THE PROGNOSIS

President Trump wants to ride to reelection on an Obamacare repeal-and-replace train – even though that train hit a dead end two years ago.

While the president is pushing for a specific plan he can take to on the campaign trail, staff at the White House Office of Management and Budget and at the Domestic Policy Council are instead working on a set of broad principles outlining the president's vision for health care, according to two people briefed on the matter.

While Trump said over the weekend that his administration is working on a new health-care plan, the president mostly stuck to criticizing Medicare-for-all and boasting about how Congress erased the Affordable Care Act's requirement to buy health coverage, in a speech last night in Orlando officially kicking off his reelection campaign. 

"We got rid of the individual mandate, right?" Trump said. "How many people are happy? They no longer have to pay for the privilege of not paying for bad health insurance." 

The Post's Cathleen Decker:

"Trump told the crowd that his election in 2016 was the result of a great political movement that has been under attack ever since, despite what he described as the great successes of his presidency," my colleagues Toluse Olorunnipa, Chelsea Janes and Anne Gearan report.

“We accomplished more than any other president has in the first 2½ years of a presidency and under circumstances that no president has had to deal with before,” he said, using the hyperbole that has marked much of his career.

Trump refrained from promising Obamacare repeal last night, even though he's pushed behind the scenes for a fresh plan to do just that. It's a project many in his administration would rather skip, after they watched the 2017 repeal-and-replace effort crash and burn.

Health care is indeed a key topic voters want to hear discussed in next week’s presidential debates, per a new Kaiser Family Foundation poll. When respondents were asked open-ended questions about what specific topics they want addressed, they most often mentioned the high cost of care. And Democrats believe health care access and costs will be key to the 2020 battle for the White House just as they were in the 2018 midterms.

But the president would have plenty to talk about on that front, without reminding voters that his party dramatically and embarrassingly failed to follow through on their promises to repeal and replace the Affordable Care Act.

His Department of Health and Human Services has taken a number of actions aimed at lowering drug prices by promoting transparency along the drug supply chain. The administration also finalized a regulation last week that could decouple health insurance from employment, by giving workers a way to use tax-free employer contributions to shop for coverage on their own.

Trump could craft his health-care message around those actions, positing himself as a candidate who will work to lower Americans’ health care costs. But it appears the president wants something bigger and bolder to tout, promising ABC News that he’ll be releasing a “phenomenal” health-care plan within the next two months.

“If we win back the House, we’re going to produce phenomenal health care,” the president told George Stephanopoulos. “And we already have the concept of the plan, but it’ll be less expensive than Obamacare by a lot.”

Any new health-care proposals would come from the White House, not from Trump’s campaign. The campaign hasn’t hired any policy staffers so far, instead relying on the executive branch to advance policy proposals the president can use in stump speeches.

President Obama’s 2012 reelection campaign also deferred to the executive branch on policy. But the campaign did hire a policy team of nine people to ensure surrogates and volunteers for the president presented a unified front on foreign and domestic matters. Its director, James Kvaal, told me the whole team was in place about 10 months before the November election.

“We saw our role as making sure everyone associated with the campaign was articulating the president’s policy agenda accurately and making the best arguments for it,” Kvaal told me.

Kvaal’s team didn’t just promote Obama’s policies. It also organized arguments against proposals being advanced by Mitt Romney’s campaign, including Romney’s support for Medicare vouchers. Similarly, the Medicare-for-all ideas being promoted by many Democratic candidates could present an opportunity for offense by the Trump campaign – if it seized the chance.

“That would be something that you might think the Trump campaign would want to be engaged in at this point in the cycle,” Kvaal said.

Trump did blast Medicare-for-all in his speech last night, calling it a "crazy Bernie Sanders socialist government takeover of health care."

"They want to end Medicare as we know it and terminate the private health insurance of 180 million Americans who love their health insurance," Trump said. "America will never be a socialist country, ever. Republicans do not believe in socialism, we believe in freedom, and so do you."

Yet repealing and replacing the ACA is a goal Trump is having trouble surrendering, even though his party has largely moved on from that elusive quest. And deepening quarrels between White House officials and Health and Human Services Secretary Alex Azar are threatening to derail Trump's health-care agenda, Politico reports.

Politico's Dan Diamond:

ACA analyst Charles Gaba:

“We almost had health care done,” Trump told ABC. “Health care’s a disaster.”

Congress didn’t “almost” have “health care done,” as the president claimed. We wouldn't blame you if you thouht the president had wiped his memory of the whole, messy repeal-and-replace effort that spanned several months back in 2017.

While the GOP-led House did pass a health-care bill that year, Republican Senate leaders struggled to get enough of their members on board for their plan, which would have whittled down Medicaid spending. More than half a dozen Republicans eventually helped to vote down two bills repealing large parts of the ACA.

A third bill, which became known as “skinny repeal,” would have done away with only a few ACA provisions. That measure famously failed with a thumbs-down from former Sen. John McCain (R-Ariz.), who joined Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) in voting no. Trump has repeatedly slammed McCain for that vote, even after the senator passed away from cancer last year.

Trump’s top health-care advisors watched all this happen – so they’re not terribly interested in proposing yet another bill to repeal the ACA that would merely serve as fodder for Democratic attacks.

AHH, OOF and OUCH

AHH: A wealthy couple in Manhattan has donated more than $3 million in recent years to groups that question the safety and effectiveness of vaccines, including to the group behind two recent anti-vaccine forums in New York’s ultra-Orthodox Jewish community that’s been at the center of a major measles outbreak.

It’s not clear how Bernard and Lisa Selz came to support this movement, our Post colleagues Lena H. Sun and Amy Brittain report, but they write “their financial impact has been enormous.” “Their money has gone to a handful of determined individuals who have played an outsize role in spreading doubt and misinformation about vaccines and the diseases they prevent,” they write. “The groups’ false claims linking vaccines to autism and other ailments, while downplaying the risks of measles, have led growing numbers of parents to shun the shots. As a result, health officials have said, the potentially deadly disease has surged to at least 1,044 cases this year, the highest number in nearly three decades.”

According to tax filings, the couple began supporting the anti-vaccine movement in 2012. That year, they gave $200,000 to the legal fund of prominent anti-vaccine activist Andrew Wakefield. The Selz Foundation also provides most of the funding for the Informed Consent Action network, a three-year-old group that says its promotes drug and vaccine safety as well as parental choice in vaccine decisions. The group’s chief executive, Del BigTree, headlined controversial forums in Brooklyn and Rockland County, N.Y. in recent weeks.

OOF: Across the country, tens and thousands of people are being impacted by a shortage of a potentially lifesaving treatment called BCG for early-stage bladder cancer, and part of the problem is the drug’s price is too low, our Post colleague Laurie McGinley reports.

And a low price can mean drugmakers aren’t driven to produce the needed medications. Benjamin Davies, a urologist at the University of Pittsburgh Medical Center, urged Merck, which is the only supplier of BCG to raise the $150 per dose price to spur profitability and more competitors.

“Merck has raised the price of the off-patent drug modestly in recent years but has shown little interest in a big hike, perhaps fearing a backlash,” Laurie writes.

But Merck’s chief marketing officer Mike Nally told The Post part of the problem is the facility that produces the drug is at maximum capacity. He acknowledged it might benefit the growing global demand for BCG if there were other suppliers of the drug but he said “there’s an element of market failure here” as there’s a lack of interests in the industry to produce it. 

OUCH: Across the country, numerous jails have faced lawsuits and investigations over allegedly mistreating or neglecting inmates, including those who were mentally ill.

Of more than 400 lawsuits that were filed in the last five years over such allegations, about 40 percent of the complaints involved inmate suicides in local jails, Sharon Cohen and Nora Eckert report in a joint investigation by the Associated Press and University of Maryland’s Capital News Service. In total there were 135 deaths and 30 attempts. About 80 percent of the inmates who committed or attempted suicide were waiting for their trial. A third of the suicides and suicide attempts occurred after inmates allegedly were denied medication for managing mental illness.

“These lawsuits represent a tiny fraction of the problem,” they write. “An exclusive 50-state reporting effort to collect recent data found more than 300 suicides in local jails from 2015 to 2017 — in just nine states. The others did not provide numbers or offered incomplete data, an issue prompting some legislatures to consider bills that would require jails to provide better information about those dying behind bars.”

AGENCY ALERT

— An online pharmacy told the Food and Drug Administration last week that it had found a believed carcinogen in widely used blood pressure medicine valsartan.

The pharmacy, Valisure, told the regulator that it discovered dimethylformamide in the drug made by several pharmaceutical companies, including Swiss pharmaceutical giant Novartis, CNBC’s Berkeley Lovelace Jr. reports. It said it found the chemical in the valsartan made by five companies.

“Valisure asked that the medication be recalled and requested that the FDA review and significantly lower the acceptable intake of [the chemical,” Berkeley writes. “…The FDA will evaluate Valisure’s findings and will respond directly to the online pharmacy chain, FDA spokesman Jeremy Kahn said in a statement to CNBC. Patients should continue to take their blood pressure medication even if it is recalled until their doctor provides a replacement or alternative treatment, he added. Abruptly discontinuing a medication is risky, he said.”

HEALTH ON THE HILL

— Rep. Elijah Cummings (D-Md.) and Sen. Debbie Stabenow (D-Mich.) are calling for more information about how HHS manages patents for drugs that were developed even partly with taxpayer money. They want the Government Accountability Office to review this issue, Stat’s Ed Silverman reports.

Such patents were the subject of a heated debate during a hearing before the House Oversight Committee last month, during which Gilead Sciences, the maker of the HIV drug Truvada, defended the high cost of the drug while lawmakers, including panel chairman Cummings, questioned the company’s chief executive about the government grants and research by government scientists that led discovery that Truvada could be used to prevent HIV.

“The session came just days after HHS and Gilead, instead, reached agreement on a donation program that would cover up to 200,000 patients over the next 11 years. However, the move was met with mixed reactions, since the company is entitled to tax breaks but did not lower the price,” Ed reports. “... Now, the lawmakers want the GAO to determine how HHS enforces government rights to royalties and licenses, how the agency prevents drug makers from infringing on patents, and whether HHS considers the effect of drug pricing when granting exclusive licenses to pharmaceutical companies.”

STATE SCAN

— In a first, a statewide offiicial in Virginia is calling on the state to legalize recreational marijuana use for adults.

Attorney General Mark Herring told reporters this weekend that criminalizing marijuana possession is “not working for Virginia.” “We are needlessly creating criminals and getting a lot of convictions,” he said, our Post colleague Laura Vozzella reports. “And this whole system — the weight of it — falls disproportionately on African Americans and people of color. There is a better, smarter way to approach cannabis, and it starts with decriminalizing simple possession of small amounts, addressing past convictions and moving thoughtfully toward legal and regulated adult use.”

The remarks come as Herring tries to move past a personal scandal.

“Herring announced in December that he would run for governor but was tarnished two months later during a period of high drama in Richmond,” Laura writes. “In the first week of February, Northam and Herring admitted to wearing blackface as young men, while two women accused Fairfax of sexually assault in the early 2000s; Fairfax says the encounters were consensual.”

— Virginia Gov. Ralph Northam (D) has called for a July 9 special session to take up gun legislation, but Republican lawmakers may now have their own agenda for that session: They want hearings to examine the sexual assault allegations against Lt. Gov. Justin Fairfax (D),” Laura reports.

“As you know, both women have stated that they will only participate in legislative hearings if the hearings are public and both Republicans and Democrats participate,” Del. Rob Bell (R-Albemarle) wrote in a letter to the state House’s Democratic leader. “I wish to renew my offer for truly bipartisan hearings.”

His letter referred to the two women who came forward alleging Fairfax sexually assaulted them in the early 2000s.

Republicans have been calling for such hearings since earlier in the year, but House Minority Leader Eileen Filler-Corn (D-Fairfax) rejected the GOP’s latest request. “[W]e will not participate in House Republicans’ political games, nor will we turn such serious allegations into a partisan sideshow,” Filler-Corn said in a response to Bell.

“Lauren Burke, a spokeswoman for Fairfax, reiterated the lieutenant governor’s recent call for prosecutors to investigate the allegations, and accused Bell and House Speaker Kirk Cox (R-Colonial Heights) of playing politics and trying to distract from the issue of how to reduce gun violence,” Laura writes.

—  And here are a few more good reads: 

TRUMP TEMPERATURE
With health care poised to play a crucial role in the 2020 election, infighting within the Trump administration threatens to derail some of the president’s most prominent pledges to voters.
Politico
MEDICAL MISSIVES
Her new legislation aims to make affordable, universal child care a reality.
Vox
Preschoolers in the Women, Infants and Children nutrition program saw obesity rates drop steadily to about 14% in 2016 from 16% in 2010.
Associated Press
Data from a federal program designed to compensate people harmed by vaccines shows how rare it is for someone to claim they were hurt after getting vaccinated.
New York Times
Morning Mix
The policy is legal thanks to a 2002 Supreme Court decision.
Antonia Farzan
INDUSTRY RX
SAN FRANCISCO (AP) — San Francisco supervisors moved a step closer Tuesday to becoming the first city in the U.S. to ban all sales of electronic cigarettes to crack down on youth...
Associated Press
Opinions
The administration is set to greatly improve employer-sponsored care.
Avik Roy
DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Protecting Title X and Safeguarding Quality Family Planning Care." 
  • Politico hosts an event on “America’s Sky-High Drug Prices & the Role of Biosimilars." 

Coming Up

  • 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

— Former astronaut Buzz Aldrin says the biggest obstacle with spaceflight is mental health: