THE PROGNOSIS

Now it’s Democratic attorneys general who are seeking to gain political ground from a high-profile legal attack on Obamacare, just as House Democrats did last year.

Today, the Democratic Attorneys General Association [DAGA] is launching a six-figure digital and print ad effort targeting five vulnerable Republican state AGs who are seeking to get the entire Affordable Care Act ruled unconstitutional — a decision that would reverberate throughout the country, with millions of Americans losing their health plans and millions more feeling the huge disruptions to the U.S. health-care system that would result.

The Republicans — who include Indiana’s Curtis Hill, Louisiana’s Jeff Landry; Missouri’s Eric Schmitt; Utah’s Sean Reyes and West Virginia’s Patrick Morrisey — are among 17 attorneys general who have taken up the mantle of trying to  get the ACA scrapped, after congressional Republicans failed in 2017 to repeal the law.

Until recently, DAGA and its Republican counterpart observed an agreement not to target the other party’s officeholders. But that ended in 2016, when Republican AGs voted to ditch the agreement. So for the Democratic AGs, who are defending the health-care law because the Trump administration won’t, the Obamacare lawsuit is more than fair game.

“Your attorney general Jeff Landry is in court wasting your tax dollars to take away health care from 494,000 Louisianans like you,” says one of DAGA’s ads targeting Landry, provided in advance to The Health 202. “Tell Jeff Landry to STOP attacking health care!”

The ads are timed to tomorrow’s oral arguments in a New Orleans courtroom. A three-judge panel on the U.S. Court of Appeals for the Fifth Circuit will consider whether to uphold a federal district judge’s previous ruling striking the ACA. Such a "win" for Republicans could perversely cause the GOP the most trouble, analysts tell my colleague Amy Goldstein.

"A 5th Circuit ruling that the health-care law is unconstitutional would almost certainly catapult the issue back before the Supreme Court — and to the forefront of the 2020 presidential and congressional races," Amy writes. "Even if the high court were to decline the case, the drama would raise fresh uncertainties about the millions of Americans who could lose insurance coverage and consumer protections created under the law — especially those with preexisting medical conditions, whom President Trump has vowed to protect even as his administration tries to eliminate the law."

The lawsuit is a prime example of the expanded role Democratic AGs are playing in the Trump era, challenging the president’s policies on climate change, immigration and, of course, health care.

Nearly two dozen have stepped up to the plate to defend the health-care law because President Trump’s Justice Department won’t. Instead of a legal battle between states and the federal government, the lawsuit is a showdown between red states and blue states, which have taken vastly different approaches to the ACA.

Democrats have watched in dismay as the lawsuit — criticized as far-fetched even by some conservative scholars — has moved forward. Yet it also presented a prime political opportunity for their congressional candidates last year, who kept up a constant stream of attacks that Republicans were trying to deprive Americans of health insurance and protections for people with preexisting medical conditions.

Protect Our Care, a group run by longtime Democratic operatives, is launching more such attacks this week, timed with the oral arguments. Its new ad will run on cable television in D.C. and in the states of four Republican senators: Sen. Joni Ernst of Iowa, Thom Tillis of North Carolina, Cory Gardner of Colorado and Martha McSally of Arizona. 

Now DAGA sees a similar opportunity, after spending the past few years trying to build a bigger profile comparable to the Democratic Party’s other national campaign committees. The group moved its headquarters from Denver to Washington, D.C., in 2016 and hired more staff in preparation for the upcoming election.

And it saw some gains; after flipping four offices last year, Democrats control 27 state attorneys general offices compared with the 23 controlled by Republicans. Of the five Republicans DAGA is targeting, Landry is running for reelection this November while the other four are up next year.

DAGA’s political director, Farah Melendez, told me her goal is to help more people recognize the crucial role played by attorneys general, who are each state’s top public lawyer. State AGs both defend the state against lawsuits and initiate litigation, often over big public health concerns. Most recently, state AGs have been working together on a massive, multi-state lawsuit against the makers of highly addictive opioids.

“It’s important to recognize the AGs are on the right side of history,” Melendez said. “The mission of the Democratic AGs Association is to elect Democratic AGs, but a key component of that is making sure people know what their AGs do.”

The committee still trails its GOP counterpart considerably when it comes to fundraising. In the last election cycle, DAGA brought in $8.9 million, according to the Center for Responsive Politics, while the Republican Attorneys General Association raised $20.3 million.

But Melendez says she’s confident 2020 voters will resonate with the committee’s health-care messaging, considering how the issue played to Democrats last year. Its ad campaign included Sunday newspaper ads in the Indianapolis Star, the Louisiana Advocate, the St. Louis Dispatch, the Salt Lake Tribune and the Charleston Gazette-Mail. It also launched a microsite dubbed healthcarehypocriteags.com.

“The health-care debate is too often limited to what is happening at Congress, whereas the real action is often happening at the state AG level,” Melendez said.

AHH, OOF and OUCH

AHH: Trump said Friday that his administration is planning to issue an executive order to make sure the United States doesn’t pay more than other countries for prescription drugs.

“We’re working on a favored-nation clause, where we pay whatever the lowest nation’s price is,” the president told reporters. “Why should other nations like Canada — why should other nations pay much less than us? They’ve taken advantage of the system for a long time, Pharma.”

But as the New York Times’s Margot Sanger-Katz reports, it was not immediately clear even to drug pricing experts what the order would include. “The White House has made the high costs of prescription drugs a policy priority, and the Department of Health and Human Services has proposed a series of measures meant to help address that,” she writes. “But until today there had been no public mention of a broad executive order.”

The Trump administration has been working on a plan for an international drug pricing index, which would tie drug prices covered by Medicare and given out by doctors to an average of lower prices paid in 16 countries, as Health 202 has reported. The president has used “favored-nation clauses” in relation to that proposal, but that proposal would “apply to only a small subset of the drug market, and would not affect the prices paid for more typical prescription drugs that are sold at retail pharmacies," Margot writes. "An executive order on drug prices would most likely have no force of law on its own, but could direct the Department of Health and Human Services to pursue or expand this approach."

OOF: Acting Homeland Security Secretary Kevin McAleenan responded to reports of filthy conditions for migrant families at Border Patrol facilities, defending the Trump administration’s actions but acknowledging there are “challenging situations at the border.”

“This is an extraordinarily challenging situation. We had an overflow situation with hundreds of children crossing every day. That’s why we were asking for funding for Health and Human Services, to provide adequate bed space so those children could be moved from that immediate border processing into a more appropriate setting for children,” he said during an interview on ABC’s “This Week.”

“What I can tell you right now is that there's adequate food, water, and that the reason those children were at Clint station in the first place is so they could have medical consolidated; they had shower facilities — for over a year there’s been showers there,” he added. “So, this is why we try to provide a better situation for the brief time they’re supposed to spend at the border.”

A team from the New York Times and the El Paso Times over the weekend published an extensive report on a border station in Clint, Tex., that has become the center of focus on the administration’s border policies and representative of the overcrowded conditions facing migrant families who enter the country and are held at such facilities.

“Outbreaks of scabies, shingles and chickenpox were spreading among the hundreds of children who were being held in cramped cells, agents said,” Simon Romero, Zolan Kanno-Youngs, Manny Fernandez, Daniel Borunda, Aaron Montes and Caitlin Dickerson write. “The stench of the children’s dirty clothing was so strong it spread to the agents’ own clothing — people in town would scrunch their noses when they left work. The children cried constantly. One girl seemed likely enough to try to kill herself that the agents made her sleep on a cot in front of them, so they could watch her as they were processing new arrivals.”

OUCH: In the United States, deaths from cancer led to an estimated $94.4 billion in lost earnings in one year, according to a new study, a result of 8.7 million years of life cut short in 2015.

“When you invest in cancer prevention, treatment, and screenings, you don’t just save lives,” study co-author Farhad Islami, scientific director of surveillance research at the American Cancer Society, told Stat’s Brittany Flaherty. “There are also substantial financial benefits.”

“On the state level, the burden was distributed unequally. After taking into account age and population differences across states, researchers found lower rates of lost earnings in the West,” Brittany adds. Utah recorded the lowest loss rate at $19.6 million per 100,000 people in 2015.

Meanwhile, lost earnings were highest in the South, and in Kentucky specifically there was $35.3 million lost per 100,000 people that year.  

TRUMP TEMPERATURE

— Former vice president Joe Biden said he would bring back the individual mandate under the ACA that penalizes people for not having health insurance.

He told CNN’s Chris Cuomo in an interview that it would be popular “compared to what’s being offered.”

He also pointed to some proposals for a Medicare-for-all health-care system, instead offering a plan he said would be “rational and will cost a hell of a lot less and will work.”

He suggested instead offering people an option to opt into a Medicare plan.

“We're in a situation where, if you provide an option for anybody who, in fact, wants to buy into Medicare-for-all, they can buy in. They buy in. And they can do it,” he said. “But if they like their employer-based insurance, which a lot of unions broke their neck to get, a lot of people like, they shouldn't have to give it up.”

MEDICAL MISSIVES

— Researchers say they've successfully removed HIV from the DNA of mice, with the use of an antiviral drug combined with the gene-editing tool CRISPR. It’s a potential early step toward finding a cure for humans, our Post colleague Hannah Knowles reports.

A research team of more than 30 scientists from Temple University and the University of Nebraska Medical Center was able to eliminate HIV in about a third of treated mice “that were modified so their immune systems better mimicked those of humans.”

“Clinical trials for the gene-editing component of the cure could start as early as next year if the Food and Drug Administration approves them, said Kamel Khalili, one of the study’s senior investigators,” Hannah writes. “But he and other HIV experts emphasized that there is a big scientific leap from promising results in mice to success in humans.”

Khalili also said the research group is working on another study that uses gene editing to target HIV in primates, and that they’re also working on increasing the odds of success after this study, in which they eliminated HIV in nine of the 23 treated mice.

— And here are a few more good reads: 

Morning Mix
After six years trying to conceive, a couple transferred two embryos they thought had been created from their genetic material. The results suggested otherwise.
Isaac Stanley-Becker
Health
Brain injury or death are far from the minds of most families who own or use pools.
Erin Blakemore
HEALTH ON THE HILL
He says the hospital’s pending demise illustrates what is wrong with the nation’s health-care system.
Politico
STATE SCAN
State legislators across the country are moving to tighten limits on vaccine exemptions for children amid one of the worst outbreaks of preventable diseases in recent history.
The Hill
Dr. William Roper led the UNC Health Care system, which is being investigated over concerns about its pediatric heart surgery program during his tenure.
New York Times
Health
Other medical centers have worked with the children’s hospital to take over the most urgent disrupted surgeries, a hospital official said.
Hannah Knowles
DAYBOOK

Coming Up

  • The House Veterans Affairs Subcommittee on Health holds an oversight hearing on the “Cost of Caring” on Wednesday.
  • The House Oversight and Reform Committee holds a hearing on “Hearing: The Trump Administration's Attack on the ACA: Reversal in Court Case Threatens Health Care for Millions of Americans” on Wednesday.
  • The House Oversight and Reform Committee hold a hearing on childhood trauma on Thursday.
SUGAR RUSH

A wooden sculpture of Melania Trump was unveiled five miles outside the First Lady’s hometown of Sevnica, Slovenia: