THE PROGNOSIS

President Trump has a new spin on why Obamacare’s still around: He decided to keep the law instead of "kill" it.

“I had a decision to make,” Trump told NBC’s Chuck Todd yesterday. “I could have politically killed Obamacare. I decided not to do it. But still it's not good. We're going to come up with great health care if we win the House, the Senate and the presidency.”

That’s quite the claim from the president, who has privately and publicly castigated congressional Republicans and staff for failing to help him deliver on one of his biggest promises in 2016, to replace the Affordable Care Act.

It was clear from yesterday’s NBC interview that Trump is trying to rewrite history around what happened with the ACA — and advance a winning health-care message — as he looks ahead to 2020. Democrats, who feel they have the upper hand with voters when it comes to health-care issues, are determined to keep Trump on the defense in his reelection campaign — and he seems to know it.

Former vice president Joe Biden spoke about the ACA over the weekend:

Today, the president will announce an executive order aimed at improving price transparency in the health-care industry, the White House confirmed to The Health 202. The order is expected to direct the Department of Health and Human Services and several other agencies to advance policies requiring more price transparency from hospitals and insurers. Trump probably will present it as one of several ways he’s trying to lower prices for health-care services and prescription drugs.

But it's clear the president still wants to appear as though he prevailed when it comes to Obamacare. He told Todd it was “my decision” that it remained law, a claim which, if you recall anything about how Republicans struggled and then dramatically failed to replace the ACA, is not credible. The president also applauded the performance of HHS Secretary Alex Azar, despite a recent Politico report that there has been friction between Azar and the White House on issues including how to approach the ACA.

“We have a man named Azar, our secretary, he's fantastic man, Alex. A total pro,” Trump said. “I could have managed Obamacare so it would have failed, or I could have managed it the way we did so it's as good as it can be. Not great, but it’s as good — It's too expensive and the premiums are too high.”

At one point during the interview, Todd pointed to the president’s 2011 claim that the health-care law would “destroy the economy.”

“Why is the economy doing so well if Obamacare is still law of the land?” Todd asked Trump.

“Because I've managed it great. I had a choice,” Trump replied. “I could have let it implode and killed it or I could have managed it.”

Donna Young, senior reporter for S&P Global News:

Trump then denied he’s trying to halt the ACA, even though his Justice Department is refusing to defend any part of the law in a lawsuit brought by Republican-led states. The closely watched case, which could result in the entire health-care law being overturned, including protections for Americans with preexisting health conditions, is scheduled for oral arguments on July 9 before the Court of Appeals for Fifth Circuit in New Orleans.

“No, no,” Trump responded, when Tapper said, “You’re still trying to kill it.”

“It has nothing to do with it,” the president said. “The lawsuit is one thing. We are going to put in a bill, total preexisting conditions. And the Republicans are in favor of preexisting conditions.”

Ways and Means Committee Democrats:

Like last year, Democrats will spend a lot of time talking about protections for people with preexisting conditions and the administration’s retreat from the law that extended such protections for the first time. Expect health care to come up a lot in 2020 campaigns, starting with the first Democratic presidential debates on Wednesday and Thursday this week. A recent Kaiser Family Foundation poll found health care was the top issue that Democratic-leaning voters wanted to hear about.

Promising Obamacare repeal used to be bread-and-butter for Republicans seeking office. But now the ACA has become an incredibly touchy subject for Trump, whose administration has taken significant steps to change the law but hasn’t been able to remove most of its core components.

While most Republicans in Congress have moved on from their refrain of repealing Obamacare, the president is continuing to promise he’ll come up with a better health-care law should the GOP get control of both chambers again. 

AHH, OOF and OUCH

AHH: The Food and Drug Administration has approved the sale of what’s being called a “female Viagra” — a new drug called Vyleesi that’s meant to enhance sexual desire in women.

The drug, also known as bremelanotide, is a shot in a push pen that can be self-administered about 45 minutes before anticipated intimacy for premenopausal women who experience distress as a result of low sexual desire, our Post colleagues Ariana Eunjung Cha and Laurie McGinley write.

“The drug is intended to be a treatment for hypoactive sexual desire disorder, or HSDD, which the medical community recognizes can be a serious issue,” they report.

The agency did acknowledge that it’s not clear how the drug acts in the brain and has advised that women take only one dose in a day or eight in a month.

Cynthia Pearson, executive director of the National Women’s Health Network, said she was “disappointed” by the FDA’s move. She said women “simply do not have enough information to make an informed decision about whether the drug is safe and effective.”

OOF: In surveys and opinion polls, Americans have repeatedly expressed worries about their health-care costs, citing the issue as their top concern. “With insurance deductibles, prescription drug costs and other medical charges squeezing the middle class, they consistently say they want elected leaders to lower their out-of-pocket costs,” our Post colleague Amy Goldstein reports.

Still, there has been a disconnect between what the voters cite as major concerns and the bold proposals for overhauling the health-care system that Democratic candidates have been touting on the campaign trail.

“Such misalignment — in candidates’ focus and, in some cases, their level of attention — is striking because surveys show that health care is the issue on which the Democratic Party holds the greatest advantage over Republicans,” Amy writes. Robert J. Blendon, a Harvard University professor of health policy and political analysis said the focus on universal coverage and Medicare-for-all is a “replay of earlier elections [when] it was about getting everybody covered.”

Blendon added candidates are failing to recognize the “the debate is not going to be 2008 or ’16 over again. It’s going to be about the price of insulin, hospital charges and insurance premiums, with, ‘What are you going to do about them for me?' "

OUCH: The state of Tennessee has lost 14 percent of its rural physicians and 18 percent of its rural hospitals in the last decade, leaving 2.5 million residents without adequate access to medical care.

Our Post colleague Eli Saslow writes in this troubling deep dive about a couple in the state who are part of what the government now estimates to be a record 50 million people in rural parts of the nation who reside in “health care shortage areas” where he writes “the number of hospitals, family doctors, surgeons and paramedics has declined to 20-year lows.”

Lisa and Stevie Crider arrived one pre-dawn morning at a first-come, first-served medical clinic with a note from a social worker that warned they were “lacking primary care and basic medication” and found dozens of others who were camped out, hundreds parked in a lot, waiting for care at one such emergency care clinic that popped up where othere health-care facilities that have shuttered. Lisa and Stevie were handed the Nos. 461 and 462. The clinic wasn’t opening for hours still. “We might not even make it in,” Lisa said.

They waited, as some moved out of the way for them, until they finally made it into the makeshift hospital set up in a local high school by nonprofit agency Remote Area Medical, filled with doctors, nurses and other volunteers. “There would be a triage station in the entryway, bloodwork in the science lab, kidney scans in the gym, dental extractions in the cafeteria, and chest X-rays in the parking lot — a range of medical care that would be available for only two days, until the clinic packed up and moved on to Hazard, Ky., and then Weatherford, Okla,” Eli writes.

REPRODUCTIVE WARS

— The Democratic candidates who appeared at a forum hosted by Planned Parenthood in South Carolina over the weekend signaled their support for allowing federal funds to be used for abortions, which has long been banned under the federal Hyde Amendment.

“Can we just be clear that if you’re a Democrat, you’re against the Hyde Amendment, period?” New York Mayor Bill de Blasio said, receiving applause from the audience, as the Wall Street Journal’s Eliza Collins reports.

There, former vice president Joe Biden addressed his recent reversal on the 1976 amendment that prohibits federal funds from being used for abortions except for in cases rape, incest or if the woman's life is at stake.

“Biden sought to explain that he shifted his stance because his overall health-care plan — which he has not released — would rely on expanding access to federally funded health insurance, which means that if the Hyde Amendment remained in place, those people wouldn’t have access to abortion coverage,” our Post colleagues Colby Itkowitz and Emily Davies report.

In an emotional exchange, a military veteran and activist stood to explain to Biden that she had been the victim of sexual assault and that she was able to have three abortions paid for by Medicaid. She cried as she expressed concern about women in her position who would not be able to get the same coverage. “I fought for some of these women, and I promise you, their pain is real and their experiences are real, and it would break your hearts,” she said. “Across the country, generations of women in situations like mine have suffered because of the Hyde Amendment, because it is in place.”

— The Missouri state health department declind Friday to renew the license for the last clinic in the state that can perform abortions — that means the fate of the St. Louis Planned Parenthood again rests with Circuit Judge Michael Stelzer.

At a hearing that morning, Stelzer said he would issue a written order to detail next steps, the Associated Press reports, though he did not say when he would do so.

In the meantime, the clinic will be able to continue to perform abortions because of a previous court order. “In a news conference Friday, health department director Randall Williams said the agency denied the clinic’s application because they have corrected only four of the 30 deficiencies that inspectors identified,” our Post colleague Reis Thebault reports. “He again cited concerns over multiple ‘failed abortions,’ which required additional procedures, and a patient who suffered life-threatening complications. The issues have been central to the state’s case against Planned Parenthood.”

AGENCY ALERT

— A Department of Veterans Affairs committee declined last week to approve broad coverage of a new antidepressant – a nasal spray called esketamine.

The drug being sold by Johnson & Johnson has been backed by the president, but the VA committee decided to approve the drug for a limited basis, Stat’s Lev Facher reports. The committee said the nasal spray will be covered for patients who don’t respond to other treatment.

The controversial product with the brand name Spravato has received criticism since the FDA approved it back in March.

“It is chemically related to ketamine, which has been long used as an anesthetic during surgery and misused recreationally as a club drug,” Lev writes. “Since its approval, watchdog groups have also raised questions about deaths by suicide among three individuals who had used Spravato in a clinical trial.”

In a statement, a VA spokesperson said the committee’s decision “will enable VA psychiatrists to offer esketamine to patients when clinically indicated,” to ensure “the medication is prioritized for use in Veterans who have not previously responded to adequate trials of other available treatments for major depression.”

— And here are a few more good reads:

TRUMP TEMPERATURE
VA health care professionals who flagged patient-care issues say actions against them are jeopardizing veterans and undercutting a key Trump promise.
USA Today
American Bridge is planning a $50 million advertising campaign targeting small-town Trump supporters and swing voters.
Politico
MEDICAL MISSIVES
Health
Known for valuing self-determination, some in the aging generation explore the idea of ending their lives rather than experience a slow and often unpleasant decline.
Melissa Bailey
On Parenting
“People are seeing for themselves that only children are not lonely.”
Caitlin Gibson
A judge called her decision “heartbreaking,” but in the best interest of the woman, who is 22 weeks pregnant.
New York Times
STATE SCAN
Georgia health officials are investigating after at least 54 children became ill this week at a popu...
Atlanta Journal Constitution
DAYBOOK

Today

  • Brookings Institution holds an event on improving opportunity through access to family planning

Coming Up

  • The House Energy and Commerce Subcommittee on Health hold a hearing on “Reauthorizing Vital Health Programs for American Families” on Tuesday.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations holds a hearing on “Learning from Whistleblowers at the Department of Veterans Affairs” on Tuesday.
  • The Hill hosts an event on Medicare and drug costs on Tuesday.
  • The House Veterans Subcommittee on Health holds an oversight hearing on “Beyond the Million Veterans Program: Barriers to Precision Medicine” on Wednesday.
  • The American Enterprise Institute holds an event on fighting Congo’s Ebola epidemic on Wednesday.
SUGAR RUSH

'Where is the money?': President Trump and Vice President Mike Pence blame poor migrant detention center conditions on Congress: