THE PROGNOSIS

Almost a year after Maine voters overwhelmingly decided to expand Medicaid to tens of thousands of people, the measure has not yet gone into effect. But supporters of the effort have another shot at tipping the scales in their favor in the open gubernatorial race in November. 

Nearly 60 percent of voters said yes to the ballot initiative last November to approve expansion, but Republican Gov. Paul R. LePage — who is term limited  — has done everything he can to block its implementation, citing concerns over funding. Before it appeared on the ballot, he had vetoed bills to expand Medicaid five times, and now it’s tied up in an ongoing legal battle.

Candidates who could follow LePage appear to be more open to implementing the ballot initiative. Democratic gubernatorial candidate Janet Mills has been a vocal supporter of Medicaid expansion. Independent candidates Terry Hayes and Alan Caron have also said they would implement it. The Republican candidate Shawn Moody previously seemed to follow LePage's lead in opposing expansion, but now says he would implement the law as long as there is funding. 

Voters in Maine and across the country have turned their focus to health care as a top priority influencing their vote in November. A new Washington Post-ABC News poll found 82 percent of respondents said health care was either the single most important or a very important issue in their vote for Congress this year. In Maine, a poll from Suffolk University in Boston in August found health care was the chief concern for respondents in deciding who to vote for as governor, with 28 percent saying that was their top concern. The same poll found 56 percent of those surveyed said they disagree with LePage’s position against expanding Medicaid.

The outcome could also make the state a leader nationally in health-care policy. Maine’s initiative last year buoyed similar movements in red states across the country. Ballot initiatives to expand Medicaid will appear in Utah and Idaho next month. And Utah activists learned from the experience of those in Maine. As The Health 202’s Paige Winfield Cunningham reported in June, when voters in that state head to the polls they will not only be asked to vote on whether the program should be expanded, but on a proposal to pay for it.

Mills has said she would implement Medicaid expansion on her first day in office.

In an interview with The Health 202, Mills criticized the governor for “essentially trying to veto what the people did at the ballot box.”

She said beyond providing access to 70,000 additional low-income people who would become eligible for health care, expansion would create thousands of jobs and support the state’s rural hospitals.

During a gubernatorial debate last week, Mills called Medicaid expansion “vital.” Of the four candidates on the stage, Moody was one of two candidates who did not also mention Medicaid.

In an emailed statement, Moody’s campaign manager, Lauren LePage, said the candidate “will implement and enforce the law with sustainable and responsible funding from the Legislature.” Lauren LePage, who is Gov. LePage’s daughter, added: “Shawn does not believe that a sustainable and responsible funding plan requires raising taxes, raiding the state’s rainy day fund, or using other one-time budget gimmicks … As Governor, Shawn would get the stakeholders around the table to negotiate a funding mechanism including hospital providers, legislators, and other impacted entities.”

But Moody hasn’t been entirely consistent about his stance. During the primary, he told the Portsmouth Herald that “welfare expansion will not strengthen Maine’s economy,” adding “I will not support funding Medicaid expansion by raising taxes on hard-working Mainers or job creators.”

In a June primary debate, Moody said he “did not support Medicaid expansion” and would “fight to repeal it.” Local station WMTW News’s Paul Merrill reported the campaign told him his previous remarks were while “the Legislature was still in session and there was an opportunity to address Medicaid expansion.”

Patricia Boozang, a senior managing director at consulting firm Manatt Health, zeroed in on Moody’s “caveat on responsible funding.”

“I think that’s consistently been Gov. LePage’s position that ‘we can’t support it because we can’t fund it.’ The question will be whether voters view that as a distinction in his statement compared to where the governor’s view is on that.”

Boozang suggested the election could have an impact on health care nationwide. “Overall, you’ll likely see just a more aggressive and bolder health reform agenda, sort of like what you’re seeing in New Jersey and Virginia, if there’s a Democratic governor and of course a Democratic legislature,” she said. 

Meanwhile, the LePage administration last month finally submitted court-ordered documents needed to expand Medicaid. But along with that plan, LePage sent a letter to CMS Administrator Seema Verma urging the federal government to reject it.

Robyn Merrill, executive director of Maine Equal Justice Partners, the advocacy group leading the legal fight against the LePage administration, pointed to the governor’s veto of a $60 million Medicaid expansion funding bill that the state legislature approved in June.

“In our Maine constitution it says the governor cannot veto a citizen’s initiative,” she added. “But he’s doing that in effect by vetoing the implementing legislation, the appropriations bill. It’s disingenuous at best.”

Merrill lamented the “confusion and worry for people who have significant health-care needs” as a result of the delay but said expansion will ultimately be implemented regardless of the outcome of the election.

“It’s just taken longer than we hoped, but it is going to happen, regardless of who is elected, because it is the law of the land.”

Keeping up with the news in President Trump’s Washington is exhausting — whether you live here, work in the nation’s capital, or are just watching from afar. That’s why tomorrow, we’re launching Power Up by Jacqueline Alemany. It's a new newsletter from The Washington Post that will land in your inbox before you reach for that first cup of coffee. It will bring you Washington, fast.

Click here to sign up.

AHH, OOF and OUCH

AHH: The Trump administration is set to announce a proposal this week to require pharmaceutical companies to list drug prices in ads, Politico’s Dan Diamond and Sarah Karlin-Smith report.

It would be the latest move from the administration outlined in the president’s drug pricing blueprint that was released in May and “follows months of battles between the administration, congressional leaders and the pharmaceutical industry,” Dan and Sarah write. “But experts caution that the impact may be relatively insignificant and it could even confuse patients, considering the complexities of drug pricing,” they add.

Health and Human Services Secretary Alex Azar is expected to give a speech related to the administration’s drug pricing moves today. And the agency’s proposal could be published in the Federal Register as soon as today as well, per the report.

“While we cannot comment on pending regulations, the President’s ‘American Patients First’ blueprint to lower prescription drug prices and reduce out-of pocket costs clearly states that HHS is looking at options to require drug pricing transparency," HHS spokesperson Caitlin Oakley told Politico. "It should not come as a surprise that this would require rulemaking."

OOF: The Food and Drug Administration announced Friday it is investigating whether e-cigarette products are being illegally marketed.

It’s just the latest move in the agency’s effort to crack down on youth vaping, our Post colleague Laurie McGinley reports.

The FDA sent warning letters to 21 importers and manufacturers, asking them to provide information about when their products went on the market to determine if they needed to receive FDA clearance before going on sale. “If the FDA determines that the products are being sold illegally, the companies could face fines, seizures or a court order to take them off the market,” Laurie writes. “Friday’s move is the agency’s first large-scale action to enforce the requirement that products introduced after the August 2016 date get advance agency clearance, officials said.”

FDA Commissioner Scott Gottlieb said the agency is prepared to “swift action when companies are skirting the law.”

OUCH: Senators from Iowa and Minnesota are calling on the Centers for Disease Control and Prevention to look into the recent outbreak of acute flaccid myelitis that has occurred in both states.

“We are writing to understand what steps the Centers for Disease Control and Prevention (CDC) is taking to investigate the recent increased reports of acute flaccid myelitis (AFM). In recent weeks seven children have been diagnosed with AFM in Minnesota and Iowa, including two children who required treatment in the intensive care unit for respiratory support,” Democratic Sens. Amy Klobuchar and Tina Smith of Minnesota and Republican Sens. Joni Ernst and Charles E. Grassley of Iowa wrote to CDC Director Robert Redfield.

The senators call on the CDC to detail what initiatives the agency has to track diagnoses, research the causes and treatments of AFM and how the agency is coordinating with health departments to provide information to physicians and hospitals.

TRUMP TEMPERATURE

— Trump confirmed a report from The Post that his administration is considering a new policy that could again separate parents and children at the United States’ border with Mexico.

“We’re looking at everything that you could look at when it comes to illegal immigration," Trump told reporters on Saturday, our colleague Philip Rucker reports, saying the administration’s controversial move to separate families successfully deterred people from illegally crossing into the country. “If they feel there will be separation, they won’t come.” 

“The Post first reported Friday that the White House was actively considering plans to again separate parents and children at the U.S.-Mexico border,” Philip writes. “Senior administration officials noted, however, that they are not planning to revive the chaotic forced separations carried out by the Trump administration in May and June that spawned an enormous political backlash and led to a court order to reunite families.”

Our colleagues Nick Miroff, Josh Dawsey and Maria Sacchetti reported that “[o]ne option under consideration is for the government to detain asylum-seeking families together for up to 20 days, then give parents a choice — stay in family detention with their child for months or years as their immigration case proceeds, or allow children to be taken to a government shelter so other relatives or guardians can seek custody.”

AGENCY ALERT

— Four months after a “tent city” in TornilloTex. opened to house separated immigrant families, the shelter holds five times the initial number of children that it initially housed. There are about 1,500 teens living at the site, and its contract has been extended through the end of 2018, BuzzFeed News’s Amber Jamieson reports.

Some teens have spent weeks or months at the facilities run by HHS before arriving in Tornillo, and officials say the average length of time spent there is 25 days. They’re sent there “to await final processing before they are released to a sponsor in the U.S." “The tent city's purpose has changed as well,” Amber writes. “Officials at the Department of Health and Human Services, the federal agency responsible for the care of unaccompanied child immigrants, say none of the teens currently housed there were detained as a result of family separations. It now holds immigrant children who crossed the border without an adult, in theory as a last stage of their stay in the vast U.S. shelter bureaucracy.”

Amber writes that the incident commander at the shelter thought the camp would shut down soon after a federal judge ordered the Trump administration to end family separations. “I'm still here, 'cause otherwise, where are these kids going?” the commander said as reporters toured the facility. The Tornillo facility in the largest in the HHS’s system nationwide, Amber writes. There are kids only ages 13 to 17 at the facility, and there are strict parameters. Pregnant teens or those who need behavioral medication are not permitted to stay at the shelter.

The incident commander also said the delay in how long these teens are at the facility is a result of a new requirement imposed by the Trump administration that they get a fingerprint background check from the FBI. “It is the extra precaution that HHS has put in place for sponsors,” the incident commander said. “That is absolutely what has caused this, without any question whatsoever.”

HEALTH ON THE HILL

— Sen. Claire McCaskill (D-Mo.) is kicking off a health-care focused tour with two events in Kansas City, Mo. And Odessa, Mo. this afternoon.

The “Your Health Care, Your Vote” push will continue for a week, the campaign tells The Health 202. McCaskill will travel the state to talk health care, an issue she’s been laser-focused on amid her tough reelection fight, as our colleague Colby Itkowitz reported in The Health 202 earlier this month. Her Republican opponent, Attorney General Josh Hawley, is part of the lawsuit brought by 20 Republican-led states looking to overturn the Affordable Care Act.

 — Democrats sudden move to saturate their campaigns with talk of health care after avoiding talking about it several election cycles makes it one of the top themes of the upcoming midterm elections. Our Post colleague Amber Phillips ranked some of the most talked about health-care themed ads from this year as fifth in a list of 13 ads that are defining next month’s elections.

Amber describes three particular health-care focused ads including one against Rep. John Faso (R-N.Y.) that has been described as “devastating,” another featuring Rep. Rodney Davis (R) smiling at the news conference where the GOP passed the House bill undoing Obamacare and another from the Democrat running for retiring House Speaker Paul D. Ryan’s (R-Wis.) seat.

INDUSTRY RX

— In a move to be more upfront about their financial ties, top researchers with Memorial Sloan Kettering Cancer Center have recently filed corrections with a handful of medical journals to disclose those financial relationships with health care companies, something they previously did not divulge. The effort follows the resignation of the center’s chief medical officer José Baselga last month after reporting from the New York Times and ProPublica revealed Baselga did not disclose his ties in dozens of medical journal articles.

The New York Times’s Katie Thomas and ProPublica’s Charles Orenstein write: “Since then, medical centers around the country, including Dana-Farber Cancer Institute in Boston and N.Y.U. Langone Health, have urged their researchers to review whether they properly reported relationships to outside companies.”

A spokesman for Memorial Sloan Kettering said the hospital told its researchers to “review their conflict-of-interest disclosures and submit corrections where necessary,” Katie and Charles write. “Beyond revisiting disclosures, Memorial Sloan Kettering is undertaking a broader review of its staff’s interactions with the health care and pharmaceutical industries, including whether senior leaders should sit on the boards of publicly traded companies. It also said it would hire an outside law firm to investigate specific allegations made following Dr. Baselga’s departure.”

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

STATE SCAN
National
The regulated California cannabis market is a $4-billion-a-year industry, a boon to the local tax base. Legalization already is reordering the business and geography of cannabis cultivation.
Scott Wilson
Fact Checker
The Democratic Congressional Campaign Committee uses a Republican's minor procedural votes to attack him for selling out his constituents on protecting a key part of Obamacare, even though he didn't.
Glenn Kessler
MEDICAL MISSIVES
The decision by the State Department is fueling worry over the impact on efforts to contain the epidemic spreading in the Democratic Republic of the Congo.
Stat
Health & Science
Some of the contaminants have been withdrawn from the market for safety reasons
Lenny Bernstein
People waiting in the many lines scattered throughout the region at grocery stores and gas stations are seeking water, ice, fuel and other essentials.
The New York Times
In Pennsylvania’s iconic Philadelphia suburb, there’s one thing Republicans and Democrats agree on: The country’s health care system is broken and getting worse.
Politico
It would save money compared with private plans, but would also probably shed features that some might miss.
The New York Times
The exchange demonstrated how Democratic arguments about health care are resonating with voters in the final weeks before the midterm elections. While Democratic enthusiasm this year has largely been fueled by anger toward President Donald Trump, candidates have targeted their messaging to focus more on health care.
Associated Press
Health & Science
Medical experts explore the causes of the painful, debilitating ailment.
Marlene Cimons
Politics
The Washington Post-ABC News poll also shows that a narrow majority says congressional investigation of the new justice should not end with his elevation to the court.
Robert Barnes and Emily Guskin
DAYBOOK

Today

  • HHS Secretary Alex Azar is set to speak at the National Academy of Medicine’s forum on “Affordable Medicines: Access, Innovation, and the Public Interest” as part of NAM’s annual meeting.
  • Brookings Institution hosts an event on “Crafting public policy to address the nation’s opioid epidemic,” moderated by The Post’s Katie Zezima.
  • The American Enterprise Institute holds an event on “Nurse practitioners and America’s primary care shortage.”

Coming Up

  • The FDA hosts a joint meeting of the Gastrointestinal Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee on Wednesday.
  • The FDA hosts a meeting of the Gastrointestinal Drugs Advisory Committee on Thursday.
  • Politico hosts an event on “Using Tech and Innovation to combat opioid abuse and diabetes” on Thursday.
  • Brookings Institution holds a conversation with CMS administrator Seema Verma on Thursday.
SUGAR RUSH
Watch 8 noteworthy moments from Trump’s ‘60 Minutes’ interview