THE PROGNOSIS

You could cite a multitude of people and circumstances that put GOP candidates in a real health-care bind this year.

The late Sen. John McCain, who died of brain cancer in August, wasn’t one of them.

Rep. Jason Lewis — a freshman Minnesota Republican who lost his seat last week — prompted outrage Monday for a Wall Street Journal op-ed in which he blamed McCain and his vote against an Affordable Care Act repeal bill for Republicans losing their House majority.

“The Republican Party lost its House majority on July 28, 2017, when Sen. John McCain ended the party’s seven-year quest to repeal ObamaCare,” Lewis wrote. “House leadership had done an admirable job herding cats. On the second try, we passed the American Health Care Act in May. Then McCain’s inscrutable vote against the Senate’s ‘skinny repeal’ killed the reform effort.”

Lewis went on to claim that McCain’s vote prompted liberal special-interest groups to “propagate false claims” that the House bill gutted coverage for people with preexisting conditions. “That line was the Democrats’ most potent attack in the midterms,” he wrote.

Lewis is right about one thing: Attacking Republicans for how they would have treated people with preexisting medical conditions certainly was Democrats’ strongest narrative in the elections. It got their voters out the door and to the ballot box; multiple exit polls found health care was the top issue among Democratic voters.

House Democrats are already planning to keep the issue front-and-center in January by holding a vote affirming the ACA’s requirements for insurers to cover people with preexisting conditions and opposing a lawsuit from GOP-led states seeking to strike the ACA.

But Lewis isn’t right about much else. If anything, McCain’s move to halt the Senate’s “skinny repeal” bill saved Republicans from ultimately passing what probably would have been deeply unpopular health-care legislation — and provided even more fodder for Democrats to use against them.

Lewis’s short piece — only 469 words – gave rise to widespread condemnation from not just Democrats but Republicans, too. Some observers also noted the op-ed attacking McCain, a celebrated war hero, was published on Veterans Day.

Doug Holtz-Eakin, an economist and former Congressional Budget Office director under George W. Bush:

Politico's Jake Sherman:

From McCain's daughter, Meghan: 

 Julie Tarallo, McCain's former communications director:

Lewis, who lost his seat to Democrat Angie Craig, is a former radio host with a history of incendiary remarks, as our Washington Post colleague Felicia Sonmez detailed here. Perhaps he was seeking someone to blame for his loss. But whatever his motivation, his piece shows a remarkable lack of knowledge about the details of the health-care bills Republicans advanced — and why they ultimately failed.

Let’s untangle a few of Lewis’s claims:

1. Lewis writes the House-passed health-care bill — the American Health Care Act — protected people with preexisting conditions.

It’s true that the AHCA said “nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with preexisting conditions.”

House Republican leaders writing that bill retained the ACA’s requirement to cover people with preexisting conditions without hiking premiums, recognizing it would be politically toxic to erase those popular protections.

What Lewis doesn’t note is that additional language was tacked on as leadership tried to get its Republicans in line to approve the legislation.

Hard-line House Freedom Caucus members threatened to rebel because they felt too much of Obamacare was being kept. That led to extended negotiations between their leader, Rep. Mark Meadows (R-N.C.), and moderate Rep. Tom MacArthur (R-N.J.). The two congressmen negotiated language allowing states to apply for waivers from the ACA’s ban on higher premiums for people with preexisting conditions. That could have had the effect of preventing some sick Americans from accessing coverage because their monthly premiums could have been exorbitantly high.

2. Lewis writes that McCain’s vote against the Senate health-care bill “killed” the whole repeal-and-replace effort.

There are multiple things wrong with this assertion. First, the House health-care bill wasn’t even on the table in the Senate. It would have enacted deeper cuts to future Medicaid spending than many moderate Senate Republicans were comfortable with, not to mention the pathway away from preexisting protections it opened up for states.

The Senate couldn’t approve its own version of a health-care bill, and it wasn’t just McCain who blocked multiple attempts to do so.

Over one week in July 2017, the Senate took up — and rejected — several iterations of measures to roll back Obamacare. Nine Republicans opposed the Senate’s replacement bill, called the Better Care Reconciliation Act. Seven Republicans voted against a pared-back version that would have delayed replacement for two years.

It was Senate Republicans’ last-ditch effort —  a “skinny” bill that repealed only a small portion of the law (its mandates to buy insurance and its tax on medical devices) that McCain is blamed for blocking. He and moderate Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) were the three Republicans to vote against that measure.

But even if McCain had gone along with skinny repeal, it’s still not at all clear the House and Senate would have been able to unite to pass an Obamacare replacement at all. Republicans were hopelessly divided over a whole host of issues, including preexisting conditions and how much to spend on subsidies and Medicaid. Both the House and Senate bills were deeply unpopular with the public and would probably have resulted in fewer Americans with insurance coverage.

And it’s clear McCain’s action didn’t give rise to Democratic attacks on preexisting conditions. House Republicans had already baked that cake.

AHH, OOF and OUCH

AHH: Democrat Kyrsten Sinema pulled out a victory, defeating Martha McSally for the long-held Republican Senate seat in Arizona.

The Associated Press projected Sinema as the winner on Monday night, almost a week after the election. Sinema had 49.7 percent of the vote, compared to McSally’s 48 percent, giving her the edge to replace Sen. Jeff Flake (R-Ariz.).

“Sinema, a three-term congresswoman, overcame attacks on her more liberal record as an Arizona state legislator and committed to a bipartisan approach in a race that hinged on issues such as health care and illegal immigration,” our Post colleague Elise Viebeck writes. “Her defeat of McSally will make her the first female senator in Arizona’s history.”

Paige wrote in The Health 202 wrote last month about how this toss-up race served as a prime showcase for Democratic attacks on Republican actions surrounding people with preexisting conditions. Sinema relentlessly slammed McSally over her vote to repeal the ACA. Paige wrote the messaging was “doubly interesting [because] Sinema has been so effective in leveraging a pro-Obamacare message in Arizona, considering the state’s marketplace has struggled more than most  in offering individual market consumers a variety of plan options.”

OOF: Health officials will soon launch a clinical trial that will mark the next move in the global response to Ebola and the latest outbreak in the Democratic Republic of Congo.

The trial will “test whether experimental Ebola therapies improve patients’ chances of survival” in the DRC's outbreak, Stat News’s Helen Branswell reports.

“The randomized controlled trial will compare three different antibody treatments and an antiviral drug to each other, rather than involving a placebo,” Helen writes. “It is unlikely that the trial will produce clear results based on a single epidemic; it is expected to span several outbreaks and countries — a novel and challenging design.”

“The four experimental therapies that will be tested have been used for weeks in Ebola treatment units being operated by nongovernmental organizations Doctors Without Borders (MSF) and Alima,” Helen writes, adding that 139 patients had as of Friday received one of the four therapies. “It is unusual for unlicensed drugs to be used in such quantities outside of the context of a clinical trial. In this case, the authorization came through a sort of compassionate use protocol established by the WHO. The idea was that the protocol would serve as a bridge to allow use while a clinical trial was being designed and signed off on by the numerous parties that have a stake in the process.”

OUCH: This week, two mothers plan to visit the office of insulin maker Sanofi in Massachusetts, bringing with them the ashes of their children who died in part because of insulin rationing due to the cost of treatment.

The two mothers, who earlier this year protested at the Minnesota state capitol and later went to Indianapolis to meet with a representative of insulin maker Eli Lilly, will participate in a “die-in” at the Sanofi office, Stat News’s Megan Thielking reports.

“Anger over insulin prices in the U.S. has swelled as the nation’s largest insulin makers have hiked the price of the drug,” Megan writes. “Those price increases are now the subject of a class-action lawsuit and have drawn the attention of lawmakers in Washington. But the price hikes are also fueling public outcry by patients, caregivers, and clinicians. Last month, patients and activists marched outside Lilly’s headquarters demanding ‘insulin for all.’”

Megan reports that Sanofi has acknowledged that “many people with diabetes have significant difficulty accessing the medicines they need.” “We take this issue seriously, and continue to explore innovative ways to find long-term solutions to help eliminate or significantly reduce the out-of-pocket expenses for patients,” said Ashleigh Koss, a spokesperson for Sanofi.

INDUSTRY RX

— The American Customer Satisfaction Index has found that after two years of growth, overall customer satisfaction with health insurance remained flat in 2018. The report notes that “health insurance is, by far, the most problematic and least satisfying category in the sector, in part because it is also the most complicated and controversial.”

The report scores from 0 to 100 customer experience as it relates to health care, including physicians and prescription drug coverage. Here are some highlights:

  • The report found overall, access to primary care doctors has improved and was scored at an 80.
  • Access to specialty care remains was steady at 78.
  • Coverage of standard medical services is scored at 77, “slightly better than it was a year ago.”
  • Prescription drug coverage remained unchanged  at 76.
REPRODUCTIVE WARS

— More women and girls in the world’s poorest countries are using modern contraception, according to a new report from United Nations-backed group Family Planning 2020.

In 69 of the world’s poorest nations, the number of women and girls who use contraceptives “surpassed 317 million in 2018, representing 46 million more users than in 2012,” the AP’s Ignatius Ssuuna and Rodney Muhumuza reports.

“Access to modern contraception helped prevent over 119 million unintended pregnancies and averted 20 million unsafe abortions between July 2017 and July 2018, although populations continue to soar across Africa and other low income countries,” Ignatius and Rodney report. “The mix of contraceptive methods has improved significantly in 20 of the surveyed countries, ‘meaning that more women are able to find the short-term, long-acting, emergency, or permanent method that suits their needs and preferences,’" the report said.

HEALTH ON THE HILL

— The Campaign for Sustainable Rx Pricing will today launch a six-figure ad buy targeting lawmakers who vowed in the midterm elections to tackle high drug prices.

“The time for campaign rhetoric is over,” the group says on its site pushing the campaign. “It is time for Members of Congress to convert those campaign promises into action.”

The group points out that in post-election comments, both House  Minority Leader Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) vowed to find common ground during the new congressional term on drug costs and other issues.

MEDICAL MISSIVES

— The latest federal exercise recommendation? Just move around a little. New government guidelines say that people can get their exercise in small doses, with just a few minutes of movement at a time, our Post colleague Lenny Bernstein reports.

The new recommendations from a Department of Health and Human Services-appointed committee “does away with the official government position that physical activity should occur in sessions of at least 10 minutes,” Lenny writes.

“Current evidence shows that the total volume of moderate-to-vigorous physical activity is related to many health benefits; bouts of a prescribed duration are not essential,” the committee of health experts wrote.

Brett P. Giroir, assistant secretary for health at HHS told The Post in an interview, “sit less, move more. Whatever you do, it really all counts."

The report, published Monday in the Journal of the American Medical Association, is the first update of government physical activity guidelines since the first ones were issued in 2008.

“For adults to stay healthy, the new guidelines call for 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous-intensity physical activity each week, along with at least two days a week of muscle-strengthening exercises,” Lenny writes, adding that these recommendations are “unchanged from a decade ago.”

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

Science
Rep. Eddie Bernice Johnson has a message for scientists: Congress is open and wants to hear from you.
Ben Guarino
Health-care software firm Athenahealth is selling itself to an affiliate of two private-equity firms for $5.47 billion in cash months after an activist investor offered to take the business private.
Wall Street Journal
National
Shortly after 12 people were killed in a California country bar, the flames started to move in, delaying what has become an all-too-familiar grieving process.
Katie Mettler
"I'm about to hit the ground but the bottom of my shoes were melting. I ... prayed to God, 'Please, don’t let me die like this,'" said nurse Nichole Jolly.
NBC News
Health & Science
Patients, doctors and policymakers struggle to find an answer to that question.
Dhruv Khullar
Democrats were victorious because they fought Republicans to a draw among Americans age 50 and up. How they did that is the story of the 2018 election.
Politico Magazine
SECOND OPINION
Local
Maryland is among 13 states where “red flag” laws can remove guns from someone who is acting suicidal — saving lives and maybe even preventing mass shootings.
Petula Dvorak
STATE SCAN
National
More than two dozen residents of the retirement community burned to death in cars, in homes and on foot, and there are more than 200 people still unaccounted for.
Scott Wilson
Education
It’s part of a broader effort to ensure that transgender and non-binary students feel welcome.
Perry Stein
National
Health inspectors in Kansas City caused a kerfuffle when they destroyed food prepared for the homeless from an unpermitted group.
Eli Rosenberg
OPIOID OPTICS
Health & Science
Such treatment has grown more in the past four years than it has in the past two decades, observers say.
Christine Vestal
DAYBOOK

Today

  • The Washington Post brings together scientists, doctors, health-care innovators, patients and policymakers, including FDA Commissioner Scott Gottlieb, for its “Chasing Cancer” live-news event.
  • HHS Secretary Alex Azar is set to speak to the National Association of Medicaid Directors at the annual meeting in Washington.
  • CDC Director Robert Redfield speaks at an NIH event on opioids.

Coming Up

  • The Atlantic holds an event on “People v. Cancer” on Wednesday.
  • The House Veterans Affairs Subcommittee on Technology Modernization holds a hearing on Wednesday.
  • The House Veterans Affairs Subcommittees on Disability Assistance and Memorial Affairs hold a hearing on oversight of contract disability examinations on Thursday.
SUGAR RUSH

Key takeaways from Michelle Obama's new memoir: 

Some of the investigations Democrats plan to pursue of the Trump administration: