THE PROGNOSIS

President Trump has said he wants to make Republicans “the party of health care.” He hoped to do so by lowering prices for prescription drugs, but that effort has taken a beating from inside and outside the administration for several months now. It all came to a head last week when the White House announced it was killing the administration’s most ambitious proposal: a rule eliminating rebates to middlemen in Medicare and Medicaid and passing on the savings directly to consumers. 

The White House killed the rule just days after a federal court blocked the administration’s other major drug-pricing effort, which beginning this month would have required drugmakers to reveal the list prices of their medications in television ads. Now, the administration’s best hope for a win on drug pricing rests with a bipartisan Senate effort.

The impasse isn’t likely to help the Trump administration politically, as health care is already becoming a pivotal issue in the 2020 race. The president, aided by GOP majorities in Congress, failed to repeal and replace the Affordable Care Act in summer 2017. Democrats effectively capitalized on the unsuccessful GOP push to win back the House majority in 2018, and most of Trump’s 2020 rivals are already promising to expand health insurance with a sweeping Medicare-for-all system. So that leaves Trump with little to claim in the way of concrete accomplishments on health care — which polling shows is a top priority with many voters — except for whatever the president secures on the cost of health care and prescription medicines. 

Any real progress, if it happens, is likely to come from Congress. 

The Senate Health, Education, Labor and Pensions Committee approved last month a modest package of bills aimed at ending surprise medical bills, increase access to generic medicines and increase transparency in health care. And the Senate Judiciary Committee advanced four bills last month that, among other things, address gaming by pharmaceutical manufacturers to extend patents. 

Now, the Senate Finance Committee is working on the most ambitious bipartisan proposal so far, which includes more than a dozen provisions; Senate aides said they expect the bill’s release in the coming weeks. The committee is negotiating language to place an inflationary cap on Medicare Part D, which covers prescription drug plans, two Senate aides said. But some conservatives and the pharmaceutical industry have balked, arguing such a measure is akin to implementing price controls. Senators are also negotiating provisions to limit out-of-pocket expenses for catastrophic coverage in Medicare, as well as placing some sort of inflationary cap in Medicare Part B, which covers drugs administered in a doctor’s office, aides said. The legislation includes changes to Medicaid, including allowing states to finance expensive gene therapy treatments.

Senate aides said the goal is to have Finance pass the measure before the August recess, in the hope the full Senate can vote on the package in the fall. The timeline is tight — if Congress is going to get anything done, it has to be this year, because it’s unlikely anything significant will pass the chamber in 2020 during an election year.

And it remains unclear whether House Speaker Nancy Pelosi (D-Calif.) would even be willing to take up the Senate bill if it does pass. Pelosi’s office has been in conversations with White House advisers about legislation allowing Medicare to negotiate the price on some drugs — currently prohibited by law — which is unlikely to gain the support of most Senate Republicans. The Democratic-controlled House may not want to take up a more modest proposal from the Senate when it could pass a more ambitious proposal that members can then campaign on. 

If Congress fails to pass a bill, that will leave few talking points for the president, who said that pharmaceutical companies were “getting away with murder,” to tout on the campaign trail.

Note to readers: Paige Winfield Cunningham is on vacation and will be back on Tuesday. Meanwhile, we have a lineup of Washington Post writers to keep you up-to-date on the health-care news of the day. Thanks for reading.

AHH, OOF and OUCH

AHH: The nation’s largest drug companies ushered in 76 billion oxycodone and hydrocodone pain pills from 2006 and 2012, according to previously undisclosed data, painting a picture of the volume of pills that flooded the country as the opioid epidemic surged, our Post colleagues Scott Higham, Sari Horwitz and Steven Rich report.

“Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart,” they report. “Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals. Purdue Pharma, which the plaintiffs allege sparked the epidemic in the 1990s with its introduction of OxyContin, its version of oxycodone, was ranked fourth among manufacturers with about 3 percent of the market.”

What’s more, the data points to what the companies knew and when they were aware of the amount of pills they were doling out. “In case after case, the companies allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits,” Scott, Sari and Steven write.

Nearly 2,000 cities, towns and counties are now suing those companies and a dozen others in federal court in Cleveland, alleging they conspired topush these opioids. The companies meanwhile, pointed fingers at overprescribing practices and the customers who abused the prescriptions.

OOF: Leana Wen has been forced out just eight months after taking over as president of Planned Parenthood.

The organization’s board met in an emergency session yesterday and approved her exit, our Post colleagues Lenny Bernstein, Ariana Eunjung Cha and Amy Goldstein report, amid a dispute over Wen's management style and direction for the organization. One person aware of the board's perspective said the organization had worked for months to "correct problems with her management style, which the person said resulted in serious conflicts and difficulty working with staff." Wen succeeded Cecile Richards in November.

"The ouster occurred at one of the most difficult moments in the group’s history," our colleagues write. "The organization faces growing financial peril from a Trump administration rule that took effect Monday barring federally funded family planning clinics from providing referrals for abortions. It is also under attack by antiabortion lawmakers at the state and federal level and is threatened by the prospect that the 1973 ruling that legalized abortion could be overturned by the Supreme Court’s new conservative majority." 

In a tweet, Wen said she learned her employment was ended “at a secret meeting.” She cited “philosophical differences over the direction and future of Planned Parenthood.”

“I believe that the best way to protect abortion care is to be clear that it is not a political issue but a health care one, and that we can expand support for reproductive rights by finding common ground with the large majority of Americans who understand reproductive health care as the fundamental health care that it is,” she said in the statement.

Wen had been trying to push a new vision for the organization’s mission, our colleagues write, refocusing it as a health-care provider offering a broad set of services, including abortions. People close to her said board members wanted to emphasize Planned Parenthood’s commitment to abortion rights.

The organization announced that former board chair Alexis McGill Johnson would take the helm as acting president: 

— The leadership shift at the group came hours after a Trump administration rule took effect to prohibit federally funded family planning clinics from providing abortion referrals.

That change could mean that Planned Parenthood and other such providers would have to cut the range of services they offer. “In the first 24 hours after HHS’s notice, two family planning organizations — Planned Parenthood of Illinois and an unrelated clinic that is Maine’s only grant recipient — announced they would no longer accept the federal funds so they could continue referring patients for abortions,” Lenny, Ariana and Amy report.

“The most controversial part of the rule — prohibiting providers from offering counseling or referrals for abortion, which critics call a ‘gag rule’ — will be enforced immediately, HHS said. Violators could lose federal funds.”

OUCH: The ongoing health-care fight between former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.) continued during a live interview with The Post yesterday during which Sanders called his rival’s criticism of his Medicare-for-all proposal “absurd.”

Sanders said the cost of his own plan would be between $30 trillion and $40 trillion over 10 years.

“Let’s talk about cost: What the most serious economists tell us, if we do nothing to fundamentally change the health-care system — which is what Joe is talking about, keeping it as it is — we’ll be spending something like $50 trillion over a 10-year period.”

“When the discussion turned to Biden, Sanders was much more willing to engage in a policy-minded critique. The interview came as tensions between Sanders and Biden are rising amid clashes over health care,” our colleagues Robert Costa and Sean Sullivan write. “Biden released a plan this week that would expand the Affordable Care Act with an optional public insurance program and warned that shifting to a more sweeping Medicare-for-all initiative like Sanders is pushing would be risky.”

Sanders said he would welcome a chance to debate with Biden on the topic but added “of course, he’s wrong,” referring to the former vice president’s health-care pitch.

— Meanwhile, Biden is setting up for another challenge, too: one in which he and Trump engage in a push-up competition.

During an interview on MSNBC’s “Morning Joe,” the former vice president was asked whether he was tough enough to stand up to Trump in a debate. Co-host Mika Brzezinski asked what he would do if the president pressed the issue of Biden’s age and mental state, as our Post colleague John Wagner writes.

“I’d say, ‘C’mon Donald, c’mon man. How many push-ups do you want to do here, pal?’” Biden said. “I mean, jokingly. . . . C’mon, run with me, man.”

TRUMP TEMPERATURE

— Nurses are leading the charge in advising health-care providers how to respond to questions from parents and families about anti-vaccine fears and misinformation.

Our Post colleague Lena H. Sun writes about one oncology nurse who has talked to doctors about addressing specific concerns about vaccines. For example, Blima Marcus explained that pears have more formaldehyde than vaccines and that while aluminum hydroxide is used to improve immune response, half of the aluminum in the vaccine clears the body within 15 minutes. 

Marcus is working with other nurses to help build trust between people and their medical professionals on these issues. She "helped form a volunteer group of health-care professionals this year to confront vaccine hesitancy and misinformation that officials blame for the measles outbreak — now in its 10th month — that is predominantly sickening Orthodox Jews in Brooklyn,” Lena writes. “Her group, the Vaccine Task Force, has written and distributed thousands of booklets to parents to counter fears and myths spread by anti-vaccination groups that have targeted the community.”

MEDICAL MISSIVES

— President Trump — who before entering the White House publicly questioned vaccine safety — is planning to issue an executive order to call on the Department of Health and Human Services to change the way flu vaccines are developed, calling for alternatives to seasonal flu vaccines, Politico’s Dan Diamond reports.

 “Research in this direction has been funded through HHS and the Biomedical Advanced Research and Development Authority for the past decade,” Dan writes. “Trump also would create an interagency task force led by health and global security officials to monitor progress and explore new economic incentives to develop better vaccines. The Council of Economic Advisers is planning to issue a separate report on flu vaccines, said three individuals with knowledge of the report.”

While the move appears to be a stark reversal for Trump on a personal level, senior Trump health officials have “consistently stressed the need for Americans to get vaccinated against common illnesses,” Dan adds. “HHS Secretary Alex Azar in April 2019 applauded Trump's call to support vaccines for measles and said the science refuting an autism link to vaccines has ‘been settled.’ ”

— And here are a few more good reads: 

AGENCY ALERT
Immigration
The group’s former chief executive made $3.6 million that year.
Mark Berman
Immigration
A 3-year-old Honduran girl was reportedly asked to choose between her parents by a Customs and Border Patrol Agent, according to NPR.
Michael Brice-Saddler
HEALTH ON THE HILL
Major Senate legislation to tackle surprise medical bills and high drug prices is expected to save the federal government about $7 billion over the next decade, according to the nonpartisan Congressional Budget Office.
Fierce Healthcare
A measure lawmakers have been working on for months to allow Medicare to negotiate drug prices will not move forward before Congress leaves for the August recess, said a key Democrat involved in the legislation.
The Hill
OPIOID OPTICS
Billions in federal grants for treatment and prevention programs are set to end next year. The Trump administration has not said whether it will seek to extend them.
New York Times
The Border Patrol's Rio Grande Valley Sector has seen a large spike in cases of rhabdomyolysis — severe dehydration and overexertion — among migrants this year. Border agents say smugglers are to blame for treating migrants like "cargo" and pushing them too hard.
Texas Tribune
INDUSTRY RX
Johnson & Johnson vowed to defend itself against lawsuits alleging the company fueled the opioid crisis and that its namesake talc-based baby powder caused ovarian cancer and mesothelioma.
CNBC
Social Issues
The rate of memory loss — an early sign of Alzheimer’s — is fastest among women who never earn a wage, according to new research.
Hannah Natanson
Business
With obesity levels skyrocketing, Americans can learn an important lesson from Latin America on promoting healthier eating habits.
Laura Reiley
STATE SCAN
Social Issues
Heather Ehle founded Project Sanctuary after listening to veterans of the 1991 Gulf War discuss their anguish as she volunteered at a free health clinic. “I kept thinking, ‘Why are they not getting care? Why are we not taking care of our vets?’ ”
Hannah Natanson
DAYBOOK

Today

  • The Bipartisan Policy Center holds an event on surprise medical bills.
SUGAR RUSH

In Iowa, Biden defends Obamacare and criticizes President Trump: