THE PROGNOSIS

Democrats fighting for House and Senate seats in this year's midterm elections are pushing an aggressive narrative that the GOP is trying to eliminate protections for people with preexisting health conditions. But that messaging doesn’t exactly make sense when it comes to sparse new health plans the Trump administration made newly available yesterday.

The danger isn’t that sick Americans might flock to these plans – it’s that healthy people would.

As of Tuesday, insurers can now sell skimpy short-term health plans that last a full year, instead of just three months, and can renew them for two additional years. The new rules – part of a much-touted effort by the administration to free more health plans from Obamacare requirements – open up a lean new category of coverage for people looking to save money when they shop for insurance.

The plans can be a lot cheaper because they’re not subject to a host of rules under the Affordable Care Act. Republicans argue they will improve much-needed consumer choice just as millions of Americans choose their health coverage for 2019.

Why do these plans cost less? They can deny coverage for whole categories of care, like maternity services, prescription drugs or substance-abuse treatment. They can limit how much they’ll pay for care in a year or even day. And they aren’t required to accept patients with expensive medical conditions.

The coverage restrictions are the part Democrats are eager to talk about, as they try to advance their charge that Republicans are going after people with preexisting conditions. That argument is based mainly on a lawsuit spearheaded by 20 attorneys general in Republican-led states that seeks to overturn the ACA because the individual mandate penalty was eliminated by Congress. 

Sen. Jon Tester, who’s locked in a competitive race for his Montana seat, noted yesterday that the short-term plans don’t have to cover many ailments. “If you have a pre-existing condition like diabetes, cancer, asthma or are pregnant, beware,” Tester said in a release.

Sen. Tammy Baldwin (D-Wis.), whose seat is also threatened, has introduced a resolution to overturn the new rule expanding short-term plans – a resolution she casts as a choice between protecting sick people or leaving them hanging.

“Anyone who says they support coverage for people with preexisting conditions should support this resolution to overturn the Trump administration’s expansion of junk insurance plans, and I hope my Republican colleagues join us to protect people’s access to quality, affordable care,” she said.

But that’s not really the problem here. People with preexisting conditions generally aren’t looking for lean coverage. They know they need generous policies that guarantee coverage for all the doctors' visits and medications they’re in need of. Even with the expansion of these short-term plans, the marketplace plans guaranteeing preexisting protections will still be available to those who need them.

So who will be attracted to these skimpy new short-term plans? Healthy people. That is, the ones whose presence in the Obamacare marketplaces is desperately needed to tamp down premiums for the rest of us.

Under the new rules, some 600,000 more people will enroll in short-term plans next year while 500,000 will leave the marketplaces, according to projections by the Centers for Medicare and Medicaid Services. A decade from now, the short-term plans will have 1.4 million more enrollees while the marketplaces will have 1.3 million fewer enrollees, per agency projections.

This shift of consumers into the short-term plans will likely worsen premiums for everyone left in the marketplaces – raising them by 1 percent next year and 5 percent by 2028, according to CMS.

“These projected changes will have significant impact on state insurance markets,” according to a blog post by the National Academy for State Health Policy. “For most states, the consumer shift from individual market coverage to short-term plans will worsen the individual market risk pool, which requires a mix of healthy and less-healthy enrollees to keep costs in check.”

So expanding the availability of short-term plans probably means somewhat higher premiums for everyone in the marketplaces. But it doesn’t mean people with preexisting conditions would lose access to crucial coverage protections.

Yet those with preexisting conditions could lose their coverage if Texas and other politically red states prevail in their lawsuit ACA. Democrats have been fixating on that court case in this election, trying to paint Republicans as unsympathetic toward the plight of Americans with expensive medical conditions.

My colleague Colby Itkowitz wrote extensively about the situation while I was on maternity leave, explaining how Democrats are running towards health care and Republicans are running away from it. Yesterday Colby noted that talking about preexisting conditions could help endangered Sen. Claire McCaskill (D-Mo.) win her race.

We’ll soon have more insight into the potency of this preexisting conditions narrative; the election is just a few weeks away. But short-term health plans shouldn’t be part of that narrative, despite what you might hear Democrats say.

AHH, OOF and OUCH

AHH: Pharmaceutical companies are among some of the major industries that will see a big win as a result of Trump’s new trilateral trade agreement with Mexico and Canada.

In the new agreement, drug companies gained guarantees against competition from generic drugs, our Post colleague Jeanne Whalen reports. The new so-called U.S.-Mexico-Canada Agreement, or USMCA, will protect biologic drugs from generic competition for “at least ten years,” she writes, a boost from the current set of eight years of protection in Canada and five years in Mexico.

“The pharmaceutical industry won stronger protection for sales of so-called biologic drugs, which are typically derived from living organisms and are administered by injection or infusion,” Jeanne reports. “The medicines are among the most costly and innovative on the market and are a major driver of drug spending.”

These protections mean fewer generics in the market that can drive down the cost, meaning there will be less competition and higher prices. Valeria Moy, an economics professor and the director of Mexico Como Vamos, a think tank in Mexico City, explained to Jeanne the change means consumers will pay more for these drugs.

“The agreement provides extra protection to drug companies in the much larger U.S. market, as well,” Jeanna adds. “Current U.S. law protects biologic drugs from generic competition for 12 years, but some Democrats, including in the Obama administration, have pushed to lower that to seven years as a way to speed cheaper generics to the market and lower drug spending.”

In a statement to The Post, the pharmaceutical industry trade group PhRMA said agreements like the USMCA are meant to “raise global standards, including for intellectual property, among our trading partners, leveling the playing field for American innovators and manufacturers.”

OOF: The Food and Drug Administration raided the San Francisco headquarters of e-cigarette maker Juul and seized more than 1,000 pages of documents related to their marketing practices.

The surprise raid followed a request from the agency earlier this year to the company for information on the high rates of youth use of Juul products as well as marketing data, our Post colleague Laurie McGinley reports. She added it’s the “latest indication of an intensifying crackdown on underage vaping.”

“Across this category, we are committed to taking all necessary actions, such as inspections and advancing new policies, to prevent a new generation of kids from becoming addicted to tobacco products,” the FDA said in a statement.

“The attention on Juul ratcheted up when the Centers for Disease Control and Prevention issued a new report Tuesday showing that the company’s sales grew more than sevenfold between 2016 and 2017,” Laurie writes. “The analysis of retail sales data, which was published in JAMA, found that Juul’s sales increased from 2.2 million devices sold in 2016 to 16.2 million in 2017.”

Juul Lab’s chief executive Kevin Burns said the company is “committed to preventing underage use, and we want to engage with FDA, lawmakers, public health advocates and others to keep Juul out of the hands of young people.”

OUCH: Concerns are growing about whether officials will be able to control and contain the latest Ebola outbreak in the Democratic Republic of Congo.

“With Ebola response teams facing restrictions on their movements in a conflict zone, officials fear containment efforts are falling further behind the virus,” Stat’s Helen Branswell reports. “And if response teams lose sight of where the virus goes, it could spread undetected and unchecked in places where they cannot safely travel.”

“At this point in an epidemic, we’d probably be peaking in terms of knowing where the virus is. And now with the insecurity, that’s compromised,” Mike Ryan, assistant director-general of the World Health Organization’s emergency preparedness and response program, told Stat.

As officials prepare for potential of spread, WHO and the Centers for Disease Control and Prevention, along with other international groups, have been working with Uganda and Rwanda in preparation efforts.

“Ugandan health care workers — they know Ebola already. They know the risks,” said Sose Fall, regional emergencies director for the WHO’s regional office for Africa.

TRUMP TEMPERATURE

— Judge Brett M. Kavanaugh’s temperament and credibility have emerged as the central questions in the fight over his nomination to the Supreme Court, our Post colleagues John Wagner and Mike DeBonis report. Sen. Jeff Flake, who joined Democrats in raising questions about whether Kavanaugh’s performance on Capitol Hill last week indicated whether he has the right temperament to serve on the high court.

Specifically, Flake on Tuesday pointed to his tone with Democratic senators on the Senate Judiciary Committee during his testimony.

“I was very troubled by the tone of the remarks,” Flake said during an event hosted by The Atlantic. “The interaction with the members was sharp and partisan, and that concerns me…I tell myself, ‘You give a little leeway because of what he’s been through.’ But on the other hand, we can’t have this on the court. We simply can’t.”

Senate Majority Leader Mitch McConnell (R-Ky.) doubled down on his promise to vote on Kavanaugh’s nomination by the end of the week. He said the nominee was the victim of open “floodgates of mud and muck.”

Meanwhile, Trump mocked the account of Christine Blasey Ford at length to a Mississippi crowd, our Post colleagues Josh Dawsey and Felicia Sonmez report.

“‘I don’t know. I don’t know.’ ‘Upstairs? Downstairs? Where was it?’ ‘I don’t know. But I had one beer. That’s the only thing I remember,’ ” Trump said of Ford, impersonating her on stage and drawing laughs from the crowd.

"Ford has said the incident happened in an upstairs room and that she is '100 percent' certain it was Kavanaugh who assaulted her, although she has acknowledged that her memories of other details of the evening remain unclear," our colleagues write.

Trump also remarked earlier in the day that Kavanaugh was being treated unfairly by allegations of actions from decades ago and expressed concern about the standard that sets, writes our colleague Philip Bump.

“If you can be an exemplary person for 35 years and then somebody comes and they say, ‘You did this or that,’ and they give three witnesses and the three witnesses, at this point, do not corroborate what they were saying — it’s a very scary situation where you’re guilty until proven innocent,” he said.

Asked what he would say to young men in America, Trump said he’d “say that it’s a very scary time for young men in America, when you can be guilty of something that you may not be guilty of.. This is a very difficult time.”

 “That specific claim — that men will be accused unfairly of misbehavior in an effort to stymie them — is a very narrow subset of the broader strain of male protectionism that runs through conservative politics at the moment,” Bump writes. “But that sentiment of suffering American men predates Trump.”

And our colleagues Devlin Barrett, Matt Zapotosky, Carol D. Leonnig and Tom Hamburger have the latest on the FBI's probe into Kavanaugh,  as the bureau faces the political implications and tight deadline around the inquiry. "FBI agents have completed a first batch of interviews of four individuals closest to the alleged events, and the White House has given the bureau a green light to conduct some further interviews," they write.

And our colleague Seung Min Kim reports several senators from both parties say they want to see at least parts of the FBI's findings released to the public.

HEALTH ON THE HILL

— Vulnerable Texas Republican Rep. Pete Sessions is joining a call to protect preexisting conditions at a time when Democrats are looking to highlight the ways Republicans are undermining them.

Sessions, along with a group of 18 Republican lawmakers, introduced a nonbinding resolution calling for any replacement of ACA to include protections for people with preexisting conditions. It calls for any replacement to "allow states to ask for and receive broad authority to reform their individual health insurance markets" and to ensure that people with preexisting conditions see "lower premiums," "lower out-of-pocket costs" and "greater accessibility to in-network providers." 

“I proudly introduced this resolution to ensure that patients with pre-existing conditions are protected from the erroneously high costs and the limited options they are experiencing now,” Sessions said in a statement.

Sessions is not the first vulnerable Republican to make such a move. "Democrats have made pre-existing conditions one of their primary lines of attack on Republicans in races across the country," The Hill's Peter Sullivan writes. "And Sessions is far from alone among vulnerable Republicans in seeking to express support for pre-existing condition protections. For example, another vulnerable Republican, Rep. David Young (R-Iowa), last month introduced his own resolution expressing support for the protections."

Some of the co-sponsors of Sessions's resolution, including Reps. Leonard Lance (R-N.J.), Mark Meadows (R-N.C.), and Kevin Cramer (R-N.D.), who is running for Senate, are also in competitive races, Peter writes. 

INDUSTRY RX

— Craig B. Thompson, the chief executive of Memorial Sloan Kettering Cancer Center, said he will resign effective immediately from the board of pharmaceutical company Merck as the cancer center revamps its leaders' corporate relationships, the New York Times’s Katie Thomas and ProPublica’s Charles Ornstein report.

Thompson has served on Merck’s board since 2008, and last year received $300,000 in compensation from the company. Thompson also said he will resign from Charles River Laboratories, a publicly traded company from which he received $70,000 in cash and $215,050 in stock last year.

“The compensation for the two corporate boards came in addition to what he was paid as chief executive at Memorial Sloan Kettering,” Katie and Charles report. “In 2016, he earned $6.7 million in total compensation from the cancer center and related organizations, according to the most recent Internal Revenue Service filings.”

They adds: “Thompson’s resignation from the boards of Merck and Charles River Laboratories does not affect the eight other Memorial Sloan Kettering officials who serve on the boards of outside companies. A task force that was created in the wake of the crisis over conflicts of interest is considering a policy that would prohibit executives from holding such roles, hospital leaders have said.”

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

AGENCY ALERT
Critics say the proposed change could lead to higher levels of exposure for medical workers doing X-rays and CT scans, among others.
Associated Press
MEDICAL MISSIVES
DOJ is investigating how health plans code Medicare members.
Axios
Venture capitalists are investing some 70% more per fundraising round in healthcare startups compared to what they did a year ago, according to an analysis conducted by Pitchbook for Forbes.
Forbes
Politics
The president says he has never had alcohol, in part because of the tragic death of his older brother, Fred, of alcoholism.
Ashley Parker and Philip Rucker
A president who says he's never had a drink finds himself consumed by a political uproar over alcohol.
Politico
National Security
The random inspection by Homeland Security found numerous alleged instances of neglect and substandard care.
Nick Miroff
STATE SCAN
Politics
The Kansas City mayoral candidate said he was done “trying to outrun depression and PTSD symptoms” that he had suffered in Afghanistan 11 years ago.
Eli Rosenberg
Health & Science
A fed who led the U.S. response to the Zika virus is among this year’s honorees.
Lenny Bernstein
Are nursing staffs hired by pharmaceutical companies serving the best interest of patients or a massive violation of public trust?
Stat
DAYBOOK

Today

  • Centers for Medicare & Medicaid Services administrator Seema Verma is set to speak at an event hosted by PhRMA.
  • The Senate Special Committee on Aging holds a hearing on patient-fo used care.
  • The Senate Health, Education, Labor and Pensions Subcommittee on Children and Families holds a hearing on rare disease.
SUGAR RUSH

White House counselor Kellyanne Conway says she didn’t mean to reveal her sexual assault: