THE PROGNOSIS

The relationship between the executive branch and Congress could hardly get more acrimonious, as House Democrats push forward on a flurry of investigations into the Trump administration. Add Obamacare to the list of tensions, with Democrats in hot pursuit of answers from the administration on why it refuses to defend any part of the health-care law in court.

Today, the chairmen of five House committees are re-upping demands that the Justice Department and the White House hand over eight categories of documents shedding light on how they arrived at the decision to abandon all defense of the 2010 health-care law in a challenge brought by GOP-led states. The committees, which first requested the information last month, hinted at issuing a subpoena if the administration doesn’t turn it over promptly.

"This action could deprive millions of Americans of health insurance coverage, including 133 million people with preexisting conditions,” the legislators wrote in letters being sent to Attorney General William Barr and White House counsel Pat Cipollone. “Given the grave consequences that would result if the Trump administration’s legal position were to prevail, it is Congress’s responsibility as an independent and coequal branch of government to understand how this decision was made.”

The letters were signed by Ways and Means Committee Chairman Richard Neal (D-Mass.), Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and Education and Labor Committee Chairman Bobby Scott (D-Va.) — the three panels with health-care jurisdiction — along with Oversight Committee Chairman Elijah Cummings (D-Md.) and Judiciary Committee Chairman Jerry Nadler (D-N.Y.).

These Democrat leaders and their colleagues in the House are fixated on holding the administration’s feet to the fire on a whole array of issues — and President Trump and his appointees appear equally determined to stonewall wherever possible.

Just in the past week, the Trump administration has rebuffed requests for the president's tax returns, refused to turn over an unredacted version of special counsel Robert Mueller’s final report on Russian election interference and barred former White House counsel Don McGahn from responding to a Hill subpoena, my Washington Post colleagues Rachael Bade and Seung Min Kim report. According to a Post tally, Trump and his allies are working to block more than 20 separate investigations by Democrats into his actions as president, with experts characterizing it as the most expansive White House obstruction effort in decades.

“Trump’s noncooperation strategy has shifted from partial resistance to all-out war as he faces mounting inquiries from the Democratic-controlled House — a strategy that many legal and congressional experts fear could undermine the institutional power of Congress for years to come,” Rachael and Seung Min write. “All told, House Democrats say the Trump administration has failed to respond to or comply with at least 79 requests for documents or other information. “The president is blocking aides from testifying, refusing entire document requests from some committees, filing lawsuits against corporations to bar them from responding to subpoenas and asserting executive privilege to keep information about the special counsel’s Russia investigation from public view."

The Obamacare lawsuit is one pressure point House Democrats plan to keep their finger on. If it’s ultimately upheld — oral arguments before the U.S. Court of Appeals for the 5th Circuit are scheduled for the week of July 8 — insurance coverage for millions of Americans could be eroded.

In a move that was criticized even by some conservatives, the Justice Department said in March it now sides with GOP-led states arguing the entire ACA should be erased now that its penalty for lacking health coverage is gone. That’s a sharp departure from the department’s previous stance, in which it said all but the law’s protections for people with preexisting conditions could still stand.

In their letter, the Democrats pointed to a puzzling facet of the administration’s new position. The stance was pushed by Mick Mulvaney — a former conservative firebrand member of Congress who now leads the White House Office of Management and Budget — but opposed by Health and Human Services Secretary Alex Azar and Barr himself.

An extensive brief filed by the Justice Department earlier this month notes that Congress specifically wrote the ACA so that insurers would have to cover people with preexisting conditions but would also be guaranteed healthy customers because of the individual mandate to buy coverage. That argument was a big part of the 2012 constitutionality challenge to the ACA at the Supreme Court — and the penalty is why the court declared the law constitutional, under the federal government’s power to tax.

But since then, Congress has repealed the penalty for being uninsured while leaving the preexisting condition protections in place — thus indicating it’s okay with severing the two. Yet the Justice Department still argues the two policies are intertwined, and that because the penalty is gone, the rest of the law must now fall with it — despite Congress clearly expressing its intent.

“The faulty legal reasoning in this submission underscores the concerns we raised in our letter that politically-motivated forces inside the White House and the Office of Management and Budget may have brought undue pressure on the Department of Justice to reverse its prior legal conclusions and disregard its own legal reasoning in violation of the Constitution’s solemn charge to ‘take care that the laws are faithfully executed,’” the Democrats wrote.

They are asking the administration to turn over documents explaining its position by May 24 and are also requesting that it allow four officials involved in the decision to testify before Congress.

“If we do not receive a response by this date, we will have no choice but to consider alternative means of obtaining compliance,” they wrote.

AHH, OOF and OUCH

AHH: Alabama lawmakers are set to vote today on a bill that would essentially ban all abortions in the state, which the American Civil Liberties Union has promised to challenge. But some Republicans there are struggling with its lack of exemptions for cases of incest or rape. Those behind the bill argue all unborn babies deserve a chance at life, even if they are a result of violent or criminal origins, our Post colleague Emily Wax-Thibodeaux reports.

Republican Del Marsh, the president of the state Senate, spoke with a group of women gathered at the “Southern Girl Coffee” truck in Oxford, Ala., the day before the vote. Marsh said he’s struggling with the restriction. “It’s just, I’m not real comfortable with having a law that forces a woman to carry a baby after rape,” he said.

“A move to amend the bill last week with exceptions for rape or incest led to a shouting match on the Senate floor and the vote was tabled. Marsh asked legislators to go home and speak to their constituents, as he himself has done. A vote on the bill has been rescheduled for Tuesday afternoon,” Emily writes. “On Monday, the impending vote had lawmakers scrambling across the state. Alabama Lt. Gov. Will Ainsworth (R) urged lawmakers to pass the abortion bill without exceptions and posted a video on Twitter urging Alabamians to call their senators.”

OOF: A jury in California has awarded more than $2 billion to a couple who said the widely used Roundup weed killer caused their cancer, a third straight trial loss for Bayer over such claims. 

The jury found Bayer liable for a couple's non-Hodgkin's lymphoma. The couple, in their 70s, said they used Roundup for more than three decades, the Wall Street Journal’s Sara Randazzo and Ruth Bender report.

In a statement, Bayer said it would appeal the latest verdict. 

“The trial unfolded much like the earlier two, with sparring over scientific studies, the credibility of expert witnesses and the relative importance of a 2015 designation by a World Health Organization branch that glyphosate, the primary ingredient in Roundup, is likely carcinogenic to humans,” Sara and Ruth write. “The case was the first to go to trial of hundreds of lawsuits consolidated in California state court. A judge put the [case of Alva and Alberta Pilliod] on an accelerated timeline because of their age.”

OUCH: The number of measles cases in the United States has jumped yet again, the Centers for Disease Control and Prevention reported yesterday, with the number now totaling 839 cases across 23 states.

The total, 75 cases more than the number of cases reported in CDC’s weekly update last week, is inching closer to surpassing the 963 cases from 1994.

The spike in cases is largely stemming from the worsening outbreak in New York, CNBC’s Angelica LaVito reports.. “Of the new cases last week, 66 were reported in New York state; of those, 41 were in New York City and 25 in nearby Rockland County,” Angelica writes. “Public health officials have been battling two outbreaks since the fall. New York City is threatening to issue $1,000 fines to people who live in neighborhoods with the worst outbreaks and refuse to get their children vaccinated. City health officials have already issued citations to 84 people for refusing to comply with the order.”

HEALTH ON THE HILL

— It shouldn’t come as a surprise that the competitive drive that pushes politicians through campaigns may also translate to athletic accomplishments. A team of our Post colleagues, Bonnie Berkowitz, Reuben Fischer-Baum and illustrator Tim Marrs, set out to learn about lawmakers with notable athletic prowess after Sen. Kyrsten Sinema (D-Ariz.) became the first U.S. senator back in March to complete an Ironman. They put together a list of 20 such politicians and called on a panel of seven experts to score their athletic feats on a scale of 1 to 5.

Some of the seven lawmakers at the front of the pack, with average scores of 3.8 to 4.1, include former congresswoman Jean Schmidt (R-Ohio), who ran more than 40 marathons during her eight years in the House, with the fastest time at 3:49:05 at 54 years old. There’s also Sen. Tammy Duckworth (D-Ill.), who completed the Chicago Marathon in a hand cycle while in the House and running for Senate. Another such politician is former congressman Bart Gordon (D-Tenn.), who holds the title of fastest lawmaker for completing a three-mile race in Washington at a record 16 minutes 59 seconds, or 5:40 per mile, at age 46.

Sinema described wanting to complete challenges deemed “audacious and too hard.” “I’m the same as an athlete, as a candidate and as a senator — very disciplined,” she said. “Which means you decide what you want, you focus relentlessly on it, you do all the work to achieve it, and then you achieve it.”

STATE SCAN

— Washington Gov. Jay Inslee (D) signed two bills yesterday addressing health care in the state: one that establishes the first public option health insurance in the nation, and another that creates a long-term care benefit program.

The public option measure will create a program to offer people tiered public plans with standard services that are paid for by the state but administered through the state’s private insurers.

“Backers say the state-defined plans will be up to 10% cheaper than comparable private insurance thanks to a cap on rates paid to doctors and hospitals,” the Associated Press reports. “But unlike existing government-managed plans like Medicare, Washington's plans will be available for purchase without an income limit.” The program will be available to residents starting in 2021.

In a statement, the 2020 Democratic contender touted the first-in-the-nation legislation as a response to action by Republicans in the White House and on Capitol Hill to undermine the ACA. “It builds on work we’ve done over the past several years to expand and protect health care under the Affordable Care Act,” Inslee said. “This legislation is one way for our state to push back and ensure all Washingtonians have a quality health insurance option they can afford … While our state continues to help lead the national fight for health care for all, this is one way our state is taking action now to ensure affordable care for more people.”

Meanwhile, another bill Inslee signed yesterday will give residents starting in 2025 a $100-a-day allowance to pay for various long-term care services for up to a year.

Starting in 2022, a payroll tax will help fund the care, with employees paying 0.58 percent of their wages into a state fund. “People who have purchased long-term care insurance will not have to pay the tax. And self-employed individuals can choose to pay into the system but will not be required to do so,” the New York Times’s Ron Lieber reports.

— A new Maryland law aims to help the state’s uninsured find out if they can get low-cost insurance based on information in their tax returns.

Maryland Gov. Larry Hogan (R) signed the first-of-its-kind bill yesterday. Under the new program, people can check a box on state income tax returns to enable the state’s health-care exchange to determine if the individual qualifies for Medicaid or subsidized health plans. If the individual qualifies for Medicaid, they will be enrolled automatically, the Associated Press reports. The health exchange will reach out to people who are eligible for private coverage.

Maryland state Sen. Brian Feldman (D) told the AP the bill was meant to respond to efforts at the federal level to overturn the Affordable Care Act. “About six or seven years ago, we had about 760,000 people without health insurance,” he said. “Now, we’re down to 360,000, and in light of what’s happening at the federal level — the dismantling of the Affordable Care Act, the elimination of the mandate, we’re starting to see some backtracking on that. So, we came up with an idea here that’s first in the nation that you can use the state income tax return to check a box, and it will immediately opt in.”

— And here are a few more good reads: 

MEDICAL MISSIVES
Republicans are being pulled to the left by the White House embrace of Democrats' ideas.
Politico
Immigration
Kirstjen Nielsen and Ronald Vitiello were ousted after halting an operation that would have targeted thousands of parents and children in 10 cities for arrest and deportation.
Nick Miroff and Josh Dawsey
Politics
The Carter Center said in a statement that Carter, 94, was leaving his home in Plains, Ga., to go turkey hunting when he fell.
Felicia Sonmez
Retropolis
The founder of the Red Cross faced down sexism her whole life.
Gillian Brockell
The Florida state legislature makes them endure monthly Code Red drills. They’re not helping. But no one is yet quite sure what will.
The Daily Beast
While college campuses have become the battleground for Title IX debates, the mishandling of sexual assault cases in primary and secondary schools receives less attention.
New York Times
INDUSTRY RX
The F.D.A. has taken an industry-friendly approach toward companies using unproven cell cocktails to treat people desperate for relief from aging or damaged joints.
New York Times
The Cleveland Clinic’s goal is to give front-line clinicians notice of serious cardiac events an hour or more before they happen.
Stat
OPIOID OPTICS
A New Jersey doctor who authorities said referred to himself as the "El Chapo of Opioids" prescribed painkillers without seeing the patients who were receiving them, often communicating via text message, and falsified records to cover his tracks, according to a criminal complaint released Monday.
Associated Press
DAYBOOK

Coming Up

  • The House Veterans Affairs Subcommittee on Health holds a hearing on the Veterans Affairs Fiscal Year 2020 budget request for the Veterans Health Administration on Wednesday.
  • The House Ways and Means Committee holds a hearing on the economic and health consequences of climate change on Wednesday.
  • The Washington Post Live will host actress and mental health advocate Glenn Close and Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) for an event on mental health and addiction on Thursday.
  • The House Oversight Committee holds a hearing on the HIV prevention drug on Thursday.
SUGAR RUSH

On her graduation cap, this high school senior created a QR code that links to a website memorializing the lives lost in school shootings: