THE PROGNOSIS

Abortion rights are on the ballot next week, as voters in three states will consider significant measures to restrict or limit access to the procedure in what could set the stage for further legal action in the states and nationally.

The moves by antiabortion activists in states like West Virginia,  Oregon and Alabama come in the wake of the confirmation of Brett M. Kavanaugh to the Supreme Court and major concerns from abortion-rights supporters that a new conservative consensus on the high court could overturn the landmark 1973 Roe v. Wade decision outlawing restrictions on the procedure before the fetus is viable. The result could be a patchwork of laws that vary according to the political leadership in different states.

In West Virginia and Oregon, voters are set to decide on a pair of measures that would block public funding for abortions by preventing state taxpayer money from covering abortions for individuals on Medicaid except for in cases of rape, incest or when the mother’s health is at risk.

In West Virginia and Alabama, voters must choose whether to change their respective state constitutions to declare that abortion rights are not protected. Alabama’s ballot initiative goes a step further to say that a fetus has "personhood" protections at conception and is thus protected by  its constitution.

The stakes are high for both sides in the highly charged abortion debate.

Opponents of the Alabama and West Virginia measures say that, if successful, they could expand the existing map of states that could ban abortion in the case that Roe is overturned. Currently, four states have so-called “trigger” laws, or abortion bans that could go into effect soon if Roe is overturned. Nine states, including Alabama and another one of the "trigger" law states, have pre-Roe abortion bans that were never repealed.  

 “What we’re looking at is a potential rolling back of federal protections of abortion and the decreasing protections in the Alabama and West Virginia constitutions,” said Elizabeth Nash of the Guttmacher Institute, which supports abortion rights.

Nash said abortion access is not often an issue left in the hands of voters, so the ballot initiatives on three pivotal issues this year could have wide-ranging consequences.

“Usually you see candidates going back-and-forth on abortion or going back-and-forth on whatever the hot social issue is,” she said. “You don’t see it playing out with voters and in ballot initiatives.”

Here are a few more details about each state’s ballot measures:  

West Virginia

Amendment 1 would add language to the state’s constitution to say “nothing in this Constitution secures or protects a right to abortion or requires the funding of abortion.”

If successful, the immediate impact would be that the procedure is no longer covered for Medicaid beneficiaries.

Opponents argue the measure goes beyond funding for abortion and sets the stage for further state-level restrictions if Roe is overturned.

“If it was about Medicaid, that’s all this amendment would say,” said Julie Warden with WV Free, a state abortion-rights group that opposes the measure. “But they added language to allow them to make further restrictions in the future. Legislatures aren’t silly; they put language in these things that they want in these things.”

But Wanda Franz, president of West Virginians for Life, which supports the measure, dismissed that argument. She said the measure would not “stop people from getting abortions.” “It simply cannot, and what it is doing is taking the issue of abortion out of the state constitution.” Franz said the measure is in response to a 1993 state Supreme Court decision that struck down a Medicaid funding ban for abortions.

Mallory Quigley, spokeswoman for the antiabortion group Susan B. Anthony List, which launched a campaign in the state to advocate for the measure, said the measure allows an “opportunity for the people to speak.”  “The people’s voice, the pro-life people’s voice, has really been shut down in a lot of these instances,” Quigley added. “The fear-mongering going on is that this is an amendment that’s about criminalizing abortion when it’s been made very clear that this is about protecting the rights of taxpayers.”

During a debate Thursday night between Sen. Joe Manchin III (D-W.Va.) and his Republican challenger Patrick Morrisey, Manchin signaled his opposition to the amendment because it does not explicitly provide exceptions on the abortion ban for life of the mother, rape or incest.

Alabama

Like the measure in West Virginia, the initiative would change Alabama's constitution to no longer protect abortion rights and funding for the procedure. The measure would require state policy to “recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life” and also to “ensure the protection of the rights of the unborn child in all manners and measures lawful and appropriate.”

If passed, Amendment 2  wouldn’t necessarily have an immediate impact on abortion access for Alabamians. But abortion-rights advocates say it could lead to restrictions if Roe is overturned. 

“It paves the way to ban abortion without exception,” said Katie Glenn, Alabama state director with Planned Parenthood Southeast. She said the measure’s advocates “would like folks to believe that if Amendment 2 passes, the Alabama legislature would carve out exceptions. But if they wanted to place exceptions for rape, incest or health of a person in this amendment, they would have.”

Oregon

If it passes, Measure 106 would change the state constitution to say the state “shall not spend public funds for any abortion, except when medically necessary or as may be required by federal law.”

The immediate impact would be to block the state’s Medicaid beneficiaries and people who have state and local employee health plans from being able to use their health coverage for the procedure. The measure does allow exceptions for cases of rape, incest or if a mother’s life is at risk.

Nichole Bentz, spokeswoman for the Yes on Measure 106 campaign denied the measure was intended to be a “ban on abortion.” Advocates have largely framed their message around tax dollars rather than around abortion rights. “It doesn’t stop anyone from choosing abortion, but it gives people the freedom from having to pay for them,” Bentz said. “Public funds shouldn’t be going to that controversial, that personal, of a choice when they’re not medically necessary.”

But opponents say the initiative disproportionately targets low-income women. Ashley Gray, state advocacy adviser at the Center for Reproductive Rights, said it not only blocks coverage for Medicaid enrollees but also “denies abortion coverage to even more women who are Oregon state employees — nurses, teachers and firefighters. What that essentially does is create a backdoor ban, as we call it, that restricts access to only those people who can afford it.” 

Polling suggests long odds for the initiative in a progressive state where both Democratic Gov. Kate Brown and her Republican challenger have said they're against it. A recent poll commissioned by Oregon Public Broadcasting found most respondents opposed the measure 50 percent to 31 percent, with 19 percent saying they were unsure.

Emily McLain, the executive director of Planned Parenthood Advocates of Oregon, said Kavanaugh’s nomination drove awareness of the measure and the midterm elections overall. “The nomination of Kavanaugh to the Supreme Court was a real day of reckoning,” she said. “More millennials, more women and young folks are paying attention to this election because of that.”

Correction: An initial version of this story included a map of ten states with pre-Roe abortion bans. The map has been updated to reflect that Massachusetts repealed its ban in July. There are nine states with pre-Roe bans.

AHH, OOF and OUCH

AHH: It seems like we’ve blinked and gone back in time.

In 2008, when Barack Obama first ran for president, he touted a promise to “force insurance companies to cover preexisting conditions.” Now, Republicans are claiming the rhetoric for themselves, our Post colleague Glenn Kessler writes.

“Before Obamacare, insurance companies could consider a person’s health status when determining premiums, sometimes making coverage unaffordable or even unavailable if a person was sick or had a condition that required expensive treatment,” Glenn writes. “The ACA included a series of provisions that prohibited such practices, but then Republicans spent years trying to repeal the law.”

The Pinocchio Test: Glenn examines ads from GOP Reps. Scott Taylor (Va.) and Rep. Martha McSally (Ariz.) who is running for Senate. (He also notes that Florida Gov. Rick Scott, a Republican running for Senate, also makes a similar claim in an ad.) He gives Taylor and McSally three Pinocchios for their claims.

“Under fire from their Democratic rivals for their votes on health care, McSally and Taylor are misleading voters,” Glenn writes. “The protections for people with preexisting conditions are already pretty strong in the ACA. Both lawmakers cast votes that the CBO said weakened protections against price increases, especially in states that took advantage of waivers in the law. The money contained in the bill to mitigate those problems was inadequate, the CBO concluded.”

OOF: Pharmaceutical giant Merck will no longer supply a vaccine for children in West Africa, NPR’s Michaeleen Doucleff reports.

The vaccine is meant to treat rotavirus, a deadly form of diarrhea that each year kills about 200,000 young children and babies. The company told NPR it was a “difficult decision for us, which did not come lightly. We would like to express our deepest regret to all of the parties involved and have offered to assist and work with UNICEF, Gavi and affected countries through the transition to alternative images [versions] of rotavirus vaccines,"  Merck said the change was a result of “supply constraints" but Michaeleen notes the company has also started sending the vaccine to China, “where it will likely be sold for a much higher price."

 “Merck's decision means it will fall short of its commitment to supply its rotavirus vaccine, RotaTeq, to four low-income countries in 2018 and 2019, according to Gavi, the Vaccine Alliance. By 2020, the company will completely stop delivering its vaccine,” Michaeleen reports.

OUCH: Trump said he plans to take executive action to block some migrants from entering the United States, including the setting up of “massive tent cities” that would hold migrants indefinitely, our Post colleagues David Nakamura and Nick Miroff report.

“But Trump offered few other details during remarks at the White House, where he reiterated unsubstantiated claims he has made in recent weeks that a caravan of migrants from Central America, traveling north through Mexico by foot, represents an urgent national security threat,” David and Nick report. “He characterized the group, which includes many families with children, as dangerous and akin to an ‘invasion.’”

“The president offered no legal rationale for his plan, and he brushed off questions about the legality of some of the methods he suggested could be employed, such as detaining families indefinitely or refusing migrants a hearing in immigration court.”

But our colleagues report that the administration appears to be moving forward with Trump’s orders. The Department of Homeland Security has asked the Pentagon to have 8,000 family detention beds prepared to be used at two sites, they report.

AGENCY ALERT

— The Centers for Medicare and Medicaid Services announced finalized regulations that will change reimbursement rates for certain drugs under Medicare Part B, which reimburses doctors and hospitals for medications administered at their facilities. Under the current system, the federal government reimburses doctors and hospitals for the wholesale acquisition cost of the drug, plus an additional 6 percent. In a conference call with reporters, CMS Administrator Seema Verma said the government would reduce that rate to the cost plus 3 percent starting in 2019, which she said would help lower prescription drug costs for seniors.

Verma said the change “impacts patients because they’re having to pay coinsurance.” “So essentially, when we lower the costs that we’re going to pay, that gets transferred to the patient; it lowers their out-of-pocket expense.”

— Daniel Best, the administration’s top drug-pricing adviser, has died, HHS announced on Thursday.

The department did not reveal the cause of Best's death. “It is with tremendous sadness that I learned of the passing of our friend and colleague,” HHS Secretary Alex Azar said in a statement. “I had the great privilege to know Dan Best for the past decade. He joined me here at HHS out of a desire to serve the American people by making healthcare more affordable.”

In the conference call with reporters, Verma also shared her thoughts on Best.  "Many of us just learned about the sudden passing of our friend and colleague Dan Best,” she said. “What a loss to our country and to all of us personally who had the great privilege of working with Dan." 

Best previously worked at Pfizer and at CVS Health before he joined HHS to oversee drug pricing policy in March. The Health 202 extends its condolences to Best's friends, colleagues and family.

OPIOID OPTICS

— In Iowa, where the number of opioid-related overdoses has spiked for a decade, state officials say the the amount of people dying there from drug overdoses is declining.  There were 89 drug-related deaths in Iowa during the first eight months of the year, a 35 percent decline compared with the 137 Iowans who died from drug overdoses during the same time last year, the Des Moines Register’s Tony Leys reports, citing the Iowa Department of Public Health.

“Kevin Gabbert, who leads the department’s efforts to combat opioid abuse, cautioned that the 2018 numbers are preliminary and could climb before the year is finished,” Tony writes. “However, he said, he believes more Iowans who overdose on opioids are being revived before they die.”

STATE SCAN

— Medicaid expansion enrollment has begun in Virginia, but officials are already making moves to curb eligibility with work requirements.

The state plans to file a waiver with CMS by Friday, the Washington Examiner’s Kimberly Leonard reports.

“Under the planned work requirement, certain Medicaid enrollees would need to work, volunteer, or take classes, and log their hours with the state,” Kimberly writes. “People would also have to pay premiums of up to $10 a month, depending on their income. If they were to skip the requirement for three months in a row, they would be knocked out of Medicaid.”

CMS announced this week that it had approved a plan for Wisconsin to start implementing a work requirement, making it the fourth state to do so.  

TRUMP TEMPERATURE

— Top tech companies are calling on the Trump administration not to make any changes to federal policy that would define gender based on biological sex at birth, our Post colleague Tony Romm reports.

“In a letter to President Trump, the businesses said such a policy would be discriminatory and harm their workers,” Tony writes. “The companies said they ‘stand with the millions of people in America who identify as transgender, gender non-binary, or intersex, and call for all such people to be treated with the respect and dignity everyone deserves.’”

The letter from Apple, Facebook, Google, Uber and dozens of other companies follows reports that the administration is “seriously” reconsidering how transgender individuals are treated by federal law, an effort that has been led by HHS, Tony writes.

“We oppose any administrative and legislative efforts to erase transgender protections through reinterpretation of existing laws and regulations,” the companies wrote. “We also fundamentally oppose any policy or regulation that violates the privacy rights of those that identify as transgender, gender non-binary, or intersex.”

MEDICAL MISSIVES

— A federal agency has released the results of what experts say is the “world’s largest and most costly experiment” to examine whether cellphone use can lead to cancer, the New York Times’s William J. Broad reports. It found that some types of cellphones could increase the risk that male rats develop cancer.

But John Bucher, a senior scientist with the National Toxicology Program, “cautioned that the exposure levels and durations were far greater than what people typically encounter, and thus cannot ‘be compared directly to the exposure that humans experience,’ ” William writes about the study, which began in the Clinton administration. “Moreover, the rat study examined the effects of a radio frequency associated with an early generation of cellphone technology, one that fell out of routine use years ago. Any concerns arising from the study thus would seem to apply mainly to early adopters who used those bygone devices, not to users of current models.”

— And here are a few more good reads: 

Physician fee schedule and quality payment rule also makes updates to interoperability, telehealth and prescription drug costs.
Healthcare Finance News
This is particularly true of the president.
The New York Times
Politics
A wife and husband have extended her father’s legacy by keeping the Nelsonville Food Cupboard going. But it’s now more than an emergency stopgap. It’s a lifeline.
Robert Samuels
HEALTH ON THE HILL
“Perverse” incentives in the insulin supply chain lead to artificially high prices, as well as limited competition in the markets, according to a bipartisan report released Thursday by two
The Hill
INDUSTRY RX
Wonkblog
The ruling amounts to a state of de facto legalization until the Mexican Congress rewrites the nation's drug laws.
Christopher Ingraham
Epidiolex, the first FDA-approved medication made from marijuana, is now available by prescription in the United States.
CNN
DAYBOOK

Today

  • HHS Advisory Committee on Heritable Disorders in Newborns and Children holds a meeting.
  • The FDA holds a joint meeting of the Psychopharmacologic Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee.
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