite for receiving Medicaid benefits.  She celebrated that 1,000 low-income beneficiaries had found work since the new requirements went into effect in July. 

"This is earned success. It is not granted by government, but realized through sweat, toil and initiative," she said. 

But Verma did not mention in her speech the 4,300 Arkansans who were kicked off of Medicaid this month for failure to meet the requirements, or adequately report them. 

HEALTH ON THE HILL

— A bitter and emotional day of hearings took place before the Senate Judiciary Committee as California professor Christine Blasey Ford testified about allegations that Judge Brett M. Kavanaugh sexually assaulted her when both were teenagers, and as the Supreme Court nominee forcefully denied the charges.

Her voice at times shaking, Ford described “in stark detail,” the alleged assault at a high school gathering, our Post colleagues Robert Barnes, Seung Min Kim and Elise Viebeck report with the help of a team of Post colleagues. 

“I am here today not because I want to be,” Ford, a psychology professor, said during her testimony. “I am terrified. I am here because I believe it is my civic duty to tell you what happened to me while Brett Kavanaugh and I were in high school.”

At one point during her hours of testimony, Ford declared that she was “100 percent” certain that Kavanaugh was the one who assaulted her.

Hours later, Kavanaugh, often tearful as he spoke about his family, was also pretty angry, and as our colleagues write “was openly contemptuous of Democratic senators, often demanding that they answer the questions they asked of him.”

“You may defeat me in the final vote, but you’ll never get me to quit. Never,” the red-faced Kavanaugh told senators.

The Republican senators also rose to the nominee’s defense. Sen. Lindsey O. Graham (R-S.C.) warned his colleagues: “If you vote no, you’re legitimizing the most despicable thing I’ve seen in my time in politics.”

The committee is set to vote as planned this morning, our colleagues report, “with procedural votes on Saturday and Monday and a final confirmation vote on Tuesday.” Following the Thursday hearings, “three potential swing GOP senators — Arizona’s Jeff Flake, Alaska’s Lisa Murkowski and Maine’s Susan Collins — remained silent about their plans.”

For his part, our colleagues report Trump was “riveted” as he watched the hearing, though calling the hearing “painful” to watch. “By the afternoon...Trump was ebullient,” our colleagues Ashley Parker, Josh Dawsey and Philip Rucker report.

— Our Post colleague Amber Phillips broke down five takeaways from the hearing, including that while Ford “came across has credible and sympathetic,” Kavanaugh “may have done what he needed to do for the most important people in the room.”

“Reading her testimony about the alleged attack was compelling,” Amber writes. “Hearing her describe it was downright gripping. Reporters who were there said all 21 senators were leaning forward on the dais as she spoke.”

Meanwhile, Kavanaugh offered an “unequivocal denial” of the allegations, declaring “I am innocent of this charge.”

Amber writes: “So Kavanaugh seems to have the support of most of the Republican senators in that committee room who will first vote on his nomination, save Sen Jeff Flake (R-Ariz.), a swing vote who didn’t let on what he was thinking. And did he win over the ones outside the room — swing votes such as Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) and the American public?”

— Our Post colleague David Fahrenthold reported that calls dramatically increased yesterday to the Rape, Abuse & Incest National Network, or RAINN, said the National Sexual Assault Telephone Hotline. According to the organization, the hotline saw a 147 percent spike from its normal volume of calls as individuals called to share their own experiences with sexual assault:

AHH, OOF and OUCH

AHH: During the hearing,  Ford used science to support her testimony and explain what she remembered and why.

Our Post colleagues Robert Barnes and Seung Min Kim write that during Ford's testimony, “she was calm and at times clinical in describing about how memory works, drawing on her training as a psychologist." 

Here’s one memorable exchange with Sen. Dianne Feinstein (D-Calif.):

Feinstein: How were you so sure that it was [Kavanaugh]?

Ford: The same way that I am sure that I am talking to you right now: It’s basic memory functions. And also just the level of norepinephrine and epinephrine in the brain that sort of, as you know, encodes that neurotransmitter, encodes memories into the hippocampus. And so the trauma-related experience then is kind of locked there whereas other details kind of drift.

Feinstein: So what you are telling us is this could not be a case of mistaken identity?

Ford: Absolutely not.

Ford, a professor of psychology at Palo Alto University and a research psychologist at the Stanford University School of Medicine, also explained the incident was “seared into my memory.”

“The hippocampus is the part of the brain that helps process information into memories,” Bianca Seidman and Dr. Jonathan Steinman report for ABC News. “Its process is extremely complex and not fully understood by scientists. In general, the senses experienced by someone at the time of the memory travel as signals to the hippocampus, where it is then consolidated into a memory. This information may be stored as a short-term or long-term memory, depending on how important the information was, and how often the information from the memory is repeated or used…Although the brain does not always store memories completely, some moments may be especially vivid if the brain prioritizes them as important or they have a strong emotional component, since the hippocampus is part of the limbic system, which is connected with human emotion.”

Ford also described that “uproarious laughter” from her attackers were “indelible in the hippocampus” and her strongest memory of the alleged incident.

When asked by Sen. Richard J. Durbin (D-Ill.) what the degree of certainty Ford had that it was Kavanaugh who committed the assault, Ford replied: “100 percent.”

OOF: A new coalition of health-care professionals is calling for an increase in federal funding on gun violence research. The organization, Scrubs Addressing the Firearm Epidemic, wants “evidence-based policy” on guns, and is citing the need for patient intervention as one reason for the push, CNN’s Arman Azad reports.

“At more than 30 medical schools across the country last week, students and physicians wore scrubs with SAFE's bright red logo as they held demonstrations at their hospitals,” Arman reports. One fourth year medical student from Stanford University, Sarabeth Spitzer, explained while there is “no prohibition whatsoever on talking about guns with patients… most physicians and medical students have never been trained in how to talk about them."

Spitzer told CNN that doctors should "talk to patients about how they store their weapons and where they store their ammunition, whether they're locked, [and] whether anyone has a history of mental illness or suicidal tendencies,” adding that such discussions could "decrease the likelihood that someone might use weapons inappropriately in the home or in a way that the purchaser didn't intend.”

OUCH: The flu killed 80,000 people in the United States last winter, more than any flu season in decades, according to data released by the Centers for Disease Control and Prevention. That number is greater than the previous high of 56,000 deaths for a regular flu season, our Post colleague Lena H. Sun reports.

“As a new flu season gets underway, public health officials say last year’s toll underscores the importance of getting a flu vaccine each year,” Lena reports. “The shot can prevent infections and reduce the severity of complications from the disease… The CDC recommends that those 6 months and older get a flu vaccine before the end of October. It takes about two weeks for the body to produce a full immune response.”

Specifically for children, the flu led to 180 pediatric deaths last season, Lena reports. That record is second only to the 358 children who were killed during the 2009 swine flu pandemic.

OPIOID OPTICS

— The Department of Veterans Affairs is working on a plan to add the opioid antidote naloxone to automated external defibrillator cabinets that already exist in buildings nationwide, WBUR’s Martha Bebinger reports.

VA looks to expand on a similar project that began in Boston that added naloxone kits to AED cabinets. “Equipping police with nasal spray naloxone is becoming more common across the country, but there has been some resistance to making the drug available in public,” Martha writes, explaining some say it could give drug users a false sense of safety.

Boston’s VA reports that so far 132 lives have been saved through three parts of its naloxone project which includes “training high risk veterans, equipping police and the AED cabinets.”

One University of Rochester doctor who led a project to add tourniquets and naloxone to AED cabinets warned about “challenges to turning AED cabinets into miniature emergency medical stations.” Martha added: “Medicines can't be left outside during extreme temperatures. They are expensive and expire.”

 “A smattering of schools, airports, churches and employers around the country have added naloxone to their AED cabinets,” she reports. “Some are stocking other lifesaving tools as well: tourniquets to stop bleeding after a shooting; EpiPens to keep airways open; and even injectors to treat diabetic shock.”

MEDICAL MISSIVES

— According to new research, restricting screen and smartphone time for children may lead to higher mental performance, our Post colleague Hamza Shaban reports.

Based on research of 4,500 8 to 11-year-old kids’ sleep schedules, those who used smartphones or other devices for less than two hours a day did better on cognitive tests that assessed thinking, language and memory, according to the study in the Lancet Child and Adolescent Health.

The researched was based on those children’s sleep schedules, time on screens, amount of exercise and how those factors impact mental abilities, Hamza writes.

“The researchers compared the results with national guidelines for children’s health,” Hamza notes. “The guidelines recommend that children in that age group get at least an hour of physical activity, no more than two hours of recreational screen time, and nine to 11 hours of sleep per night. The researchers found that only 5 percent of children met all three recommendations. Sixty-three percent of children spent more than two hours a day staring at screens, failing to meet the screen-time limit.”

REPRODUCTIVE WARS

— Planned Parenthood Action Fund released a six-figure advertisement on the same day as Ford and Kavanaugh’s hearing on Capitol Hill that addressed the allegations against the Supreme Court nominee.

The ad, titled “Survivors are not on trial,” was set to be played in states including Maine, Alaska, Arizona and West Virginia, Axios’ Sam Baker reports, states where some senators including  Republican Sens. Collins, Murkowski and Jeff Flake are expected to be potential swing votes on Kavanaugh’s nomination.

INDUSTRY RX

— Health insurer Aetna announced that it is set to sell its Medicare prescription drug business to WellCare Health Plans, a move that was a condition of antitrust officials approving the CVS Health’s acquisition of the insurer, Axios’s Bob Herman reports.

The move signals further that the companies believe the merger is imminent. The price of the deal with WellCare was not disclosed.

“While Aetna's divestiture likely leads to federal approval, consumer advocates say they are still worried about whether CVS will impede competition with its health insurance and pharmacy benefits management under one roof, and whether CVS will force other insurers to drive business toward its own retail stores and pharmacies,” Bob notes.

— Here are a few more good reads from The Post and beyond: 

“He does not to me sound like he’s lying, and neither did she.” Maine Democrats and Republicans watched the daylong testimony and came away torn.
The New York Times
Politics
A July 1 party including people mentioned by Christine Ford is raised -- and then dropped.
Philip Bump
After two failed buyout attempts that could have put it in a better position to compete against larger rivals, Rite Aid is shuffling its board of directors and dividing power at the top of the drugstore chain.
Associated Press
Health & Science
The slow and subtle movements of the Feldenkrais Method aim to retrain the body and brain.
Lisa Rein
AGENCY ALERT
A top health official in the Trump administration defended Medicaid work requirements Thursday, arguing that its intent isn't to expel people from the program.
The Hill
TRUMP TEMPERATURE
Federal family planning funds, known as Title X, will soon fund for-profit women’s clinics that bar condoms, hormonal birth control and IUDs and offer only “natural family planning.”
Kaiser Health News
STATE SCAN
DAYBOOK

Today

  • The FDA Office of Women’s Health Scientific Conference on opioid and nicotine use, dependence and recovery.
SUGAR RUSH

Late-night reactions to the Kavanaugh hearing:

Protesters and counterprotesters gathered during the day of hearings: