THE PROGNOSIS

President Trump tweeted yesterday that "all" Republicans support protections for people with preexisting health conditions, adding that he'd work to change the minds of any in his party who disagree. 

Trump's tweet comes as Republicans work to fend off a slew of Democratic attacks that the failed congressional attempt to repeal and replace the Affordable Care Act means they don't actually support protecting access to care for those with health conditions. Many GOP candidates are airing campaign ads pledging their support for preexisting condition protections and some endangered incumbents have introduced bills in Congress to ensure that the protections remain.

Senate Majority Leader Mitch McConnell (R-Ky.) reinforced the urgent GOP message in an interview with Bloomberg News this week that the GOP is able to "deal with" the attacks on health care, which has become the central issue in the midterm campaign in which control of Congress is at stake. "There's nobody in the Senate that I'm familiar with who is not in favor of coverage of preexisting conditions," McConnell said.

Here's the problem, however, with what McConnell and Trump are saying: Making sure people with preexisting protections are able to afford health care is part of the reason the ACA was passed to begin with. Before Obamacare, people with costly conditions had trouble accessing health care. Now, insurers are no longer allowed to deny them coverage or charge them higher premiums because of their illnesses.  And while the president -- and Republicans on the campaign trail -- are touting support for these protections, health-care experts said they seem to be disregarding their own actions to overturn Obamacare. 

Matthew Fiedler, a health-policy expert at the Brookings Institution, said there is a "conflict between what the president is saying here and the legislation that Republicans and the president himself supported during last year's repeal debate."

Really, are three problems with the GOP claim, Fielder and other experts say:

1. The House effort to repeal and replace Obamacare included an amendment allowing states to request waivers that would have essentially nullified the preexisting conditions protections it promised.

 2. Trump's Justice Department has refused to defend Obamacare against a lawsuit that 20 state attorneys general have brought in Texas. The GOP officials want to eliminate the ACA because a key part of it, the individual mandate -- originally intended to help pay for sick individuals to get affordable coverage --  was thrown out in last year's GOP tax overhaul.

McConnell has defended the ACA lawsuit, telling Bloomberg, "It’s no secret that we preferred to start over [to repeal and replace Obamacare]…So no, I don’t fault the administration for trying to give us an opportunity to do this differently and to go in a different direction."

3. Republicans are still pushing to repeal the ACA. 

Sabrina Corlette, a senior research fellow at Georgetown University's Center on Health Insurance Reforms and a former committee aide to then-Sen. Tom Harkin (D-Iowa), called the president's claim that Republicans want to protect preexisting conditions  a "baldfaced lie," referring to the administration's decision not to fight the ACA lawsuit in Texas.

"I don't want to suggest the ACA is the only exclusive way to protect people with preexisting conditions. People could come up with other policy proposals to get the same result, but they haven't," Corlette said. "Every single thing [the GOP has] come up with through the whole repeal and replace debate would have left people without coverage, paying more, or without specific benefits they need for coverage." 

Democrats pounced on the president's tweet yesterday. From House Minority Leader Nancy Pelosi (D-Calif.): 

And Sen. Brian Schatz (D-Hawaii) had this to say about the idea of Republicans pushing their support for preexisting condition protections: 

Another prime example of the dueling rhetoric on the campaign trail from Democrats and Republicans: During a debate last night between Sen. Claire McCaskill (D-Mo.) and her Republican opponent, Missouri Attorney General Josh Hawley, the senator criticized Hawley for his role as one of the attorneys general leading the lawsuit to overturn the ACA. 

Health care has been a prime focus in this particular race as the candidates have traded fire on the issue. Both have released personal ads saying they want to support protections for preexisting conditions. 

During the debate, Hawley called for such protections but also criticized the ACA. "We can protect people and we must with preexisting conditions," Hawley said. "But they shouldn't be forced to pay the prices they are paying now. They shouldn't have the narrowing of networks that we are seeing all over this state because of Obamacare."

But McCaskill replied by saying: “You don’t go to court and get rid of important protections when there is no backup.” “There is no backup plan for preexisting conditions if he’s successful,” she said. “If he believes we should protect preexisting conditions, he should ask tomorrow for the case to be dismissed.”

Here's why the president, as well as both Republican and Democrats on the trail, keep bringing up this issue: It's deeply personal for candidates and for voters.

A new tracking poll from the Kaiser Family Foundation found that in Florida and Nevada -- two bellwether states where health care has been a top focus -- more than half of respondents said they or someone in their household has a preexisting condition. The poll also found more than 70 percent of voters said health care is a “very important” issue that will influence who they vote for in November. And in Florida and Nevada, majorities of voters said they are more likely to vote for a candidate who supports maintaining the ACA’s protections. To that end, a Post-ABC News poll released this week found Democrats have an 18-point advantage over Republicans on which party voters say would do a better job of handling health care. 

KFF has estimated that 27 percent of all American adults ages 18-64 – about 52 million people – have a preexisting condition that could have prevented them from accessing health coverage before the ACA. In 2016, the foundation compiled a list of what insurers considered “declinable medical conditions" that could have resulted in them being denied coverage before Obamacare was passed in 2016.

Along with cancer, pregnancy, mental disorders and alcohol and drug abuse -- some of the commonly cited examples of preexisting conditions -- the foundation listed more than two dozen common conditions that would mean patients would find it harder to get coverage. The list includes congestive heart failure, arthritis, severe obesity, diabetes and paralysis.

“That’s just the starting point,” Karen Pollitz, a senior KFF felow, told The Health 202.

Pollitz said the issus surrounding preexisting conditions are complicated and also fluid, as some conditions like pregnancy can be temporary. But that also means that some kind of condition can affect practically everyone.

“We all get them, it’s just a matter of timing,” she said. “Nobody is made out of cast iron, nobody never develops a preexisting condition.”

AHH, OOF and OUCH

AHH: If you’re still unconvinced of how central the issue of health care is in these midterm elections, just take a look at the report out yesterday from the Wesleyan Media Project.

From Sept. 18 to Oct, 15, it found that 45.9 percent of television ads aired in federal races mentioned health care, as did just over 30 percent of ads that aired in gubernatorial races.

The report also noted the topic is “most prominent in ads supporting Democrats, appearing in 54.5% of pro-Democratic airings.” There are mentions of health care in 31.5 percent of Republican ads this year. 

That's a huge shift from previous cycles. The report found that in 2010, after the ACA was passed, health care appeared in 8.7 percent of pro-Democratic ads and 33.9 percent of pro-Republican ads in federal races. Health care appeared in 7.7 percent of pro-Democratic ads in 2012, 7 percent of them in 2014 and 10 percent of spots in 2016. On the Republican side, health care was mentioned in 28.4 percent of pro-Republican ads in 2012, and 20.8 percent in 2014 and 16 percent in 2016.

“After the Affordable Care Act passed, Democrats ran away from health care as a campaign talking point while Republicans used the issue as a central point of attack,” Erika Franklin Fowler, co-director of the Wesleyan Media Project, said in a statement. “Unified Republican control of government has changed the calculus for both parties this cycle with Democrats going on offense and Republicans searching for new ways to talk about the issue.”

OOF: There are 245 migrant children still in government custody, the American Civil Liberties Union says, four months after a federal judge ordered the Trump administration to reunite families it separated at the border as part of their controversial “zero tolerance” immigration policy.

A new analysis of government data from the ACLU found the parents of 175 of the children have been deported, and 125 of them have decided to stay in the United States to pursue asylum on their own, our Post colleague Arelis R. Hernández reports. The parents of another 70 kids are still in the United States.

A federal judge ordered the federal government to reunite all 2,654 children originally in custody as soon as possible following a lawsuit from the ACLU. But the ACLU’s Lee Gelernt, lead attorney on the child separation lawsuit, said it’s “taking forever. “[I]t shouldn’t be taking this long,” he said. “It is an enormous task, but on the other hand, it’s the United States government. When they really prioritize something, they can get it done.”

The report found more than 1,000 of the children, who had been placed in the custody of the Department of Health and Human Service’s Office of Refugee Resettlement, were under 10-years-old. They were scattered among 121 shelters in 17 states, Arelis reports.

 “The report was released this week, as President Trump is promising a renewed crackdown on the record number of migrant families entering the United States and weighing whether to launch a modified version of the family separation effort to deter migrants from crossing the border,” Arelis writes.

OUCH: The New York Times’s Christina Goldbaum has a shocking investigative piece about a wave of sexual abuse accusations against a doctor that the hospital at which he worked says it knew about. It’s worth reading in full, but here’s the top line of her report.

“For almost 30 years, parents sought out Dr. Reginald Archibald when their children would not grow,” Christina writes. “They came to his clinic at The Rockefeller University Hospital, a prominent New York research institution, where he treated and studied children who were small for their age. He also may have sexually abused many of them.”

The hospital sent a letter last month to former patients of Archibald, who died in 2007, asking for information about their interactions with the doctor.  Days later, the hospital posted a statement online about evidence of “inappropriate” behavior with patients. The hospital said it first learned of “credible allegations” in 2004, Christina writes.

“The New York Times spoke with 17 people, most of them men, who said they were abused by Dr. Archibald when they were young boys or adolescent,” she writes. “Most of them learned of the possibility of other victims for the first time when they received the letter. A few, however, said they had filed complaints with the hospital or authorities in the past, but their allegations were not investigated.”

HEALTH ON THE HILL

— Sens. Elizabeth Warren (D-Mass.) and Ron Wyden (D-Ore.) are calling on the Trump administration to answer questions on the implementation of its “zero tolerance” immigration policy following a report that suggested officials provided misleading information about the method for tracking separated families.

Our Post colleagues Nick Miroff, Maria Sacchetti and Seung Min Kim wrote on the report from the Department of Homeland Security’s Inspector General earlier this month.

In the letter sent Wednesday, the senators call on HHS Secretary Alex Azar to respond to questions about details of the agency’s method for tracking and matching separated children and parents. They also called for information about what steps the agency is “now taking to ensure that children in its custody can be matched promptly with their parents or other family members.”

"We were, and continue to be appalled by the administration's cruel policy of family separation, and disturbed by the possibility that your agency provided inaccurate or misleading information to Congress and to the American public on the administration's ability to locate and track these children," they wrote in the letter.

Warren and Wyden requested that HHS respond to the questions by Nov. 2.

STATE SCAN

— Virginia Gov. Ralph Northam (D) announced the state will begin accepting applications for its expanded Medicaid program on Nov. 1, and coverage for the newly eligible will begin at the beginning of 2019.

“As Medicaid-expansion states go, Virginia is bringing up the rear, signing on long after most states that opted to enlarge the federal-state insurance program for the poor,” our Post colleague Laura Vozzella reports.  “The General Assembly voted earlier this year to add up to 400,000 uninsured, low-income Virginians to the state’s Medicaid rolls… Federal officials notified the state last week that they had signed off on Virginia’s expansion, clearing the way to move ahead.”

“It was a long time coming, but we’re glad it’s here,” Northam said. “I really believe that we can be leaders in Virginia and show the rest of the country how to move forward.”

The state is still waiting on approval from federal officials on its plan to “customize its program by imposing work requirements and co-pays on recipients,” Laura notes, but it will still implement expansion while it awaits that approval.

MEDICAL MISSIVES

— Fertility rates in the United States have declined, the Centers for Disease Control and Prevention has found, noting that the decrease comes as first-time mothers are getting older.

The CDC found that total fertility rates dropped for women in both rural and urban areas, ABC New’s Anna Jackson reports, noting that the rate is based on the “total number of births in an area to the population of women most at risk of childbearing.” “In rural counties, rates declined 12 percent, in small or medium metro counties, rates fell 16 percent and major metros saw a drop of 18 percent,” Anna reports. 

The average age of first-time mothers rose 1.3 years from 23.2 years-old to 24.5 years. Broken down by area, “in medium-sized regions it rose to 25.8 years from 24.3 and in major metros it climbed to 27.7 years from 25.9,” Anna adds.

— And here are a few more good reads: 

Republicans across the country are telling voters they’ll protect preexisting conditions rules even though many of them have voted against the healthcare law dozens of times.
Los Angeles Times
Despite congressional GOP candidates' promises, health policy analysts doubt whether victorious Republicans would move to replace those ACA protections with equally strong measures to cover people with health conditions as part of repeal legislation.
Modern Healthcare
AGENCY ALERT
Migrant children who come into the U.S. without family are staying longer in crowded shelters as authorities struggle to handle their growing numbers and to screen potential sponsors.
Wall Street Journal
Local
The CDC says the disease has sickened 62 children this year and killed one.
Andrea K. McDaniels
John Mashburn, a former Trump White House official, is leaving the Energy Department for a senior position at the Department of Veterans Affairs, according to three people familiar with the move.
Politico
INDUSTRY RX
Dialysis companies have contributed more than $104 million to defeat an initiative on California’s Nov. 6 ballot that would limit their profits — and are on the cusp of breaking the $109 million re…
California Healthline
OPIOID OPTICS
SUGAR RUSH

What can we expect in the 2018 midterms? Here's what the polls say:

From The Post's Fact-Checker team: "Dear attack-ads, use our Pinocchios correctly or not at all":