THE PROGNOSIS

Alabama’s three abortion clinics insist they’re not planning to close their doors, even as a new state law threatens to criminalize the procedures they provide.

“We’ve been through this fight over and over again,” Dalton Johnson, owner of the Alabama’s Women’s Center, told me yesterday. “Our main goal is to keep the women apprised that we will be challenging it in court.”

Alabama’s Women’s Center in Huntsville — whose two doctors provide about 2,000 abortions every year — is one of just three abortion clinics left in a state where there were more than 20 back in the 1990s. Now the abortions they provide would become almost entirely illegal under a sweeping restriction signed yesterday by Alabama Gov. Kay Ivey (R), who said in a statement that the legislation “stands as a powerful testament to Alabamians’ deeply held belief that every life is precious and that every life is a sacred gift from God.”

The measure, which is easily the most restrictive abortion law in the country, would make performing an abortion a criminal act — including in cases of rape or incest. Doctors caught attempting to perform an abortion could face up to 10 years in prison and those who actually complete the procedure could receive a sentence as long as 99 years. The law does not penalize the woman receiving the abortion.

There are three exceptions in which it permits abortions: if the woman’s life is at risk, if the fetus has a “lethal anomaly” or if the pregnancy is ectopic, in which a fertilized egg is implanted outside the uterus.

From the advocacy and political arm of Planned Parenthood Southeast:

The Onion poked fun at the law's lack of exceptions for rape and incest:

The law doesn't go into effect for six months. But the American Civil Liberties Union has said it will petition the courts for an injunction halting the law from taking effect at all. And it is likely to be successful, considering the Alabama law is more drastic than “heartbeat” restrictions courts have already blocked in several states.

But to antiabortion advocates, getting the law enacted in Alabama isn’t really the point. Their strategy is to get the Supreme Court — now tilted 5 to 4 in favor of conservatives — to consider overturning its 1973 Roe v. Wade ruling legalizing abortion by passing a slew of abortion restrictions that clearly violate that standard (here are some great Washington Post graphics showing where states have advanced abortion restrictions and protections).

Antiabortion advocacy group Susan B. Anthony List:

Alabama Women’s Center is unique in two respects, Johnson told me. It’s the state’s only clinic with doctors who have hospital admitting privileges, and it’s the only one that performs abortions up to the state’s current legal limit of 20 weeks of pregnancy. The clinic performs between 400 and 500 second-trimester abortions every year.

Because of these factors, the clinic sees patients from across Alabama as well as the nearby states of Mississippi, Tennessee, Louisiana and the Florida Panhandle, Johnson said.

“We get patients coming from six and eight hours away all the time, on a regular basis,” Johnson said.

Alabama Women’s Center is on the north end of the state. Reproductive Health Services is in Montgomery, in the center of the state, and West Alabama Women’s Center in Tuscaloosa is to the west. When I called those two clinics, receptionists who answered the phone said they plan to stay open as long as possible.

“If the law goes into effect … we’re not criminals; we would not be able to stay open,” said an employee at the West Alabama Women’s Center, who referred me to the ACLU for further comment. “But until it’s all resolved, we will be here.”

“We don’t see any interruption in any kind of service whatsoever,” said an employee of Reproductive Health Services.

There’s a good possibility the Supreme Court will confront a state abortion restriction in its term that begins in October — but the Alabama law probably isn’t at the top of its list, my Post colleague Robert Barnes explains. The justices are much more likely to take a gradual approach on the issue, perhaps by considering Louisiana’s abortion doctor requirements or Indiana’s ban on sex, race or disability-selective abortions.

“The court in general — and Chief Justice John G. Roberts Jr. in particular — prefers a step-by-step process when shifting the court’s jurisprudence, rather than disposing of an iconic landmark ruling in one grand gesture,” Robert writes. “That would probably hold true especially for one as etched in the American public’s consciousness as Roe.”

There’s a reason state legislators hadn’t yet attempted criminalizing the provision of abortions, per The Post’s Aaron Blake. Americans have historically supported modest increases in abortion restrictions but overwhelmingly oppose the kind of legislation Alabama passed.

Some abortion foes appeared skeptical of Alabama's new law. Longtime televangelist Pat Robertson decried Alabama’s new abortion ban as “extreme,” saying on his show yesterday that the state legislature has “gone too far,” my Post colleague Sarah Pulliam Bailey reports.

“They want to challenge Roe vs. Wade, but my humble view is I don’t think that’s the case I’d want to bring to the Supreme Court because I think this one will lose,” Robertson told viewers of CBN’s “The 700 Club” on Wednesday.

Sen. Richard Shelby (R-Ala.) appeared none too eager to discuss the law, via HuffPost's Igor Bobic: 

Sen. Susan Collins (R-Maine), via NBC News's Frank Thorp: 

The new law drew heated denouncements from abortion rights advocates, Democrats and 2020 presidential contenders, some of whom seized the opportunity to ask for donations to Planned Parenthood.

Former vice president Joe Biden: 

Sen. Kirsten Gillibrand (D-N.Y.): 

Former Texas congressman Beto O'Rourke:

South Bend, Ind., Mayor Pete Buttigieg:

Sen. Cory Booker (D-N.J):

AHH, OOF and OUCH

AHH: The Food and Drug Administration is set to approve a second gene treatment for infants with spinal muscular atrophy that will cost $1.5 million to $5 million – it will be the costliest drug on the planet.

It’s only the second drug on the market for the rare disease after a gene treatment was first introduced in 2016, as our Post colleague Christopher Rowland reports. Biogen, the drugmaker behind the initial treatment, had already drawn criticism for the price tag of the drug Spinraza, which costs $750,000 for the first year and $375,000 for each subsequent year.

But the new drug is set to kick off a “new era of debates over cost and value as gene therapies are developed for growing numbers of rare diseases” and it has already set off a clash between the manufacturer of the new drug, Novartis, and Biogen. And the clash has already produced what independent communication experts describe as a coordinated effort featuring “op-ed columns by former Cabinet secretaries warning about the safety of the Novartis therapy.”

“The controversy is clouding the debate as parents, doctors, and insurance companies will soon be grappling with highly complex decisions over which drug to choose and how to pay for it,” he adds. “How the medical system handles these questions of safety, effectiveness and price will set a precedent for future battles. The FDA is poised to review more applications for gene therapies for inherited diseases such as hemophilia and Duchenne muscular dystrophy.”

OOF: North Carolina has filed a lawsuit against e-cigarette maker Juul Labs, alleging the company has been “deceptively downplaying the potency and danger of the nicotine." The suit, filed by state Attorney General Joshua Stein, also accuses the company of using advertising tactics to target underage users, our Post colleague Deanna Paul reports.

“Addicting a new generation of teenagers is unacceptable, illegal, and that’s why I’m taking action,” Stein told The Post. “This is about a company that is selling its product predominantly to [youth]. There has to be some limitation on the way they do business.”

E-cigarette use has been a focus of scrutiny at the federal level. The Food and Drug Administration in March rolled out a policy meant to combat youth vaping. But North Carolina’s suit goes a step further than what the FDA has already called for. In addition to calling for a ban on sales of Juul and other such products to minors, North Carolina has requested that mint-flavored products and popular fruit flavors such as mango be taken off the market.

The state also wants the court to employ a marketing ban that would block the company from specific advertising via email or social media that targets minors, and also wants the court to stop Juul from advertising in certain spaces, such as near playgrounds or schools, where young consumers are targeted.

A Juul spokesman said the company shares “the Attorney General’s concerns about youth vaping, which is why we have been cooperating with his office and why we have taken the most aggressive actions of anyone in the industry to combat youth usage.”

OOF: A federal judge has temporarily blocked a controversial policy for distributing scarce livers for transplant, a ruling that comes just one day after the new rule was implemented.

U.S. District Judge Amy Totenberg had initially decided not to halt the rules, asking the government to voluntarily delay the policy until the Supreme Court could weigh in on a relevant case, our Post colleague Lenny Bernstein reports. When the Department of Health and Human Services moved ahead with the policy anyway, the judge stepped in.

“For years, transplant hospitals generally had first claim to organs donated in their areas. The new policy offers livers to the sickest patients as far as 500 nautical miles from the donor. It was approved after a lawsuit was filed in New York by patients who said they were waiting longer for livers than less-ill people in other parts of the country,” Lenny writes. “The plaintiffs — which include transplant centers in Georgia, Michigan, Kansas, Missouri and elsewhere, as well as people on the waiting list for livers — say the rules will leave patients in those places with about 20 percent fewer organs than the current policy, resulting in an increase in waiting-list deaths … Supporters of the new policy maintain, however, that regional disparities have become too great.”

“Given the gravity of the medical issues and risk of disruption in the transplant system and the concrete likelihood of harm to the plaintiffs and the public at large if the status quo is not maintained, the Court finds that the public interest is best served” by keeping the old policy in place, Totenberg wrote in her decision.

OPIOID OPTICS

— New York’s Metropolitan Museum of Art announced it will stop accepting donations from the Sackler family that has been at the center of growing criticism for its role in the nation’s opioid crisis.

The family connected to OxyContin maker Purdue Pharma has donated to museums around the world for decades. As members of the family face lawsuits from hundreds of cities and counties for allegedly fueling the opioid crisis with deceptive marketing practices, other major art institutions have announced they would stop taking gifts from the family, including the Tate galleries and National Portrait Gallery in London and the Solomon R. Guggenheim Museum in New York, as our Post colleague Peggy McGlone reports.

“The Met said that its decision came after a months-long review of its gift policies, which was prompted by the public outcry over the Sackler gifts,” Peggy writes. “The Sackler donations to the Met — including the gift that funded the wing housing the museum’s Temple of Dendur — date back half a century. The museum does not plan to remove the Sackler name.”  

HEALTH ON THE HILL

— Sens. Bill Cassidy (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Maggie Hassan (D-N.H.), Lisa Murkowski (R-Alaska), and Tom Carper (D-Del.) have introduced the latest legislative effort to protect patients from unexpected medical bills.

The bipartisan STOP Surprise Medical Bills Act is meant to protect patients who get emergency care at an out-of-network facility or by an out-of-network provider, pateints who receive elective services at an in-network facility by out-of-network providers and patients who need additional services at an out-of-network facility if they need medical transport from such a facility. Under the bill, patients will only be responsible for their in-network cost-sharing. 

“Patients should be the reason for the care, not an excuse for the bill,” Cassidy said in a statement. “This is a bipartisan solution ensuring patients are protected and don’t receive surprise bills that are uncapped by anything but a sense of shame.”

INDUSTRY RX

— In an effort to prevent wasted spending on health services that may result from misdiagnoses, Walmart has started recommending its workers use high-quality imaging centers for CT scans and MRIs.

The company is the largest private employer in the nation, and its health plan covers 1.1 million employees and dependents in the United States, Kaiser Health News’s Phil Galewitz reports, adding that it also seems to be the first such major employer to direct its workers toward a specific service, in this case an imaging provider, because of accuracy rather than because of price.

“Walmart employees are not required to use those 800 centers, but if they don’t use one that is available near them, they will have to pay additional cost sharing,” Phil writes. “Company officials advise workers that they could have more accurate results if they opt for the specified centers.”

The shift first started after the company noticed a trend in workers who had misdiagnosed health conditions after going to certain specialized hospitals, which turned out to be a result of high error rates in their diagnostic imaging.

Lisa Woods, the senior director of benefits design at the Walmart pointed to a long-term benefit, even if the new effort is not specifically about saving money. “It’s been demonstrated time and time again that high quality ends up being more economical in the long run because inappropriate care is avoided, and patients do better,” she said.

— And here are a few more good reads: 

MEDICAL MISSIVES
Her latest proposal would focus on executive actions she could take as president.
Politico
Plastic surgeons’ Instagram accounts of the weekend trip didn’t note the drug company’s sponsorship, which some ethicists say should be disclosed.
New York Times
AGENCY ALERT
A federal judge is siding with public health groups suing the Food and Drug Administration to begin reviewing thousands of e-cigarettes on the U.S. market.
Associated Press
REPRODUCTIVE WARS
Morning Mix
The only women who spoke during the four-hour debate in the Alabama Senate on Tuesday acknowledged in interviews with The Washington Post that the divide on the issue of abortion is primarily one of ideology rather than gender.
Meagan Flynn
Morning Mix
"The Good Place" star slammed Georgia's "heartbeat bill" as "so upsetting, inhumane, and blatantly demonstrative of a hatred of women, a disregard for our rights, bodies, mental health," in a series of tweets this week.
Allyson Chiu
DAYBOOK

Today

  • 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.
  • The House Oversight Committee holds a hearing on the HIV prevention drug.
SUGAR RUSH

What the Alabama governor has said about abortions so far:

What Alabama’s abortion legislation could mean for the rest of the country: