THE PROGNOSIS

There’s a bit of good news for detained migrants in the spending package President Trump signed last week, although the plan does little to fix the underlying problem of historically high numbers of people being held in detention.

Tucked within the $333 billion spending package, which prevented yet another government shutdown by funding the government through the end of September, is money for humanitarian assistance at the border and more health staffers at detention facilities throughout the United States, as well as some guidance mandating better treatment of detainees.

As we've detailed previously, the U.S. falls short in some significant ways when it comes to caring for immigrants held at the border and in facilities around the country. Yesterday, a 45-year-old Mexican national detained by Customs and Border Protection died at a medical facility in McAllen, Tex., after twice seeking medical attention, my colleague Isaac Stanley-Becker reports. That incident follows the December deaths of two migrant children in government custody.

Here are some of the humanitarian provisions in the spending bill:

  • An additional $415 million to CBP in aid to migrants, including $128 million for hiring more medical professionals; $40 million for food, infant formula and diapers; and $24 million for transportation between detention facilities.
  • Directives for CBP to brief Congress within 60 days on its progress in providing better, more consistent care to detainees, including meeting their water, nutrition, hygiene and sanitation needs.
  • An additional $12 million to Immigration and Customs Enforcement for hiring 112 more staffers focused on health.
  • A directive that new processing and Border Patrol facilities in Texas should be equipped with “appropriate temperature controls and avoid chain-link fence-type enclosures.”
  • A directive for migrants to receive warmer blankets, saying CBP “is encouraged to use a more appropriate blanket type than currently utilized.”

Trump has said little about these parts — or any parts — of the spending agreement passed Thursday, which provides far less funding for new fences along the border in Texas than he’d originally sought. The compromise funds $1.375 billion for 55 miles of new fences, compared with the $5.7 billion Trump had requested from Congress for building 234 miles of steel walls.

Instead, the president has kept his focus on the influx of illegal drugs from Mexico, repeating claims that building a more comprehensive wall by declaring a national emergency at the southern border will solve what he’s dubbed a “national security crisis.” The White House spent the weekend defending Trump’s emergency declaration and seeking to clarify his contradictory statements about its necessity, my Washington Post colleague Amy B Wang reports.

“Trump’s announcement last week — an attempt to circumvent Congress by redirecting taxpayer money to pay for 230 miles of barriers along the Mexican border — has led to lawsuits and protests,” Amy writes. “California’s attorney general said he estimated about a dozen states would join a lawsuit against the White House that his office would file Monday. Various groups have held demonstrations against the declaration across the country.”

Republican lawmakers had different takes on Trump's emergency declaration:

Yet immigrant advocates and more liberal Democrats didn’t exactly get a marked win in the spending bill, either. While Democrats and Republicans have different spins on whether the agreement will ultimately result in more or fewer detentions, one thing is clear: It doesn’t provide any significant change in the number of people who can be detained by ICE.

The measure funds enough beds to detain a daily average of 45,274 people. That’s slightly below the 49,000 people ICE currently has funding to detain, but still far more than in the early 2000s, when the agency detained about 20,000 migrants on a daily basis.

Grace Meng, a senior research for Human Rights Watch, said given that reality, the extra humanitarian funding feels “a little like window-dressing.”

“It’s good to see resources being placed into making those places more humane, but I think the overall goal of keeping people safe is really undercut when there’s not a real commitment to reducing the number of people in detention,” Meng told me.

Still, it’s a positive sign that Congress is providing some funding and directives to improve the situation for detained migrants, considering that multiple independent reports have found serious shortcomings in how people held in Border Patrol and detention facilities are cared for. As I noted in January, both HRW and the inspector general for the Department of Homeland Security have issued multiple reports raising significant concerns about their care.

— In the fall, DHS's inspector general 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, according to the report. 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 saying ICE failed to adequately inspect and monitor more than 200 facilities it operates around the country.

— The same month, HRW 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: What if your boss knew how many steps you took today? Or how many times you worked out this week?

That kind of health surveillance is becoming part of a norm, as employees are increasingly wearing digital fitness trackers that send information to insurance companies and employers, our Post colleague Christopher Rowland reports.

“The volume of highly sensitive health data scooped up from individual employees is exploding...raising privacy concerns and adding a new dimension to the relationship of workers and their employers,” he writes. “Often the information is not covered by federal rules that protect health records from disclosure. And when it’s combined with data such as credit scores, employees are giving up more insights about themselves than they realize.”

Employees are generally incentivized to join the programs with cash bonuses, premium reductions or copayment or deductible reimbursements. Such programs aim to help people move more, manage fitness and save on health-care costs, though “evidence is mixed at best about whether the approach works,” Christopher writes. And experts are also warning about how the information could be used to favor healthier employees and stigmatize those who are less healthy.

And where does this information go? “Once health and fitness data leaves an employee’s wrist, it enters a digital realm that critics say is loosely regulated,” Christopher writes. “The information streams to an app on the worker’s phone, and from there to several possible places: the manufacturer of the device, the health insurance company, the employer or a wellness-plan administrator — or all of them.”

OOF: Facebook is weighing whether to remove or demote misinformation about vaccines on its platform, as the social media company grapples with public pressure regarding how it deals with anti-vaccination content, our Post colleague Taylor Telford reports.

The pressure intensified last week after Rep. Adam Schiff (D-Calif.) wrote a letter to Facebook chief executive Mark Zuckerberg inquiring about how the company plans to handle misleading information about vaccinations.

“Specifically, Facebook is looking into cutting back or removing this content from recommendations, including ‘Groups you should join,’ according to a Facebook spokesperson,” Taylor writes. “It’s also considering demoting it in search results.”

“We’ve taken steps to reduce the distribution of health-related misinformation on Facebook, but we know we have more to do,” Facebook said in a statement to The Post. "We’re currently working on additional changes that we’ll be announcing soon.” Bloomberg News’s Sarah Frier first reported that Facebook was considering removing anti-vaccination content following Schiff’s letter.

OUCH: A state House panel in Washington passed legislation that bans personal or philosophical exemptions to the vaccine for measles, mumps and rubella.

The party-line vote in the Health Care and Wellness Committee on Friday comes as the state deals with the worst measles outbreak in more than two decades, one that centers in Clark County.

The only Republican to support the bill, state Rep. Paul Harris, is the bill’s sponsor and is expecting the measure to advance quickly, the Seattle Times’s Jake Goldstein-Street reports.

“While the nonmedical exemption rate for kindergarten enrollment in the 2017-2018 school year was approximately 2 percent nationwide, according to the Centers for Disease Control and Prevention, Washington had an exemption rate on philosophical, personal or religious grounds of 4 percent,” Jake writes. “By comparison, Clark County, where the vast majority of this year’s measles cases are located, had a 6.7 percent exemption rate.”

Meanwhile, the outbreak seems to have slowed in Washington. As of Thursday, there were 54 confirmed cases, with just one new case in the previous week, Jake writes.

— In the District, the House Energy and Commerce Committee plans to address the national measles outbreak in a hearing scheduled for later this month.

“Measles is a highly contagious, life-threatening virus that was previously eliminated in the United States thanks to the success of the measles vaccine,” the committee’s bipartisan leaders said in a joint statement last week. “Unfortunately, measles cases are on the rise as a consequence of the virus’s transmission among unvaccinated groups."

The panel’s Oversight and Investigations subcommittee is scheduled to hold a hearing on the outbreak and response efforts on Feb. 27.

TRUMP TEMPERATURE

— During Trump's Friday speech declaring a national emergency at the border with Mexico, the president praised the practice of executing drug traffickers by suggesting it would help end the nation's drug problem. 

Speaking about a conversation with Chinese President Xi Jinping, Trump said Xi told him there was no drug problem in China: “We give death penalty to people who sell drugs. End of problem," he said. 

“Trump has repeatedly praised authoritarian leaders around the world and shown a particular affinity for the punitive measures some have used against drug traffickers and users,” our Post colleague Eli Rosenberg writes. “Last winter, he told an audience in Pennsylvania that discussions about instituting the death penalty for drug dealers was ‘a discussion we have to start thinking about,’ again saying he got the idea from Xi. Trump previously suggested the death penalty was a way to fight the opioid epidemic.”

But human-rights experts warn it’s both a concerning and misleading claim. For one, it does not appear to be the case that China does not have a drug problem, Eli writes. Brad Adams, the Asia director at Human Rights Watch, told Eli that “China does execute people in some cases for drug trafficking, distribution and manufacturing but that its legal processes would not pass muster in the United States.”

— During the same speech, Trump claimed drugs aren’t smuggled through ports of entry. However, our Post colleague Philip Bump writes the claim was, “to put it bluntly, nonsense.”

“A big majority of the big drugs, the big drug loads don’t go through ports of entry,” Trump said. “They can’t go through ports of entry. You can’t take big loads because you have people. We have some very capable people, the Border Patrol, law enforcement, looking.”

Philip writes: “First of all, we know that drugs flow through ports of entry because Trump’s own administration has repeatedly said they do... You need only give a cursory look at CBP news releases, touting their interdictions, to see how ridiculous it is to claim that you can’t smuggle large amounts of drugs through ports of entry.”

HEALTH ON THE HILL

— Sen. Bernie Sanders (I-Vt.), whose 2016 presidential campaign grew from a left-wing insurgency to a force that reshaped the Democratic Party, has announced he'll seek its nomination for president again in 2020, our colleague Dave Weigel reports. Sanders wrote in an email sent to supporters that he was building “an unprecedented and historic grassroots campaign” that would draw on people across the country.

"The senator cited health care, climate change, student debt, the 'demonization' of undocumented immigrants, income inequality, gun violence and the myriad problems of America’s needy as propelling him into his second presidential contest," Dave writes.

— Sen. Elizabeth Warren (D-Mass.) is set to launch a plan to make child care universal, HuffPost’s Jonathan Cohn reports.

The plan would dole out federal funds to providers offering childcare on a sliding income scale and would ensure families spend no more than 7 percent of their household incomes on care, regardless of the number of children in the family. And care would cost nothing for families with incomes below twice the poverty line, or about $50,000 for a family of four, Jonathan reports.

“Officials with Warren’s 2020 presidential campaign declined to comment on the proposal and the sources familiar with the plan cautioned that some details were still in flux as of last week,” he adds. “But, the sources said, the campaign has an internal analysis that shows the initiative will likely require approximately $700 billion in new federal spending over 10 years…If that estimate is indicative, the new outlays in Warren’s plan would be at least four times what the federal government currently spends on its main early childhood programs, which include Head Start, a block grant for state-level child care programs, and a tax credit that mostly benefits middle-class families.”

Warren’s plan could also put the issue of child care on the map leading up to the 2020 presidential election cycle, potentially pushing other candidates to respond with their own childcare plans.

— In a small courthouse 20 miles south of Oklahoma City, big pharma is facing a major test: the first trial at which a jury could decide whether drug companies bear responsibility for the nation’s opioid crisis.

"Thousands of cities, counties, Native American tribes and others have filed lawsuits up and down the opioid supply chain, alleging various claims of culpability for the crisis that began with widespread abuse of powerful painkillers," our colleagues Lenny Bernstein and Katie Zezima write. "Most of the cases have been consolidated in a major federal action in Cleveland. But as that case lags, smaller state cases like the one here in Oklahoma are quickly moving to hold companies to account, creating an early test of how costly the opioid crisis might be for the pharmaceutical companies that made billions of dollars off the drugs.

Oklahoma’s case is scheduled to begin May 28 at a state courthouse in Norman. "Judge Thad Balkman has repeatedly refused to delay the trial and has agreed to have it televised live every day, raising the prospect of nationwide coverage of grieving families and embarrassing internal company emails," Lenny and Katie writes. "Nearly 800 Oklahomans died of drug overdoses in 2017, about half of them from opioids."

— And here are a few more good reads: 

AGENCY ALERT
Health
The House Oversight chairman objects to an ‘unconventional and nontransparent’ review process.
Ariana Eunjung Cha
Morning Mix
The 45-year-old passed away at a hospital in McAllen, Tex., after twice asking for medical attention and being cleared for travel the first time.
Isaac Stanley-Becker
INDUSTRY RX
A copy of an unredacted lawsuit provides various examples in which state prosecutors alleged companies worked together to manipulate prices.
Stat
A review of insulin's 100-year history makes it clear that drug makers, their generic counterparts, doctors, and FDA all share blame for the broken market.
Stat
As people shop online more, CVS and Walgreens are trying to give people reasons to keep coming into their stores.
CNBC
MEDICAL MISSIVES
Health & Science
Such medications are seen as lifestyle-related rather than medically necessary. Experts and patients don’t agree.
Michelle Andrews
Public Safety
Judge Leonie M. Brinkema said authorities have shown no evidence justifying the termination decision, which the airmen are challenging.
Rachel Weiner
Courts & Law
It’s likely she will be on the bench Tuesday when the court resumes its oral argument schedule.
Robert Barnes
Science
Spaceflight changes gene expression and poses radiation hazard but NASA sees no showstoppers as it dreams of a Mars mission
Joel Achenbach
Health & Science
Three antibody treatments and one antiviral are being tried against the often-lethal virus
Aimee Cunningham
STATE SCAN
DAYBOOK

Coming Up

  • The Brookings Institution holds an event on policy solutions to surprise medical bills on Wednesday.
  • The American Enterprise Institute holds a discussion on e-cigarette regulation, teens and trade-offs, featuring remarks from Iowa Attorney General Tom Miller on Thursday.
SUGAR RUSH

Lawmakers argue over Trump’s national emergency declaration

Fact-checking Trump's national emergency declaration | Fact Checker