THE PROGNOSIS

At least one family planning provider is not backing down from a plan to reject federal dollars after the Trump administration said it would delay enforcement of its new abortion rule.

Days after announcing that recipients of federal family planning grants would have to immediately stop referring patients for abortions, Department of Health and Human Services officials sent a rare Saturday night notice to Planned Parenthood affiliates, state governments and other organizations that they would now have two months to comply with the contentious Title X rule change, as my colleague Amy Goldstein reports. That announcement came after a federal health official told more than 200 reproductive health organization leaders last week that she wanted to give providers 60 days to comply with the change once the department issued guidance on how to do so, Amy reported. 

Maine Family Planning was one of the first organizations to say it would no longer accept federal money, withdrawing from the federal family planning grant program it has been part of for nearly five decades after the Trump administration initially said it would immediately enforce the referral ban. George Hill, the president and chief executive of the independent provider, told me the “gag rule” is “completely at odds with our mission,” and said the administration’s backpedaling won’t change his mind.

“It does not change our decision at all,” Hill told me. “It’s sort of symptomatic of the administration’s treatment of the family planning network over the last however many months. They issue a directive, and neglect to provide direction on it, any analysis on it, and then they pull it back, and then they move forward. We’re done. We’re going to withdraw from the program and rely on local resources for as long as we can.”

The network that serves about 23,000 people in Maine will sacrifice nearly a million dollars in funding for the rest of the year, Hill said. It will dip into reserves to make up for a pot of cash that usually accounts for nearly 30 percent of its annual budget. It was one of a few grant recipients that announced last week they would stop taking federal money or withdraw from Title X funding altogether, a group that includes Planned Parenthood, the largest recipient of the money, and its Illinois affiliate, both of which said they would not comply with the rule. 

The Trump administration’s delay is just the latest twist for family planning providers who say they will ultimately be forced to choose between rejecting federal dollars or compromising on an ethical obligation to provide a range of reproductive health services for patients, including abortion referrals.

Alina Salganicoff, senior vice president and director of women’s health policy at the Kaiser Family Foundation, said she expects most Title X grantees to make the same decision as they would have before the delay.

“At the end of the day, the decisions I think are going to remain the same,” she told me.

Movement on the Title X rule changes had been quick leading up to the administration's initial announcement last week, she pointed out. A panel of federal appeals court judges last month said the administration could implement the rules while lawsuits opposing them played out.

“The timeline was very tight, clinics were not expecting the courts to rule so soon, and we don’t have the final ruling on these cases,” Salganicoff said. “So [the delay] gives time for that whole process to work itself out. It gives the grantees and clinics more time to figure out their contingency plans if they decide they’re not going to take federal money.”

From Salganicoff:

Providers now have more time to adhere to the new restrictions. But before the Saturday night change, grant recipients had been split on whether to stop accepting federal money or to continue to do so because forgoing funds could force them to cut critical services, beyond abortion referrals, for vulnerable patients.

Caroline Hoke, the chief clinical officer at Erie Family Health Centers in Illinois, told me last week that its providers had planned to keep taking Title X funding. “We found ourselves in an untenable position of trying to decide whether to provide vital services or honor our providers’ commitment and belief to provide thorough, clear and non-biased counseling that our patients expect and deserve,” she said in an interview.

Illinois Gov. J.B. Pritzker (D) announced Thursday the state would refuse about $2.4 million in federal funds for 28 grantees and direct the Illinois Department of Public Health to provide that funding instead — an announcement that left another question mark for Hoke’s organization about whether that would fill the gap for Erie and other providers. 

Hoke later told me the administration's rule delay hadn't changed any plans for the Erie centers. 

"We're grateful that [Pritzker] has promised funding that would allow us to continue to care for the patients who need us and depend on Title X funding without asking our providers compromise their values or integrity," Hoke said in an email, saying she's waiting for additional guidance about the state's assistance this week. 

Mary Kate Knorr, the executive director of Illinois Right to Life, called Pritzker’s response “purely political.”

“For him to say that the state will essentially cover the costs, I’d like to know where they’re going to get the money for that,” she said. She also challenged concerns from family planning providers who say the Title X rule change could jeopardize health services. “It’s a purely political move. Women aren’t going to lose care as a result of the Title X change, especially not in Illinois,” she said, saying there were hundreds of federally qualified health centers in the state that provide “all the services” that organizations such as Planned Parenthood provide. “They actually provide more than Planned Parenthood provides but they don’t provide abortions,” she said.

From Pritzker: 

Hoke said last year, Erie Family Health Centers received about $440,000 in Title X funding, which enabled it to help 5,800 Title X clients out of a total of 75,000 patients with services including contraceptives as well as STI and cancer screenings.

Title X is considered the “payer of last resort,” Hoke said. Patients who come to these clinics are low-income but may not qualify for Medicaid or otherwise have access to private insurance. She criticized the Trump administration’s rule for what she called “villainy.” “The strategy is targeted at vulnerable groups, women who are poor who rely on public insurance who already disproportionately suffer higher rates of unplanned pregnancies and STIs,” she said. 

Hill said Maine Family Planning would consider reapplying for federal funding “if and when the gag rule is completely off the table.” “Raising private dollars to support public health services is not a long-term solution,” he said. “It's just a necessity under these circumstances.”

CORRECTION: An earlier version of this story misidentified the total number of patients Erie Family Health Centers serves. It is 75,000 patients. 

AHH, OOF and OUCH

AHH: A federal judge upheld the Trump administration’s expansion of health insurance plans that don’t comply with the Affordable Care Act.

U.S. District Judge Richard Leon in Washington, D.C., dismissed a complaint by insurance companies that argued the administration’s expansion of short-term health plans undermined the ACA because although cheaper, the plans don’t cover preexisting conditions or the same benefits as ACA plans.

“The plaintiff, the Association for Community Affiliated Plans, said it planned to appeal,” the Wall Street Journal’s Stephanie Armour reports.

“We remain firm in our contention that the Trump administration’s decision to expand dramatically the sale of junk insurance violates the Affordable Care Act and is arbitrary and capricious,” said Margaret A. Murray, chief executive of the trade group that represents more than five dozen health plans told Stephanie.

“Consumer-health advocates have said the Trump rule would drive up premiums on ACA exchanges because younger, healthier people may be drawn to buy short-term plans, siphoning them away from exchanges, where they help offset the cost of insuring older, sicker people,” Stephanie adds. “The action on short-term plans was one of the most significant taken to date by the administration to undercut the ACA. A bigger threat is a suit from GOP states that the administration is supporting.”

Meanwhile, Brian Blase, a special assistant at the White House on health policy, said the federal judge “correctly indicated that the benefits of the rule far outweigh any costs.”

OOF: Sen. Bernie Sanders (I-Vt.) closed out the set of forums hosted by the Des Moines Register and AARP this weekend by defending his Medicare-for-all plan and telling the audience that former vice president Joe Biden was not accurate when he criticized the plan. “We should not have distortions of what Medicare-for-all stands for,” Sanders said.

Earlier in the week, Biden began the week by telling people the Medicare-for-all plan would mean “Medicare goes away as you know it.”

“As usual, Sanders was outnumbered, in ways that will matter in the months to come,” my Post colleague Dave Weigel writes in his latest edition of his campaign newsletter The Trailer. “The AARP forums demonstrated how the entire party has shifted left since 2016; as Sen. Elizabeth Warren (D-Mass.) pointed out, the days of Democrats pondering cuts to Social Security were over. They also put most of the Democratic candidates loudly on record against Medicare-for-all legislation, warning that it would disrupt a system millions of Americans were happy with. Most of these Democrats, obviously, will not win the nomination; if a Medicare-for-all sponsor does win the nomination, the words said in Iowa could haunt them through November 2020.”

After the AARP forums, the candidates seem to shake out in three groups: those who would implement Medicare-for-all; those who say they want a public health option as a stepping stone to Medicare-for-all; and those want to create a public option with no expectation of Medicare-for-all. The takeaway is this, Dave writes: “Sanders has shifted the center of gravity in the Democratic Party, and a public option that was too much for Joe Lieberman 10 years ago is now the ‘conservative’ position.”  

OUCH: Federal inspectors found last year that detained migrants had made nooses from their bedsheets in 15 out of 20 visited cells in a California detention facility, an inspection that “revealed the extent of a largely unseen mental health crisis within the growing population of migrants who are being held in detention centers in border states,” Politico’s Renuka Rayasam reports.

It’s a growing problem for Immigration and Customs Enforcement, which is grappling with how to deal with a wide range of serious mental illnesses.

“One estimate puts the number of detainees with mental illnesses between 3,000 and 6,000,” Renuka writes. “Some advocates and lawyers who work with migrants in the facilities say it’s probably more. Many of the migrants with mental illness are not stable enough to participate in their own legal proceedings, so they languish in detention.”

Just 21 out of 230 detention facilities run by the agency offer mental-health services by agency medical staff, according to a 2016 report. In January, a unit with 30 beds opened, dedicated to treating migrants with mental illnesses, but it can only help a fraction of the patients who need the help.

OPIOID OPTICS

— A couple of counties in Ohio will soon be at the center of the biggest civil trial over how responsible drug companies should be for the opioid epidemic. Unless there’s a settlement, Cuyahoga County and nearby Summit County will go to trial in October as the first in a series of consolidated lawsuits brought by 2,000 counties, Native American tribes and other plaintiffs, my Post colleagues Lenny Bernstein and Jordan Heller report.

There’s another reason these and other counties have come into particular focus in the past week: In a database reported on by The Post, it was revealed that drug companies saturated the country with 76 billion painkillers, and one particular CVS in Cuyahoga County had received more pain pills, at 6.4 million, over a seven-year period than any other drugstore in the county.

“U.S. District Judge Dan Polster, who is presiding over the consolidated case in Cleveland, selected the counties to represent the legal arguments that other plaintiffs have made. The two counties alone are asking for billions of dollars from companies to help stem the crisis,” Lenny and Jordan report. “In a court filing released Friday, lawyers for the two counties accuse some of the biggest names in the drug industry of creating a ‘public nuisance’ that endangered the health of residents by failing to control the drug flow, even when they knew, or should have known, that some painkillers were being diverted to illegal use.”

— In the latest in a week of revelations from my colleagues on the nation’s opioid epidemic, Lenny, Joel Achenbach, Robert O’Harrow Jr. and Shawn Boburg report on the failures at all levels of the supply chain that contributed to the crisis, from the manufacturers to distributors to pharmacies and doctors.

It was a lucrative move to saturate vulnerable communities across the country with billions of painkillers, and players in the medical community and government agencies did not act to stop the flow of pills “even when it became apparent that these pills were fueling addiction and overdoses and were getting diverted to the streets,” they write. “This has been broadly known for years, but this past week, the more precise details became public for the first time in a trove of data released after a legal challenge from The Washington Post and the owner of the Charleston Gazette-Mail in West Virginia.”

“This really shows a relationship between the manufacturers and the distributors: They were all in it together,” Jim Geldhof, a retired DEA employee who is now a consultant for plaintiffs in a lawsuit against the drug industry, told them. “We’re seeing a lot of internal stuff that basically confirms what we already knew. It just reinforces the fact that it was all about greed, and all about money.”

— In a trove of documents unsealed by a judge’s order last week in a landmark case in Cleveland against major drug companies, internal emails show a particular indifference to the escalating opioid crisis, my colleagues Scott Higham, Sari Horwitz and Steven Rich report

In January 2009, Victor Borelli, a national account manager for opioid manufacturer Mallinckrodt, told Steve Cochrane, the vice president of sales for drug distributor KeySource Medical that 1,200 bottles of oxycodone 30 mg tablets had been shipped.

“Keep ’em comin’!” Cochrane emailed in response. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are. . .”

Borelli responded: “Just like Doritos keep eating. We’ll make more.”

— And here are a few more good reads: 

Politics
Policymakers, media outlets and others react to newly public data that shows the sheer scope of the opioid crisis.
Colby Itkowitz and Katie Zezima
AGENCY ALERT
Your Cadillac tax questions answered, as Congress considers its repeal.
New York Times
HEALTH ON THE HILL
Politics
Isakson, 74, was admitted to George Washington University Hospital on July 16 after he fell in his apartment in the District.
Hannah Knowles
Health care policy has become a primary focus among the Democratic candidates ahead of the second set of debates July 30-31.
Politico
The lobbying group is calling on its lobbyists to fight a budget deal that reportedly includes drug pricing reforms that will cost drug makers $115 billion.
Stat
MEDICAL MISSIVES
Morning Mix
After a year without answers as to what caused Donnamay Brockbank to die from a routine procedure, the family has sued the hospital and the doctors overseeing the botched surgery on multiple claims of negligence.
Timothy Bella
Health
The risk of premature birth increased among Latina women after the election, a new study found. Beyond pregnancies, other studies have found increased fear, anxiety and anger among Latino youth since President Trump’s election.
William Wan and Lindsey Bever
INDUSTRY RX
Courts & Law
The pizza chain and other businesses want to know how the ADA relates to the Internet.
Robert Barnes
STATE SCAN
Education
"It was heavy-handed, it was harsh. It was a scare tactic," said the school board vice president.
Reis Thebault
DAYBOOK

Coming Up

  • The Senate Banking, Housing and Urban Affairs Committee holds a hearing on cannabis and banking on Tuesday.
  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on oversight of the unaccompanied children program on Wednesday.
  • The House Oversight and Reform Subcommittee on Economic and Consumer Policy holds a hearing on Juul’s role in the youth nicotine epidemic on Wednesday and Thursday.
  • The House Homeland Security Subcommittee on Intelligence and Counterterrorism holds a hearing on the security implications of the opioid crisis on Thursday.
SUGAR RUSH

A former Florida House candidate said she treated dozens of Pulse shooting victims in 2016. It turns out she lied: