THE PROGNOSIS

Abortion protesters are set to gather today for their annual March for Life, buoyed by a slew of regulations the Trump administration is advancing to restrict federal funding for abortion and expanding protections for those who are morally opposed to providing  or buying specific services

They’re eager for more such announcements — perhaps during today's protest — from the Department of Health and Human Services. The agency is expected to soon release a final regulation strengthening enforcement of 25 existing health-related religious freedom laws and another rule banning abortions from being provided at the same location where Title X family planning services are offered.

"HHS looks forward to issuing the final rule promptly," spokeswoman Caitlin Oakley wrote me, referring to the proposed Title X changes, although she didn't confirm whether they'll be released today.  Oakley said HHS Secretary Alex Azar will be speaking this morning at a pre-march conference hosted by the Family Research Council and confirmed that Deputy Secretary Eric Hargan will be attending the march.

Earlier this week, Sen. Steve Daines (R-Mont.) sent a letter to President Trump signed by 169 House members and 49 senators praising the president for his actions and urging him to veto any bills that might expand access to abortion. Daines, one of the scheduled speakers at a rally before the march, told me he plans to announce a formal effort to mobilize antiabortion senators around the issue.

But if Democrats win the White House and Senate majority in 2020, the good fortunes of abortion foes could quickly evaporate. Democrats in Congress are trying to broaden abortion rights more aggressively than ever before, targeting even a long-held truce between the parties known as the Hyde Amendment, which governs when taxpayer dollars can — and can’t — be used for abortions.

“If the Republicans were to lose the House and Senate and the White House I would say within a year there would not be a pro-life provision left,” Tom McClusky, vice president of government affairs at March for Life, told me, though 60 votes are still needed for most Senate actions.

Leaders of the House’s Pro-Choice Caucus, which boasts its largest membership ever, said this week they’ll push for legislation scrapping the Hyde language, which for years has been attached on a bipartisan basis to federal appropriations bills. Hyde prohibits the use of federal funds for abortions except in cases of rape, incest or if the woman’s life is at stake.

Rep. Barbara Lee (D-Calif.), co-chair of the House Pro-Choice Caucus:

Senate Republicans pulled in the opposite direction yesterday, trying to advance a bill to make the Hyde language written into permanent law and ban federal subsidies for any Obamacare marketplace plans that include abortion coverage. They failed to gain the 60 votes needed, opposed by two Republicans and all but two Democrats.

The increasing polarization of the abortion issue will be on stark display at today’s protest, where just one Democratic member of Congress is scheduled to speak: Rep. Dan Lipinski (D-Ill.). While several dozen House and Senate Democrats identified as antiabortion rights back in 1990s, just a handful do now. Besides Lipinski — who was snubbed by his party in a primary challenge last year — they include Rep. Collin Peterson of Minnesota and Sens. Joe Manchin of West Virginia, Joe Donnelly of Indiana and Bob Casey of Pennsylvania.

“The newest class in Congress heralds a redrawing of the battle lines in the ever-contentious fight over abortion,” my Washington Post colleague Julie Zauzmer writes. “Not so long ago, many moderate members of Congress broke from their parties over this deeply felt issue. Now, Republicans who support abortion rights are ‘nearly extinct.’ Democrats who oppose abortion are a ‘dying breed.’ ”

March for Life President Jeanne Mancini told Julie the march strives for political balance but finds it increasingly difficult to persuade Democrats to speak to attendees.

“We’re a bipartisan organization. And sadly, it’s gotten much, much more difficult to get Democrats to speak at the March for Life or just to be involved in the pro-life movement,” she said. “We very actively pursue pro-life Democrats.”

More polarization will almost certainly lead to ever more bitter fights on Capitol Hill. If Democrats keep backing away from the Hyde language — they proposed in their 2016 platform for it to be abandoned — it could result in huge fights over virtually any health-care-related spending bill (this is the issue that derailed the marketplace stabilization measure championed last year by Sens. Lamar Alexander and Patty Murray).

It’s notable that House Appropriations Committee Chairwoman Nita Lowey (D-N.Y.) and Rep. Rosa DeLauro (D-Conn.), who heads the subcommittee that handles HHS spending, are both members of the House Pro-Choice Caucus.

Democrats have tried do away with the Hyde language before, but there may be a stronger political climate for such an effort now, Mary Ziegler, a law professor at Florida State University who specializes in the legal history of reproduction rights, told me.

“It’s probably too soon to know whether the current divisions over the Hyde Amendment are going to last or not,” Ziegler said. “I think there’s a lot of energy in both parties — not in the middle, but further to the right or left — and Hyde is the type of proposal that would appeal more to people in the middle.”

AHH, OOF and OUCH

AHH: The Trump administration may have separated thousands more migrant children from their parents than was previously made public, according to a report released by HHS’s inspector general.

The report found 118 children were taken into custody between July and early November, after the administration announced it was halting its controversial family separation effort. But the report also says even before the government announced its family separation policy, thousands of other children were separated from their families starting early in the administration, our Post colleague Amy Goldstein reports. The inspector general report found no one was systematically keeping count of separated children until the "zero tolerance" policy triggered a lawsuit.

"According to the report, the most common reason the Department of Homeland Security gave health officials for the 118 most recent separations was that parents had a criminal history," Amy writes. "But information on the parents’ criminal records often was so sketchy, the report said, that it is unclear whether the separations were warranted or whether the children could be safely returned to their parents."

The report "draws fresh attention to flawed data systems and poor communication between federal agencies, which left HHS officials uncertain this summer which of the minors in their custody had been separated," Amy adds.

In a statement, Lee Gelernt, lead attorney and deputy director for the American Civil Liberties Union’s Immigrants’ Rights Project, said the “policy was a cruel disaster from the start.” Gelernt said the group will be “back in court over this latest revelation.”

California Attorney General Xavier Becerra (D) said it was “disgraceful that the Trump Administration has been hiding such outrageous actions from the American people. Who would believe that in the 21st century our government would separate thousands of children from their parents, and without any public awareness?”

OOF: A new report from the Veterans Affairs inspector general found former secretary David Shulkin violated ethics rules and that the agency’s security detail compromised safety procedures.

The investigation was initially sparked by “various complaints” alleging VA’s Executive Protection Division was being mismanaged, our Post colleagues Katie Mettler and Lisa Rein report, adding the alleged failures "detail missteps that went on for years and came to a head under Shulkin."

The report said there were “insufficient written operational procedures that resulted in security vulnerabilities,” such as agents frequently leaving keys for Shulkin’s motorcade behind the fuel door instead of putting them in a secure spot.

There were also complaints that Shulkin misused security services. “The inspector general’s office determined that he violated ethics rules when he permitted his VA employee driver to use a personal vehicle to drive around his wife,” Katie and Lisa write. “Generally, the Executive Protection Division exclusively provides security and transportation for the VA secretary and deputy secretary. Family may benefit from those protective services only if they are traveling with the secretary or deputy.”

The report said Shulkin, who was fired by Trump in March,  was advised about these rules.

OUCH: Utah Lt. Gov. Spencer Cox (R) said he expects Medicaid expansion to proceed as planned in the state, even as state lawmakers are considering a bill to effectively repeal the expansion plan approved by voters.

In November, 53 percent of voters approved Proposition 3, a measure set to take effect in April, to expand the program and increase a state sales tax to generate about $90 million to help fund the care to 150,000 low-income residents, with the help of $800 million in federal funding, the Salt Lake Tribune’s Benjamin Wood reports. But Cox acknowledged that may not be sufficient. “It’s very clear that tax increase [in Prop 3] is not going to cover the entire amount of the expansion,” he said.

“Supporters of the initiative say the funding structure is sufficient to pay for expansion, and that unforeseen costs in the future could be dealt with through budget prioritization,” Benjamin writes. “But Republican state lawmakers have long opposed full expansion, citing the increased cost to the state. And despite the majority vote in favor of Prop 3, Sen. Allen Christensen, R-North Ogden, is preparing legislation to impose enrollment caps and work requirements on beneficiaries, and to delay implementation of the expansion until those changes can be approved by federal Medicaid administrators.”

AGENCY ALERT

— The Centers for Medicare and Medicaid Services has proposed a list of changes to how insurers sell plans within the individual insurance marketplaces, including reducing the fees they pay and allowing them to make mid-year changes to the list of drugs they cover in order to encourage use of more generics. The agency said the change will create a "more stable and predictable regulatory framework" to make the marketplaces more efficient and competitive.

"The changes proposed in the rule are targeted to further the goals of lowering premiums, enhancing the consumer experience, increasing market stability, and reducing regulatory burdens," CMS wrote. Other proposals in the 331-page notice include:

  • Asserting the administration supports making payments for the extra cost-sharing subsidies (popularly known as CSRs) insurers give the lowest-income marketplace enrollees and ending the practice known as "silver loading" (where insurers hiked premiums for "silver" level plans in order to compensate when the adminstration cut off the CSR payments). The notice invites comments from stakeholders on how the agency might address silver loading in the future.
  • Requiring marketplace insuers covering abortion services must also offer a "mirror" plan omitting coverage of abortion services, to the extent permissible under state law, starting in the 2020 plan year.
  • Allowing insurers to exclude drug manufacturer coupons from counting toward the annual cost-sharing limit when a generic drug is available. Insurers may also refuse to count cost-sharing toward a patient's maximum out-of-pocket limit if the patient selects a brand-name drug when a generic alternative is available.

— The Food and Drug Administration plans to preserve resources amid the partial government shutdown by furloughing more employees and suspending lower-priority tasks in order to shift money toward reviewing critical drugs, including new treatments for depression, diabetes and several types of cancer, our Post colleague Laurie McGinley reports.

“What we are trying to do is to keep the review process continuing because of important drugs in the pipeline,” FDA Commissioner Scott Gottlieb told Laurie in an interview. Such drug reviews are funded by fees paid by the pharmaceutical companies, which the agency can’t collect during the shutdown. The fees from 2018 are set to run out around Feb. 8.

And the planned cost-saving measures will buy the agency only weeks of extended resources for drug reviews. “The FDA’s new plans are a sign of the burgeoning impacts of the impasse, some visible and others invisible to the public,” Laurie writes.

— The FDA also announced an effort aimed at making it simpler for pharmaceutical companies to make over-the-counter versions of the opioid antidote naloxone.

For the first time, the FDA developed sample labels for drug manufacturers to use when applying for approval for the nonprescription drug. Drugmakers must develop and test drug facts labels before applying for a new over-the-counter drug “to show that consumers can understand how to use the product without the supervision of a health care professional,” Gottlieb explained in a statement.

The commissioner said the move was part of the agency’s efforts to address opioid-related deaths.

“Naloxone is a critical drug to help reduce opioid overdose deaths. Prevention and treatment of opioid overdose is an urgent priority,” Gottlieb said. “FDA-approved versions of naloxone currently require a prescription, which may be a barrier for people who aren’t under the care of a physician or may be ashamed or even fearful of admitting to issues with substance abuse. Having naloxone widely available, for example as an approved OTC product, is an important public health advance, and a need that we’ve been working on at the FDA.”

HEALTH ON THE HILL

— Three Democrats on the House Energy and Commerce Committee called on federal officials to brief Congress on the status of the Ebola outbreak in Congo.

House Energy and Commerce Committee Chair Frank Pallone Jr. (D-N.J.), along with Health subcommittee Chair Anna Eshoo (D-Calif.) and Diana DeGette (D-Colo.), chair of the Oversight and Investigations subcommittee, expressed concern about the “tragic and alarming” spread of Ebola. The Energy and Commerce Committee oversees the Centers for Disease Control and Prevention. 

“The Committee will continue its longstanding oversight of federal efforts to respond to emerging foreign infectious disease threats,” the trio said in a joint statement. “We have asked the CDC to provide us a full briefing on the scope of this Ebola outbreak, the challenges it faces in trying to contain it and how public health agencies are working to address it.” 

— Pennsylvania Republican Rep. Tom Marino announced he is resigning from Congress this month to take a gig in the private sector, just weeks after he was elected to a fifth term, our Post colleague Mike DeBonis reports.

“As of January 23, 2019, I am officially stepping down from Congress,” he said in a statement. “Having spent over two decades serving the public, I have chosen to take a position in the private sector where I can use both my legal and business experience to create jobs around the nation.”

In 2017, Marino withdrew his name from consideration to be the nation’s drug czar after a joint Washington Post/“60 Minutes” investigation detailed how he helped push legislation to weaken the Drug Enforcement Administration’s power to go after drug distributors amid a rise in opioid-related deaths.

“Marino’s departure will leave the GOP with 198 seats, as the outcome of the House race in North Carolina remains unresolved,” Mike writes. “Pennsylvania’s governor will have to set a date for a special election to fill the seat.”

— And here are a few more good reads: 

The Women's March and other progressive organizations are planning to lobby for "Medicare for All" legislation on the eve of the annual Women's March in Washington, D.C., this weekend.
The Hill
PowerPost
There’s early bipartisan support for potentially expunging criminal records involving nonviolent drug offenses.
Karoun Demirjian
TRUMP TEMPERATURE
A draft plan obtained by NBC News also shows officials wanted to specifically target parents in migrant families for increased prosecutions.
NBC News
National
But the U.S. Labor Department says that hundreds of thousands who are working without pay do not qualify for the benefits.
Tim Craig
PowerPost
President Trump has signed a bill guaranteeing that federal workers sent home unpaid due to the partial government shutdown will receive retroactive pay--which already had been assured for those who have continued to work without pay in shuttered agencies.
Eric Yoder
Business
In the wake of Hurricane Maria, the governor has largely tried to avoid alienating the White House.
Jeff Stein
Answer Sheet
A recent accident seems more serious than originally believed.
Valerie Strauss
MEDICAL MISSIVES
Tens of thousands of embryos are stuck in limbo in fertility clinics, leftovers from pregnancy attempts and broken dreams of parenthood.
Associated Press
The head of the World Health Organization has ordered an internal investigation into allegations the U.N. health agency is rife with racism, sexism and corruption, after a series of anonymous emails with the explosive charges were sent to top managers last year.
Associated Press
INDUSTRY RX
Amy Skuse maintained she was fired because she refused to receive a yellow fever vaccine, which went against her religious beliefs as a Buddhist.
Stat
STATE SCAN
Education
Classes are being held in office buildings, portable classrooms and an old hardware store.
Moriah Balingit
Grade Point
Appointed a year ago in the wake of a sexual-abuse scandal, John Engler made comments that offended the victims of disgraced former university sports medicine and USA Gymnastics doctor Larry Nassar.
Simon Schuster and Susan Svrluga
Officials at our state's Medicaid program are demanding changes at Hacienda Healthcare, the facility where a woman in a vegetative state recently gave birth.
Arizona Republic
State leaders have promised to tackle school safety this session, and lawmakers are expected to push bills that would beef up mental health screening programs and make it easier to arm teachers.
Texas Tribune
DAYBOOK

Today

  • The 46th annual March for Life rally will be held in Washington.
  • The National Institutes of Health's All of Us Research program hosts a live Twitter chat on digital health technology and the future of health research.
SUGAR RUSH
President Trump's request for $5.7 billion toward the border wall has caused a nearly month-long partial government shutdown. Here's how that number stacks up to other federal spending

Trump ordered his former lawyer, Michael Cohen, to lie to Congress about negotiations to build a Trump Tower in Moscow: