THE PROGNOSIS

President Trump's renewed fixation on  repealing and replacing Obamacare took another bewildering turn late last night, as he promised Republicans would pass a "truly great" health-care plan after they supposedly win back the House and hold on to the Senate in November 2020.

The president fired off these tweets Monday night:

It's almost as if someone at the White House finally convinced Trump there's zero chance of Republicans repealing the Affordable Care Act while Democrats control the House. But even if Trump's prediction comes true -- and Republicans once again control both chambers of Congress (and Trump wins reelection) -- it's not at all clear they'd be able to agree on a repeal-and-replace bill.

None of these realities have stopped Trump from firing off a series of anti-Obamacare tweets over the past week. Invigorated by the Russia investigation’s findings, Trump has resumed calls for Congress to repeal Obamacare, pouring pressure on several senators he’s asked to lead an effort. He has repeatedly named three Republican senators — John Barrasso of Wyoming, Bill Cassidy of Louisiana and Rick Scott of Florida — as the leaders on crafting an Obamacare replacement.

Barrasso and Cassidy are both physicians, while Scott is a former hospital executive – perhaps indicators of Trump’s decision to name them directly.

Trump named the senators again — plus Senate Majority Leader Mitch McConnell -- in a tweet earlier in the day:

Only a handful of members of Congress have responded positively to the president’s demands. Sen. Lindsey Graham (R-S.C.), known for his friendship with Trump, issued a release yesterday saying “Obamacare cannot be fixed…it must be replaced.” Rep. Mark Meadows (R-N.C.) has told reporters he’s working on a replacement plan.

Rep. Bruce Westerman (R-Ark.) has been shopping around a 200-page bill he introduced a few weeks ago that would revise the ACA but would also clamp down on hospital consolidation and mergers. Westerman’s communications director Rebekah Hoshiko sent out a plea last week to a listserv of GOP staff to have their bosses consider signing on.  

“GOP does actually have viable options, so let’s combat Dems’ narrative,” Hoshiko wrote.

But McConnell has indicated he has no interest in trying again to repeal Obamacare. And the other three senators Trump mentioned in his tweet have stressed they’re focused on ways to lower health-care costs generally rather than try to scrap the health-care law.

Scott and the president spoke on the phone last week, according to spokesman Chris Hartline. But Hartline quickly added the senator’s focus is on driving down the cost of prescription drugs, pointing to a bill Scott released last week requiring insurers and pharmacies to give consumers more transparent pricing information.

“Sen. Scott is focused on what can get passed Congress this year, which is why his focus has been on lowering the cost of prescription drugs,” Hartline said.

Other members of Congress are more explicit in their refusals to participate in more Obamacare repeal-and-replace exercises – an effort bound to be fruitless partly due to a Democrat-led House. 

“Not only is this a poor political move, this decision hurts real people who will unfairly lose their health insurance coverage as a result,” Rep. Tom Reed (R-N.Y.) said in a statement to The Health 202. “We need to work to find ways to fix our health-care system – not blow it up.”

Rep. Tom Reed (R-N.Y.):

New York Times's Maggie Haberman: 

The Post's Fact Checker Glenn Kessler: 

Democrats are indeed delighted by the recent turn of events.

This morning, House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) will gather with other top Democrats on the steps of the Supreme Court, where they’ll introduce a resolution condemning the Trump administration for now refusing to defend any part of the ACA in a legal challenge brought by conservative-led states.

The Democratic-majority House may vote later today to pass the resolution, which calls the Justice Department’s position “an unacceptable assault on the health care of the American people,” as way of putting Republicans on the hook for either supporting or opposing a Trump administration decision many of them privately disagree with.

“We are going to put Republicans on record about where they stand with this latest assault,” a senior Democratic aide told The Health 202. “It will be interesting to see whether more Republicans break off.”

The House passed two measures back in January allowing its legal counsel to weigh in on the lawsuit and condemning the Justice Department’s position that the ACA’s protections for people with preexisting conditions should be struck down. Three Republicans, including Reed, John Katko of New York and Brian Fitzpatrick of Pennsylvania, voted with Democrats at the time.

But more Republicans may be willing to cross the aisle now that the administration has taken an even firmer stance against the ACA, saying last week that it agrees with a federal court ruling that the entire law should be invalidated. Reed said he will again vote with Democrats on their latest resolution criticizing the administration for refusing to defend the ACA.

AHH, OOF and OUCH

AHH: China announced it would ban all types of the synthetic opioid fentanyl, listing all variants of the powerful drug as controlled substances, our Post colleague Gerry Shih reports. The decision follows a vow Chinese leader Xi Jinping made to President Trump during a December meeting.

“For years, China’s vast chemical and pharmaceutical industry exploited loopholes in Chinese law to create synthetic painkillers and their precursors that were not explicitly banned,” Gerry writes. “U.S. officials including Trade Representative Robert E. Lighthizer have pushed Beijing to significantly broaden its list of scheduled substances to cover the entire class of synthetic opioids, their analogues and precursors, and crack down on their unchecked production and export.

But Liu Yuejin, a deputy commissioner at the China National Narcotics Control Commission, also pointed fingers at drug culture in the United States and over prescription by U.S. physicians.

“If the United States truly wants to resolve its fentanyl abuse problem, it needs to strengthen its domestic work,” Liu said. “Some people link drug consumption with freedom, individuality and liberation.”

OOF: New research from Gallup and West Health found Americans are borrowing tens of billions in order to pay for health care and 45 percent of Americans fear bankruptcy in the case of a major health event. 

A quarter of Americans skip medical treatments because of high costs, and 15 million Americans have deferred buying prescription medications because of the cost, the survey found. Given the choice between freezing their health care costs for five years or getting a 10 percent bump in household income, 61 percent of respondents said they preferred freezing their medical costs.

OUCH: The number of people sickened by measles in the first three months of the year has already surpassed the total last year, and it’s also the second highest number reported since the highly contagious disease was declared “eliminated” by U.S. health officials in 2000.

The 387 cases have emerged from outbreaks in 15 states, including New York, California, Texas and Washington, our Post colleague Lena H. Sun reports. There were 372 reported cases in all of 2018.

“Many of those outbreaks originated after unvaccinated individuals traveled to Europe, the Philippines and Israel, where the infection is more common, and returned to the United States after contracting the illness,” Lena writes. And the outbreaks have also sparked an increase in activity among anti-vaccine activists. In Rockland County, N.Y., where officials banned unvaccinated children from public spaces amid its growing outbreak, anti-vaccination activists compared the public health measures to the Nazi persecution of Jews.

“In Austin, Del Bigtree, chief executive of an anti-vax group called ICAN, wore a yellow star during a rally last Thursday to identify with parents who decline to vaccinate their children,” Lena writes. “A spokesman for Bigtree said he took the action ‘to let the Jewish community of Rockland County know he stands with them.’”

In response to Bigtree’s demonstration, the official account of the Auschwitz Memorial and Museum in Poland tweeted:

TRUMP TEMPERATURE

— America's Health Insurance Plans has filed an amicus brief in the Texas case that looks to kill the ACA, supporting the arguments by the Democrat-led states that are defending the law.

 In the brief, AHIP called a December decision by U.S. District Judge Reed O'Connor striking the whole law “indefensible.” “That decision not only contravenes Congress’s clear intent, but does so with cavalier indifference to the impacts it would unleash on the health care system—including for all of the 295 million Americans with health coverage today,” the brief says.

AHIP wrote that if left to stand, the judge’s ruling, “would undo scores of reforms that have reset the American public’s expectations about the availability and scope of health care coverage.”

— Meanwhile, two Republican attorneys general in Ohio and Montana filed a brief in federal appeals court opposing O'Connor's ruling that the ACA should be invalidated. 

While the pair oppose the law's individual mandate, they argue the rest of of the health care law should be able to remain. They warn that striking down the entire law would be detrimental to millions.

"The court's decision, if affirmed, will deprive millions of non-elderly Ohioans and Montanans of coverage of pre-existing conditions," they write. "It will also negatively affect countless others who organized their affairs in reliance on the Act’s many unrelated provisions. To be sure, the fact that a ruling has negative consequences does not mean it is wrong. Let justice be done, though the heavens may fall. But the District Court’s ruling is wrong, and its errors threaten harm to millions of people in the Buckeye and Treasure states."

REPRODUCTIVE WARS

— In a win for Planned Parenthood, the Supreme Court rejected a request from antiabortion activists to block a lawsuit brought against them by the women's health care and abortion provider.

In the lawsuit, Planned Parenthood alleges the Center for Medical Progress illegally filmed its employees and released a video to try to falsely show illicit sale of aborted fetal tissue.

“The suit, first brought by Planned Parenthood in January 2016, was in response to the release of the heavily edited videos produced in 2015 by the Center for Medical Progress, which secretly taped Planned Parenthood officials talking about the sale of fetal tissue,” CNN’s Ariane de Vogue and Devan Cole report. “The videos sparked a political firestorm, with Republican lawmakers accusing Planned Parenthood of profiting from the sale and and spurring repeated efforts in Congress and states to block funding for the organization. Planned Parenthood officials have maintained that the group does not profit from its sale of tissue donations to medical research and uses any money received to cover its costs.”

Monday’s ruling from the high court leaves in place a federal appeals court ruling and was issued without comment.

HEALTH ON THE HILL

— A top adviser to Pelosi told about two dozen attendees at a November meeting that House Democratic leadership was worried about the push for Medicare-for-all from some in the party, calling on health policy groups to raise public concerns about it, Politico’s Adam Cancryn reports. It was just weeks after the party had recaptured the House majority.

Wendell Primus, a senior Pelosi health policy aide, said there was concern talk around Medicare-for-all was taking attention away from the health care agenda that helped Democrats win back the House.

“Primus dismissed Medicare for All during the private session as an unhelpful distraction, according to four people in the room and two people briefed on the meeting, and he expressed a need for more scrutiny of single-payer’s policy implications,” Adam writes.

Pelosi spokesperson Henry Connelly dismissed the idea that Primus wanted negative analysis of Medicare-for-all. “Wendell absolutely did not ask for any kind of one-sided analysis of Medicare-for-all, and anyone who says otherwise wasn’t actually listening,” he said. “As Democrats, across the entire spectrum, we believe in legislating based on facts, data and honest analysis.”

Adam adds: “It’s not apparent that the meeting sparked any new outcry against Medicare for All — though plenty of Democratic writers and analysts have criticized the proposal as politically risky, overly ambitious and fiscally shaky.”

AGENCY ALERT

— FDA Commissioner Scott Gottlieb, who is leaving his post on Friday, told CNBC’s Angelica LaVito that his last week would be hard.

“The first week after I announced, it was difficult,” Gottlieb said. “I was very emotional because in some respects, I’m walking away from the best job I’ll ever have. That’s hard to do.”

He explained that the long commute every Sunday to get back to Washington, D.C. from his home with his wife and three kids in Connecticut didn’t bother him as much until last year when his wife was hit by a car and slightly fractured her knee, Angelica writes.

“It put a bigger weight on me in terms of feeling disconnected and far away and not being there,” Gottlieb said. “There was a fear that, God forbid, if something happened and I need to be home quickly, I just couldn’t.”

And Gottlieb insisted spending more time with his family is the true reason for his departure.

“Usually, when an official of Gottlieb’s stature resigns in Washington or Wall Street, ‘spending more time with my family’ is rarely the real reason,” Angelica writes. “And his unexpected departure, just two months after denying plans to step down, fanned speculation that he was at odds with the Trump administration and forced out like so many other top officials over the last two years.”

He also said he didn’t know what would come after this job. “It’s the first time in my life I don’t know what I’m doing next,” he said. “I’m a doctor so I always had my next job planned out, but this is truly the first time I’m leaving a job and I do not have a job.”

— And here are a few more good reads: 

The Republican Senate is where House Democratic bills go to die.
Politico
Fact Checker
The acting White House chief of staff claimed that more people paid an Obamacare penalty than gained under the law. That's false.
Glenn Kessler
OPIOID OPTICS
Three generations of the Sackler family were deeply involved in running Purdue Pharma and knew of opioid abuse risks, according to lawsuits.
New York Times
INDUSTRY RX
Novartis on Monday said it had agreed to pay $310 million upfront, with the poss...
Reuters
Telehealth use jumped 53% from 2016 to 2017, outpacing all other sites of care, according to a new report.
Modern Healthcare
STATE SCAN
National Security
As the NRA cheered the forceful ruling, Eric Tirschwell of Everytown for Gun Safety blasted “the dangerous gun lobby view that more lethal firearms will make America safer.”
Fred Barbash
Local
A roundup of news from the Washington region.
— Justin Jouvenal
Maryland Politics
As self-dealing scandal widens, state comptroller calls on Pugh to resign
Rachel Chason, Erin Cox and Ovetta Wiggins
MEDICAL MISSIVES
DAYBOOK

Today

  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on the NIH budget request for 2020.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on rising insulin costs.
  • The House Education and Labor Subcommittee on Health, Employment, Labor and Pensions holds a hearing on surprise billing.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on addressing campus sexual assault.
  • The Senate Special Committee on Aging holds a hearing on Alzheimer’s research and caregiving.

Coming Up

  • The House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration and Related Agencies holds a hearing on the FDA budget request for 2020 on Wednesday.
  • Sen. Bill Cassidy speaks at the American Enterprise Institute discussion on paid family leave on Wednesday.
  • The House Veterans Affairs Committee holds a hearing on the Veterans Affairs budget request for 2020 on Wednesday.
  • The House Appropriations Subcommittee on Defense holds a hearing on Defense health programs on Wednesday.
SUGAR RUSH

Why former vice president Joe Biden’s physical politicking feels different in the era of Trump and #MeToo: