THE PROGNOSIS

Nine years into the Affordable Care Act, Democrats and Republicans still can’t agree on improving the health-care law even as participation in its insurance marketplaces slopes downward.

Final enrollment figures released yesterday by the Centers for Medicare and Medicaid Services showed a small decline in signups compared to 2018, with 300,000 fewer enrollees across all the states and D.C. A total of 11.4 million Americans signed up for 2019 marketplace coverage during the enrollment period late last year.

The totals aren’t abysmal, but they do indicate that the ACA’s initial progress towards reducing the country’s uninsured rate has stalled. And lawmakers on Capitol Hill appear as divided as ever on how to improve the marketplaces by making them more affordable for the consumers who shop there.

This afternoon, House Speaker Nancy Pelosi and House Democratic committee leaders will roll out legislation they say would improve the marketplaces and roll back harmful policies advanced by the Trump administration. The measure – which will include reinsurance programs to help insurers reduce premiums and more generous subsidies to help consumers afford them – is expected to incorporate elements of six bills considered by the House Energy and Commerce Committee in two recent hearings.

But the measure doesn’t have GOP buy-in, including from Sen. Lamar Alexander (R-Tenn.), the senator who tried to negotiate a bipartisan marketplace stabilization bill last year with Sen. Patty Murray (D-Wash.) only to see the whole effort ultimately crumble.

So while congressional Republicans have halted their efforts to dismantle Obamacare, the health-care law remains ever the political football – with the Trump administration claiming it is providing consumers with more affordable options and Democrats accusing it of sabotaging the law.

The administration won't even defend the ACA in a legal challenge brought by conservative-led states, yesterday adopting an even more dramatic stance against the law.

The Justice Department said it wants a federal court to completely repeal Obamacare instead of just its individual mandate to buy coverage, a departure from its previous stance that the mandate was legally distinct and other provisions could still stand.

In a legal filing Monday with the U.S. Court of Appeals for the 5th Circuit in New Orleans, where an appeal is pending, three Justice Department attorneys wrote the ruling from a federal judge in Texas that the health-care law is unconstitutional should be affirmed. “The Department of Justice has determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal,” Justice Department spokewoman Kerri Kupec said in a statement.

As CMS released the enrollment totals yesterday, the agency also announced it will grant an additional year before certain “grandmothered” health plans that still don’t fully comply with ACA regulations must fall in line. The move is similar in nature to previous moves by the administration expanding leaner, cheaper health plans through short-term coverage and associations plans.

“By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare,” CMS Administrator Seema Verma said in a statement.

Verma also shrugged off the small enrollment decline, saying it reflects a lower demand for marketplace coverage because more people are receiving coverage through their workplaces and through Virginia’s recent Medicaid expansion. But it’s not the first year of declining enrollment. Signups decreased by 400,000 people between 2017 and 2018.

Expect Pelosi – along with Ways and Means Chairman Richard Neal, Energy and Commerce Chairman Frank Pallone and Education and Labor Chairman Bobby Scott – to draw a sharp contrast today between the administration’s approach to the marketplaces and their own. The measure they’re introducing will propose rolling back the administration’s expansion of short-term and association health plans and restore funding it had slashed to navigators who provide enrollment assistance for hard-to-reach groups.

The legislation will also roll back guidance Democrats have said could undermine people with preexisting medical conditions by expanding the waivers states can get to run their marketplaces in alternative ways. Democrats have been particularly eager to keep talking about preexisting condition protections, after making it a top issue in the midterm elections helped them seize the House majority.

“Frankly, the anticipation is not that this package is going to get to the president’s desk and signed into law,” Shawn Gremminger, senior director of federal relations at Families USA, told me. “This is about Democrats fulfilling their promise to the American people.”

A health-care industry coalition called Partnership for America's Health Care Future, which is deeply wary of Medicare-for-all legislation proposed by far-left Democrats, is applauding Pelosi's focus on improving the ACA instead of overhauling the entire health-care system.

"It isn’t difficult to understand why Speaker Pelosi and most Democratic Members of the House favor this approach over embracing calls by some to push ahead with a disruptive, costly and unpopular Medicare for all-style proposal," the group's executive director Lauren Crawford Shaver wrote in a memo to be released this morning, pointing to the ACA's expansion of coverage to roughly 20 million Americans.

From a Center for American Progress spokesman: 

Larry Levitt, vice president of the Kaiser Family Foundation:

Healthcare Dive's Rebecca Pifer:

AHH, OOF and OUCH

AHH: Pelosi's staff has been having early-stage discussions with the White House about potential drug-pricing legislation, Politico’s Jake Sherman, Anna Palmer and Daniel Lippman report this morning.

“We’ve been having some staff-level discussions with the Administration about lowering prescription drug prices, but they aren’t negotiations. House Democrats promised the American people we'd take bold action to lower prescription drug prices, and that’s what we’re going to do,” Pelosi’s deputy communications director Henry Connelly told Politico.

It’s an issue that both Democratic lawmakers and the Trump administration have said they want to tackle but it’s unclear whether these conversations will move forward.

OOF: The termination of food stamp benefits for 43 percent of Puerto Rico residents has led to a new crisis for the U.S. territory that’s still grappling with the impact of the 2017 Hurricane Maria.

In one nonprofit clinic that serves HIV-positive men with severe health needs, nurses have had to let patients sit in soiled diapers, sometimes for hours, because the facility needs to save money. It normally relies on patients’ food stamp money for funding, as our Post colleagues Jeff Stein and Josh Dawsey write in an extensive report on the crisis facing Puerto Rico. There’s a full-time nurse who has two daughters, one who needs expensive asthma medication, and who plans to stop buying yogurt, meat or vegetables because of her reduced benefits.

“While Congress may address this issue soon, the lapse underscores the broader vulnerability of Puerto Rico’s economy, as well as key parts of its safety net, to the whims of an increasingly hostile federal government with which it has feuded over key priorities,” Jeff and Josh write. “Puerto Rico will again need the federal government’s help to stave off drastic cuts to Medicaid, the health-care program for the poor and disabled, as well as for the disbursement of billions in hurricane relief aid that has not yet been turned over to the island.”

And President Trump has privately said he won’t approve additional aid for Puerto Rico beyond food-stamp benefits. At a February meeting at the Oval Office, he “asked top advisers for ways to limit federal support from going to Puerto Rico, believing it is taking money that should be going to the mainland,” our colleagues write.

OUCH: Women who say breast implants made them sick are calling on the Food and Drug Administration to take action to protect patients, such as providing more information about potential risks.

Dozens of patients told an FDA advisory panel to suggest long-term research or bans or restrictions on products linked to serious complications, our Post colleague Laurie McGinley reports.

About 400,000 women a year get breast implants, with 75 percent for cosmetic reasons and the other fourth for reconstruction after breast-cancer surgery.

There are two types of ailments patients say are associated with implants. There is “breast implant illness,” which is a set of autoimmune problems like joint and muscle pain and allergies and fatigue. An uncommon lymphoma has also been linked to the implants.

“Several plastic surgeons pleaded with the panel to proceed carefully, saying that implants generally are safe and an important option for women who want breast augmentation or reconstruction after breast cancer surgery,” Laurie writes. “They said that women’s choices should not be curtailed.”

INDUSTRY RX

—  Bayer AG and Johnson & Johnson have agreed to settle more than 25,000 lawsuits in the United States over claims  the top-selling blood thinner Xarelto causes uncontrollable bleeding.

The two companies developed the drug together and will split the settlement payment, the Wall Street Journal’s Sara Randazzo reports.

The product is still on the market and the companies have won the six cases related to Xarelto that have so far gone to trial.

“The settlement resolves a legal headache for Bayer and Johnson & Johnson, but several more remain for both companies,” Sara writes. “Bayer is fighting claims that its popular weedkiller Roundup causes non-Hodgkin lymphoma and other cancers; uncertainty over the litigation and two adverse jury verdicts have depressed the company’s stock price. Other lawsuits challenge the safety of two Bayer birth-control drugs. Johnson & Johnson faces lawsuits claiming its talcum-based baby powder causes cancer as well as claims over hip implants, pelvic mesh and diabetes medication.”

OPIOID OPTICS

— Tufts University announced it has hired a former U.S. attorney to probe its relationship with pharmaceutical giant Purdue Pharma and ties to the Sackler family – the wealthy family that has become increasingly linked to the ongoing opioid crisis.

The move to hire Donald K. Stern, a former U.S. attorney in Massachusetts, follows allegations that the drugmaker tried to gain influence at the university with donations, Stat’s Andrew Joseph reports. Public scrutiny over the Sackler family’s ties to Tufts mounted after a Massachusetts Attorney General Maura Healey filed a lawsuit against Purdue last year and Sackler family members “revealed that the company allegedly influenced educational and research programs at Tufts and sought to use the Tufts brand to bolster the company’s,” Andrew writes.

“The anguish that opioids have inflicted on so many individuals and families is tragic and deserves our serious attention,” Tufts President Tony Monaco wrote in a letter to the university community. “I strongly believe it is important to both our university and those who have suffered as a result of the opioid crisis to investigate these allegations thoroughly.”

— Meanwhile, the Sackler Trust announced that it will halt all new charitable donations as the Sackler family, which runs the trust, faces hundreds of lawsuits over its role in the opioid crisis.

The trust, which says it has donated about 60 million pounds, or more than $79 million to organizations in the United Kingdom since 2010, “has now said all philanthropic giving will temporarily cease so the issue ‘will not be a distraction for institutions that are applying for grants,’” The Guardian’s Frances Perraudin and Ruper Neate report.

“The current press attention that these legal cases in the United States is generating has created immense pressure on the scientific, medical, educational and arts institutions here in the UK, large and small, that I am so proud to support,” Theresa Sackler, the trust’s chair, said in a statement.

MEDICAL MISSIVES

— The father of a first-grader who was killed in the 2012 Sandy Hook Elementary School shooting was found dead in an apparent suicide

Lt. Aaron Bahamonde, a spokesman for the Newtown Police Department, told The Post the death of 49-year-old Jeremy Richman “puts Newtown back into the spotlight again,” as our colleague Lindsey Bever writes. “We certainly recognize the heartbreak that this is causing,” Bahamonde added. “It’s a difficult situation that we’re all dealing with here and it’s a sad situation.”

Richman, whose daughter Avielle Richman was killed in the 2012 massacre, was a neuroscientist who founded the Avielle Foundation, a nonprofit that aims to prevent gun violence.

The news of Richman’s death follows a one week span in which two teenagers died by apparent suicide in Parkland, Fla., the community where 17 students and teachers were killed in a mass shooting at Marjory Stoneman Douglas High School in 2018.

“A former cheerleader and recent graduate, 19-year-old Sydney Aiello, took her life on March 17 after struggling with survivor’s guilt and post-traumatic stress disorder, her mother said,” our Post colleagues Lori Rozsa, Kayla Epstein and Katie Mettler report. “Six days later, a sophomore who authorities have not identified died by apparent suicide."

Mental health advocates cautioned against making conclusions as the details surrounding the second student’s death remain unclear, our colleagues write, even as many in the community placed the deaths in context of the other lives lost at Marjory Stoneman Douglas last year.

STATE SCAN

— A new analysis out from U.S. News & World Report and the Aetna Foundation found the Denver suburb of Douglas County, Colo. is the healthiest community in the country. The findings are based on an examination of nearly 3,000 counties and 81 indicators and 10 categories that measure overall health, such as housing equality or obesity.

The state of Colorado has seven of the top 25 healthiest communities and 28 of the top 500 overall, U.S. News’s Rachel Cernansky writes.

— And here are a few more good reads: 

In New York’s Nassau County, a broad portrait of healthy suburbia masks disparities that lie at the local level.
U.S. News & World Report
Lawmakers were trying to legalize cannabis with a bill that sought to reckon with the racial inequities caused by the war on drugs.
New York Times
HEALTH ON THE HILL
House Minority Whip Steve Scalise (R-La.) plans to move forward with introducing a discharge petition next week that would force a vote on a bill that would require medical practitioners to provide the same level of care to infants that survive an
The Hill
Oklahoma’s top court on Monday declined to delay a landmark trial set for May in a multibillion-dollar lawsuit accusing OxyContin maker Purdue Pharma LP and two other drugmakers of helping fuel an opioid abuse and overdose epidemic in the state.
Reuters
Old brains from people who didn't have dementia have much higher rates of neurogenesis than the brains of people with Alzheimer’s disease, the study found.
Stat
AGENCY ALERT
In an interview, FDA Commissioner Scott Gottlieb reacts to a KHN/Fortune investigation of the drawbacks and risks of electronic health records.
Kaiser Health News
DAYBOOK

Today

  • The House Budget Committee holds a hearing on the HHS budget.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 21st Century Cures Act.
  • The Bipartisan Policy Center holds an event on federal funding to combat the opioid crisis.

Coming Up

  • Politico hosts an event on "Opioid Misuse, Hepatitis C and HIV" on Thursday. 
SUGAR RUSH

Trump on Mueller probe: "We can never ever let this happen to another president"