THE PROGNOSIS

President Trump was right about one thing in his address to the nation last night: Migrants trying to enter the United States are encountering some big humanitarian problems. But his punitive policies have augmented the problem instead of abating it.

Last month’s deaths of two Guatemalan children while in U.S, custody highlighted what experts say is insufficient medical care for those seeking asylum. The long-standing problem has been exacerbated by record numbers of migrant families — many of them Central Americans fleeing untenable living conditions — who are straining holding and detention facilities beyond their capacity.

“This is a humanitarian crisis, a crisis of the heart and a crisis of the soul,” Trump said in his first address from the Oval Office, adding that humanitarian and medical funding is included in the border wall plan he’s asked Congress to pass. “Last month, 20,000 migrant children were illegally brought into the United States, a dramatic increase. These children are used as human pawns by vicious coyotes and ruthless gangs.”

The White House and the Department of Homeland Security sent Democratic lawmakers a letter Friday blaming them for creating a “border security and humanitarian crisis” by refusing to fund a border wall. The president adopted a similar tone in these tweets last month:

House Speaker Nancy Pelosi (D-Calif.) responded this way last night: "The fact is, the women and children at the border are not a security threat. They are a humanitarian challenge, a challenge that President Trump's own cruel and counterproductive policies have only deepened."

Indeed, Trump administration policies haven't exactly helped a situation that has troubled immigrant advocates for years.

Immigration and Customs Enforcement has significantly ramped up arrests of undocumented immigrants under a 2017 executive order issued by the president directing ICE to go after a broader set of migrants. Immigration courts are now facing a backlog of more than 800,000 cases. The result: Border Patrol and detention facilities that are overcrowded and now must house children, even though these centers were never designed with them in mind.

“I think there is a crisis, but it’s one that has been exacerbated by this administration’s failures to create an efficient, appropriate, competent system to take care of people,” Grace Meng, a senior researcher for Human Rights Watch, told me.

Thirty percent more people are now held in ICE detention centers and jails than under the Obama administration, according to a report by NBC News. These 200-some facilities house an average of about 42,000 people a day. Twenty-two immigrants have died under ICE custody in the past two years, CBS found.

My colleagues Nick Miroff and David Nakamura report that so many parents with children are among the 2,000 unauthorized migrants being taken into federal custody every day that authorities “have resorted to mass releases of families onto the streets of El Paso and other border cities.”

“U.S. agents are bringing dozens of migrants coughing and feverish each day to clinics and hospitals after stays in jam-packed holding cells where children sleep on concrete floors and huddle in plastic sheets for warmth,” they write.

Investigations have found these centers lack sufficient medical staff, particularly pediatricians. Scott Allen and Pamela McPherson, two doctors who looked into facilities in Pennsylvania, Texas and New Mexico at the request of the Department of Homeland Security, found serious medical neglect.

In a recent interview with NPR, Allen described a toddler with diarrhea who wasn’t given any significant treatment until it was discovered the child had lost one-third of his body weight. In another facility, numerous children were given adult doses of vaccines because the providers weren’t familiar with dosing appropriate for kids.

“Children with significant illness were presenting to the health-care providers who were trying to provide their care, but they were missing some of the most basic things about pediatric care,” Allen told host Michel Martin.

Independent groups have reached similarly troubling conclusions about medical care at detention centers. Consider these reports:

— In the fall, the inspector general for the Department of Homeland Security released the results of a surprise inspection of the Adelanto ICE Processing Center in Southern California. Its 2,000 detainees lacked access to timely medical and dental care. One detainee reported “having multiple teeth fall out while waiting more than 2 years for cavities to be filled,” the report said.

— DHS’s inspector general also issued a report in December 2017 concluding that four out of five detention facilities it examined fell short of ensuring detainees were treated humanely in a safe and healthy environment. In one of the facilities, detainees were strip-searched in violation of standards.

— The inspector general released a second audit in June 2018 saying ICE failed to adequately inspect and monitor more than 200 facilities it operates around the country.

— The same month, Human Rights Watch released an analysis of 15 deaths in immigration detention from December 2015 to April 2017. It found evidence in all but one death of “subpar and dangerous practices including unreasonable delays, poor practitioner and nursing care and botched emergency response.”

— HRW also released a report in February detailing how adults and children are detained in freezing holding cells without access to beds or showers.

AHH, OOF and OUCH

AHH: Fed up with the latest prescription price hikes by drugmakers, Trump convened a meeting yesterday with some of his top officials, Politico’s Dan Diamond, Adam Cancryn and Sarah Owermohle report. The meeting was to include Health and Human Services Secretary Alex Azar, Council of Economic Advisers Chairman Kevin Hassett and acting White House chief of staff Mick Mulvaney.

Trump tweeted over the weekend expressing his frustration with companies he said are “not being fair to the consumer, or to our Country!," on the heels of reports that pharmaceutical companies were increasing prices for hundreds of medications as the new year began, despite opposing pressure from the administration.

OOF: The Trump administration acknowledged Americans would not be able to get food stamps if the partial government shutdown continued into March but pledged there was enough funding to continue to dole out benefits through February.

Officials from the Agriculture Department said states would be given funding for February food stamps ahead of time, by Jan. 20, but states will have to ask for the money to be allocated sooner than it normally would be, our Post colleague Jeff Stein reports.

“The move is part of a series of attempts by the Trump administration to limit the pain inflicted by the government shutdown now in its third week, as officials scramble to prevent essential federal services from expiring,” Jeff writes.

The February fix is based on a provision in the expired government budget bill that allows the federal government to make certain payments up to 30 days after funding elapses. It does not take money from the $3 billion contingency fund for food stamps, and it isn't clear whether that allowance could help pay for food stamps if needed in March.

OUCH: Police are collecting DNA samples from male workers at a health-care facility in Arizona where a woman in a vegetative state gave birth to a child.

Police served a search warrant for Hacienda HealthCare in Phoenix, the company said Tuesday, an announcement that came a day after its CEO stepped down following reports the woman had given birth after being in a vegetative state for nearly a decade, our Post colleagues Herman Wong and Cleve R. Wootson Jr. report. It’s not clear whether any staff members have so far responded to the police request.

“The birth — and the sexual assault of a vulnerable individual that must have preceded it — has cast a harsh glare on conditions at a nonprofit organization that bills itself as a leading provider of health care for Phoenix’s medically fragile,” they write.

The woman, who Herman and Cleve write received round-the-clock care at the facility and was mostly confined to a room at the facility, suddenly went into labor a few days after Christmas and with help from nurses gave birth to a healthy baby boy.

“No one has been arrested in connection with the incident, and it’s unclear whether police have identified any suspects,” our colleagues write. “In Arizona, sexually assaulting a vulnerable adult is a felony.”

HEALTH ON THE HILL

House Democrats are moving forward with their health-care agenda:

— House Budget Committee Chairman John Yarmuth (Ky.) has requested an analysis from the Congressional Budget Office on single-payer health-care proposals, as he prepares to hold hearings on Medicare-for-All plans. The report would provide additional information on how the government would administer such a program and what coverage and cost-sharing may look like, among other issues, though it is not expected to tally up the costs of such a program, according to the Kentucky Democrat’s office.

"The House Budget Committee will soon schedule hearings to review potential ways to achieve affordable, high-quality health care coverage for everyone, including Medicare for All,” Yarmuth said in a statement. “To begin that work, I have requested that the Congressional Budget Office provide a report on the design considerations that policymakers should consider in developing proposals to establish a single-payer system in the United States.”

— Reps. Peter Welch (D-Vt.) and Francis Rooney (R-Fla.) led a bipartisan group of nine lawmakers in introducing a bill Tuesday to mandate the federal government negotiate drug prices to lower prescription costs for seniors in Medicare’s Part D program.

The pair cited the administration’s focus on lowering drug prices and urged Trump to call for such a plan. “Leveraging the federal government's enormous purchasing power to cut drug prices for seniors is common sense and long overdue,” Welch, a member of the House Energy and Commerce Committee, who is seen as a leader on the drug pricing issue, said in a statement. “Paying retail prices for wholesale drug purchases is ridiculous and irresponsible. If the President is serious about lowering drug prices, he should demand that Congress send our bill to his desk.”

— Top Democratic health leaders in both chambers are calling on the Trump administration to provide more information about the rule expanding the availability of short-term insurance plans.

“We have written to you on multiple occasions regarding the Administration’s actions to promote these junk plans, and we have not received a substantive response,” reads a letter signed by lawmakers including House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.); Ways and Means Committee Chairman Richard Neal (D-Mass.); Ron Wyden (Ore.), the ranking Democrat on the Senate Finance Committee; and Patty Murray (Wash.), the ranking Democrat on the Senate Health, Education, Labor and Pensions Committee.

“Expanding STLDI plans will take us back to the days when consumers could be denied coverage entirely, charged more based on age, gender, or health status, or denied access to basic health care benefits such as prescription drugs, maternity coverage, and treatment for substance use disorders,” the Democrats wrote.

— March for Life announced this week its bipartisan group of congressional speakers for the Jan. 18 rally, which will include Sen. Steve Daines (R-Mont.), Rep. Chris Smith (R-N.J.), and Rep. Dan Lipinski (Ill.), the only Democratic member of Congress who will join the event and one of the few antiabortion Democrats remaining in Congress.  Louisiana state Rep. Katrina Jackson (D) will also join the rally. This year's theme is "Unique from Day One: Pro-life is Pro-Science."

STATE SCAN

— In New York City, Democratic Mayor Bill de Blasio announced a plan to offer affordable health care for all residents, including for undocumented immigrants — a vow that comes as the nation debates both universal health coverage and immigration rights, our Post colleague Amy Goldstein reports.

The Big Apple would become the second city in the country to attempt to provide broad health coverage for its residents, following an effort from San Francisco a dozen years ago. De Blasio’s plan comes as calls for a national health-care plan, such as Medicare-for-all, have gained momentum and become a key talking point among potential Democratic presidential candidates.

The mayor said during a Tuesday speech on his plan that he would prefer a federal or state single-payer health-care system but insisted “we are not going to fall for the trick of waiting for Washington, D.C., to solve our problems.”

Amy writes: “Under NYC Care, as the program is being called, uninsured New Yorkers will be able to call a central phone number to get an insurance card and be assigned a doctor, giving them access to primary care and an array of specialty services, the mayor said. The services won’t be free for everyone: Fees will be assessed on a sliding scale, depending on income.”

— In Washington, Gov. Jay Inslee (D) took a step toward universal health coverage in the state, announcing a proposed public option plan.

The plan would be offered in every county in the state, The Seattle Times’s Ryan Blethen and Joseph O’Sullivan report, and would “have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange.” The governor proposed a state budget that would provide $500,000 to fund the initial work to set up such a plan.

“We are proposing to the state Legislature that we have a public option that is available throughout the state of Washington so that we can increase the ability to move forward on the road to universal health care in the state of Washington,” said Inslee, who is said to be considering a presidential run.

“Washington state Insurance Commissioner Mike Kreidler said getting the legislation passed will be difficult, but is necessary, especially for people buying health insurance on the individual market who don’t qualify for a subsidy,” Ryan and Joseph write.

 — In California, newly inaugurated Gov. Gavin Newsom (D) made his first order of business an executive order to tackle prescription drug costs by expanding the state’s financial power.

Newsom’s order would create the largest single-purchase system for drugs in the country by having the state’s Department of Health Care Services negotiate prescription prices on behalf of all 13 million beneficiaries of Medi-Cal, the state’s Medicaid program, the San Francisco Chronicle’s Joe Garofoli reports.

The governor also proposed extending the program eligibility to undocumented immigrant adults up to age 26, expanding coverage that now ends at age 19. His budget is set to also include a proposal to raise the income eligibility for Affordable Care Act premium subsidies for individuals making up to $72,840 and families of four making up to $150,600.

— And here are a few more good reads: 

Democrats’ long-pledged push to tighten the country’s gun laws will take center stage as lawmakers introduce legislation aimed at expanding background checks on gun sales.
Wall Street Journal
This battle over an obscure budget rule is really a fight for the future of the Democratic Party.
Vox
MEDICAL MISSIVES
The virus, whose disovery was reported this week, has traits similar to those that have helped its cousin viruses break into human cells.
Stat
Lower smoking rates are translating into fewer deaths. Advances in early detection and treatment also are having a positive impact, experts say.
Associated Press
INDUSTRY RX
Eli Lilly and Co. won’t put the price of its prescription drugs in television ads, as the Trump administration has called for pharmaceutical companies to do, but will begin promoting a website where prices are available.
Bloomberg News
A California jury on Monday heard opening statements in the latest trial over allegations that Johnson & Johnson’s (JNJ.N) talc-based products, including the company’s baby powder, were contaminated with asbestos and cause cancer.
Reuters
DAYBOOK

Today

  • The 37th annual J.P. Morgan Healthcare Conference continues in San Francisco.

Coming Up

  • A joint meeting of the FDA’s Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee is scheduled for Friday.
  • Brookings India and Tufts University hold a roundtable on ‘Opportunities for India Beyond 2019: The Future of Health and Geopolitics’ on Jan. 15.
  • Politico hosts an event on health care innovators on Jan. 16.
SUGAR RUSH

Watch Trump's full address to the nation on border security:

House Speaker Nancy Pelosi (D-Calif.), Rep. Mike Thompson (D-Calif.) and former congresswoman Gabrielle Giffords introduced legislation to expand background checks for the sale and transfer of firearms: