THE PROGNOSIS

The health and well-being of migrant children is again front and center in the immigration wars as the Trump administration rejiggers rules around keeping them — along with their families — in jail-like settings for longer periods of time.

Two federal agencies that handle immigrants — the Department of Health and Human Services and the Department of Homeland Security — say they’ll issue a rule tomorrow allowing children to stay with their parents in United States detention centers for longer than the current 20-day maximum, as they await hearings on their cases.

The change lets the Trump administration keep entire families in custody as long as needed. The other options are to release migrant  kids before their cases are resolved or separate children from parents, as DHS did last year before ending the practice after a massive outcry from the public. President Trump has claimed that holding families in custody will discourage more people from seeking U.S. asylum at the Mexico border.

“One of the things that is happening, when they see you can’t get into the United States — or when they see if they do get into the United States they will be brought back to their country — they won’t come,” the president said yesterday. “And many people will be saved.”

But to Democrats and immigrant advocates, it’s yet another protectionist advance by an administration intent on spurning immigrants wherever possible — and could allow virtually unlimited incarceration of children, a condition which experts say carries risks for their mental and physical health.

“This proposed rule breaks every international treaty governing humane detention of prisoners — and make no mistake, that’s what these children would be,” said Krish O’Mara Vignarajah, president of Lutheran Immigration and Refugee Service. “There is simply no justification for detaining children — or any humans — indefinitely.”

Sen. Patrick Leahy (D-Vt.):

Rep. Lucille Roybal-Allard (D-Calif.):

The Congressional Hispanic Caucus:

This all revolves around a 1997 court settlement known as known as the Flores Settlement Agreement governing how migrant kids and teens should be treated while in U.S. custody. The federal government was accused in the 1980s of mistreating immigrant children, which led to a series of lawsuits that were settled under Flores, according to a Congressional Research Service report.

Generally speaking, the Flores Settlement says the government must move kids from austere border jails into licensed, child-appropriate facilities as quickly as possible. While the agreement doesn’t specify a time period, a federal judge set out the 20-day standard in a 2015 ruling.

Tomorrow’s final rule will replace the provisions of Flores — and will face a tsunami of legal challenges saying it falls far short of upholding the Flores protections. The rule’s impact will be most immediately felt by migrant families currently in U.S. custody, who could find themselves held within border detention facilities for months.

But there could also be ripple effects for children who have arrived at the border without their parents, many of them fleeing violence and poverty in Central American countries. These unaccompanied children, who are the responsibility of HHS, are also covered by the Flores Settlement. The new rule could significantly weaken protections around them.

“It will allow HHS, in more circumstances, to hold children in more secure facilities,” Tom Jawetz, vice president for immigration policy at the liberal Center for American Progress, told me. “It would diminish the requirement they have to continuously look for release alternatives for unaccompanied children.”

Julia Preston, former immigration correspondent for the New York Times:

NBC News's Andrea Mitchell, quoting an American Civil Liberties Union attorney:

Border Patrol facilities have been criticized for overcrowded and less-than-humane conditions. HHS has come under some similar criticisms for temporary shelters it says it was forced to set up as the number of unaccompanied children surged. But HHS Secretary Alex Azar has consistently defended his agency’s handling of the situation and said in a statement yesterday that it will continue providing migrant children with compassionate care.

“As before, HHS will continue to protect the safety and dignity of unaccompanied alien children in our custody as we seek to place the with a parent, relative or other suitable sponsor,” Azar said in a statement.

As for families who are still together — keeping them in detention longer would mark a major coup for the White House, which has said it’s a way to deter mass migration at the border, my colleague Maria Sacchetti reports.

“Officials said they hoped the threat of longer detention would deter the crush of Central American migrants at the U.S.-Mexico border and complement existing enforcement measures,” Maria writes. “Border apprehensions have slumped more than 40 percent since May, a major drop officials have attributed to increased enforcement in Mexico, but officials worry about a resurgence in the fall.

“Smugglers have sold families discounted trips to the border and instructed them to seek asylum because the Flores agreement meant they were likely to be released,” she continues. “Such families are rarely deported, officials said.”

Sen. Marsha Blackburn (R-Tenn.):

The conservative Heritage Foundation:

To readers: We are taking a short hiatus next week as the summer winds to a close. We'll be back in your inboxes full time after Labor Day.

AHH, OOF and OUCH

AHH: The Trump administration is appealing a federal court ruling earlier this summer striking down its new requirement that drug companies disclose wholesale prices in TV ads. Yesterday HHS filed a notice of appeal to the ruling, in which U.S. District Judge Amit Mehta said the agency would need authority from Congress to require the disclosure of list prices. The HHS rule is part of a larger push by the administration to put downward pressure on drug prices.

"If the drug companies are embarrassed by their prices or afraid that the prices will scare patients away, they should lower them," HHS spokeswoman Caitlin Oakley told Reuters.

OOF: Sen. Bernie Sanders (I-Vt.) is responding to fears among organized labor that his Medicare-for-all plan would negatively affect their benefits. His campaign announced a change yesterday that would effectively give organized labor more negotiating power than other consumers would have under his plan by forcing employers to pay out any money they save to union members in other benefits, The Post's Chelsea Janes, Dave Weigel and Holly Bailey report.

"Labor representatives have expressed concerns to candidates publicly and to campaign staffs privately that a single-payer system could negatively affect their benefits, which in many cases offer better coverage than private plans," my colleagues report. "One of the primary concerns union members and leaders have raised about Sanders’s Medicare-for-all plan is that they negotiated health-care coverage under the current system, in some cases ceding salary in exchange for those benefits."

A Sanders aide said the provision “does not open a door for private insurance,” which would be mostly eliminated under Medicare-for-all. Campaign adviser Jeff Weaver said the change is meant to guarantee that any savings to employers under the Medicare-for-all plan “must be passed on to their organized workers in the form of additional wages or benefits.” Here's our recent Health 202 on how organized labor feels about Medicare-for-all.

OUCH: In the wake of Planned Parenthood's decision to reject $60 million in federal family planning funds, its clinics in several states are charging new fees, tapping into financial reserves, intensifying fundraising and warning of more unintended pregnancies and sexually transmitted diseases, the Associated Press reports.The group announced Monday it will refuse about $60 million in federal grants to provide low-income women with birth control and screenings. The new Title X rules, which we explained in this Health 202, say clinics can't use the funds to refer for abortions and must have financial separation from any abortion services.

"The fallout is especially intense in Utah, where Planned Parenthood has been the only provider participating in the nearly 50-year-old Title X program, and will now lose about $2 million yearly in federal funds that helped serve 39,000 mostly low-income, uninsured people," AP's Lindsay Whitehurst and David Crary write. 

"It intends to maintain its services — which include contraception, STD testing and cancer screening — but is considering charging a small copay for patients who used to get care for free...Planned Parenthood in Minnesota is in a similar situation, serving about 90% of the state’s Title X patients, and plans to start charging fees due to the loss of $2.6 million in annual funding," they write.

— Nationally, Planned Parenthood is trying to fundraise off its decision to withdraw from Title X, sending at least two email blasts earlier this week asking supporters for donations to help it fight back against the Trump administration's changes to the program rules.

“Planned Parenthood health centers nationwide are being forced out of the Title X program,” one of the emails says. “Right now we're doing everything we can do keep health center doors open. Say you're ready to fight back by rushing an emergency gift now.”

— A few more good reads (and watches) from The Post and beyond:

Check out this new Post video documenting the many shades of health care positions we've seen from Sen. Kamala Harris (D-Calif.) in her 2020 presidential bid:

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