THE PROGNOSIS

Republicans in Congress are starting to bring paid family leave proposals to the table, after years of resisting the idea. Several of them, led by Sen. Marco Rubio (R-Fla.) and Rep. Ann Wagner (R-Mo.), will introduce a bill today providing mothers and fathers with pay while caring for a new baby by allowing them to draw from future Social Security benefits.

The measure – which Rubio first introduced last August and has since slightly modified – avoids creating a new government benefit by drawing on existing retirement funds, stopping far short of a more generous but expensive parental leave bill Democrats are backing.

But it signals a major shift for Republicans, who are starting to acknowledge the growing role women are playing in the country’s economy. Their recent embrace of the issue also shows the influence of President Trump and his daughter Ivanka, who have indicated paid family leave is an issue they want to see Republicans solve rather than spurn.

"Our economic policies have left young, working families behind at a time when our marriage and childbirth rates are falling," Rubio said in a statement provided to Health 202. "It is time to realign our economic policies in support of American families, which is why I am proud to re-introduce the New Parents Act."

Rubio and Wagner's bill would allow parents of a newborn biological or adopted child to pull forward one month, two months or three months of their Social Security benefits in order to finance their time off of work. A summary of the bill provided to Health 202 says nearly all parents earning less than the $60,000 median family income would receive leave pay equal to about two-thirds of their wages.

Upon retirement, the recipients of paid family leave could choose to delay their Social Security benefits by three to six months. This latest version of the bill would also give them the option of having the sum gradually deducted from their benefits over the first five years of retirement.

Wagner is sponsoring the House version of the bill, with Rep. Dan Crenshaw (R-Texas) as a co-sponsor. Sen. Mitt Romney (R-Utah) will be a co-sponsor in the Senate.

Earlier this month, Sens. Joni Ernst (R-Iowa) and Mike Lee (R-Utah) rolled out similar legislation which also provides benefits through the Social Security system. Their legislation would require parents to take leave from work in order to receive the benefit, whereas under the Rubio/Wagner bill, parents could choose to keep working full-time or part-time and use the extra funds to pay for childcare expenses.

Sen. Bill Cassidy (R-La.) has also been looking into the issue. He and other members (including Wagner) met last month with Ivanka Trump to discuss it, and is scheduled to speak on the topic next week at the conservative American Enterprise Institute.

“When we started working on it there was literally no action on the Republican side,” Aparna Mathur, a resident scholar in economic policy studies at AEI, told me. “No talking about paid leave, forget about coming up with a bill.”

Mathur was part of a joint working group with scholars from the Brookings Institution that released recommendations last September for paid family leave. They endorsed eight weeks of paid parental leave at 70 percent of wages with a maximum benefit of $600 per week, paid for with a modest payroll tax increase.

“I think here is a recognition that this is not just an issue that you can keep shoving under the carpet and say this is something families need to deal with or that the private sector can fix it on its own,” Mathur said.

Mathur said her and her colleagues’ plan could be seen as a compromise between what Republicans have suggested and the plan Democrats are backing.

Democratic members of Congress have coalesced around the FAMILY Act, which would provide up to 12 weeks paid leave not just to care for a new child, but also to recuperate from a serious illness or care for a family member. It’s more generous than what Republicans have proposed, but it would also require more employee and employer payroll tax contributions.

As I wrote in this Health 202, paid family leave is an issue ripe for partisan cooperation because it’s extremely popular among the public. But at least so far, Democrats have blasted the GOP plans as insufficient while Republicans accuse Democrats of promising benefits that cost too much.

“Republicans have sometimes shied away from tackling these problems head on,” Ernst wrote in an op-ed published by the Des Moines Register on Saturday. “I’m trying to change that. Meanwhile, Democrats have been happy to unveil so-called solutions that increase the growing deficit and simply take more money out of every Iowan’s paycheck.”

AHH, OOF and OUCH

AHH: Democrats on Capitol Hill seized onto news that the Trump administration filed a motion to support a full invalidation of the Affordable Care Act, pivoting back to health care and moving away from news of the special counsel report summary that was less damaging to Trump than expected, our colleagues John Wagner, Mike DeBonis and Rachael Bade report.

Instead, the Justice Department’s decision gave Democratic leaders a chance to capitalize on a message they homed in on during the midterm elections. It also pushed the health care battle into the middle of the 2020 campaign, as our colleagues Toluse Olorunnipa and Seung Min Kim report, with several presidential candidates tweeting to blast the president on health care. 

“This is actually an opportunity for us to speak to the American people with clarity: They say one thing, and they do another,” House Speaker Nancy Pelosi (D-Calif.) said of Republicans.

—On his way to Capitol Hill to meet with Senate Republicans, Trump tweeted his party would be the one to gain the upper hand on the issue. Several senators present told our colleagues the president spent much of his time at the Senate lunch talking about health care.

After the lunch, Sen. John Neely Kennedy (R-La.) said Trump "thinks that that’s the one area where we’ve fallen short and he wants to see us address it...He made that very clear.”

"But neither the White House nor Republicans in Congress have offered a new plan to replace the comprehensive Obama-era law, which was passed nearly a decade ago and has grown in popularity since Trump was elected," Toluse and Seung Min add. 

—Politico's Eliana Johnson and Burgess Everett also report the Trump administration's decision to back invalidating Obamacare was made despite objections from Health and Human Services secretary Alex Azar and Attorney General William Barr. In a statement, however, HHS insisted there was no dispute. 

—From the Senate floor, Minority Leader Chuck Schumer (D-N.Y.) called it an “escalation of the Trump administration and Republicans’ attacks on protections for people with pre-existing conditions.”

House committee leaders also weighed in on the Justice Department move. “This decision demonstrates a shocking disregard for the health and well-being of Americans across this country,” said House Energy and Commerce Chairman Frank Pallone, Jr. (D-N.J.), Ways and Means Chairman Richard Neal (D-Mass.), and Education and Labor Chairman Bobby Scott (D-Va.) in a statement.

—Even a Republican, Sen. Susan Collins of Maine, said she was “very disappointed” in the administration’s legal position. “It is highly unusual for the Department of Justice not to defend duly enacted laws, which the Affordable Care Act certainly was,” Collins said. “This decision to even go more broadly in failing to defend the law is very disappointing.”

How another moderate Senate Republican, Lisa Murkowski of Alaska, responded to the news, via Burgess:

OOF: Purdue Pharma and the state of Oklahoma have reached a settlement in a major lawsuit over the pharmaceutical company’s role in the deadly opioid crisis. It's the "first major test of who will pay for more than two decades of death and addiction sparked by prescription opioids," our colleagues Lenny Bernstein and Katie Zezima report.

Under the settlement, Purdue will spend $102.5 million to help establish a new addiction center at the Oklahoma State University. Sackler family members, who were not defendants in the case, will pay $75 million in personal funds over five years. Purdue will also pay $20 million to provide additional treatment drugs and $12 million to cities and towns and cover about $60 million in litigation costs. 

The state can continue its lawsuit against two other defendants, Johnson & Johnson and Teva Pharmaceutical Industries. The lawsuit contends that the three companies are partly responsible for the thousands of opioid deaths there. “Purdue and others face similar claims in several other courts, and the first major settlement in the flood of lawsuits could help set the bar for compensation sought by hundreds of states, cities, counties and Native American tribes for the costs incurred in responding to the epidemic,” Lenny and Katie write.

OUCH: A job scarce community that’s one of the poorest in the already low-income state of Arkansas has provided an early glimpse into the difficulty of implementing work requirements for Medicaid beneficiaries, as our colleague Amy Goldstein reports. The state became the first in the country to impose the requirements on the part of Medicaid expanded under the ACA and seven others have gotten the green light from the Trump administration to do so, while seven others are waiting still.

And a federal judge is expected to rule soon on the validity of the work rules in Arkansas.

“The president and Republican governors contend that this abrupt turn in Medicaid, one of the most enduring legacies of the Great Society of the 1960s, will propel poor people to economic self-reliance,” Amy writes. “In Arkansas, however, 18,000 people so far have lost their insurance, including 85 here in Lee County, state figures show.”

Writing from Marianna, Ark., Amy writes of confusion over the program and little evidence as to whether it’s motivating people to find jobs.

“What the state is doing is kicking tens of thousands of people off health care, under the guise of an experiment that they aren’t even collecting any data about, let alone analyzing it,” Kevin De Liban, a Legal Aid lawyer in northeast Arkansas who is active in the federal lawsuit against the work rules, told Amy.

REPRODUCTIVE WARS

— The Trump administration announced an expansion of a ban on U.S. aid groups that provide or promote abortions overseas to now include groups that financially support other groups that provide or promote abortion.

“We will refuse to provide assistance to foreign NGOs that give financial support to other foreign groups in the global abortion industry,” Secretary of State Mike Pompeo told reporters. “We will enforce a strict prohibition on backdoor funding schemes and end runs around our policy. American taxpayer dollars will not be used to underwrite abortions.”

Pompeo said the “vast majority” of groups partnering with the United states comply with the so-called “Mexico City policy,” Politico’s Nahal Toosi and Dan Diamond report.  

Antiabortion advocates praised the announcement, while critics who say the policy is a “global gag rule” said the move harms organizations that provide services beyond abortion

From March for Life:

From Sen. Jeanne Shaheen (D-N.H.):

MEDICAL MISSIVES

—  Unvaccinated children have been barred from public spaces in a New York county as the state deals with its largest measles outbreak in decades, our colleague Lindsey Bever reports.

A countywide state of emergency was declared in Rockland County, starting a ban that will last 30 days or until unvaccinated children get the measles, mumps and rubella vaccine. Until then, unvaccinated minors will be prohibited from being in churches, schools, shopping centers and other public spaces, though the ban does not included outdoor areas like playgrounds.

“In Rockland County, about 40 miles from Manhattan, there have been more than 150 confirmed cases, according to county health officials,” Lindsey writes. “More than 82 percent of the measles patients had not received a single dose of the MMR vaccine, health officials said. The data shows that the largest number of cases — 46 percent — were seen in children ages 4 to 18, and 39 percent of them were in children younger than 3.”

— Gun control groups are shifting their attention toward preventing gun violence and suicide at the state level, after seeing little success in advancing federal gun legislation. Last week, Everytown for Gun Safety launched a campaign to educate people about red flag laws in various states that can help take guns away from people who are a risk to themselves or others, as our colleague Katie Zezima reports.

“If you truly want to continue to reduce gun deaths in this country, you have to talk about gun suicide and the tools for preventing gun suicide,” John Feinblatt, president of Everytown, told Katie. “It’s fair to say that it’s sort of 2.0 for us. This is just a new chapter.”

The new chapter comes as groups like Everytown acknowledge the gun lobby in Washington and engrained views about gun rights pose a major obstacle in changing gun laws at the national level. The group’s “One Thing You Can Do” campaign looks to educate people who live in the 13 states and District of Columbia with red flag laws about how they work. 

“The state-level shift is also practical,” Katie adds. “Many of the groups have eschewed the phrase ‘gun control’ for ‘gun safety’ to appeal to a broader swath of the electorate. They hope that advocating for background checks and safe storage of existing firearms attach them to policies that will garner them support with gun owners.”

— A new poll from the Kaiser Family Foundation found less than half of people in America are aware of HIV treatments and their effectiveness.

The survey found 42 percent of the public overall is aware of PrEP, a prescription drug that greatly reduces the chances of acquiring HIV, and just 27 percent say antiretrovirals are “very effective” and 15 percent believe the drugs can help prevent the spread of the virus.

The foundation also surveyed people about the Trump administration’s goal of eliminating HIV within a decade. Just 8 percent said they had heard some or a lot about the administration’s plans, but 56 percent said they are very or somewhat confident that the goal of eradicating HIV infections in the country is possible by 2030.

— And here are a few more good reads: 

Health & Science
Survivors of mass shootings remain vulnerable to “emotional shock waves,” experts say.
Joel Achenbach, William Wan and Katie Mettler
Inspired Life
“It’s hard to make sense of this, but his legacy and work must continue,” reads the fundraiser, started by philanthropist Ron Conway.
Allison Klein
Museums
“It is the better course for the trust to halt all new giving until we can be confident that it will not be a distraction.”
Peggy McGlone
Business
Critics say the CDC is “twiddling their thumbs” and failing to leverage patent for public health.
Christopher Rowland
The plant extract CBD blurs the regulatory line between drugs and supplements.
Politico
Politics
Aid for Puerto Rico has long been a fixation for Trump, who has asked advisers how to reduce money for the island and signaled that he won’t support any more assistance beyond food stamp funds. 
Seung Min Kim, Josh Dawsey and Paul Kane
Martha McSally became the first American woman to fly in combat. But years before, she had been attacked by one of her own.
New York Times
The Trump administration will convene a task force to look into how a pediatrician was allowed to sexually abuse Native American boys for decades while working for the Indian Health Service and to try to prevent such a crime from happening again.
Wall Street Journal
STATE SCAN
Health
The law had been in effect since 1973, but a 2015 amendment prompted abortion rights groups to file a lawsuit. A judge ruled in their favor this week.
Reis Thebault and Emily Wax-Thibodeaux
INDUSTRY RX
Centene is buying government-sponsored health-care provider WellCare Health Plans in a deal the companies are valuing at $17.3 billion.
Wall Street Journal
Caregivers carry a financial and emotional burden.
Axios
DAYBOOK

Coming Up

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

Senate Minority Leader Chuck Schumer (D-N.Y.) said the Trump administration's move to strike down Obamacare is a "slap in the face":