THE PROGNOSIS

Republicans who say they hate Obamacare are scrambling to introduce legislation protecting Americans with preexisting conditions. But it’s precisely because of the health-care law that they embraced such protections in the first place.

Sen. Thom Tillis (R-N.C.), one of the Senate’s most vulnerable Republicans in 2020, reintroduced a bill this week banning health insurers from refusing coverage to such patients, charging them more or denying coverage for their specific treatment — protections already extended in the Affordable Care Act.

Tillis and his bill’s 17 GOP co-sponsors want badly to look like pioneers on the issue, after Democrats effectively attacked them over preexisting conditions in last year’s elections.

But that's a hard image to craft as Democrats already blazed that trail back in 2010 when they passed the health-care law.

“Now everyone — Republicans and Democrats — say they support a framework where everyone with a preexisting health condition would be protected,” Kathleen Sebelius, who was Health and Human Services secretary at the time, told me yesterday. “That was not the case prior to the ACA.”

“People talk about that as if that has always been the situation,” Sebelius added. “It couldn’t be further from the truth.”

Before the ACA, Americans buying insurance on their own without the help of an employer were often rejected by health insurers if they were deemed too risky or expensive to cover. This included people with conditions like diabetes, cancer, heart disease or anything that would make them a less-than-ideal customer.

“I … have watched people be turned down,” said Sebelius, who served as Kansas’s insurance commissioner from 1995 to 2003. “Today, that is almost a given, the thought that health-care is more a right than a privilege and should be accessible to everyone in the United States.”

Case in point: The country’s four largest for-profit health insurers — Aetna, Humana, UnitedHealth Group and WellPoint — denied coverage to more than 651,000 people over a three-year period due to preexisting conditions, according to a congressional investigation released in October 2010 by the House Energy and Commerce Committee.

Democrats writing the ACA insisted that guaranteeing coverage to everyone must be a core component of health reform. Republicans held mixed opinions on the topic — but an alternative bill offered by House Republicans at the time did not explicitly prohibit insurers from denying coverage to people because of preexisting conditions, instead setting up high-risk pools for such patients. An alternative bill from Senate Republicans did include the protection.

Nine years after the health-care law was passed, it’s inconceivable that any politician would publicly admit they don’t support preexisting condition protections. The ACA has ensconced these protections in the country’s health insurance system, forcing Republicans to jump on board after the fact.

The issue has been a top political topic over the past year because of the Trump administration’s refusal to defend the health-care law in a lawsuit aiming to knock down the entire health-care law — including its preexisting condition protections. That has put Republicans in a precarious position, walking a fine line between supporting the president while insisting they support that popular part of the ACA.

President Trump, despite directing his Justice Department to oppose the ACA and its consumer protections, tweeted this last year:

Some Republicans in last year’s races even cast themselves as the originators of preexisting conditions protections, neglecting to mention those protections are already guaranteed via the ACA. An ad run by Sen. Martha McSally (R-Ariz.) claimed she was “leading the fight…to force insurance companies to cover preexisting conditions.”

ACA supporters charge that Tillis’s measure is little more than a way for Republicans to defend themselves from Democratic attacks that they would dismantle preexisting condition protections if given the chance.

“It is simply a piece of political CYA for Republican senators who are up,” said Brad Woodhouse, a Democratic operative who now directs the group Protect Our Care. “The law on the books is what Americans need to protect themselves with preexisting conditions.”

AHH, OOF and OUCH

AHH: Ohio Gov. Mike DeWine (R) has signed one of the strictest abortion restrictions in the country, a "heartbeat bill" that prohibits abortions after a fetal heartbeat is detected, or as early as six weeks into a pregnancy -- and puts prison time on the table for doctors who perform them after. 

“The signing of this bill today is consistent with that respect for life and the imperative to protect those who cannot protect themselves,” DeWine said while speaking at the Ohio Statehouse before he signed the bill, the Cincinnati Enquirer’s Jessie Balmert reports.

The state’s Republican-controlled legislature passed the bill earlier this week. Soon after DeWine's signing, abortion rights activists including the American Civil Liberties Union of Ohio vowed to take the measure to court. DeWine’s predecessor, Republican Gov. John Kasich, twice vetoed the heartbeat bill.

"Under the bill, doctors would face a fifth-degree felony punishable by up to a year in prison for performing an abortion after detecting a heartbeat,” Jessie writes. “The bill has an exception to save the life of the woman but no exception for rape or incest – in line with current state law.”

From the ACLU and its Ohio chapter: 

A statement praising the governor, from antiabortion group Ohio Right to Life, via health reporter Lauren Lindstrom:

— Our Post colleague Katie Mettler writes about how states are continuing to introduce and pass their own “heartbeat bills,” even as lower courts have ruled them unconstitutional and as the Supreme Court has refused to hear an appeal.

“We know that the pro-abortion forces are going to sue, and that’s part of the process,” Lori Viars, an antiabortion activist in Ohio, told Katie. “We want this bill to go to the Supreme Court. It was written for this purpose.”

“Though lawmakers have been introducing six-week abortion bans for years, it has taken nearly a decade of failed attempts for the movement to build the kind of momentum it has seen in the early months of 2019,” Katie adds. State-level abortion restrictions have been introduced in droves, as advocates on both sides are questioning the fate of Roe v. Wade after Trump appointed two conservative justices to the Supreme Court.  

OOF: Amid a serious measles outbreak in New York, the city’s efforts to combat the crisis are involving New York’s Hasidic Jewish community, members of the ultra-Orthodox Satmar sect known for their strict religious and cultural traditions, our Post colleagues Lenny Bernstein, Lena H. Sun and Gabrielle Paluch report.

“[T]he refusal of some parents to vaccinate their children — a decision not based on any religious proscription — and a resulting measles outbreak have brought public health authorities to their doorsteps in a collision of cultures that could turn messy,” they write.

This week, the city sent more than a dozen “disease detectives” into the community to conduct interviews with people who may have been exposed to measles and to check immunization records of those they had contact with. Health Department spokeswoman Marcy Miranda said there are 1,800 unvaccinated Orthodox Jewish students with religious exemptions in the four Zip codes the city has targeted.

“In Williamsburg, the attention is becoming a sore spot for some in a community that would rather be left alone,” our colleagues write. David Oberlander, principal of a yeshiva where measles was discovered in the outbreak, insisted “ninety-seven percent of our students and family are vaccinated.” But John Marshall, chairman of emergency medicine at Maimonides Medical Center in the area said it “certainly can’t be 98 or 99 percent. If there were 90 percent of people immunized in the community, it wouldn’t be spreading.”

OUCH: At the peak of the opioid crisis, sales representatives from Purdue Pharma swarmed the state of New York, making half a million visits to doctors and pharmacies between 2006 and 2017 to promote the company’s painkillers, including OxyContin, the New York Times’s William K. Rashbaum, Roni Caryn Rabin and Danny Hakim report.

The details of such sales tactics were disclosed in court documents filed yesterday by the state’s Attorney General Letitia James in a lawsuit against opioid makers, distributors and several members of the family that owns Purdue.

The disclosures also revealed Purdue employees were aware as early as 1999 just how much patients were abusing OxyContin, and also knew and shared internal emails about the methods used to abuse the drug.

“In a statement, Purdue Pharma said the new court filing ‘contains factual errors and gross distortions and misrepresentations based on highly selective excerpting of language from tens of millions of documents. The complaint is designed to publicly vilify Purdue and its former directors,’” William, Roni and Danny write, adding the new court filing also reveals Purdue wasn’t the only drugmaker with a similar sales strategy.

A supervisor at another company, Ireland-based Mallinckrodt Pharmaceuticals that manufactures branded and generic opioids, called on his sales staff to “ATTACK,” the filing finds, and told them “big bonus dollars” were available to representatives who waited at the doors of health care providers.

— A UnitedHealthcare executive’s remarks at an employee town hall sheds light on how the health insurer has been working to weaken support for Medicare-for-all.

“One of the things you said: ‘We’re really quiet’ or ‘It seems like we’re quiet.’ Um, we’ve done a lot more than you would think,” chief executive Steve Nelson said in response to a question about the company’s efforts in the Medicare-for-all debate, according to a video of his remarks obtained by our Post colleague Jeff Stein. “You want to be kind of thoughtful about how you show up and have these kind of conversations, because the last thing you want to do is become the poster child during the presidential campaign."

As we've written frequently in Health 202, there's a larger push from the health care industry to block Medicare-for-all proposals that could put private insurance companies out of business and reduce payments to providers. “Wary of bringing unwanted political controversy to their companies, some private health-care firms have in part relied on advocacy groups and lobbyists in their fight against Medicare-for-all — joining the push without leaving too many company-specific fingerprints,” Jeff writes.

HEALTH ON THE HILL

— Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and the panel’s top Democrat Ron Wyden (D-Ore.) are calling on the Health and Human Services’ internal watchdog to probe a pricing practice by pharmacy benefit managers known as spread pricing.

In the letter to HHS’s inspector general, the senators specifically cited concern about “inappropriate profiteering and potential anti-competitive practices in state Medicaid programs.”

The letter refers to reports about PBM profits related to such practices in Ohio, Pennsylvania, and Kentucky. “Given the potential vulnerabilities created as a result of opaque drug pricing practices employed by entities like PBMs, we believe additional transparency and oversight in this space is warranted,” they write. “We request your office conduct a federal-level analysis of PBM practices across state Medicaid programs, including practices that may allow for inappropriate profiteering and potential anti-competitive practices in state Medicaid programs.”

The letter follows the committee’s third hearing on prescription drug prices during which they grilled PBM executives over concerns about transparency and pricing practices, including so-called spread pricing.

— The maternal health crisis in the United States has reached the 2020 presidential campaign, as multiple Democratic contenders have embraced plans to address healthcare access as well as the racial gap in the treatment of white and black women, the Los Angeles Times’s Melanie Mason writes.

Sen. Kamala Harris (D-Calif.) has proposed providing federal funding to train medical providers about how racial prejudice impacts health care. Sen. Cory Booker (D-N.J.)  proposed a measure to expand Medicaid coverage to include pregnant women, a measure candidates and Sens. Harris and Kristen Gillibrand (D-N.Y.) have co-sponsored.

Booker has said maternal health “is an issue of access, but it’s also about correcting for the racial disparities that we see baked within significant systems of our country.”

“There are humanitarian reasons for the surging interest in a long-standing problem. But there are also political considerations,” Melanie writes, adding that black women are a key Democratic voting bloc.

MEDICAL MISSIVES

— The full results of NASA’s “twins study” found astronaut Scott Kelly experienced numerous physiological and chromosomal changes during the almost year he spent on the International Space Station in low Earth orbit, compared with his identical twin brother who stayed on Earth.

“His immune system went on high alert, both when he went to space and upon returning to Earth,” our Post colleague Joel Achenbach reports. “His body acted as if it were under attack.”

The researchers said the study found no health consequences so severe that it would hinder a human mission to Mars, or other long-term mission, Joel writes. But it suggested the human body, adapted for life on Earth, “goes haywire in zero gravity.”

Scott Kelly told Joel when he landed back on Earth, he dealt with flulike symptoms and felt bad for weeks, which altered his cognitive performance. “Imagine going to take the SATs when you have the flu. You probably wouldn’t do as well,” Kelly said.

During a teleconference yesterday, Mark Kelly, a retired astronaut married to former congresswoman Gabby Giffords (D) who is running for the Democratic nomination for Senate in Arizona, praised his twin: “As a citizen of our country, not just as his twin brother, I appreciate the sacrifice he took to spend a year in space.”

— And here are a few more good reads: 

Health
Answers to your questions about measles and the current outbreaks.
Lena Sun
AGENCY ALERT
The Food and Drug Administration announced Thursday that it will investigate the three most common active ingredients in hand sanitizers to make sure they are safe and effective.
Washington Examiner
STATE SCAN
Lawmakers in Annapolis overcame a drug industry lobbying blitz to enact a first-of-its kind “affordability board” that could cap payments for pricey meds.
Stat
The bill passed by the New York City Council was the latest in a series of steps to ease cannabis restrictions as efforts to legalize marijuana have stalled.
New York Times
OPIOID OPTICS
Opinions
He had nothing to do with OxyContin. Why are beneficiaries of his philanthropy being targeted for protests?
Jillian Sackler
INDUSTRY RX
Ketamine appears to spark the growth of neural connections that had been diminished by chronic stress, new research published in Science shows.
Stat
DAYBOOK

Today

  • Medicaid and CHIP Payment and Access Commission holds a public meeting.
SUGAR RUSH

Trump wants the GOP to be the 'party of healthcare.' Other Republicans aren't so sure: