THE PROGNOSIS

President Trump repealed Obamacare’s penalty for lacking health coverage. Now he’s reinstating a coverage requirement for immigrants seeking to enter the United States — yet refusing to let them access Obamacare’s benefits.

Under the president’s latest tightening of immigration rules, people seeking visas to enter the United States will have to prove to consular officers that they either have health insurance or are wealthy enough to cover their own medical costs. The White House issued the proclamation Friday evening, in a statement that blasted uninsured immigrants with burdening the country’s hospital system.

“Immigrants who enter this country should not further saddle our health care system, and subsequently American taxpayers, with higher costs,” the proclamation says.

It would be one thing if these immigrants could meet the requirement by enrolling in the Medicaid program or use federal subsidies to buy private plans in the Affordable Care Act’s marketplaces. Those are the main tools available to lower-income Americans to help them afford coverage.

But most of them can’t.

While legal immigrants may buy subsidized private plans on the ACA marketplaces, the Trump administration won’t count such coverage as fulfilling its new requirement. Only unsubsidized plans will count. That means someone making as little as $16,000 a year would have to show they can cover the entire cost of a plan on their own to gain admittance to the United States, even though as a citizen they’d be eligible for sizable subsidies.

The situation is even bleaker for applicants who earn below 133 percent of the federal poverty level — the threshold in most states to qualify for Medicaid. Most adult immigrants in the country legally, except for refugees, asylum seekers and pregnant women, are barred from enrolling until they’ve been in the country for at least five years. So that’s also out of the picture for immigrants trying to obtain health coverage under this new proclamation.

The administration has characterized this move — and other crackdowns on immigrants — as a way to ensure that only people who are financially self-sufficient can enter the United States. But to critics of Trump’s immigration policies, it’s yet another way to discourage immigration by poorer people while favoring the wealthy.

“This is consistent with past efforts to remake the composition of immigrants in this country,” said Steven Lopez, associate director of health policy for the immigrant advocacy group UnidosUS. “To move toward a more merit-based system, between those who are deemed desirable and contributors to the United States, and those characterized as taking from this country.”

The nonpartisan Migration Policy Institute:

Rep. Joe Kennedy III (D-Mass.):

Constitutional scholar Laurence Tribe:

Requiring people to buy health coverage isn’t a new idea, by any means. In fact, the Democrats and liberals who are criticizing Trump’s new requirement for immigrants to be covered also protested when he signed a 2017 law effectively removing just such a mandate for the American public.

Health-care advocates have long argued that having everyone — not just sick people who prove expensive for insurance companies — buy in to the insurance system is key to making health care affordable for everyone. Generally speaking, it’s a good thing for immigrants to have health insurance, to ensure they can access needed medical services and to protect them from heavy debt should an emergency arise. And in the long run, having insurance means less health-care spending.

And even though legal immigrants can’t access ACA subsidies or Medicaid, there may be some more-affordable insurance options available to them. Visa applicants could find a job with employer-sponsored coverage. They could also join the family plan of a spouse or family member already in the country. Or they could purchase either “catastrophic” plans (that protect only from the steepest medical costs) or leaner but cheaper short-term plans recently expanded by the Trump administration.

Supporters of Trump’s proclamation pointed me to those options, arguing that even without public assistance, immigrants should be able to afford at least bare-bones insurance coverage to meet the new requirement.

“Although we'll need to see more details, it appears that only the most destitute applicants will be barred due to the new policy,” said Steven Camarota, director of research for the Center for Immigration Studies, a group that advocates reduced immigration.

But the administration’s strategy on the issue — releasing a proclamation — is highly unusual. It could have included the requirement to have coverage in a set of controversial revisions to the “public charge rule” set to take effect next week (we explained the public charge rule here). Immigrant advocates say they’re frustrated the new requirement was issued via proclamation — which means the public had no chance to weigh in.

“Even for this administration, it’s a shocking bypassing of legal procedures in order to change immigration law,” said Jackie Vimo, a policy analyst for the National Immigration Law Center.

Here’s another odd thing about the president’s move. Trump had long railed against the individual mandate, calling it “the absolute worst part of Obamacare.” Yet in his proclamation, the president levied the same arguments used by ACA advocates to promote such a mandate, saying the uninsured burden the country’s health-care system by obtaining care they can’t pay for and thereby raising costs for everyone else.

“While our healthcare system grapples with the challenges caused by uncompensated care, the United States Government is making the problem worse by admitting thousands of aliens who have not demonstrated any ability to pay for their healthcare costs,” the proclamation says.

AHH, OOF and OUCH

AHH: Planned Parenthood’s political arm announced a $45 million campaign ahead of the 2020 presidential election -- its largest-ever electoral effort and more than triple what it spent in the 2016 cycle.

The country's largest abortion provider is pushing back against efforts by state and federal lawmakers to restrict abortions. In the past year, a wave of Republican-controlled states passed new antiabortion bills, some in an attempt to mount a challenge to the landmark Roe v. Wade ruling.

Kelley Robinson, executive director of the super PAC Planned Parenthood Votes, told NPR’s Sarah McCammon that it wants to fight back against a “coordinated level of attack” from those who oppose abortion rights. “It's clear that all these attacks have one goal: to undermine and to gut Roe v. Wade,” Robinson told Sarah.

“The group is targeting 5 million voters nationwide, with a focus on nine key states: Arizona, Colorado, Florida, Michigan, Minnesota, New Hampshire, North Carolina, Pennsylvania and Wisconsin,” Sarah writes. “The campaign will include digital, television and radio ads rolling out later this year; direct mail; and voter canvassing beginning in 2020.”

CNN’s Caroline Kelly also notes the campaign “clocks in at more than triple what the group spent during the last presidential election year and eight times what it spent during the 2018 midterms — a telling sign of Planned Parenthood's anticipated full court press in the coming election.”

OOF: The recent massive $8 billion jury award against Johnson & Johnson may be the latest sign of increasing frustration with the pharmaceutical industry, our Post colleague Christopher Rowland reports.

A jury in Philadelphia ruled this week that the company and its subsidiary Janssen Pharmaceuticals owes the whopping sum to a Maryland man in a personal injury case – one of thousands of similar cases against the company over Risperdal, an antipsychotic drug.

“It was more bad news for an industry hammered by negative headlines in 2019: an epidemic of opioid abuse fueled by addictive pills, ever-rising prescription drug prices, and alleged price-fixing and other anti-competitive practices in the industry,” Christopher writes.

Although experts have suggested the $8 billion verdict may be reduced, it was also a signal of the risk companies face when cases are fought instead of settled.

OUCH: The U.S. Army is treating two soldiers for vaping-related lung illnesses — the first such cases reported by the military as authorities continue to investigate what’s behind a spate of mysterious illnesses that have sickened more than 1,000 people across the country.

In most cases, the illness has been linked to vaping products containing THC.

“Army officials said they are still investigating the cases of the two soldiers and haven’t determined the substances they used. They declined to discuss further details, citing privacy concerns,” the Wall Street Journal’s Ben Kesling and Jennifer Maloney report

Now, Army health officials are urging soldiers and their families to stop using any e-cigarette or vaping products. “Exchanges on Army, Air Force, Navy and Coast Guard bases removed all e-cigarettes from their stores under a ban that went into effect Oct. 1. The e-cigarette ban at military shops is broader than those enacted in several states, which have barred the sale only of certain flavors to curb a rise in underage vaping," Ben and Jennifer write.

— Melania Trump hosted a group of teenagers at the White House for a listening session about vaping. “The teens, ranging in age from 13 to 18 years old — and from several different parts of the country — are part of Truth Initiative, which bills itself as the largest nonprofit public health organization dedicated to eradicating tobacco use,” CNN’s Kate Bennett reports.

The first lady asked the teens in the room about how they may have started using e-cigarette and vaping products, and told them the administration needs to be “proactive” on the issue.

HEALTH ON THE HILL

— Sen. Bernie Sanders (I-Vt.) said he misspoke when he suggested to reporters he would pull back on his campaign schedule after suffering a heart attack.

“I misspoke the other day. I said a word I should not have said, and media drives me a little bit nuts to make a big deal about it,” Sanders said in the interview with NBC News. “We’re going to get back into the groove of a very vigorous campaign. I love doing rallies, and I love doing town meetings.”

The previous day, he told reporters he planned to “change the nature of the campaign a bit," adding that would mean “Probably not doing four rallies a day.”

The Vermont senator also defended his decision to wait to disclose that he had suffered a heart attack – he initially only said stents had been implanted, our Post colleague Sean Sullivan reports. He told NBC it was “nonsense” that he had not been transparent enough about the experience. “I don’t know what people think campaigns are — you know, we’re dealing with all kinds of doctors, and we wanted to have a sense of what the hell was going on, really,” Sanders said. “So the first thing that we’re trying to do is understand what’s going on and not run to the New York Times and have to report every 15 minutes. You know, this is not a baseball game. So I think we acted absolutely appropriately.”

“The campaign has yet to say how severe a heart attack Sanders suffered or what, if any, lifestyle changes his physicians have recommended,” Sean writes. “The senator said Tuesday he will release his health records at ‘the appropriate time’ but declined to specify when that would happen. His campaign earlier committed to releasing them before the Feb. 3 Iowa caucuses.”

AGENCY ALERT

— A federal appeals court will hear oral arguments on Friday over the plan proposed by Kentucky Gov. Matt Bevin (R) to mandate that some adults comply with work requirements to maintain Medicaid coverage.

Kentucky was the first state to win federal approval for such a plan.

The appeals panel in the District of Columbia is set to determine whether Kentucky’s work mandate violates federal Medicaid law. “The panel of judges also will hear an argument from Arkansas, which along with Kentucky, had its proposal for Medicaid work requirements overturned in March by a federal judge in Washington,” the Louisville Courier Journal’s Deborah Yetter reports. “It is the first such challenge to reach an appeals court and has far-reaching implications. So far, 15 other states either have won approval to enact Medicaid work requirements or are seeking permission to do so from the Trump administration, which has endorsed the idea and proposes enforcing it nationwide.”

— And here are a few more good reads: 

A new study finds that NIH funding gaps between black and white scientists may be partly explained by the choice of research topics.
Stat

TRUMP TEMPERATURE

Drug companies developing cancer treatments can fold the risk assessment of unapproved screening tests into their clinical trial application instead of filing separately.
Bloomberg
Democratic presidential candidates are threatening to take a drastic step that even the Obama administration rejected to lower drug prices without congressional approval.
The Hill
Beto O'Rourke unveiled Wednesday a plan aimed at guaranteeing women's equality in the workplace, featuring proposals that would mandate equal pay, require accommodations for pregnant women and reduce child care costs.
CNN

MEDICAL MISSIVES

The initiative will provide resources to children and the adults in their lives to address the issue and help answer common questions that kids have.
Stat
More than 4,000 people have died in Congo this year in the world’s largest measles outbreak, the United Nations children’s agency said Wednesday.
Associated Press

INDUSTRY RX

The average American household spent almost $5,000 per person on health care last year, about twice as much as they were spending in 1984, even after adjusting for inflation. There's one expense driving the rapid rise.
CNBC

STATE SCAN

Patients at VCU Health will no longer be taken to court and can more easily get financial assistance to pay their bills.
Kaiser Health News

REPRODUCTIVE WARS

Business
Lawyer Roxanne Conlin was one of them. “It irritates me immensely,” she told The Post. “How short their memories are. Some of them weren’t even born at the time.”
Eli Rosenberg

DAYBOOK

Coming Up

  • The Senate Special Committee on Aging holds hearings to examine fall prevention, and national, state and local solutions to better support seniors on Oct. 16. 
  • The House Veterans Affairs Subcommittee on Oversight and Investigations holds a hearing on VA systems for protecting veterans from clinical harm on Oct. 16. 

SUGAR RUSH

— Stephen Colbert on the identity of the whistleblower: