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The Health 202: Oversight of Trump administration's Obamacare actions at top of Democratic wish list

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with Paulina Firozi


House Republicans spent six years summoning President Obama’s top health officials to Capitol Hill and berating them over Obamacare.

Get ready for Democrats to do the same if they seize the House majority next month — except this time it will be President Trump’s health honchos on the hot seat.

“Our goal is to return to normalcy and finally do what Republicans have refused to do, and that is conduct independent, fact-based and credible investigations that lead to concrete reforms that help the American people,” Rep. Elijah Cummings, the top Democrat on the Oversight Committee, said in a statement provided to The Health 202.

Wielding subpoena power, Democrats are contemplating aggressive oversight of how the Trump administration is handling the Affordable Care Act, drug prices and other controversial health-policy topics. They’re chomping at the bit to highlight everything they hate about the administration’s actions — such as its slashing of ACA outreach and advertising dollars or its easing of coverage requirements — and force top officials to explain their actions in person.

Democratic aides for the two leading committees with health-care jurisdiction — the Ways and Means Committee and the Energy and Commerce Committee — also pointed to the Department of Health and Human Service’s role in Trump’s family separation policy and the Department of Justice’s refusal to defend the ACA against a lawsuit brought by Texas and 20 other states as other areas where Democrats might conduct oversight.

Assuming Democrats do take over the House (see my colleague Jackie Alemany's report on the state of play this morning) — and thus control its committees — expect a slew of oversight hearings. Democrats, who made health care a central issue in the midterm campaign, will be seeking  to highlight the narrative that the administration is trying to sabotage Obamacare and carve out its protections for vulnerable Americans such as low-income and people with serious medical conditions.

Cummings said he’s especially interested in exploring how the administration is undermining coverage for people with preexisting health conditions -- a major issue in the midterm campaign -- and why Trump has backtracked on his campaign promise to allow Medicare to set drug prices.

At least in recent years, Congress’s oversight powers have often been used in political ways. When Republicans controlled the House during the Obama years, from 2010 to when he left office in 2016, they designed hearings to draw attention to practically every problem they could find with the ACA.

The Ways and Means Committee and the Energy and Commerce Committee — and their respective subcommittees — held at least 50 hearings involving the health-care law, according to our review of hearing notices. The House Oversight Committee also convened dozens of ACA-themed hearings designed to highlight what Republicans saw as the law’s biggest flaws.

At these hearings, the committees hauled in top IRS and HHS officials — including former HHS secretary Kathleen Sebelius and former Centers for Medicare and Medicaid Services administrators Marilyn Tavenner and Andy Slavitt — where members would typically ply them with questions and interrupt them mid-answer to make their own points about the ACA.

Don’t get us wrong — oversight is a key role for whichever party is outside the White House. It’s a way for Congress to hold the executive branch accountable.

And it illustrates why divided government can be valuable. Had Democrats controlled the House during the 2013 meltdown, they may not have been as eager to seek answers about what happened and demand that HHS fix the website as quickly as possible.

After years of being battered by the GOP, Democrats may soon get their chance to question administration officials on moves they’ve made on health care, some of which have been — or may be — challenged in court.

One example is CMS’s granting of work requirements for Medicaid. Another is its dramatic expansion of state waivers that could lead to subsidizing much sparser health plans than the ACA envisioned. These are both policy changes which raise serious questions about whether the agency is going beyond what the law allows.

“We’ll conduct vigorous oversight and hold the Trump administration accountable for its culture of corruption that seriously undermines critical health-care protections,” said top Energy and Commerce Democrat Frank Pallone Jr. (D-N.J.).

There’s a danger Democrats could risk overreaching if they overwhelm the Trump administration with too many probes, my colleague Seung Min Kim writes in this broader piece on how Democrats might balance investigating and cooperating with the president. Former Democratic congressman Henry A. Waxman (D-Calif.), who led oversight efforts for Democrats after they took over the House in 2006, warned that investigations should be “approached in a straightforward, honest way.”

“Any investigation that looks like it’s just a political witch hunt or for partisan purposes will not be credible,” said Waxman, who retired from Congress in 2015. “If subpoenas are issued wildly and it’s not clear what they’re getting at, I think the Democrats would open themselves to attacks from President Trump.”


AHH: Retired Supreme Court justice Sandra Day O’Connor revealed she is suffering from dementia and will be withdrawing from public life.

O’Connor,  the 88-year-old who in 1981 became the first female justice, said in a letter released by her family that she wanted to be “open about these changes, and while I am still able, share some personal thoughts,” our colleague Robert Barnes reports.

“How fortunate I feel to be an American and to have been presented with the remarkable opportunities available to the citizens of our country,” she wrote. “As a young cowgirl from the Arizona desert, I never could have imagined that one day I would become the first woman justice on the U.S. Supreme Court.”

Robert Egge, Alzheimer’s Association chief public policy officer, said O’Connor had been involved in research around Alzheimer’s and dementia. She retired from the court in 2006, leaving to care for her husband, John, who was diagnosed with Alzheimer’s disease.

“Driven by her own experience caring for her husband as he battled dementia, Justice Sandra Day O'Connor channeled this passion in her work as a critical member of the Alzheimer's Study Group,” Egge said in a statement. “She played an important role in making Alzheimer's the national priority it is today.”

OOF: A top official at the Department of Veterans Affairs has removed a portrait of the Ku Klux Klan’s first grand wizard from his Washington office after offended employees started to collect signatures for a petition to send to VA Secretary Robert Wilkie. 

“David J. Thomas Sr. is deputy executive director of VA’s Office of Small and Disadvantaged Business Utilization, which certifies veteran-owned businesses seeking government contracts,” our Post colleague Lisa Rein reports. “His senior staff is mostly African American.

Thomas said he took the painting down on Monday after a Post reporter explained that the subject of the painting was a Confederate general and slave trader who became the first figurehead of the KKK in 1868. Thomas told the Post he was unaware of the affiliation that Nathan Bedford Forrest, the painting's subject, had with the hate group. 

Lisa notes that a "basic Google search of Forrest’s name returns various biographies detailing his role in the Confederacy and the white-supremacist strains of its aftermath."

“It was just a beautiful print that I had purchased, and I thought it was very nice,” Thomas said.

“I don’t know what to do with this thing,” Thomas told to The Post, “except to destroy it."

OUCH: The team leading the Ebola response effort in the Democratic Republic of Congo is having trouble keeping track of the outbreak, which could make the disease harder to contain.

“Public health officials had been hopeful that an experimental vaccine could help curb the spread of the outbreak,” Stat’s Helen Branswell reports. “But, for that to happen, response teams must be able to identify people who have been in contact with Ebola patients. Persistent violence in the outbreak zone has made that hard to do.”

The safety concerns in the region have hampered officials' efforts to “quickly detect cases and follow up on their contacts,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told Helen.

He added that vaccines can’t be administered “to people you don’t know exist.”

Stat’s Ike Swetlitz noted that CDC director Robert Redfield noted yesterday he made the case that American experts should remain in the DRC but was overruled by the others in the Trump administration.

“Those decisions are security decisions that really are outside the realm of my public-health expertise,” Redfield said. “I do think they’re at an enormous disadvantage by not having the expertise the CDC has on the ground.”


— The White House rejected half of the candidates selected for the Board of Veterans’ Appeals, which is run by dozens of judges who determine whether injured veterans are entitled to lifetime benefits, our Post colleague Lisa reports. The rejections came “after the White House required them to disclose their party affiliation and other details of their political leanings,” Lisa writes, noting that the board has long filled a nonpartisan role in the government.

The rejections spurred questions from former and current officials at he VA about partisanship. The candidates were selected by the board chairwoman to serve as administrative judges and make decisions about disability cases. "The rejected applicants are three Democrats and an independent," Lisa writes. "Of the four accepted by the White House and sworn in last week, three are Republicans, and one has no party affiliation but has voted in GOP primaries, according to documents and interviews."

“As part of the process, the candidates were asked to provide links to their social media profiles and disclose whether they had ever given a speech to Congress, spoken at a political convention, appeared on talk radio, or published an opinion piece in a conservative forum such as Breitbart News or a liberal one such as Mother Jones, according to one candidate, who requested anonymity because the person is not authorized to speak to the media,” Lisa reports. She added: “Such questions had not been asked of judge candidates in the past, according to former judges and board staff.”

Veterans groups said they were concerned about delays and the potentially shrinking list of candidates. “The idea that these judges may have been selected based on a political litmus test when we’re talking about taking care of veterans is very worrisome,” AMVETS spokesman John Hoellwarth told Lisa.

— HHS Secretary Alex Azar says the administration is planning to boost its aid for infants and mothers impacted by the opioid crisis. The agency intends to work with states to offer resources to help mothers with substance-use disorders and the growing number of newborns dependent on drugs, our Post colleague Lenny Bernstein reports.

Azar said HHS’s Center for Medicare and Medicaid Innovation is set to launch a program “specifically devoted to helping address the effects the opioid crisis is having on mothers and infants.” The secretary also referred to the slight drop in the rate of opioid deaths from late 2017 to early 2018, suggesting the country is starting to "turn the tide" on the opioid crisis.

“Plateauing at such a high level is hardly an opportunity to declare victory. But the concerted efforts of communities across America are beginning to turn the tide,” Azar said. “We are so far from the end of the epidemic, but we are, perhaps, at the end of the beginning.”


— CDC director Redfield chimed in on the reports of the Trump administration’s proposal to change how transgender people are identified and protected under the law. While he did not criticize the proposal explicitly, Stat’s Swetlitz reports, he said “[w]e need to understand that stigmatizing illness, stigmatizing individuals is not in the interest of public health.”

Redfield also said he was not involved in the consideration of a new policy.

— The Government Accountability Office says the Trump administration has not exhausted what it can do to fight the opioid crisis using the public health emergency declaration it made last year.

“The GAO found that since Trump declared opioid abuse a national emergency in October 2017, his administration has used three authorities pursuant to the public health emergency,” the Washington Examiner’s Robert King reports. “But GAO found that as of July 2018, there were 14 other authorities that became available after the declaration that the administration has not used.”

HHS has said it has not used these authorities because it said “many are not relevant to the circumstances presented by the opioid crisis,” according to the GAO report.


— House Oversight Democrats released a report this morning laying out potential consequences of the Trump administration’s move not to defend the provisions that protect patients with preexisting conditions in Texas ACA lawsuit. Here are some of the key estimates in their report, which assumes the law is ultimately overturned:

  • An estimated 15,631,000 people in the individual market could be at risk of losing federal protections that guarantee coverage or prevent premium increases.
  • An estimated 10,030,000 people with preexisting conditions who buy insurance through the individual market could lose such protections.
  • An estimated 4,823,000 of those have conditions “severe enough that insurers may deny them coverage altogether."

— Voters in three states will have the chance to vote on midterm ballot initiatives that look to ban or limit access to abortion.

The initiatives in West Virginia and Alabama “would amend those state constitutions to expressly declare that abortion rights are not protected, allowing conservative state legislatures to ban the procedure should the high court strike down Roe vs. Wade,” Politico’s Alice Miranda Ollstein reports. “A third measure in Oregon would effectively cut off public funding for abortions, blocking access to residents enrolled in Medicaid and state and municipal employee health plans."

The conservative Supreme Court majority resulting from the confirmation of Judge Brett M. Kavanaugh has perhaps pushed those opposed to abortion rights to rally last-minute support for the initiatives, Alice writes.

"Even if all three measures fail, their presence on the November ballot may drive turnout in close races," Alice adds. "Conservatives are particularly hoping that the abortion question boosts the fortunes of Republican Patrick Morrisey, who currently trails Sen. Joe Manchin (D-W.Va.) by double digits."


— A new survey reveals that a quarter of college students could develop future stress or post-traumatic stress disorder following the 2016 presidential election.

In a survey of 769 introductory psychology students at Arizona State University in January and February of last year, the analysis found that 25 percent of students had “clinically significant event-related distress,” our Post colleague Isaac Stanley-Becker reports. The report argues that distress “can predict future distress as well as diagnoses of PTSD, commonly associated with veterans and defined by the Mayo Clinic as ‘a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it,’” Isaac writes.

“The analysis reveals that women, racial minorities, people from working and lower-middle social classes, Democrats, non-Christians and sexual minorities reported significantly more election-related distress,” Isaac writes. “Controlling for party affiliation, other demographic factors still influenced stress symptoms. In other words, Hagan said, it wasn’t just a case of sore losers.”

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

Transgender protections could be rolled back — again — under the Trump administration (Eugene Scott)


People with mental illness share what they want scientists to study (Stat)

E-cigarette maker Juul boosts lobbying more than 400 percent amid scrutiny (The Hill)


How One Colorado Town Is Tackling Suicide Prevention — Starting With The Kids (NPR )

Stacey Abrams and Brian Kemp Renew Attacks in Georgia Debate (New York Times)

Rick Scott defends health care record in new ad: 'For me, it’s personal' (The Hill )


FDA launches global crackdown on websites selling illicit opioids and drugs (Washington Examiner)


Coming Up

  • The Medicaid and CHIP Payment and Access Commission holds a public meeting starting Thursday.
  • The American Enterprise Institute holds an event on postelection analysis for 2018 and beyond on Nov. 8.

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on Nov. 28.