THE PROGNOSIS

The Trump administration has gone after pharmaceutical companies and pharmacy middlemen in its quest to lower prices for prescription drugs and medical services. Now, hospitals and insurers could be next.

President Trump, in his usual superlative but vague style, promised on Friday “another big announcement” within the next two weeks that will have a “profound effect on the things that we’re talking about.” The president was speaking from the Rose Garden about his health care-related actions thus far, including a new, expanded use of tax-free health care accounts used by employers.

“It’s going to be something really incredible,” Trump said. “Nobody knows what it is. It’s going to be a big surprise, but it’s going to be a very pleasant one.”

The White House hasn’t said exactly what the president is referring to — but hospitals and insurers are worriedly eyeing a potential executive order reportedly being readied by the departments of Health and Human Services, Labor and Justice. The order, which my colleagues Amy Goldstein and Josh Dawsey reported on a few weeks ago, could require them to publicize the discounted rates they negotiate for medical services.

Cloaked in secrecy, these rates are part of a bewildering health-care pricing system that leaves many Americans in the dark about how much their care costs and the share they’ll have to pay for it. As a result, consumers have limited ability to make informed financial decisions when obtaining care or buying prescription drugs, and providers have little incentive to lower prices.

That’s why the issue of transparency has emerged as a key goal for both HHS and members of Congress as they pursue a basket of initiatives to lower health-care costs. Republicans — who are hesitant about more heavy-headed measures to extract lower prices from industry — have especially embraced the goal of transparency to force more competition into the sector.

“No American should be blindsided by bills for medical services they never agreed to in advance,” President Trump said. “We’re promoting price transparency to force competition and drive down cost.”

The pending executive order probably wouldn’t create policies right away. Instead, the president would direct federal agencies to pursue multiple new regulations aimed at price transparency, Amy and Josh reported.

Besides requiring disclosures from insurers and hospitals, the order could also make it easier for Medicare enrollees to find out what they would pay for treatment at various hospitals by widening the range of services for which hospitals must post their prices. It could also include an effort to promote more competition among hospitals by slowing a trend toward consolidation.

The policies are certain to engender firm resistance from hospitals and insurers, which argue that simply listing prices wouldn’t necessarily help consumers make informed decisions. Because patients with insurance don’t pay the full price of medications and services, requiring the disclosure of price negotiations wouldn’t directly help consumers and could even cause prices to rise further, they’ll argue.

That’s precisely the argument hospitals have levied against a requirement under the Affordable Care Act that they publicize what’s known as their “chargemaster” — their list prices for all the services they provide. Journalist Steven Brill brought additional attention to the chargemaster with his 2013 Time magazine article “Bitter Pill,” in which he detailed how chargemaster prices vary dramatically between hospitals, automatically increase every year and often appear arbitrary.

Hospitals had to start complying on Jan. 1 with the ACA requirement to publish their chargemaster in a computer-friendly format, under rules finalized last year by the Centers for Medicare and Medicaid Services. Yet they’ve got a point — publicizing their prices doesn’t necessarily mean it’s easy for people to ingest.

“What’s resulted — confusing, unwieldy lists of thousands of goods and services posted on thousands of individual hospital websites — is of dubious relevance to patients in its current form,” says an analysis by the Commonwealth Fund.

While transparency is a worthy goal, there are a few reasons it might not help lower health-care prices in the same way it assists in other industries. Hospital patients usually have no idea what services they’ll end up needing during a visit or stay. And shopping for care is incredibly difficult because it requires a huge amount of information about treatments that is hard for most patients to absorb or even obtain.

“In reality, patients receive a complex package of services during an episode of care, such as a knee replacement,” the Commonwealth authors wrote. “Hospital-pricing information should be presented in the same way. In additional, patients covered by insurance rarely pay hospitals’ published list prices.”

Of course, industry opposes regulations it thinks will harm its bottom line or worsen its public perception. Other corners of the country’s health-care complex have lobbed similar criticisms whenever the administration has tried to force transparency.

The pharmaceutical industry hates an HHS regulation finalized last month requiring drugmakers to include the list price of drugs in television advertisements. Amgen, Eli Lilly and Merck are suing HHS to block the rules, my colleague Christopher Rowland reported Friday. The drugmakers say the requirement not only violates their free speech rights, but are “entirely unnecessary, bad for patients and detrimental to healthcare.”

“The lawsuit claims that the list price required to be disclosed in advertisements is not meaningful because it doesn’t take into account discounts, insurance coverage, deductibles and co-payments that affect what patients actually pay for their drugs,” Chris wrote.

The drug manufacturers are even arguing that disclosing high list prices could hurt health-care costs in the long run by misleading people who have insurance.

“The rule is . . . likely to cause many patients to overestimate how much they would have to pay for treatment, and indeed to cause many patients to conclude — incorrectly — that it is not worth asking their doctors about the advertised product even though the treatment might save or significantly improve the quality of their lives,’’ according to the lawsuit, filed in U.S. District Court in Washington.

But that contention — that transparency is sometimes harmful — isn’t one HHS Secretary Alex Azar is likely to buy, either from pharmaceutical companies or from hospitals and insurers.

“Claiming list prices don’t matter is almost the same as claiming there is no problem with high drug costs at all — and I don’t think many American seniors or patients with serious illnesses would say that’s the case,’’ Azar said while rolling out the final rule on TV ads.

Whatever Trump rolls out next, it will be with an eye to his bid for reelection next year. The president told George Stephanopoulos in an interview with ABC News that health care will be a priority for his campaign, saying he plans to release a new health plan in “about two months. Maybe less.” He said it would be announced before the election.

“We already have the concept of the plan, but it’ll be less expensive than Obamacare by a lot. And it’ll be much better health care,” he said in the interview that aired Sunday. 

He acknowledged the plan's success would be conditional on Republicans “winning back the House, Senate and the presidency. You need the three.”  

And he lamented Republicans' failed attempt at repealing and replacing the ACA, saying “we almost had health care done. Health care's a disaster, Obamacare,” he said. “We almost had it done… We would have had great health care. So we're going to do that if we win the House. If we win back the House, we're going to produce phenomenal health care.”

At one point during the same interview, Trump – who is a self-professed “germaphobe” – asked his acting chief of staff Mick Mulvaney to leave the room because he let out a cough. “If you’re going to cough, please leave the room,” the president said. “You just can’t, you just can’t cough.”

“The president was in the middle of answering a question about his financial records when he became distracted by the sharp sound of his chief of staff expelling air from his lungs,” our Post colleague Isaac Stanley-Becker writes. “Trump tripped over his words, requesting to Stephanopoulos, ‘Let’s do that over.’ Appearing to point at Mulvaney, he said, ‘He’s coughing in the middle of my answer.’”

AHH, OOF and OUCH

AHH: Officials from Homeland Security’s Immigration and Customs Enforcement announced they quarantined 5,200 migrants at more than three dozen detention centers across the country largely due to exposure to mumps at the facilities.

There have been 334 mumps cases since September, the agency said. It’s the latest strain on a system that’s been dealing with a wave of more migrant families and children entering the country, our Post colleague Abigail Hauslohner reports.  

“The quarantines, which were first reported by CNN, come as the Trump administration has struggled to manage an ongoing influx of migrants across the U.S.-Mexico border, where immigration authorities have apprehended nearly 600,000 people since October,” she writes. “ICE agents have apprehended another 34,500 people in the interior of the United States, according to official government statistics. The agency says it is currently holding about 52,560 people in detention facilities across the country, 5,000 more than it forecast in its 2019 budget."

Nathalie Asher, the executive associate director for ICE Enforcement and Removal Operations, told Abigail the quarantines necessary to address such contagions mean migrants will be detained for a longer amount of time. Asher also pointed to the influx of migrants as a “significant” factor in the mumps outbreak.

OOF: In Colorado and Washington, the first two states to legalize recreational marijuana, teenagers are increasingly using highly potent pot, even as both states boost the industry and reap huge tax windfalls from its sales, Jennifer Oldham writes for the Post.

"Though the legal purchase age is 21 in Colorado and Washington, parents, educators and physicians say youths are easily getting hold of edibles infused with tetrahydrocannabinol, or THC, the psychoactive component that causes a high, and concentrates such as 'shatter,' a brittle, honey-colored substance that is heated and then inhaled through a special device," Jennifer writes. "Each poses serious risks to adolescents’ physical and mental health."

“Underage kids have unbelievable access to nuclear-strength weed,” said Andrew Brandt, a Boulder, Colo., software executive whose son got hooked while in high school.

OUCH: More Americans are trekking to Canada in search of cheaper insulin as the cost of the lifesaving drug skyrockets here.

Our Post colleague Emily Rauhala writes about Lija Greenseid, a Minnesota mother of a Type-1 diabetic who “led a small caravan last month to the town of Fort Frances, Ontario, where she and five other Americans paid about $1,200 for drugs that would have cost them $12,000 in the United States.”

She writes the “organizers of the caravan — their word, a nod to the migrants traveling in groups through Mexico to the U.S. border — are speaking out about their trip because they want Americans to see how drug prices push ordinary people to extremes.”

Greenseid has bought insulin for her daughter from six different countries and she pointed to the United States as having both the highest and the most unpredictable prices. But Emily writes the group, which is planning another trip to Canada this month, sees the effort as a way to raise awareness about costs in the United States, rather as a suggestion that going to another country is the best solution to lowering costs for patients.

HEALTH ON THE HILL

— Volunteers working with National Nurses United are going door to door in critical House districts pushing voters on the issue of the Medicare for All Act.

Since February, canvassers working as part of the effort by the nation's largest nurses union have knocked on 20,000 doors and collected 14,000 signatures across the country, the New York Times’s Abby Goodnough reports.

Democratic lawmakers declared this past weekend one of "action on heath care,” but Abby reports they are “split over whether to embrace extreme change or something closer to the status quo.”

“The nurses’ union and a number of other progressive groups want nothing less than a government system that pays for everyone’s health care, seizing on the issue’s prominence and a round of Medicare for all hearings in the House with canvassing in the districts of many of the 123 House Democrats who have not thrown their support behind a single-payer system,” she writes. “The nurses’ union campaign began just after Democrats won the House in November, when the union and several other groups held a strategy call with Representative Pramila Jayapal, Democrat of Washington, the chief author of the Medicare for All Act, and Senator Bernie Sanders of Vermont, who pushed Medicare for all into the mainstream during his 2016 presidential campaign.”

Jasmine Ruddy, who leads organizing for the nurse’s union’s Medicare-for-all effort, said the strategy is to “reach the people who are already convinced that health care is a human right, to bring them in and actually make them feel the action they are taking matters.”

MEDICAL MISSIVES

— The World Health Organization declined to declare the Ebola outbreak in the Democratic Republic of Congo as a global health emergency.

The decision followed even as the disease spread from the Congo to Uganda last week. Stat’s Helen Branswell reports WHO instead called the outbreak an “emergency for the country and a threat to its neighbors.”

“In previous instances when a public health emergency of international concern — called PHEIC for short — has been declared, the WHO’s recommendations on travel and trade have sometimes been ignored,” Helen writes. “Countries have interpreted the declaration as a threat. Many, for instance, stopped issuing visas to people from Ebola-affected countries during the West African Ebola outbreak of 2014-2016. And most international airlines stopped flying into those countries.”

Still, WHO’s decision came even as global health experts have been urging the organization to declare a global health emergency. “The lack of such a declaration is potentially depriving the Ebola response of badly needed assistance and donor cash, they have argued,” Helen adds.

— And here are a few more good reads: 

AGENCY ALERT
If the president follows through on issuing a plan, it could help shape a presidential race that Democrats would like to focus largely on health care.
New York Times
OPIOID OPTICS
REPRODUCTIVE WARS
Abortion is anything but a simple issue. But the nuance in how most Americans think about it has all but disappeared from the political conversation, some voters say.
New York Times
STATE SCAN
U.S. measles outbreaks, with more than 1,000 confirmed cases in 28 states this year, are exacting a hefty toll on local and state health departments and siphoning health-care workers away from other needs.
Wall Street Journal
The state is advancing a sweeping health care package that could shape Democrats' debate over universal coverage.
Politico
BIRMINGHAM, Ala. (AP) — Planned Parenthood is building the stage for another possible fight over abortion in Alabama: a large women’s clinic that’s under construction despite the state’s passage of a near-total ban on abortions.
Associated Press
Local
Authorities do not know what caused the suspected overdoses, a prison spokeswoman said.
Steve Thompson
National
As cannabis concentrates and edibles proliferate, a Colorado doctor says “horrible things are happening to kids.”
Jennifer Oldham
INDUSTRY RX
The researchers hope their work will lead to a test for the condition, called acute flaccid myelitis, which has been diagnosed in more than 500 kids.
Stat
Health
Big Papi was ‘beyond lucky,’ one expert said. ‘It wasn’t his time.’
Rachelle Krygier and Lenny Bernstein
DAYBOOK

Coming Up

  • The Washington Post hosts FDA Acting Commissioner Ned Sharpless as well as Sens. Jack Reed (D-R.I.) and Shelley Moore Capito (R-W.Va.) at an event examining the latest developments in cancer prevention, detection and treatment on Tuesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the Lower Health Care Costs Act on Tuesday.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Protecting Title X and Safeguarding Quality Family Planning Care” on Wednesday.
  • Politico hosts an event on “America’s Sky-High Drug Prices & the Role of Biosimilars” on Wednesday.
  • The House Oversight Subcommittee on Government Operations holds a hearing on “Ensuring Quality Health Care for our Veterans” on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “Strengthening Health Care in the U.S. Territories for Today and Into the Future” on Thursday.
SUGAR RUSH

White House press secretary Sarah Sanders once said she wanted to be remembered as “transparent and honest.” Did she live up to her own standard?