THE PROGNOSIS

President Trump just signed an executive order that is aimed squarely at tackling a top concern of 2020 voters: The high cost of health care and the lack of transparency about how much they'll have to pay for it. 

The order signed yesterday aims to shine a light on the secretive rates insurers pay hospitals for medical services. These rates are virtually impossible for American patients to obtain, forcing them to accept care with little to no idea of how much money it will cost them -- or where they could get the same services cheaper.

The idea that price transparency will ultimately lower prices by allowing consumers to comparison shop is central to his emerging message on health-care policy as he seeks reelection. After failing to carry out his biggest 2016 health-care promise — repealing Obamacare — the president is trying to reinvent himself as the champion of consumer choice in the often-befuddling American health-care system.

“No Americans should be blindsided by bills for medical services they never agreed to in advance,” the president said in a signing ceremony in the White House’s grand foyer, flanked by Health and Human Services Secretary Alex Azar, Centers for Medicare and Medicaid Services Administrator Seema Verma and several doctors and patients. “We are fundamentally changing the nature of the health-care marketplace . . . This is a truly big action. People have no idea how big it is. Some people say bigger than health care itself.”

Trump’s potential Democratic opponents all have similar health-care platforms of enabling the country to reach universal coverage, either by a dramatic, Medicare-for-all-type overhaul or by providing consumers with a government-run plan in addition to private options on the marketplaces.

But it’s been less clear how the president would broach health care on the campaign trail -- given his administration’s turbulent relationship with the Affordable Care Act, the inability of Republicans to coalesce around any kind of viable replacement and their struggles to deflect Democrats' arguments that they're trying to take access to care away.

But the president gave hints yesterday, contrasting his approach to consumer choice with Medicare-for-all ideas and repeating his claims from the weekend that he always intended to keep the ACA around and just make it work “adequately.” 

“As we fight to increase transparency and lower costs for patients, more than 120 Democrats in Congress support Bernie Sanders’s socialist takeover of American health care,” Trump said. “It's very dangerous.” 

Trump’s order could be a politically smart move. It ties into a parallel and bipartisan effort in Congress to lower health-care prices and improve transparency, including eliminating the surprise medical bills many people get after unexpectedly receiving care from a provider outside their plan’s network.

Policymakers are giving increasing attention to these kinds of bills and the hazards they pose to consumers. A Kaiser Family Foundation analysis recently found that in 2017, 18 percent of all emergency visits and 16 percent of in-network hospital stays resulted in at least one out-of-network charge for people in large group plans, which is the type of insurance most Americans have.

And polls show medical costs are a top concern for Americans. Sixty-seven percent of Americans, according to a Kaiser poll last year, said they were worried about unexpected medical bills, compared with 41 percent who worried about paying their rent or mortgage.

From Rep. Daniel Lipinski (D-Ill.): 

Trump’s order doesn’t immediately trigger changes in the health-care system, but instead directs HHS and several other federal agencies to propose regulations. The most contentious will be a requirement for hospitals and doctors employed by hospitals to post their charges, including disclosing for the first time the discounted rates they negotiate with insurers, my Washington Post colleague Amy Goldstein writes.

Hospitals and insurers are complaining that the disclosures will have the opposite effect of what Trump is predicting — that it will drive up prices when some hospitals realize they were charging less than competitors. 

-- The American Hospital Association’s Tom Nickels told Amy the order’s language “is pretty vague” about publicizing negotiated rates. “Prices in the aggregate, prices for individual patients, prices for individual services, prices for geographic areas?” he said.

AHA also tweeted this:

— Chip Kahn, president of the Federation for American Hospitals, told Amy the health-care industry “should be doing everything we can” to provide timely, useful information to help consumers make sound health-care decisions. “On the other hand, if it swerves and calls for the publication of health-care pricing data information that may lead to more spending, that’s a problem,” he said. “It is still an open question what the government will require here.”

— And Matt Eyles, president of America’s Health Insurance Plans, said the trade group supports the idea that patients should have accurate, real-time information about costs. “But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers,” he said.

Larry Levitt, a vice president at the Kaiser Family Foundation:

New York TImes's Margot Sanger-Katz: 

The administration was anticipating the pushback and had some responses ready to go. An administration official told reporters that the order “leaves room for us to … work with industry” to decide the level of detail hospitals would have to make public.

An official also noted that hospitals already disclose some rates to consumers in explanation-of-benefit notices — but the notices are sent after the care is received, not before, so patients don’t have the tools they need to make informed financial decisions.

“We are saying you have the right to have an estimate of the information before you get the service … rather than after the fact when it does you no darn good,” the official said.

AHH, OOF and OUCH

AHH: The Supreme Court says it will determine whether the federal government owes health insurers billions of dollars that were promised to them under the Affordable Care Act.

The “risk corridor” program that was established under the health-care law in 2010 was meant to offset losses for insurers as a way to make sure that they didn’t just seek healthy customers who needed little medical care and could participate in the state marketplaces without knowing what kind of patients would sign up for coverage.

“But insurers say the government never fully funded the program, and owes them $12 billion,” our Post colleague Robert Barnes reports. “… The risk corridors program was designed for the health exchanges’ initial years. It was supposed to help insurers with costs that are substantially greater than they expected. Originally, the program was not required to pay for itself, but, in a 2015 funding bill, congressional Republicans prohibited the Health and Human Services department from using any of its other resources for the program.”

The court is set to hear three consolidated cases on the issue starting in October.

OOF: A judge has ruled the last abortion clinic in Missouri must take its case to an independent state appeals panel, the Administrative Hearing Commission, after the state health department declined to renew its license to perform abortions.

For now, the judge ruled to extend the order allow the St. Louis Planned Parenthood to continue to conduct the procedure at least until Friday, “giving the clinic four days to argue that the board should overturn the health department’s decision or at least further delay the license expiration, our Post colleague Reis Thebault reports.

Three commission members were appointed by a Democratic governor, former Gov. Jay Nixon, while the fourth was appointed earlier this month by the current Republican Gov. Mike Parson. The fourth member, former judge Philip Prewitt who was once disciplined for supporting an antiabortion organization, previously told the Associated Press that he does not see a conflict but would consider recusing himself from the case if it was requested.

“The terrifying reality is that access is hanging on by a thread with a narrowing timeline,” clinic OB/GYN Colleen McNicholas said in a statement. “The truth is, if the Administrative Hearing Commission does not act by Friday, abortion access in the state of Missouri will be gone. This creates uncertainty for the patients we serve.”

OUCH: Health and Human Services Secretary Alex Azar defended how migrant children have been treated at detention facilities the agency oversees across the country in an interview during which he also said the conditions at other facilities were not acceptable “for kids to be in.”

“Our system was not built at the borders to be housing tens and thousands of unaccompanied kids or 80,000 family members last year. It was built for single adults coming across back in the '80s, '90s, and 2000s,” Azar said in a Fox News interview about facilities run by U.S. Customs and Border Protection. “The systems are just completely overwhelmed there — these are not good conditions for kids to be in.”

He also said HHS is set to run out of money in July for the facilities that it runs, calling on lawmakers to “act to fund us and fund the Department of Homeland Security,” Azar said.

But Azar also defended the administration against comments made by Rep. Alexandria Ocasio-Cortez (D-N.Y.), who compared the detention facilities to “concentration camps.”

“Well, I think some of the verbiage is just really outrageous,” he said. "We've got professional men and women at the Department of Homeland Security who are doing their best to try to deal with a catastrophic border crisis...These kids are in a safe, secure environment." 

He added it would be “more productive right now to get them funding so that they can actually enhance the facilities that we've got.”

— Meanwhile, House Speaker Nancy Pelosi (D-Calif.) called a meeting of House Democratic leaders after liberal lawmakers “threatened to withhold their votes over the Trump administration’s treatment of migrant children at detention centers,” our Post colleagues Mike DeBonis and Rachael Bade report. Reports of poor conditions at such facilities as well as the president’s threats of mass deportations “cast doubt on whether Congress would be able to pass a border funding package before lawmakers leave Washington on Thursday for a week-long recess.”

After a nearly two-hour meeting that involved members of the Congressional Progressive Caucus and the Congressional Hispanic Caucus, Democratic leaders seemed to agree to amend the border emergency aid bill to address the humanitarian crisis. After the meeting, Assistant Speaker Ben Ray Luján (D-N.M.) signaled a vote on the bill would proceed today.

“Rep. Raul Ruiz (D-Calif.) said Pelosi agreed to back changes to the bill detailing what constitutes humane treatment for migrant children in U.S. custody,” Mike and Rachael write. Some lawmakers, like Ocasio-Cortez, challenged the idea of providing billions in funding for the detention of unaccompanied migrant children. Others “struck a more measured tone,” our colleagues write. In prepared remarks, House Appropriations Committee Chairman Nita M. Lowey (D-N.Y.) said lawmakers “cannot allow our anger at this president to blind us to the horrific conditions at facilities along the border as the agencies run out of money.”

Mike and Rachael note that while HHS, which is “responsible for caring for unaccompanied children who arrive at the border, said it will exhaust its funding at the end of the month. The worst conditions have been documented at border stations under the control of the Department of Homeland Security, where children have been held while they await HHS placement.”

— After a group of lawyers expressed concern about the circumstances they saw at a detention facility in Clint, Tex., hundreds of migrant children are reportedly being transferred out of a Border Patrol station there.

The children had been “detained for weeks without access to soap, clean clothes or adequate food,” the New York Times’s Caitlin Dickerson reports. “Some of the children were transferred into a shelter system maintained by the Department of Health and Human Services, while others were sent to a temporary tent facility in El Paso, according to Elizabeth Lopez-Sandoval, a spokeswoman for Congresswoman Veronica Escobar, who began looking into the overcrowded facility in Clint, Tex., last week after reports about the conditions there.”

The station in Clint was meant to just be temporary, Caitlin writes, and children that had been placed there were meant to be moved after 72 hours. Instead, because HHS shelters were full, the children were kept there.

HEALTH ON THE HILL

— The bipartisan package from Sen. Lamar Alexander (R-Tenn.) that looks to lower health-care costs for patients will now include a measure from Senate Majority Leader Mitch McConnell (R-Ky.) to increase the minimum age to buy tobacco products to 21, as well as the CREATES Act, which aims to block branded drugmakers from tactics to prevent other companies from developing alternatives.

The Senate Health, Education, Labor and Pensions Committee is scheduled to vote on the package, known as the Lower Health Care Costs Act of 2019, tomorrow morning. As the Hill’s Peter Sullivan points out, the inclusion of McConnell’s provision could signal that he will take up the package for a vote:

In a statement, Alexander applauded the senators who worked with McConnell on the “important, bipartisan proposal, and I welcome the value and support it brings to our legislation.” He also praised the CREATES Act, which he said will “help bring more lower-cost generic drugs to patients by eliminating anti-competitive practices by brand drug makers.”

“More amendments are likely coming,” Modern Healthcare’s Susannah Luthi reports. “Senators have until Tuesday morning to file any additional proposals ahead of the Wednesday morning committee markup and vote. Alexander is eyeing a July Senate floor vote for his legislation, which he hopes to pair with the upcoming proposals on drug pricing from the Senate Finance Committee.”

— Democratic presidential contender Beto O’Rourke released a proposal yesterday that focuses on improving veterans' lives, a plan that includes more medical care for veterans such as additional medical services for female veterans and resources to hire more medical professionals and to expand programs that help veterans as they transition from military life.

The plan specifically calls for ending the wars in Iraq and Afghanistan and spending that funding on veterans instead as it looks to modernize the VA health-care system, our Post colleague Jenna Johnson reports.

The former Texas congressman “became intimately aware of the challenges facing veterans when he ran for Congress in the El Paso area in 2012, personally knocking on more than 16,000 doors and hearing from veterans that they were waiting too long for medical care,” Jenna writes. As a congressman, O’Rourke requested to be on the House Veterans' Affairs Committee, where he was “involved with legislation that provides mental health screenings to members of the military as they leave service and mental health services to veterans with other-than-honorable discharges, among other issues.”

STATE SCAN

— The liberal advocacy group NextGen America announced it will target 11 mostly Republican-held districts in Virginia as part of an effort to get at least 12,000 millennial voters registered. The group, founded by billionaire activist Tom Steyer, will spend $1 million for efforts including digital ads to target voters ages 18 to 35 “with messages centered on gun safety, reproductive rights and climate change,” our Post colleagues Antonio Olivo and Laura Vozzella report.

Meanwhile, two national Democratic political action committees — Priorities USA and Emily’s List — announced they will dole out a total of $600,000 for a digital campaign meant to boost female candidates, including some of the 36 female candidates in Virginia who support abortion rights.

— And here are a few more good reads: 

PowerPost
In an announcement video, Maine House Speaker Sara Gideon highlights the Republican senator’s votes for President Trump’s tax cuts and Supreme Court nominees.
John Wagner
OPIOID OPTICS
Health
Tens of millions of dollars will go toward helping the state abate an opioid epidemic that has killed thousands there.
Lenny Bernstein
MEDICAL MISSIVES
Running counter to the efforts of suicide prevention experts and many religious and social norms, some seniors are quietly exploring the option of turning to suicide when they feel they’ve li…
Kaiser Health News
Legal Issues
The court also said Monday that next term it will hear a dispute stemming from the Affordable Care Act.
Ann Marimow and Robert Barnes
Legal Issues
The court’s liberals joined Justice Neil Gorsuch in the 5-4 ruling, which drew dissent from Justice Brett Kavanaugh.
Ann Marimow
INDUSTRY RX
Business
A new line of beverages containing “active hemp extract” debuts in stores this week, which may push the FDA closer to establishing a regulatory framework
Laura Reiley
REPRODUCTIVE WARS
It’s been a busy time for Dr. Leana Wen, the new president of Planned Parenthood and the first physician at the helm of the organization in 50 years. 
Stat
DAYBOOK

Today

  • The House Energy and Commerce subcommittee on health holds a hearing on “Reauthorizing Vital Health Programs for American Families."
  • The House Veterans Affairs subcommittee on oversight and investigations holds a hearing on “Learning from Whistleblowers at the Department of Veterans Affairs."
  • The Hill hosts an event on Medicare and drug costs.

Coming Up

  • 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.