with Paulina Firozi


The gulf could hardly be wider between the Trump administration and Republicans on Capitol Hill when it comes to replacing Obamacare. Just look at the raft of contradictory statements from senior White House officials and top members of Congress over the past 72 hours.

Two of President Trump’s top officials — his counselor Kellyanne Conway and acting White House chief of staff Mick Mulvaney — took to the Sunday morning shows to insist there is a plan at the ready should the courts ultimately strike down the Affordable Care Act. The case, brought by conservative-led states, revived a furious debate this week when the administration said it now believes the entire law — not just its protections for people with preexisting conditions — should fall.

“There is a plan,” Conway said on “Fox News Sunday.” “We’ve been working on a plan for a long time.”

Mulvaney said, “we’ll try and fix it by ourselves,” saying on ABC’s “This Week” that Democrats probably wouldn’t help to “fix” the law should the courts strike it down.

Mulvaney also promised Americans with preexisting conditions will still be guaranteed coverage even without the ACA, which mandated such protections for the first time. Republicans are “trying to … pass a piece of legislation that meets the requirements of the United States Constitution,” he said on CNN’s “State of the Union.”

ACA analyst Charles Gaba:

Yet Republicans in Congress — the ones who would need to ultimately negotiate and vote on a bill to repeal and replace the ACA — say none of these promised efforts are underway. Resurrecting a repeal-and-replace effort is just about the last thing they’re interested in doing these days.

“No,” Senate Finance Chairman Chuck Grassley (R-Iowa) bluntly told The Post's Seung Min Kim and Josh Dawsey when they asked whether the two Senate committees overseeing health-care policy are planning to draft an ACA replacement.

“Obamacare is something that’s not going to be replaced unless the courts would declare it unconstitutional,” Grassley told them. “You won’t know that for a long time.”

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, indicated as much, saying he’s focused on legislation to reduce overall health-care costs.

—An official familiar with party strategy said top Senate Republican Mitch McConnell (R-Ky.) doesn’t have plans to put together a working group to construct an ACA replacement.

Sen. Rick Scott (R-Fla.), one of three senators Trump had named as working on an Obamacare replacement bill, appeared to toss the onus for a replacement bill back onto the White House.

“Look, I’m going to try to get something done,” Scott told my colleagues. “But I think it accelerates everything if the White House had a plan.”

—Even a senior White House official directly involved in the discussions said there was no specific proposal, my colleagues write.

— Sen. Susan Collins (R-Maine) -- who acknowledged last week that Republicans don't have a viable plan to replace the ACA that could pass this divided Congress -- is sending Attorney General William Barr a letter today chiding him for refusing to defend the law in court and saying the White House should instead propose changes to it or again seek its repeal.

"The Administration should not attempt to use the courts to bypass Congress," Collins wrote.

President Trump’s foray last week back into the world of Obamacare-repeal-and-replace is a terrain most Republicans clearly don’t want to revisit. While they effectively leveraged that message in several elections after Democrats’ 2010 health-care law, Democrats managed to switch the script last year by hounding the GOP over appearing to oppose protections for patients with preexisting conditions.

The lawsuit before the U.S. Court of Appeals for the 5th Circuit, led by Texas and other Republican-led states, seeks to overturn the entire law because Congress erased its penalty for lacking health coverage. That penalty is the basis for which the Supreme Court upheld the ACA as constitutional back in 2012.

Even conservative legal scholars have criticized the administration for refusing to defend the ACA, and most Republicans view it as a political loser in 2020 by opening them up to more political attacks around protecting people with preexisting conditions.

It’s hard to overstate the disconnect between Capitol Hill Republicans and the administration on this topic. It’s almost as if the White House has no recollection that just two years ago, when Republicans controlled both chambers of Congress, their fraught attempt to repeal and replace the ACA failed badly — and embarrassingly.

Insisting that an ACA overhaul is still on the table, Mulvaney said the White House will take a similar approach to taxes, by sending “principles” for health-care reform to Capitol Hill and ask Congress to write the actual legislation.

“We’re going to give people the choice they want, the affordability that they need and the quality that they deserve,” Mulvaney said on CNN.

One thing’s for sure: We’ve heard that promise from Republicans many times before. And it's less likely than ever before they'll follow through on it.

Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services under President Obama:


AHH: Less than two days after a federal judge blocked Medicaid work requirement programs in Arkansas and Kentucky, the Centers for Medicare and Medicaid Services gave another state the green light to impose such rules.

CMS on gave Utah permission on Friday to require low-income individuals on Medicaid to work, saying in an approval letter that “we believe an objective of the Medicaid program, in addition to paying for services, is to advance the health and wellness needs of its beneficiaries, and that it is appropriate for the state to structure its demonstration project in a manner that prioritizes meeting those needs,” as Kaiser Health News’s Phil Galewitz reports.

Health-care experts said the Utah waiver approval from the Trump administration signals it will appeal the judge’s rulings for Arkansas and Kentucky.

“Verma’s stance runs directly counter to U.S. District Court Judge James Boasberg, who in twin rulings Wednesday said work requirements in Arkansas and Kentucky are illegal under the 1965 Medicaid law,” Phil writes. “Boasberg said several times that promoting health was not the objective of Medicaid, despite that opinion from Verma and Health and Human Services Secretary Alex Azar.”

OUCH: A Purdue Pharma executive allegedly spoke critically of opioid addicts in discussions about how to address abuse of the company’s painkiller OxyContin, according to details of a newly amended lawsuit filed by New York's attorney general, the Wall Street Journal’s Sara Randazzo and Jared S. Hopkins report.  

Richard Sackler, an owner of the major pharmaceutical company, said he didn’t want “criminal addicts” to be “glorified as some sort of populist victim,” the lawsuit reads.

“I’ll tell you something that will totally revise your belief that addicts don’t want to be addicted. It is factually untrue. They get themselves addicted over and over again,” Sackler said in another email exchange included in the lawsuit.

“The emails are included in portions of the lawsuit, filed Thursday, that were publicly redacted but were reviewed by The Wall Street Journal,” Sara and Jared write. “The filing brings sweeping civil claims against Purdue, eight members of its controlling Sackler family, and several other drugmakers and distributors, seeking to hold them accountable for opioid addiction in New York.”

Both the drugmaker and Sackler family have denied the allegations in the more than 1,600 lawsuits brought against them.

OOF: House Democrats introduced a resolution on Friday condemning White House support for the lawsuit striking down the ACA, Politico’s Dan Diamond reports. A spokesperson for Rep. Colin Allred (D-Texas), who introduced the measure with support from House leadership, said the party is planning a vote as early as Tuesday.

"Americans are facing higher health care costs than ever, but this administration’s lawsuit would drive up prices and put coverage out of reach for thousands of Texas families," Allred said.

The symbolic measure and vote is another move to pressure Republicans on health care as the GOP scrambles to come up with a viable replacement plan for the ACA, Dan writes.


— Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.) are planning to reintroduce their “Medicare X” plan this week that would create a new government health insurance option but is far less sweeping than the Medicare-for-all proposals some of their colleagues have embraced.

The plan is an alternative expansion option for Democrats who don’t want to get rid of private insurance. Under the plan, people could buy a plan on an ACA individual or small business exchange, acquiring access to the network of Medicare providers and physicians in addition to the benefits of other plans under the ACA such as maternity and newborn care, Politico’s Marianne Levine reports.

“In an interview, Kaine said many Americans report high levels of satisfaction with the insurance they receive through their employers and that the goal of the Medicare X proposal is to provide another, lower cost option to people through the Centers for Medicaid and Medicare Services,” she writes.

“180 million people in America get their insurance through an employer-based plan and Medicare X gives people the opportunity to decide whether they want to stay on that plan,” Bennet told Marianne. “Some of the other plans take away insurance from those 180 million.”

— Trump isn't the only politician making bold promises. Sen. Bernie Sanders (I-Vt.) — saying yesterday on CBS's “Face the Nation” that “thousands of people will literally die” if the Trump-backed court challenge to invalidate the entire ACA succeeds — promised if elected to cut prescription drug prices in half if he's elected president next year.

In the next few weeks Sanders is planning to reintroduce a modified version of his Medicare-for-all bill, a measure that would establish a single-payer, government-run health care program. Sen. Rick Scott (R-Fla.), appearing on the same program, fired back, saying that approach would “ruin the entire system.”


— More doctors are using genetic information to help prescribe better antidepressants for their patients. But even as genetic information has been used to evaluate risk and treatment for diseases, using pharmacogenetics to address depression remains a controversial practice, our colleague Ilana Marcus reports.

Jeremy Bruce, a physician in Cincinnati, followed the same protocol for almost every patient he treated for depression, first starting them on one kind of medication and switching to another until something seemed to help. But patients were leaving his practice angry before they found the right treatment, and Bruce explained that he started using patient DNA samples to find something more likely to work.

“Doctors such as Bruce say they have seen promising patient results, but others say there is not enough solid evidence to show that pharmacogenetics can work for the complexities of mental health treatment,” Ilana writes. “Some lab tests have shown relationships between genes and the way a drug physically affects the body, but studies on whether using that information leads to better results for patients have been inconclusive.”

Genetic testing can also be pricey. The National Institutes of Health has found it can cost from $100 to more than $2,000.

The Food and Drug Administration has also warned about genetic testing that hasn’t gained approval from the agency, including those that guide antidepressant prescriptions.


— Georgia became the latest state on Friday to pass a bill to prohibit abortions once a fetal heartbeat can be detected, as early as six weeks of pregnancy. If signed, it would become one of the most restrictive such laws in the country.

Republican Gov. Brian Kemp is expected to sign the bill, the New York Times’s Sarah Mervosh reports. He praised lawmakers in the state on Friday.

The bill would be a major shift for the state, which currently allows women to seek an abortion in the first 20 weeks of pregnancy. “The measure allows exceptions to prevent death or serious harm to the woman, in cases in which the pregnancy is ‘medically futile’ because the fetus would not be able to live after birth, and in cases of rape or incest in which a police report has been filed,” Sarah writes.

— And here are a few more good reads: 


Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on addressing campus sexual assault on Tuesday. 
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on rising insulin costs on Tuesday. 
  • FDA Commissioner Scott Gottlieb is set to testify before the House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration and Related Agencies on Wednesday. 

Trump continues to push for new GOP health-care plan

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