THE PROGNOSIS

Another major plank of Obamacare fell by the wayside on Wednesday. But this time, the change was spearheaded by many of the 2010 health-care law's fiercest supporters: Democrats.

The Democratic-led House voted nearly unanimously, 419 to 6, to permanently repeal the so-called “Cadillac tax” on generous employer health-care plans that was intended to sharply contain health-care costs over the long term. But the tax was neverimplemented and was opposed by some of the Democrats' most important political allies: unions, many of whose members negotiated costly health-care plans in lieu of wage hikes.

The Senate is also expected to take up the measure — Sen. Martin Heinrich (D-N.M.) is the sponsor of a similar bill in the upper chamber — in one of the few health-care measures that has bipartisan support.

Getting rid of the tax marks a surprising point of agreement between the parties, who have found almost nothing to unite around on health care and the Affordable Care Act especially. And it further weakens Obamacare, which President Trump and his allies have repeatedly chipped away at since he took office. Though Republicans failed to repeal and replace the law, they did rollback its requirement to require people to buy coverage and the Trump Justice Department has refused to defend  in court a GOP-led lawsuit seeking to eliminate the law.

But that partisan enmity found common cause yesterday in the vote to strike the “Cadillac tax,” which had already been delayed twice and was set to take effect in 2022.

The biggest consequence of the repeal — if the Senate ultimately signs on and Trump agrees — would be to remove one of the key ways architects of the measure intended to pay for the ACA and do nothing to stop the rising trajectory of health-care costs.

The Congressional Budget Office estimated repeal of the tax would cost nearly $200 billion over the next decade. But it had long been the target of ire from unions, businesses and health insurers.

Delayed repeatedly by Congress, the tax would impose a 40 percent excise tax beginning in 2022 on employer-provided health benefits that exceed $11,200 for an individual and $30,100 for a family. The idea was to reduce soaring health care costs by discouraging employers from offering such generous plans, as well as to pay for the landmark law passed by a Democratic Congress in 2010,” reports my colleague Yasmeen Abutaleb.

Yasmeen reports: “'The full repeal of the Cadillac tax would eliminate one of the most consequential policy levers to actually lower health care costs,' said Benedic Ippolito, a health economist at the American Enterprise Institute. 'When it comes to sensible policies about what to do about spending, ironically there’s bipartisan, bicameral agreement that we absolutely shouldn’t do anything.'”

It's not a done deal yet without passage in Senate. But that didn't stop the tax's opponents from cheering its incremental demise.

AHH, OOF and OUCH

AHH: Drug overdose deaths saw a marked drop in the United States – a 5.1 percent decline from 2017 to 2018 – according to provisional data from the Centers for Disease Control and Prevention. If the decline remains steady when final numbers are confirmed later this year, it could “represent the first significant decline in drug overdose deaths since the 1990s,” our Post colleague Christopher Ingraham reports.

Among the categories included in the CDC’s preliminary data, the biggest drop involved prescription painkillers: a total of 12,757 fatal overdoses occurred involving prescription painkillers in 2018, compared with 14,495 in 2017. That fall in painkiller-related fatal overdoses could be having a major impact on the declining rates.

“The latest provisional data on overdose deaths show that America’s united efforts to curb opioid use disorder and addiction are working,” Health and Human Services Secretary Alex Azar said in a statement. “Lives are being saved, and we’re beginning to win the fight against this crisis.”

Keith Humphreys, a former senior policy adviser at the White House Office of National Drug Control Policy, told Christopher the decline in painkiller overdoses may be because doctors are prescribing fewer opioids, which translates over time to fewer people developing a dependency and fewer overdoses.

But not all the data points are declining: “Synthetic opiates including fentanyl continued to drive tens of thousands of deaths in 2018. Cocaine and methamphetamine deaths also rose significantly last year," our colleague reports. 

OOF: The Louvre in Paris has taken down the name of the Sackler family from a gallery entrance and other signs, the first major museum to do so amid a growing backlash against the family whose name has become increasingly tied to the opioid epidemic, the New York Times’s Alex Marshall reports.

A Louvre guard told the Times that a plaque acknowledging the family’s donations was removed from the entrance of the Sackler Wing of Oriental Antiquities earlier this month while the wing was closed to visitors. Another large sign was also removed and nine other signs at the museum referencing the wing were taped over. References to the wing were also removed from the website. Alex reports that "Jean-Luc Martinez, the museum’s president, told RTL, a French radio station, that the Sackler name had been taken down because the Louvre’s policy on naming rights is that they last for 20 years.”

After the British National Portrait Gallery turned down a $1.3 million donation from the Sackler's charitable group, other institutions including the Tate museums in Britain and New York’s Solomon R. Guggenheim Museum said they would stop taking donations from the family that has both jointly and individually given to major cultural institutions for decades.

“But many museums also said they would respect past philanthropy and would not be changing the name of any wing or gallery named after the family,” Alex writes.

OUCH: The Ebola outbreak in eastern Congo is now a global health emergency. The World Health Organization made the rare declaration yesterday, just days after a first case of the virus was confirmed in Goma, a major city on the border with Rwanda, our Post colleague Max Bearak reports

There have been 2,500 people infected and 1,700 have died since Ebola began spreading last summer. 

The decision to declare the outbreak a "public health emergency of international concern" came after a committee of 10 scientists declined to dos o three times before. "The committee said delays in funding had constrained the response and hoped the declaration would add to the international community’s sense of urgency. But members also cautioned against using the declaration to impose punitive travel restrictions on countries in the affected area," Max reports. 

From WHO Director-General Tedros Adhanom Ghebreyesus:

HEALTH ON THE HILL

— Sen. Bernie Sanders’s latest challenge to the Democratic presidential field: reject money from health insurance and pharmaceutical companies.

The independent senator from Vermont announced a “No Health Insurance and Pharma Money Pledge” to reject any donations “over $200 from the PACs, lobbyists, or executives of health insurance or pharmaceutical companies" except for contributions from “rank-and-file workers employed by pharmaceutical giants and health insurance companies.”

ABC News’s Soo Rin Kim, Adam Kelsey and Lissette Rodriguez report that earlier in the campaign, Sanders accepted such donations, identifying "at least three contributions of more than $200 from two individual donors who could be considered executives at companies included on the list." 

During a speech a George Washington University yesterday, Sanders also defended his Medicare-for-all proposal amid a week of public sparring with former vice president Joe Biden, who unveiled his own health-care plan to expand the ACA while creating a public health care option.

With his new pledge, as our Post colleague Sean Sullivan writes, Sanders also "underscores his desire to expand the debate over health care beyond the competing policy proposals and shows how his campaign is seizing on health care as an effective issue to wield against the more centrist Biden — a fight Biden appears to welcome. Sanders has opted not to hold fundraisers catering to wealthy donors and is not seen by insurance and drug companies as an ally. Biden, in contrast, has some ties to those industries. He has received four-figure donations from executives at companies such as Merck & Co. Inc., Independence Blue Cross and Gilead Sciences, campaign finance records show."

Other candidates, including Sen. Kamala D. Harris (Calif.) and South Bend, Ind., Mayor Pete Buttigieg, have also taken contributions from industry officials or lobbyists, Sean reports. 

— Several Democratic lawmakers are pointing fingers at members of their own party for proposing a plan that would cut health care services for poor Americans.

“Rep. Frank Pallone Jr. (D-N.J.), chair of the House Energy and Commerce Committee, is pushing a bipartisan plan that would provide flat levels of federal funding for hundreds of community health centers nationwide, at about $4 billion for the next four years,” our Post colleague Jeff Stein reports. “A similar plan is advancing in the Senate with the support of Sen. Patty Murray (D-Wash.), the top Democrat on the Health, Education, Labor and Pensions committee.”

While Pallone argues the plan would avoid a September deadline after which funding for community health centers would lapse, flat funding could also reduce how many people these centers could serve – one expert told Jeff that 4 million fewer people would be served annually by 2023. Meanwhile, progressive lawmakers including Sanders, Reps. Ro Khanna (D-Calif.), Alexandria Ocasio-Cortez (D-N.Y.), and Pramila Jayapal (D-Wash.) say they should instead push for the House to approve a funding increase for the centers, and then try to craft a deal with Senate Republicans.

“We should be substantially increasing funding. I was very, very disappointed by Democratic leadership,” Sanders told Jeff. “We will do everything we can to rectify this.”

OPIOID OPTICS

— In case you missed it: Previously undisclosed data from the Drug Enforcement Administration released this week revealed the largest drug companies in America poured tens of billions of pain pills into the country from 2006 to 2012 – a data trove released following a year-long legal battle by The Washington Post and HD Media, publisher of the Charleston Gazette-Mail in West Virginia.

The Post reached out to the opioid distributors, pharmacies and manufacturers to respond to the story and our colleagues Aaron C. Davis and Jenn Abelson include their public responses here.

A Post team also put together an interactive graphic that highlights where the highest concentrations were of oxycodone and hydrocodone pills in that time frame: "It is a virtual road map to the opioid epidemic. Yearly totals show the influx of pills in the U.S. between 2006 and 2012." 

The Post team detailed five of the biggest takeaways from the information. Two of those key points were that the volume of pills skyrocketed over the course of the seven years and that some states and rural areas were more saturated than others. "The volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the same period," they write, adding: "The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate from 2006 through 2012."

In the communities that were saturated with pain pills, opioid-related death rates surged, our Post colleagues Sari Horwitz, Steven Rich and Scott Higham write in this analysis. “The national death rate from opioids was 4.6 deaths per 100,000 residents...But the counties that had the most pills distributed per person experienced more than three times that rate on average. Thirteen of those counties had an opioid death rate more than eight times the national rate, according to the government data. Seven of them were in West Virginia.”

—  And here are a few more good reads: 

Health
Nearly 2,000 communities hurt by the opioid crisis are suing drug companies for staggering sums of money to cover the costs of treatment, education and law enforcement.
Lenny Bernstein and Christopher Rowland
MEDICAL MISSIVES
A House committee approved its version of legislation to solve the problem of surprise medical bills. But the measure includes a key provision that’s got less support in the Senate.
Kaiser Health News
Politics
The 74-year-old is in pain but expects to make a full recovery, according to a spokeswoman.
Michael Brice-Saddler
Retropolis
Rep. Christopher H. Smith (R-N.J.) believes government scientists experimented with ticks as disease-carrying bioweapons between the 1950s and the 1970s. Lyme disease wasn't discovered until the 1980s.
Morgan Krakow
National Security
Sens. Rand Paul and Mike Lee face backlash from Democrats and advocates eager to see the measure passed.
Devlin Barrett
INDUSTRY RX
CVS is making a move into kidney care, launching a clinical trial for a home-dialysis device. The company is working to capitalize on a Trump administration initiative pushing for home procedures.
Wall Street Journal
A House panel on Wednesday voted to advance legislation aimed at protecting U.S. consumers from the billions of illegal robocalls made every year.
The Hill
AGENCY ALERT
A 13-year-old girl from Honduras waited for her father to join her in the United States. But her father was repeatedly detained at the border. He came too late.
New York Times
U.S. lawmakers on Wednesday called for heightened scrutiny of Puerto Rico’s Medicaid program as the bankrupt territory seeks increased federal healthcare funding while it deals with repercussions from a government corruption scandal.
Reuters
STATE SCAN
Local
Three people have died since the outbreak at Greenspring Village's assisted-living and skilled-nursing unit, county officials said. Nineteen employees have also become sick since it began on June 30.
Fredrick Kunkle
REPRODUCTIVE WARS
The departure of Planned Parenthood’s president, Leana Wen, underscores a central tension: Is it a political organization first, or a health organization? And can it be both?
New York Times
A new wing of the movement aims to challenge Roe v. Wade directly with heartbeat bills, seeing hope in Supreme Court change and developments in science. Traditional opponents favoring incremental steps say a high court defeat could stall momentum for years.
Wall Street Journal
DAYBOOK

Coming Up

  • The House Homeland Security Subcommittee on Emergency Preparedness, Response and Recovery holds a hearing on "Assessing Emergency Preparedness for Underserved Populations" on July 23. 
  • The House Oversight and Reform Subcommittee on Economic and Consumer Policy holds hearings on "Examining Juul's Role in the Youth Nicotine Epidemic" on July 24 and July 25. 
SUGAR RUSH

Whose 2020 campaigns are raising the most money?