THE PROGNOSIS

Just over a month before this year’s open enrollment period began for 2019 Obamacare plans, the Trump administration removed an online resource intended to help members of the Latino community enroll for health coverage.

The Centers for Medicare and Medicaid Services removed a presentation called “Marketplace Outreach: Best Practices for Outreach to Latino Communities” from one of its Web pages sometime in late September, according to a report released last week from the Sunlight Foundation, a nonpartisan government watchdog group. The presentation, an 18-slide PDF file, was intended to provide training for groups like navigators — a group formed under the obama administration to promote health-plan selection — on better engaging with Latino communities and on challenges the community faces in enrollment.

Critics are pointing to this latest move as another in the list of actions the Trump administration has taken to undermine the Affordable Care Act and to weaken the Latino and immigrant communities’ access to public programs like health care.

A CMS spokesman told me the removal was part of routine “updates and maintenance of CMS.gov, which sometimes includes the revision and removal of content that is not current or underutilized.”

“This ongoing process is managed and implemented by agency career staff and is not influenced or directed by political leadership,” the spokesman said. “In this instance, the slide presentation contained outdated information and the page was archived in September of this year.”

Jodi Ray, who oversees a navigator program as director of Florida Covering Kids & Families at the University of South Florida, said resources like the one removed are critical to her group’s efforts.

“If you pull credible resources, make it less accessible, it does make our job more difficult,” Ray told me.

“Being that Florida is so demographically and geographically diverse, we use those resources in a way to make sure we aren’t using a one-size-fits all approach,” she said. “You have to know your community, the population, the culture of who you’re trying to reach. If we’re not providing the resources to be able to do that effectively, we’re going to lose that population that needs this more than anyone.”

Here is one page of the 18-slide presentation that was taken down: 

To that point, data from the Kaiser Family Foundation in January notes members of the Latino community face challenges in health-care access and coverage and are at a much higher risk of being uninsured compared to white Americans.

Ray also lamented the change as yet another move to reduce resources after the administration already slashed federal spending on advertising and outreach to promote the ACA, including dramatically reducing funds for navigator grants.

The removal of a training guide on the CMS website also preceded an open enrollment period for 2019 Obamacare plans that has so far seen lagging numbers.

In The Health 202 on Friday, I wrote that experts have pointed to a lack of awareness about enrollment and reduced marketing efforts as some of the biggest factors contributing to the slow sign-up rates thus far. But Ray noted we won’t know until after this year’s open enrollment if any of the administration’s actions really had an impact on a particular population.

Steven T. Lopez, associate director of the Health Policy Project at UnidosUS, a leading Latino civil rights organization, called the removal of the CMS guidance part of a “consistent effort to undermine the law for our community in particular and to make coverage out of reach for so many.”

“This type of resource conducted in a culturally relevant and linguistically appropriate way has proven effective in enrolling the Latino community and other underserved communities,” Lopez said in an interview. He said it was important to “build upon gains” that have resulted for the Latino population following the implementation of the ACA, “not reverse them.”

Rachel Bergman, director of the Sunlight Foundation’s Web Integrity Project and author of the report, called the removal a “piece of the puzzle of limited marketing, limited outreach under this administration.”

Bergman also challenged CMS’s explanation that the material was out of date. She said one bullet point on the presentation referring to the ACA’s individual mandate, which was repealed as part of the GOP tax overhaul last year, was the only thing that stood out to her as “out of date.”

In response to a question about whether the agency planned to update outdated content on its site, a spokesman told me: "CMS will continue to review and update website information as necessary to ensure all Americans have the resources to select a health plan that best fits their individual needs."

The Sunlight report also pointed out that around the same time the change was made, the Trump administration announced a proposal to change the “public charge” rule, which could make it harder for legal immigrants to gain citizenship if they have used public welfare programs.

My colleague Colby Itkowitz reported in The Health 202 earlier this year the “mere suggestion of the expanded policy has already had a ‘real chilling effect’ on immigrants using health-care services.”

In an interview about open enrollment in New Jersey last week, Raymond Castro, director of health policy at progressive group New Jersey Policy Perspective, told me there was concern about whether the public charge proposal could impact enrollment. He said the proposal “does not include subsidies in the ACA exchange, but a lot of people don’t know that.”

Maura Collinsgru, health-care program director for New Jersey Citizen Action, a longtime ACA advocate, said the administration’s actions “go to promoting an agenda this administration seems to have to discourage inclusion, the full inclusion of Latinos and immigrants in all aspects of our economy and our communities.”

She added, “to target health care within some of those changes I think is an egregious act.”

AHH, OOF and OUCH

AHH: National Institutes of Health researchers were quietly ordered to halt acquisitions of new fetal tissue for their research, Science Magazine’s Meredith Wadman reports. The halt, which began in September, also began the same month the administration started a review of government-funded research using fetal tissue.

The NIH suspension also impacted an HIV research project.

“We were all poised to go and then the bombshell was dropped,” HIV researcher Warner Greene, director of the Gladstone Center for HIV Cure Research in San Francisco told Meredith. “The decision completely knocked our collaboration off the rails. We were devastated.”

“The shutdown of the HIV research at the federal lab in Montana, first reported in Science, was never disclosed publicly by government officials, who have forbidden affected researchers from discussing what happened,” my Post colleagues Amy Goldstein and Lenny Bernstein report. “But colleagues say they are incensed by the action, which has fanned a controversy that pits the biomedical research community against antiabortion activists and other social conservatives pressing the administration to stop the flow of federal grants and contracts for work involving fetal tissue. Such tissue comes from elective abortions.”

“News of the halted study broadens the actions the administration is known to have taken to obstruct such research,” they add.

In an emailed statement to Science Magazine, NIH said the halt to fetal tissue procurement was "an action NIH thought was prudent given the examination of these procurements. Research with tissue already on hand could proceed, and NIH leaders asked to be notified by intramural investigators if new procurement would be necessary”

The statement also indicated the agency “was not informed that new procurement was necessary for the” HIV study referenced in the Science report and is “looking into why this did not occur."   

OOF: Wisconsin’s Gov.-elect Tony Evers (D) is weighing legal action against the lame-duck bills passed by the state’s Republican legislature to limit his authority.

“I’m not making any promises one way or the other, but we’re looking at all issues, all options on the table,” Evers said in a Sunday interview on NBC News’s “Meet the Press.” “I need to stand up for the people of Wisconsin. There’s 2.6 million people that voted in this last election, and they expect me to do that. So we’re going to pursue this.”

The bills are awaiting the signature of outgoing Republican Gov. Scott Walker, who has previously signaled support, and who Evers said he has pushed to veto the measures.

Inside the legislative package is a measure to limit the governor’s authority to withdraw the state from a lawsuit without approval from a legislative committee, a move some say is meant to stop Evers from withdrawing the state from the lawsuit challenging the ACA. The legislation also blocks Evers from withdrawing a federal waiver to impose work requirements for Medicaid beneficiaries in the state.

“If Scott Walker had won this election — and he did not; I did — we wouldn’t be sitting here talking about this today,” Evers said Sunday. He said Republicans want to “invalidate the will of the people.”

OUCH: A national shortage of the vaccine recommended to protect older adults from shingles is only getting worse.

The surging demand for the Shingrix vaccine is in part due to the fact that the two-dose vaccine “provides much greater protection than an older, single-shot vaccine from a disease that affects 1 in 3 adults and an cause debilitating nerve pain that can last months, or even years,” my Post colleague Lena H. Sun reports.

There are about 115 million people across the country that are eligible for the vaccine to prevent from shingles, which occurs when the chickenpox virus reemerges and the risk for which increases as people get older.

Federal health officials also recommended Shingrix last year for healthy adults over 50 years old, another reason for the surging demand. “Those recommendations took British drugmaker GlaxoSmithKline by surprise, leaving it scrambling to keep up with demand, say company representatives,” Lena writes.

As a result, consumers have been unable to find the vaccine in local pharmacies or corporate chains.

“Sean Clements, a spokesman for GSK, said the manufacturer has increased supply of Shingrix in the United States, shipping ‘large volumes’ every two to three weeks,” Lena writes, adding Clements said the company will start this month on a twice-monthly shipping schedule.

Lena writes that a Walgreens pharmacist in downtown Washington said there hadn’t been any shipments of Shingrix to the story since August. A Walgreens pharmacist told Lena there isn’t even a waiting list for the vaccine because “there’s no promise of when it’s going to come out again.”

AGENCY ALERT

— In a 1995 speech, Robert Wilkie, who is now Veterans Affairs secretary, praised the president of the Confederacy as a “martyr to the ‘Lost Cause,’” my Post colleague Lisa Rein reports with the latest details on Wilkie’s past commemoration of the Confederacy.

Lisa wrote previously about Wilkie’s prior defense of Confederate symbols.

“Wilkie called Jefferson Davis an ‘exceptional man in an exceptional age,’ and while the VA leader called slavery and its aftermath ‘a stain on our story as it is a stain on every civilization in history,’ he defended Confederate history and the soldiers who fought for the South,” Lisa writes. “The speech sheds further light on Wilkie’s lifelong fascination with military history, including that of his ancestors, who fought for the Confederacy.”

In a statement to The Post, VA spokesman Curt Cashour said, “Like many other Democrat and Republican officials, including President George W. Bush, Gov. Lawton Chiles, and Senators Sam Nunn, Jim Webb and Lloyd Bentsen, Secretary Wilkie occasionally participated in events recognizing Civil War Veterans years ago.”

HEALTH ON THE HILL

— The groups that once helped the Democratic Party save the ACA during the repeal-and-replace debate last year are now fracturing on the issue of "Medicare-for-All," Politico’s Adam Cancryn reports.

“Deep-pocketed hospital, insurance and other lobbies are plotting to crush progressives’ hopes of expanding the government's role in health care once they take control of the House,” he writes. “The private-sector interests, backed in some cases by key Obama administration and Hillary Clinton campaign alumni, are now focused on beating back another prospective health care overhaul, including plans that would allow people under 65 to buy into Medicare.”

It’s also a sign of what’s to come in the division between establishment Democrats and the incoming group of progressive freshmen Democrats in the House, some of whom campaigned on "Medicare-for-all." House Democratic leaders have already signaled they will prioritize improving the ACA over tackling a new health-care proposal, Adam writes.

"We know the insurance companies and the pharma companies are all putting tens of millions of dollars into trying to defeat us," said Rep. Pramila Jayapal (D-Wash.), co-chair of the "Medicare-for-All" caucus. "Which I take as a badge of honor — that they’re so concerned about a good policy that they're going to put so much money into trying to defeat it."

— A vote is expected in the House this week on bipartisan legislation introduced by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) to give the federal government authority to ensure drugmakers aren’t overcharging Medicaid, The Hill’s Peter Sullivan reports.

The bill, which was sparked by allegations that Mylan overcharged Medicaid for the EpiPen, could be a sign of continued commitment from the pair on drug prices. Grassley and Wyden are the incoming chair and ranking member of the Senate Finance Committee. Peter writes their bill is “expected to pass the House next week as part of a larger package that includes the ACE Kids Act, a bipartisan bill aimed at improving care for children with complex medical needs.”

— A group of health-care organizations are announcing today they compiled and signed onto a list of policy recommendations in an effort protect consumers from getting surprise medical bills. 

In the guidelines, the groups — including America's Health Insurance Plans, Blue Cross Blue Shield Association and Families USA, among others — call for federal legislation "to end surprise medical bills," for patients to be informed when the care they receive is out of network, and for federal policies that "protect consumers from surprise bills, while ensuring that those policies do not simultaneously increase premiums or other costs for consumers." 

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

INDUSTRY RX
Business
Executives fixed prices and blocked competition in their “sandbox,” authorities say.
Christopher Rowland
Maryland Politics
Instagram shuts down the accounts of medical cannabis dispensaries, sometimes in error.
Steve Thompson
Altria is investing nearly $2 billion for a huge minority stake in Canadian cannabis company Cronos. The Marlboro owner is taking a 45% stake, with the option of boosting it to 55% over the next few years.
CNN
Gilead Sciences has hired industry veteran Daniel O’Day to take the helm and help the drug company revive sales and recover from a disappointing deal.
WSJ
MEDICAL MISSIVES
Africa
The violence has stymied the international response to the outbreak, now the second-largest ever.
Max Bearak
The Washington Post found that nearly half of the women who were murdered during the past decade were killed by an intimate partner; in five cities, about a third of the male killers were known threats.
Katie Zezima, Deanna Paul, Steven Rich, Julie Tate and Jennifer Jenkins
Health
“No one on our team has seen anything close to this,” said physician Gavitt A. Woodard.
Alex Horton
California health IT emergency workers pass a fiery test.
Politico
Academic research publications rely on doctors to voluntarily disclose their payments from drug and health companies in a lax reporting system some say is broken.
New York Times
STATE SCAN
The Trump administration will consider whether to approve work requirements for Virginia's Medicaid expansion program, with the Department of Health and Human Services opening the proposal for public comment on Friday.
The Hill
TRUMP TEMPERATURE
Fact Checker
President Trump rarely stops repeating false statements in response to fact checks, so 14 of his repeated claims make the initial list.
Glenn Kessler
OPIOID OPTICS
Federal prosecutors said the doctors unnecessarily prescribed opioids to patients and sought to defraud insurance companies.
New York Times
National
Brandon Wentz, 24, had resigned as mayor of Mount Carbon before he died of an overdose of heroin and fentanyl.
Michael Rubinkam
DAYBOOK

Today

  • Brookings Institution holds a roundtable discussion on health care and data.

Coming Up

  • The House Energy and Commerce Subcommittee on Health is scheduled to hold a hearing on implementing the 21st Century Cures Act on Tuesday.
  • The House Energy and Commerce Committee Subcommittee on Oversight and Investigations is scheduled to hold a hearing on "Examining the Availability of SAFE Kits at Hospitals in the United States" on Wednesday.
  • The Heritage Foundation holds an event on "Defending the Rights and Wellbeing of Children Today" on Wednesday.
  • The House Oversight and Government Reform Subcommittee on Healthcare, Benefits and Administrative Rules holds a hearing on “Exploring Alternatives to Fetal Tissue Research” on Thursday.
  • Medicaid and CHIP Payment and Access Commission holds a public meeting on Thursday and Friday.
SUGAR RUSH

— Meet the bottomless Pinocchio. President Trump's repeated false and misleading claims have led to a new Pinocchio rating:

— A group of police officers tried to pull a 1-year-old child from his mother’s arms as they arrested her at a Brooklyn food-assistance center: