THE PROGNOSIS

Conservative Republicans made clear yesterday they don’t love a bold bipartisan bill to suppress drug spending.

But if they don’t play ball, they might have to swallow even more aggressive tactics.

That’s precisely what Senate Finance Committee Chairman Chuck Grassley (R-Iowa) is warning the Republicans on his panel, nine of whom  refused to vote for the package he forged with his Democratic counterpart, Sen. Ron Wyden (D-Ore.).

“Look at what’s down the road,” Grassley said after yesterday’s 19-to-9 vote advancing the bill. “It seems to me the Grassley-Wyden approach is a very mild approach to what could come out. There ought to be a realization on the part of Republicans about this and there ought to be a realization on the part of pharmaceutical companies where they would be.”

The Grassley-Wyden bill has emerged this week as the strongest chance for President Trump to carry out his promises to tackle the high cost of prescription drugs in the United States. Its most controversial provision would require rebates in Medicare from drugmakers who hike prices faster than inflation. 

It could get rolled in with legislation from two other Senate committees and brought up for a floor vote after the August recess, although there are still many details for legislators to iron out.

Bloomberg News reporter Steven Dennis:

The bill has sparked strong pushback from some Republicans and the pharmaceutical industry, who charge that it amounts to government price-fixing.

The bill “imports a price control mechanism from Medicaid,” said Sen. Pat Toomey (R-Pa.), one of the Republicans who voted against it. The others included Sens. Richard Burr (N.C.), Mike Crapo (Idaho), Mike Enzi (Wyo.), Johnny Isakson (Ga.), James Lankford (Okla.), Pat Roberts (Kan.), Tom Scott (S.C.) and John Thune (S.D.).

“The way I think about it is it’s a 100 percent tax or penalty on any price increase that’s greater than ordinary inflation,” Toomey added.

From Juliette Cubanski, associate director for the Medicare policy program at the Kaiser Family Foundation: 

Bloomberg News's Anna Edney: 

C-SPAN's Craig Caplan: 

But the Grassley-Wyden measure, which also caps what seniors pay for drugs at $3,100 a year beginning in 2022 and would save the government $100 billion, could be Republicans’ best option at this point.

House Democrats are putting the final touches on their own bill, which would allow the federal government to directly negotiate lower prices in Medicare. That type of a measure is the worst-case scenario for traditional Republicans, who view it as an even more direct way of allowing the government to determine the prices of drugs.

There’s been talk of Trump, who called during his 2016 campaign for direct Medicare negotiations, potentially striking a deal with House Speaker Nancy Pelosi (D-Calif.), which would put heavy pressure on members of his own party to go along.

“If he was going forward with Pelosi, look at what that would do to everything we Republicans stand for in the United States Senate,” Grassley said, referring to the president.

The administration has a few other tools in its back pocket. The White House is eyeing two other policies should Republicans buck the Grassley-Wyden measure. One, a proposed rule being reviewed by the White House, would link the prices of Medicare drugs dispensed by doctors to prices in other countries. Trump is also considering a far-reaching executive order that would apply such an index to Medicare’s broader prescription drug program, Reuters reported yesterday.

The quest toward lower drug prices will continue unfolding through the fall, as both parties angle for the advantage on a top concern of 2020 voters. Democrats are grappling with whether to work with a president they hope to defeat — or opt for just dinging Republicans for refusing to give the government negotiating power for Medicare drugs.

Political considerations were on full display yesterday, as several members presented unsuccessful amendments to either pare back the Grassley-Wyden bill or give it even more teeth.

The committee voted down an amendment from Toomey to strip the bill of its rebate requirement in the Medicare prescription drug program. Lawmakers also rejected an amendment from Sen. Debbie Stabenow (D-Mich.) to allow the health and human services secretary to directly negotiate lower Medicare prices.

“Today we can actually do something that will cut prices, if we have the will to do it,” Stabenow said.

Sen. Amy Klobuchar (D-Minn.) pounced on that amendment vote, calling it “a loss for seniors across the country.” She isn’t on the Senate Finance Committee, but she is running for president. 

And Wyden vowed Democrats won't support commencing floor debate on the measure without promises they would be allowed to vote on amendments adding in Medicare price negotiations and protecting people with preexisting conditions — a jab at the Trump's administration's refusal to defend the Affordable Care Act in court.

“We’re certainly not going to sit quietly by while protections for preexisting conditions are wiped out," Wyden said at the hearing. “We’re not going to sit by while opportunities for seniors to use their bargaining power in Medicare are frittered away.”

AHH, OOF and OUCH

AHH: Lawmakers on a House Oversight and Government Reform subcommittee grilled e-cigarette maker Juul Labs about tactics to market to children and teens, accusing the company of “deploying a sophisticated program” in order to become the largest seller of the products in the country.

During the hearing, company co-founder James Monsees acknowledged Juul had made “missteps” it was seeking to correct.

The panel’s investigation was based on about 55,000 documents, including email exchanges and receipts showing how much the company spent on certain programs. “The subcommittee said that Juul operated a division that persuaded schools to allow the company to present its programming to students and paid the schools in several instances at least $10,000 to gain access to students during classes, summer school and weekend programs,” our Post colleagues Laurie McGinley and William Wan report. “The effort ended last fall and involved about a half dozen schools and youth programs, Juul officials said.”

The panel questioned the company about a five-week summer camp it held that was meant to help young participants “create a personal ‘healthy lifestyle plan’” but that was targeted toward low-income youth vulnerable to poor health choices.

“We had hired education experts that we thought would be helpful to stop kids using Juul and we then received feedback,” Ashley Gould, chief administrative officer of Juul told lawmakers. “The company ended the program last September…We take the criticism that that was not well received.”

Still, some critical lawmakers pointed to the company as responsible for what former Food and Drug Administration commissioner Scott Gottlieb has deemed an “epidemic” of youth vaping.

OOF: Numerous Republicans seem to believe that if the Affordable Care Act is overturned by the courts that GOP lawmakers will be able pass an alternative health-care plan.

"It’s a scenario that has grown more realistic month by month," BuzzFeed News's Paul McLeod reports. "The Trump administration and 20 Republican-led states are arguing in court that the entire Affordable Care Act should be tossed out. One federal judge has already sided with them, and earlier this month they presented arguments to what appeared to be a receptive panel of judges at the 5th Circuit Court of Appeals. It is widely expected to be appealed to the Supreme Court either way, setting up a possible climactic decision in 2020."

Some Republicans say such a scenario could force lawmakers to come to an agreement over a health-care plan, Paul reports in this piece, which features several excellent quotes from lawmakers. “It would be noisy and loud but it would need to be done. Congress only seems to get things done when they have to, so this would be one of those ‘have to’ ones,” Sen. James Lankford (R-Okla.) told Paul. Similarly, Sen. Ron Johnson (R-Wis.) said: “One thing I’ve learned in eight and a half years here is you need almost a crisis to concentrate the minds and actually accomplish something, so hopefully we’d be able to do that.”

Sen. Todd Young (R-Ind.) recognized there would be some hurdles: “There are already some plans out there that could be dusted off and people of goodwill could conceivably come together,” he said. “I know it would be challenging and — why are you giving me that look? I’m acknowledging the challenge!”

Meanwhile, Democrats seem unconvinced. “Seriously? You’ve got Republican senators who actually say that with a straight face,” Sen. Chris Coons (D-Del.) asked Paul in a Senate elevator where there were also some of his Republican colleagues. “They had nine years to come up with a replacement plan and haven’t. I don’t find that credible.”

OUCH: Social media companies have sought in the last few years to shore up their reputations and moderate content by hiring outsourced content moderators who spend hours on end reviewing often gruesome content on these platforms. But it's a task that takes a serious mental toll on the workforce. 

“Workers here say the companies do not provide adequate support to address the psychological consequences of the work,” our Washington Post colleagues Elizabeth Dwoskin, Jeanne Whalen and Regine Cabato report in this dispatch from Manila. “They said that they cannot confide in friends because the confidentiality agreements they signed prevent them from doing so, that it is tough to opt out of content that they see, and that daily accuracy targets create pressure not to take breaks.”

Our colleagues interviewed 14 current and former moderators who worked in the Philippines, whose job it was to assess images, videos and posts from across the globe to determine what should stay and what should be removed. In these interviews, people “described a workplace where nightmares, paranoia and obsessive ruminations were common consequences of the job. Several described seeing colleagues suffer mental breakdowns at their desks. One of them said he attempted suicide as a result of the trauma.”

Meanwhile, officials at tech companies acknowledged they are still figuring out how best to offer support for moderators and improve working conditions. Sylvia Estrada-Claudio, dean of the College of Social Work and Community Development at the University of the Philippines, expressed concern especially for young people who are exposed to disturbing and violent imagery. “For people with underlying issues, it can set off a psychological crisis,” she said.

HEALTH ON THE HILL

— Protect Our Care, a group run by Democratic operatives and that aims to defend the Affordable Care Act, is launching a national tour to seize on the issue of health care that remains critical to voters ahead of the 2020 election.

“It really is to focus on what has not changed since the election,” the group’s executive director, Brad Woodhouse, told CQ Roll Call’s Mary Ellen McIntire. “We had an election that was about health care. It was the No. 1 issue in the election. It’s what swept Democrats into power in the House.”

Starting on Aug. 5, the group will have at least 22 events and tour 13 states. The group is hoping to support freshman Democrats, criticize Republican lawmakers who voted to roll back the ACA in 2017 and remind voters about the ongoing Republican-led lawsuit that aims to undermine the health-care law.

MEDICAL MISSIVES

— According to a survey from the Centers for Disease Control and Prevention, only about a third of men in America at high risk for HIV are taking Truvada, the once-daily HIV prevention pill.  

“For the report, published in MMWR, C.D.C. researchers studied 7,873 high-risk men from 20 American cities who were negative for H.I.V. and completed a behavioral survey in 2014 or 2017,” the New York Times’s Toby Bilanow reports. “Among the men in the survey, PrEP use rose steeply from 2014 to 2017, from 6 percent to 35 percent. But PrEP use varied by race, with 42 percent of high-risk white men taking the drug, 30 percent of Hispanic men and 26 percent of black men."

High-risk men include individuals who had at least two male sexual partners over the last year, and those who reported having a sexually transmitted infection or having unprotected anal sex in the last year.

The researchers said without higher rates of PrEP use, it would be difficult to reach the target recently set out by the Trump administration to end the HIV epidemic in by the end of the next decade. “Higher coverage is needed, especially among black and Hispanic men who have sex with men, to end the H.I.V. epidemic in the United States by 2030,” the researchers said.

— And here are a few more good reads: 

Business
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OPIOID OPTICS
Politics
The senator, whose home state is one of the hardest hit, cited The Post’s reports in calling for more lawsuits.
Colby Itkowitz
In a trial in Oklahoma, records showed the firm was consulted about sales at a time when abuse of pain medicine was widespread. Cases in two other states also shed light on its role.
New York Times
AGENCY ALERT
Francisco Erwin Galicia, a Dallas-born U.S. citizen, spent 23 days in the custody of U.S. Customs and Border Protection in conditions that made him...
Dallas Morning News
The Trump administration's expensive new facility for holding unaccompanied migrant children in Carrizo Springs, Texas, will remain open, but empty of any children, the Department of Health and Human Services (HHS) said Thursday.
The Hill
INDUSTRY RX
He needed the lifesaving treatment — he never expected a half-million-dollar bill for 14 weeks of care.
Kaiser Health News
Medicare could save $1.57 for every dollar spent delivering free healthy meals to frail seniors after a hospitalization, according to a new study that comes as lawmakers look to restrain costs by promoting patients’ well-being.
Associated Press
STATE SCAN
D.C. Politics
Advocates said the District did not plan for a transition after the end of the Georgetown University services.
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Rockland County will not renew the state of emergency order issued during its months-long measles outbreak.
NBC New York
Health & Science
A change to state law will allow certain terminally ill patients in Oregon more direct access to life-ending medications under the state’s assisted suicide law
Associated Press
DAYBOOK

Today

  • The House Oversight and Reform Committee holds a hearing on “The devastating impacts of skyrocketing drug prices on American families.”
SUGAR RUSH

A theater critic reviews Joe Biden's campaign performance: