Unaccompanied children are flooding across the United States and Mexico border at record levels, overwhelming the ability of the Department of Health and Human Services to care for them and once again landing the agency in the middle of intensifying political battles over immigration.

Both the House and the Senate are taking steps to direct more money at the problem, including extra dollars for HHS’s Office of Refugee Resettlement, which is tasked with caring for unaccompanied children and uniting them with parents or other approved guardians. Last night, the House approved a $4.5 billion emergency border aid bill, setting up a high-stakes negotiation with President Trump and Senate Republicans to deliver aid before a looming deadline, my colleagues Mike DeBonis and Erica Werner report.

Yet Senate bill does not have most of the protections for migrant kids that House Democrats added to their bill in order to win over support from their caucus -- leaving the financial relief HHS has said is crucial to caring for them in limbo. 

"The backdrop for the vote is not only the humanitarian concerns about the surging numbers of migrants but also [President] Trump’s threats — delayed but not canceled Saturday — to begin a mass deportation of undocumented immigrant families," Mike and Erica write. "Democratic lawmakers has expressed concerns about passing a border aid bill that would not address both of those issues."

Heightening the drama yesterday, Trump replaced his interim border chief John Sanders with Mark Morgan, who will take over as acting commissioner of Customs and Border Protection. Meanwhile, his administration is struggling to care for the children in custody, keep up with the volume and address mounting concerns that kids being held at CBP facilities aren’t getting sufficient care — partly because ORR says it’s at full capacity and can’t take on any more children.

“We are full right now. We are full,” HHS Secretary Alex Azar told reporters at the White House on Monday. “We do not have capacity for more of these unaccompanied children who come across the border. And what happens is they get backed up there at the Department of Homeland Security’s facilities because I can’t put someone in a bed that does not exist in our shelters.”

Facilities run by CBP are supposed to hold unaccompanied children for no longer than 72 hours before sending them to ORR, but hundreds of kids are spending days or weeks at the holding centers without the specialized care they’re guaranteed under the law, my Washington Post colleague Abigail Hauslohner reports.

“Immigration and health authorities have scrambled in recent days to move hundreds of migrant children out of one Border Patrol station in Clint, Tex., after lawyers who visited the facility described scenes of sick and dirty children without their parents, and inconsolable toddlers in the care of other children,” Abigail writes.

A CBP official said the agency has been working closely with HHS to move the children to appropriate shelters, cutting the number held at Border Patrol facilities from 2,600 to fewer than 1,000 in the past week. But the official also said 100 children had to be moved back to the Clint facility yesterday because of space limits.

The New York Times's Caitlin Dickerson: 

ORR is certainly dealing with a lot more unaccompanied children than it’s used to. Nearly 51,000 children were referred to ORR between October and May, an increase of nearly 60 percent compared with the same period last year. A spokesman told us the agency had 13,500 kids in its custody as of Tuesday, adding that it has managed to decrease the average length of care from a recent high of 93 days in November to 44 days in May. 

Most of the children in ORR custody are housed in shelters run by private licensed contractors who provide them with housing, food, education and recreation until they can be released to a sponsor. These facilities are required to give each child a routine medical exam and additional screenings within the first 45 hours after they’ve arrived.

But HHS was forced last year to open some emergency shelters to accomodate the extra kids, and those facilities aren't subject to the same requirements. There are plans to open three more emergency shelters in two military shelters and a facility in southern Texas to house 3,000 to 4,000 migrant kids, federal officials said this month. The bill passed by House Democrats would limit children's stays in these shelters to no more than 90 days and would require HHS to report to Congress on their use.

A statement from House Appropriations Chairwoman Nita Lowey: 

A few weeks ago, ORR told facilities to start scaling back or discontinuing activities including education, legal services and recreation, which aren’t directly necessary for the protection of kids’ life and safety. However, the impact on the kids may be limited because several states where the facilities are located — including California, Arizona and Texas — require the facilities to provide education and recreation anyway.

“HHS is very proud of the work of the care providers in our shelter network,” ORR spokesman Mark Weber told The Health 202. “We don’t want to make these reductions but the law requires us to do so until Congress appropriates additional funds.”

Democrats have seized on reports that some migrant children have been detained for weeks without access to soap, clean clothes or adequate food. Some have made especially dramatic pronouncements about the conditions of the facilities, including Rep. Alexandria Ocasio-Cortez (D-N.Y.), who called them “concentration camps.”

They’re referring to the CBP facilities, which are only supposed to hold the kids temporarily. But Azar has still been put on the defense over the whole situation, saying the kids that are in the custody of his agency get good care.

“They have three square meals a day. They get two snacks,” Azar told Fox News on Monday. “They are getting education services. They get recreation. We get funding from Congress. We are paying $220 to $1,200 a day per kid. They are in a good state, and a healthy environment.”

But ORR needs more “funding so that they can actually enhance the facility that we have,” Azar added.

For months, Trump has been pointing to a humanitarian crisis at the border. Now that it’s clear Customs and Border Protection really is encountering a rash of immigrants from Central American countries, Democrats who’d formerly mocked Trump’s claims are now willing to allocate money for humanitarian purposes — even as they resist the president’s demands for funding to complete a border wall and push back against his threats of mass deportations.

House Speaker Nancy Pelosi tamped down a rebellion brewing among her caucus’s hard-left members, who initially resisted providing any funding that could be used to detain migrant children and potentially conduct the mass deportations the president has threatened.

Pelosi characterized a vote against the House bill as “a vote for Donald Trump and his inhumane, outside-the-circle of civilized attitude toward the children,” according to notes taken by an aide present in a closed-door caucus meeting yesterday. 

“The stronger the vote, the bigger the message to the Senate,” she said, adding: “Think about children being in their parents’ arms. Think about what our values are as a country, and not about each of us.”


AHH: A federal judge has issued a 16-page injunction to stop Florida-based U.S. Stem Cell Clinic from performing an unapproved and scientifically unproven treatment that blinded at least four patients.

The order places a major financial fine on the stem-cell company if they disobey the injunction and perform the procedure that uses fat to create a stem cell treatment, our Post colleague William Wan reports.

“The order comes three weeks after the judge ruled against the company and in favor of the U.S. Food and Drug Administration, which has ramped up its efforts in the past year to rein in the booming and lucrative stem-cell industry,” he writes.

In a statement, the FDA said the action by Judge Ursula Ungaro “is significant and sends a strong message to others manufacturing violative stem cell products. Court decisions like this reaffirm the FDA’s compliance and enforcement efforts in the ongoing fight to protect the public from individuals and clinics who mislead patients with unapproved and potentially harmful medical products.”

But William notes it’s unclear whether the injunction will push other such clinics to stop performing the procedure. Meanwhile, U.S. Stem Cell representatives said they are considering whether to appeal.

OOF: A new law in Alabama will end parental rights for individuals convicted of first-degree rape as well as certain other sex crimes. After state lawmakers banned abortion even in cases of rape, abortion rights advocates expressed concern that it could require rape victims to have children conceived through assaults and then co-parent those children with their attackers.

Gina Maiola, press secretary for Alabama Gov. Kay Ivey (R), said the “new law, which takes effect Sept. 1, will address the issue — at least in cases in which the assaults result in conviction. The law applies in cases of first-degree rape, first-degree sodomy and incest,” our Post colleague Emily Wax-Thibodeaux reports.

The mandate is part of what's known as Jessi’s Law, which ends parental rights for people who sexually assault their own children, though this particular mandate addresses anyone convicted of a sexual assault, regardless of the relationship between the victim and the attacker or the victim’s age.

OUCH: A new study found nonprofit hospitals are more likely than for-profit institutions to sue patients and garnish wages — meaning the patient’s wages are withheld and sent to the institution to pay off unpaid debts.

The study, led by a health policy professor at Johns Hopkins University and published in the Journal of the American Medical Association, found nonprofit hospitals in Virginia filed 20,000 lawsuits against patients in 2017, the Wall Street Journal’s Stephanie Armour reports. That year, 36 percent of hospitals in the state sued patients and garnished their wages because of unpaid debts. And most of the hospitals that garnished wages were nonprofits.

“Rather than turn over unpaid bills to debt collectors, some hospitals, including nonprofit ones, sue directly to seek payments. But they say they do so as a last resort. They say they offer payment plans, charity care and price reductions for people who are uninsured,” Stephanie writes. Even with requirements under the Affordable Care Act meant to limit such collection efforts, lawmakers at the federal and state level are concerned about how nonprofits have gone after low-income patients even as they receive tax breaks because of their nonprofit status.

Meanwhile, nonprofits claim “they are being unfairly maligned, given what they do for their communities,” Stephanie writes. “… Nonprofits say a big reason patients suffer is outsized bills from doctors, such as anesthesiologists, who are out of a patient’s insurance network but work at the facility. These high charges can make hospitals, including nonprofits, look like they are overcharging.”


— The Senate Health, Education, Labor and Pensions Committee will vote today on a multipronged, bipartisan measure to lower health-care costs, co-sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). Senate Majority Leader Mitch McConnell (R-Ky.) is expected to bring the measure to the floor in the next few weeks.

“Altogether, this legislation will help reduce what the American people pay out of their own pockets for health care by ending surprise billing, creating more transparency, and increasing competition to bring down drug costs,” Alexander plans to say, in remarks shared in advance with The Health 202. “A recent Gallup poll found that the cost of health care was the biggest financial problem facing American families. And last July, this committee heard from Dr. Brent James, from the National Academies, who testified that up to half of what the American people spend on health care may be unnecessary.”

— Our Post colleague Rhonda Colvin has published a video project on three members of Congress who have experienced gun violence and what they believe lawmakers should do to tackle the issue. Watch all the videos here. 

Rep. Steve Scalise (R-La.) recalled being shot by a gunman during a 2017 practice for an annual congressional baseball game. “It clearly was people with guns that saved my life,” he said. “There was a shooter — a crazed gunman — who showed up on a baseball field to kill every one of us out there. Luckily there were people with guns to counter and confront him and ultimately take him down, and that’s the reason I’m alive today.” He signaled that the incident reinforced his stance on Second Amendment rights and drove home the importance of enforcing laws already on the books.

Rep. Jackie Speier (D-Calif.) was working as an aide to a California congressman in 1978 when associates of a cult leader opened fire on a congressional delegation that had boarded a flight on a Guyana airstrip. Speier was shot five times at point-blank range. “I support the Second Amendment and I support common-sense gun violence prevention measures,” she said. “Having experienced the devastation associated with automatic weapons and surviving … You don’t need an assault weapon to kill Bambi.”

Rep. Lucy McBath’s son was killed when a man shot into a car after confronting McBath’s son Jordan and his friends about the music they were listening to. “Each and every day that we do nothing about gun violence, more and more people die — and those are just the ones that we know about,” she said. McBath (D-Ga.) highlighted so-called “red-flag laws” as a priority. “If we’re able to identify individuals who might have behavioral problems or might have an element of something disturbing in their behavior,” she said, “… that’s extremely important to be able to identify those kinds of people and give families the ability to say this person might be, in the future, be a risk to the community or to himself, or to us.”


— The Food and Drug Administration sent warnings to two private companies for selling illegal, unapproved and misbranded drugs containing kratom that they claim can cure opioid addiction and withdrawal symptoms.

“We have issued numerous warnings about the serious risks associated with the use of kratom, including warnings about the contamination of kratom products with high rates of salmonella that put people using kratom products at risk, and resulted in numerous illnesses and recalls,” acting FDA commissioner Ned Sharpless said in a statement. “Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence.”

The controversial product, as our Post colleague Laurie McGinley has previously reported, is an herb that advocates say can alleviate pain and other medical conditions.

The warnings were sent to Folsom, Calif.-based Cali Botanicals and Kratom NC, of Wilmington, N.C.

 “As we work to combat the opioid crisis, we cannot allow unscrupulous vendors to take advantage of consumers by selling products with unsubstantiated claims that they can treat opioid addiction or alleviate other medical conditions,” Sharpless added.


— In New Jersey, the state’s health commissioner will now allow paramedics to start treating patients with the drug buprenorphine at the scene of an overdose immediately after revival, Stat’s Lev Facher reports. The state will be the first in the nation to begin such an effort.

The move is the latest example of how the use of buprenorphine, which is used to reduce opioid cravings and alleviate withdrawal symptoms, has ramped up as a way to address the opioid epidemic. Health officials in the state say administering the drug right away can not only immediately address withdrawal symptoms, it can essentially serve as a transition into long-term treatment for the patient.

“The bold program is without precedent in the U.S., but serves as a testament to many states’ increasingly aggressive and innovative efforts to reduce drug overdose deaths,” Lev writes. “And while the announcement came as a surprise to many addiction experts, most applauded the effort.”

“As a safeguard, New Jersey’s 1,900 paramedics will need to obtain permission from the emergency physician overseeing their unit before administering buprenorphine when responding to an overdose call,” he adds. “The supervising physician must have a DEA waiver to prescribe buprenorphine, a spokeswoman said.”

— Illinois Gov. J.B. Pritzker (D) signed a bill to make the state the 11th to legalize marijuana for recreational use.

The law, which allows the growth, sale, possession and consumption of marijuana for people ages 21 and older, may also expunge criminal records for nearly 800,000 people whose records involved purchasing or possessing 30 grams or less of marijuana, the Associated Press’s John O’Connor reports.

By signing the law, Pritzker also made good on one of his main campaign promises.

“In the past 50 years, the war on cannabis has destroyed families, filled prisons with nonviolent offenders, and disproportionately disrupted black and brown communities,” Pritzker said. “Each year, law enforcement across the nation has spent billions of dollars to enforce the criminalization of cannabis. ... Yet its consumption remains widespread.”

— And here are a few more good reads: 

San Francisco’s Board of Supervisors passed the first blanket ban on e-cigarette sales in the U.S. The measure will now need to be signed by Mayor London Breed.
Wall Street Journal
The Senate majority leader’s meeting comes after he was sharply criticized by comedian Jon Stewart over his handling of the measure.
Felicia Sonmez and Emily Davies
Journalists rely on secondhand accounts of hungry and sick children in federal custody because of government restrictions.
Paul Farhi
The transaction would give AbbVie a potent source of popular treatments as it faces the loss of patent protection for its best-selling drug, Humira.
The New York Times
The patent office reopened a fight between the Broad Institute and the University of California over the invention of CRISPR.
North Dakota's sole abortion clinic has filed a federal lawsuit over two state laws it believes violate 1st Amendment rights
Associated Press
The Fix
Joe Biden is discovering that it is difficult to please either side when it comes to abortion.
Eugene Scott
Minimize the danger to minors while preserving a smoking-cessation tool.
Scott Gottlieb via Wall Street Journal


  • The House Veterans subcommittee on health holds an oversight hearing on “Beyond the Million Veterans Program: Barriers to Precision Medicine."
  • The American Enterprise Institute holds an event on fighting Congo’s Ebola epidemic.

What to expect from Democrats on the crowded debate stage: