THE PROGNOSIS

About 12,000 pregnant women who are incarcerated each year may be freed from shackling throughout their pregnancies — including during labor and delivery of their babies — under a criminal justice bill Congress could try to pass before year’s end.

That’s a provision contained in the First Step Act — a bill loosening some mandatory minimum sentencing laws that Congress would probably use as a framework for criminal justice reform. The measure, which won support from President Trump last week, is thought to be among just a few tasks lawmakers might undertake on a bipartisan basis during the lame-duck session.

The main point of the bill, which easily passed the House in May and has been revised in the Senate, is to get nonviolent offenders out of prison faster and help them stay out. A large share of the U.S. prison population, which is already much bigger than in other countries, is made up of nonviolent offenders charged with drug crimes.

But the measure also contains a nod to the particular challenges women prisoners can face, especially if they’re pregnant. Incarcerated women are routinely shackled during pregnancy and childbirth in the 32 states that don’t have any limits on the practice, prompting calls from medical organizations and civil-rights group to ban what they term an inhumane practice.

Being shackled, for example, can make it more likely for pregnant women to trip and fall, potentially causing harm to the fetus. Women have also been shackled to beds while delivering their babies, even though having one’s movements restricted can make labor pains even worse. (It also strikes your Health 202 author — who has undergone childbirth three times — as a pretty impossible time to cut and run.)

“Shackling pregnant prisoners endangers the health and safety of both the mother and the fetus, and is almost never justified by the need for safety and security for medical staff, the public or correctional officers,” says a fact sheet from the American Civil Liberties Union, which backs the bill.

The First Step Act bans prison guards from shackling prisoners from the time they are determined to be pregnant until they have completed a period of postpartum recovery. It also directs that prisoners are incarcerated as close as possible to their families — making it easier for many new mothers to see their babies regularly — and mandates that tampons and sanitary pads are provided  free to those who need them.

These are changes backed by a slew of medical groups, including the American Medical Association and the American Congress of Obstetricians and Gynecologists, and by those all along the political spectrum (including the libertarian-minded Koch political organization). Over the weekend, two Republican senators called on Senate Majority Leader Mitch McConnell (R-Ky.) to bring the Senate version to the floor.

“I’m urging Mitch McConnell, put this bill on the floor,” Sen. Lindsey O. Graham (R-S.C.) said on NBC’s “Meet the Press,” predicting that it would get “80 votes.” Sen. Rand Paul (R-Ken.) also said he thinks it would pass with 65 to 70 votes.

“It’s all up to one person,” Paul said on CBS’s “Face the Nation.” “Sen. McConnell has the ability to call any vote he wants to anytime.”

Criminal justice reform is also a particular priority for Jared Kushner, Trump’s son-in-law and senior adviser. In a Sunday op-ed in USA Today, Kushner argued the First Step Act would go a long way toward reducing incarceration costs and recidivism.

Add it all together, and you’d think the First Step Act would be a shoo-in. “The criminal justice overhaul, scaled back from its initial ambitious Senate draft but vastly more comprehensive than legislation the House passed this year, could be one of the most significant and bipartisan laws signed by Trump in his first two years in office,” my colleagues Seung Min Kim and Josh Dawsey wrote last week.

But it’s still unclear whether the Senate will ultimately act. McConnell told Trump last week that there probably wasn’t enough time to debate it before the end of this calendar year, Dawsey and Philip Rucker report.

And Sen. Tom Cotton (R-Arkansas) has emerged as the bill’s loudest critic on Capitol Hill. Cotton and Sen. Mike Lee (R-Utah) got into a Twitter war yesterday over the measure:

Cotton pushed back:

Lee wrote that Cotton doesn't understand how these credits work:

AHH, OOF and OUCH

AHH: Tom Price, the disgraced former Health and Human Services secretary, has been named to the transition team for Republican Brian Kemp, the incoming governor of Georgia. Kemp announced members of his transition team during a press conference yesterday, one day after the Associated Press declared him the winner of a close gubernatorial race. His Democratic opponent Stacey Abrams effectively ended her bid for governor on Friday.

Price, an outspoken critic of the Affordable Care Act, will help Georgia seek federal waivers to help stabilize marketplace premiums but won't push the state toward accepting the ACA's Medicaid expansion, Kemp said. “Price and other members of Kemp’s ‘Georgians First’ team will spend the next two months further developing policy initiatives, hashing out his initial budget proposal and proposing appointments to a powerful posts and boards," the Atlanta Journal-Constitution’s Greg Bluestein reports.

Price resigned from his role at the head of HHS in September 2017 following criticism for his extensive use of taxpayer-funded charter flights.

OOF: Scott Lloyd, the director of the Office of Refugee Resettlement at HHS, is changing roles within the department. Lloyd had been criticized for his role overseeing the Trump administration’s now-reverted “family separation” policy that separated minors from their parents at the U.S.-Mexico border.

He will now be in a position at HHS’s Center for Faith and Opportunity Initiatives, according to the Associated Press. The Daily Caller first reported the move.

“While I have valued my time at the Office of Refugee Resettlement, I am excited to take on this new challenge,” Lloyd said in a statement to the publication. “I am grateful to Assistant Secretary Johnson and the incredible people at ORR and the Administration for Children and Families, and I am proud of what we have accomplished together.”

Lloyd had been director of ORR since March 2017.

“A top HHS official has been reviewing the department's handling of the migrant crisis, and senior officials believe Lloyd mismanaged aspects of the response,” Politico’s Rachana Pradhan reports. “For instance, Lloyd told staff to stop keeping a spreadsheet tracking separated families. At one point during the height of the crisis, HHS Secretary Alex Azar personally stepped in to review case files after he learned Lloyd's office had yet to review hundreds.”

OUCH: California’s air pollution level surpassed world health standards by 60 times last week following a spate of devastating blazes, including the deadliest wildfire the state has ever seen.

Air particulates reached up to 1,500 micrograms per cubic meter. That’s compared with the standard of 25 set by the World Health Organization, Bloomberg’s Brian K Sullivan reports. “Lower levels on Monday still exceeded the benchmark,” he adds.

“On Monday, Sacramento’s air was listed as unhealthy and particulates reached a level of 135.4 micrograms per cubic meter, according to the U.S. Forest Service. San Francisco has a reading of 55 with San Jose at 76.1 and Stockton at 152,” Sullivan reports.

“The particulates can irritate lungs, eyes and nasal passages and are particularly dangerous for people with respiratory diseases,” he adds. “In addition to the smoke, fires cause ground-level ozone to form, triggering more-severe health issues.”

OPIOID OPTICS

— A drug manufacturer inflated the price of an overdose reversing medication by more than 600 percent, according to an investigative report released by Sens. Rob Portman (R-Ohio) and Thomas R. Carper (D-Del.).

The report from the Senate Homeland Security and Governmental Affair’s Permanent Subcommittee on Investigations found that by 2016 the company kaléo increased the price of its naloxone drug EVZIO by more than 600 percent — the drug went from an initial price of $575 per unit in 2014 to $3,750 in 2016 and $4,100 in 2017, the investigation found.

The report was detailed during a Sunday night episode of CBS News’s “60 Minutes.”

“The company’s sales force focused on ensuring doctors’ offices signed necessary paperwork indicating that EVZIO was medically necessary, ensuring the drug would be covered by government programs like Medicare and Medicaid,” according to a news release from Portman’s office. “The plan worked, resulting in increased costs to taxpayers, to date, totaling more than $142 million in just the last four years, despite the fact that less costly versions of naloxone exist.”

— Bisexual women are more likely to abuse prescription opioid drugs, according to a new study from the New York University School of Medicine.

It found that individuals who identify as lesbian, gay or bisexual are overall more likely to engage in opioid abuse. The study, published Monday in the American Journal of Preventive Medicine, "is the first to use a nationally representative sample of adults in the United States to examine sexual orientation as a risk factor for prescription opioid misuse," our Post colleague Samantha Schmidt reports.

“Its findings shed light on the disproportionate risks faced by members of the LGBT community amid the ongoing opioid epidemic, which resulted in nearly 50,000 overdose deaths last year,” Schmidt writes. “The study’s authors said the results are consistent with other research showing that sexual minorities, particularly bisexual women, are more likely to report alcohol and substance abuse — and poorer health overall.”

Lead study author Dustin Duncan, an associate professor in the Department of Population Health at NYU School of Medicine, "attributes this trend to the ‘minority stress model,’ the theory that members of minority groups tend to experience greater degrees of stress due to stigma and discrimination,” Schmidt writes. Duncan argues that bisexual women are a minority within a minority, not belonging fully to lesbian or gay circles. The stigma and discrimination they face due to being  woman and being a member of the LGBT community could add stressors that "could predispose them to increased rate of substance abuse," Schmidt adds. 

HEALTH ON THE HILL

— Sen. Ron Johnson (R-Wis.) is calling on the Centers for Medicare and Medicaid Services to provide information on an audit showing California's Medicaid program may have made eligibility errors costing the federal government billions of dollars. The chairman of the Senate Committee on Homeland Security and Governmental Affairs wants to know if the agency “intends to attempt to recoup from California more than $3.3 billion in potential wasted federal Medicaid funds.”

The letter to CMS administrator Seema Verma cites a report from the California auditor from October that found “the state made at least $4 billion in questionable Medicaid payments between 2014 and 2017 on behalf of more than 450,000 people marked as Medicaid-eligible in the state system but ineligible in the county systems.”

“This audit, in conjunction with a separate federal review, shows that potential improper payments in California have cost federal taxpayers more than $3.3 billion. I respectfully request your assistance in understanding how the Centers for Medicare and Medicaid Services (CMS) plans to address the findings of these audits,” Johnson wrote in the letter.

REPRODUCTIVE WARS

— The research arm of antiabortion group Susan B. Anthony List found that 65 percent of state exchange plans through the Affordable Care Act for 2019 cover abortions, which is about 650 plans.

Analysis from the Charlotte Lozier Institute (CLI) found the coverage represented an increase from 527 plans, or 53 percent of these plans, this year. In eight states and the District of Columbia, 100 percent of individual and family plans on the exchange cover abortion, the group found.

“Our research reveals that consumers across nearly half the country have even fewer pro-life policy options to choose from on their state health insurance exchanges in 2019. In several states and the District of Columbia, there are no pro-life plans offered at all,” CLI President Chuck Donovan said in a statement.

TRUMP TEMPERATURE

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

STATE SCAN
Politics
Although Republicans won the closely watched contests for Senate and governor, Democrats saw hope in Nikki Fried’s victory as agriculture commissioner.
Lori Rozsa
National
Tens of thousands of Californians are facing months, if not longer, without permanent housing.
Frances Stead Sellers, Scott Wilson and Tim Craig
National
A gunman at Mercy Hospital opened fire on a woman believed to be his former fiancee and others. The shooter was also found dead.
Michael Brice-Saddler, Mark Guarino and Keith McMillan
MEDICAL MISSIVES
Health
A large clinical trial showed that children and teenagers could be desensitized to peanut allergies with an experimental drug, but the treatment had a high risk of adverse events.
Carolyn Y. Johnson
More children have been diagnosed with acute flaccid myelitis, the polio-like paralyzing illness, according to numbers released Monday by the US Centers for Disease Control and Prevention.
CNN
The average person on Earth would live 2.6 years longer if their air contained none of the deadliest type of pollution, according to researchers at the University of Chicago’s Energy Policy Institute. Your number depends on where you live.
Bonnie Berkowitz, John Muyskens, Manas Sharma and Monica Ulmanu
INDUSTRY RX
Health & Science
Baton Rouge agency’s van travels to housing complexes, churches, parks and schools in poor neighborhoods.
Christine Vestal
Novartis AG’s recent acquisition streak is pivoting the company toward new treatments that bear little resemblance to traditional drugs.
Wall Street Journal
Voraciously
Doctors report that most of the injuries involve something other than the peel.
Maura Judkis
State-level legalization on marijuana has created a patchwork of laws. We need strong, clear, and fair federal guidelines on maijuana.
Rep. Joe Kennedy III (D-Mass.) via Stat
DAYBOOK

Coming Up

  • The American Enterprise Institute holds an event with CMS Administrator Seema Verma on "The new Medicare physician payment regulation" on Nov. 27.
  • The Heritage Foundation holds a discussion about fetal tissue research on Nov. 27.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on reducing health care costs on Nov. 28. 
SUGAR RUSH

From The Post's Anna Rothschild: "Dealing with anxiety as a kid":