THE PROGNOSIS

It’s not just climate change that could suffer under the Trump administration’s climate policy rollback. There could be public health effects, too.

More coal-fired power plants probably will stay open under the Affordable Clean Energy rule, signed yesterday by Environmental Protection Agency Administrator Andrew Wheeler. Obama-era rules placing strict limits on the power sector’s emissions would have gradually phased out coal-fired power generation faster than competition from cheaper electricity sources, including natural gas, solar and wind. But by making it easier for coal plants to keep operating, the new regulation makes more room for the pollutants these plants release.

And these pollutants, which include sulfur dioxide, nitrogen oxides and particulate matter, are precursors to smog and soot, which can lead to respiratory and cardiovascular illnesses, and even premature death. About 141 million Americans were exposed to unhealthy air between 2015 and 2017, according to a report by the American Lung Association.

Of course, potential health effects are a sidebar to the question of how the administration’s new rule allows for less drastic reductions in carbon emissions than power plants would have otherwise pursued, and its bigger effects on the planet and climate change.

The new rule requires the U.S. power sector to cut its 2030 carbon emissions by 35 percent compared with 2005 levels — less than half of what experts calculate is needed to avert catastrophic warming of the planet, my Washington Post colleagues Juliet Eilperin and Brady Dennis write. That’s an extremely modest goal, considering that as of last year, power companies had already cut greenhouse gas emissions 27 percent compared with 2005.

Speaking to a supportive audience that included coal miners from Pennsylvania and West Virginia, Wheeler said the new rule will overturn a climate policy that would have imposed higher costs on low- and middle-income Americans.

“That means cleaner and more affordable energy for the American public,” he said.

The regulatory rollback arrives as many firms and dozens of states grapple with how to curb greenhouse gas emissions, despite Trump's rejection of the scientific consensus that burning fossil fuels is already bringing about major effects on the climate, including more-frequent droughts, wildfires and intense storms.

The move reverses the Obama administration's Clean Power Plan, which mandated the energy industry switch from coal-fired generation to lower-carbon fuels, including natural gas, solar and wind. Some of the industry’s biggest players, including American Electric Power, DTE, Duke Energy and Southern Co., had previously pledged to cut emissions by 40 percent to 60 percent by 2030.

While it’s climate advocates who are most excited about shuttering coal-fired power plants, health experts also point to ancillary benefits from reducing pollutants released by these plants. And it’s children who can benefit disproportionately from improving air quality, because their lungs are still developing, they breathe faster and they tend to spend more time outdoors than adults. Polluted air especially poses a risk for kids with asthma.

The American Academy of Pediatrics issued a statement opposing Trump’s new rule, citing an estimate from the World Health Organization that more than 80 percent of the health burden from climate change occurs in children younger than 5 years old.

“It will worsen air quality, exacerbate the effects of a changing climate and increase unique health risks for children,” AAP President Kyle Yasuda said.

There’s a bright spot here: Over the past 50 years, there has been huge improvements in air quality. Air pollution emissions have declined by 73 percent since 1970, and deaths related to air pollution fell by about 30 percent between 1990 and 2010. That’s especially encouraging when you consider that population, energy use and miles driven in the United States have ballooned.

Those improvements have a lot to do with the Clean Air Act, passed by Congress in the 1970s, which allowed EPA to regulate pollution from sources such as gas stations, factories and power plants. The Obama administration used authority under that act to implement its Clean Power Plan, which is being replaced by the new Trump regulation.

Research has suggested there would be more public health improvements under a plan like Obama’s compared to Trump's rule. In a 2015 paper, Harvard researcher Jonathan Buonocore and colleagues estimated 10 more premature deaths per year under an approach similar to the Affordable Clean Energy rule but 3,500 fewer premature deaths annually under an approach similar to the Clean Power Plan.

“Carbon standards implemented for existing U.S. power plants that result in improvements in air quality can lead to immediate local and regional health co-benefits,” the researchers wrote.

AHH, OOF and OUCH

AHH: Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), leaders on the Senate Health, Education, Labor and Pensions Committee, formally unveiled a bipartisan package yesterday including a strategy to tackle disputes over surprise medical bills.

A notable part of the package is a plan to set a “benchmark” for physician pay, which Alexander said in a statement was determined in part because the Congressional Budget Office “indicated that the benchmark solution is the most effective at lowering health care costs,” Kaiser Health News’s Rachel Bluth reports.

“When a patient is seen by a doctor who isn’t in their network, the Alexander-Murray bill says insurance would pay them the ‘median in-network rate,’ meaning the rate would be similar to what the plan charges other doctors in the area for the same procedure,” Rachel writes. “If there aren’t enough other doctors covered by the plan to compute a median in-network, the plan would use a database of local charges that is ‘free of conflicts of interest.’”

The committee is expected to mark up the measure next week.

—The bipartisan measure from Alexander and Murray is already facing potential opposition. Sen. Chris Murphy (D-Conn.) told reporters he’s considering voting against the bill next week unless there’s explicit language to address efforts by the Trump administration to undermine the Affordable Care Act.

Murphy said there’s “no language in the measure to counteract the massive sabotage campaign that's happening by the administration,” the Hill’s Peter Sullivan reports.

In response to Murphy’s remarks, Alexander said the ACA needs to be dealt with separately from this measure. “What to do about Obamacare is a different debate that I’m sure will continue,” Alexander said. “In the end, it is hard to lower the cost of health insurance without first lowering the cost of health care.”

Murray, who negotiated the bill with Alexander, said she too wants to address the Trump administration’s actions but said the issue won’t change her support for the bipartisan measure, Peter writes.

“I adamantly oppose what the administration has been doing,” Murray said. “We're working on a much smaller package of bills, but I still agree with Chris and all of us that we need to address sabotage.”

OOF: Conservative political action committee One Nation, headed by longtime Republican operative Steven Law, will announce a multimillion-dollar ad campaign against Medicare for All today, Axios reports.

"The first commercial, entitled 'Signs,' features patient horror-stories from Canada’s single-payer system and will begin airing this week on television, radio and digital platforms," says a forthcoming release from the PAC..
 

OUCH: Sen. Jeff Merkley (D-Ore.) sent a letter yesterday calling on the Smithsonian to remove the name of the Sackler family behind drug manufacturer Purdue Pharma from its Asian art museum.

The family that owns the company that makes the opioid OxyContin has been increasingly linked to the nation’s opioid epidemic. Members of the family face thousands of lawsuits that allege they were personally involved in deceptive marketing practices that deepened the crisis, our Post colleague Peggy McGlone reports. “The Sackler family hooked thousands of Americans on OxyContin through aggressive and misleading marketing tactics and profited from one of the deadliest public health crises in our country,” Merkley wrote in the letter to new Smithsonian secretary Lonnie Bunch. “I ask that you remove the name from the gallery.”

There’s also been growing momentum to remove the Sackler name from several cultural institutions — the family has both individually and jointly supported such institutions for decades, with the name appearing at the Metropolitan Museum of Art, the Guggenheim, the Louvre, the Tate, and the Victoria and Albert museums, and universities including Harvard, Princeton, Cornell, Tufts and Yale.

Last month, the Metropolitan Museum of Art “followed the lead of the Tate galleries and National Portrait Gallery in London and the Guggenheim Museum in New York, in stating they would no longer accept Sackler family gifts,” Peggy writes.

HEALTH ON THE HILL

— The Senate Appropriations Committee voted 30 to 1 to approve $4.6 billion in emergency spending for the U.S.-Mexico border, with approval by the full chamber expected next week, our Post colleagues Erica Werner and Seung Min Kim report.

The funding comes as a wave of migrant families and children have entered the United States, a surge that has strained facilities, resources and personnel tasked with sheltering and caring for vulnerable immigrants.

Already, the Department of Health and Human Service’s Office of Refugee Resettlement has canceled funding for resources for unaccompanied minors staying in federal shelters nationwide, such as education services, legal services and recreational activities. Without additional help, ORR will run out of money at the end of the month and will need to cut more services, our colleagues report.

The legislation that advanced yesterday includes $2.88 billion for HHS, which must care for unaccompanied minors who enter the country. The money will allow the agency to restart the suspended services as well as to expand shelter capacity.  

“However, the Senate deal has not been agreed to by the House, where the Congressional Hispanic Caucus has objected to the administration’s plans for some of the money it has sought,” Erica and Seung Min report. “Hispanic Caucus leaders have grown particularly alarmed since President Trump announced over Twitter this week that his administration would begin mass roundups of unauthorized immigrants who have made it into the United States."

STATE SCAN

— The Oklahoma Supreme Court rejected a legal challenge to block a petition letting state residents vote on whether to expand Medicaid.

The state’s highest court rejected the effort just hours after hearing oral arguments in the case. Now, supporters can move ahead with gathering about 178,000 signatures required to get the issue on the ballot in 2020, Tulsa World’s Barbara Hoberock reports. Amber England, a spokeswoman for a group supporting the measure, Oklahomans Decide Healthcare, applauded the decision. 

“Our mantra has been that Oklahoma voters should get the chance to decide what’s best when it comes to our health care,” she told Tulsa World. “Today, the Oklahoma Supreme Court agreed with us.”

Oklahoma is one of 14 states that has not yet expanded Medicaid. And according to the Associated Press’s Sean Murphy, a 2016 study commissioned by the Oklahoma Hospital Association said about 272,000 low-income residents in the state would quality for coverage under an expanded program in the first year.

— And here are a few more good reads:

OPIOID OPTICS
OxyContin made the Sackler family billions—but now, after 400,000 opioid deaths, it’s made them near-pariahs. Citing “vitriolic hyperbole” and “endless castigation,” David Sackler tells his story for the first time.
Vanity Fair
The World Health Organization notified U.S. lawmakers Wednesday that it will discontinue two publications on prescribing opioid painkillers in response to allegations that the pharmaceutical...
Associated Press
AGENCY ALERT
VA Secretary Robert Wilkie said broaching the topic is important to save more veterans lives.
Military Times
TRUMP TEMPERATURE
The two frontrunners for the 2020 presidential race have both recently pledged to cure cancer. But experts say it's not that easy.
Stat
MEDICAL MISSIVES
Fact Checker
We surveyed several leading researchers on poverty, and almost all agreed Biden was including people who are not poor.
Salvador Rizzo
Inspired Life
One woman had a genetic disease that prevented her from having children. So her twin, a former player for the Arizona State basketball team, stepped up with the ultimate assist: She'd carry the babies.
Cathy Free
Does it make sense, medically or ethically, when fertility clinics refuse to treat prospective mothers they consider too large?
New York Times
NHL
Robin Lehner has previously talked about his battle with bipolar disorder, addiction and thoughts of suicide.
Desmond Bieler
INDUSTRY RX
Juul is giving Meharry Medical College, a historically black institution, money for a research center that will study, among other things, Juul.
New York Times
UnitedHealth Group announced Wednesday it has closed on its $4.3 billion purchase of DaVita Medical Group after the parties reached a settlement with the Federal Trade Commission that resolves the federal government's concerns about harm to competition in Nevada.
ModernHealthcare
DAYBOOK

Today

  • The House Oversight Subcommittee on Government Operations holds a hearing on “Ensuring Quality Health Care for our Veterans."
  • 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."
SUGAR RUSH

Are almost half of Americans living in poverty?