THE PROGNOSIS

President Trump’s top Obamacare chief refused to tell Congress yesterday how the administration would replace the landmark 2010 health-care law should a federal appeals court knock it down in the coming weeks.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, instead had a single line ready every time a Democrat on the House Energy and Commerce oversight subcommittee pressed her for details on what would happen to the millions of Americans who have obtained coverage under the Affordable Care Act and benefited from its consumer protections.

“The president has made clear we’ll have a plan in action to make sure Americans have access to affordable coverage,” Verma told member after member, during her first-ever testimony before a House committee under the control of Democrats.

The hearing gave Democrats a rare face-to-face opportunity to directly bludgeon a top Trump administration official over the administration’s controversial refusal to defend the ACA in a challenge brought by Texas and other GOP-led states.

A decision is expected any day now from the U.S. Court of Appeals for the 5th Circuit, although any ruling is likely to be stayed as the losing side appeals to the Supreme Court. While the administration has worked on some ideas to replace the ACA, those are far short of the sweeping actions Congress would need to take to prevent millions of Americans from being affected.

“If the court rules the way the administration has asked, the entire ACA will be invalidated, is that correct?” subcommittee Chairwoman Diana DeGette (D-Colo.) asked Verma. “If the ACA was invalidated, about 21 million people would lose their health insurance, is that correct?”

Mary Ellen McIntire, health-care reporter for CQ/Roll Call:

Patient advocate Peter Morley: 

Politico's Adam Cancryn: 

As we’ve reported, Verma was no fan of the decision to oppose the ACA in court and had even internally advocated going the opposite direction and defending all of it.

But she and Health and Human Services Secretary Alex Azar were overruled by top White House officials — and ultimately Trump himself — and are now forced to explain and defend that decision to irate Democrats seeking to capitalize politically off of it.

And Democrats did try to capitalize. Not only on the ACA decision, but also over the administration’s expansion of leaner, cheaper health0-care plans that cover fewer medical benefits, its permission for states to institute Medicaid work requirements and new data showing the country’s uninsured rate is creeping back up, particularly among children.

Donna Young, senior reporter for S&P Global News:

As often happens in such hearings, the Democrats frequently interrupted Verma as she started to answer their questions, charging the CMS official was only giving them “talking points” and wasting the five minutes they were each allotted for questioning.

“You’re not going to spin me for the five minutes; I’m going to reclaim my time,” Rep. Joe Kennedy (D-Mass.) said, after asking Verma to respond to reports that new Medicaid work requirements, such as those in Arkansas and New Hampshire, have resulted in people being kicked off the program.

Politico's Dan Diamond: 

At another point, Rep. Yvette Clarke (D-N.Y.) questioned Verma on recent reports that more than a million children have dropped out of the Medicaid program and the Children’s Health Insurance Program over the past two years. But as Verma began to answer, Clarke interrupted her.

“I don’t want to hear your talking points,” Clarke said.

Verma stressed improvements in the ACA insurance marketplaces, where average premiums will drop 4 percent next year and a larger percentage of customers will have access to at least three plans. But she also criticized the marketplaces' basic structure, saying the administration was compelled to expand leaner, short-term plans as a less expensive option for consumers who still find plans unaffordable without federal subsidies.

“What our administration is trying to do is provide more choices when there aren’t any,” Verma said. “Short-term, limited-duration plans may give [people] a different option. It’s better than having no insurance at all.”

Democrats would have wildly applauded the reduction in marketplace premiums (which we detailed in Tuesday’s Health 202) under the Obama administration, but the news went barely mentioned in yesterday’s hearing.

Here’s why: Republicans are still reluctant to praise anything related to Obamacare. And Democrats are mainly focused on the ACA lawsuit, which has put the Trump administration in a tough political position.

“If the president was honest and said, ‘Look, I want to get rid of the ACA; I don’t think the federal government should be involved in health care,’ I’d say, ‘Okay, that’s your ideology,’ ” Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) said. “I think it’s deceptive, though, to suggest you’re going to do something better but you’re not giving us anything.”

AHH, OOF and OUCH

AHH: Trump is planning to nominate Texas oncologist Stephen M. Hahn to lead the Food and Drug Administration, the Wall Street Journal’s Thomas M. Burton reports.

Hahn would take over for acting FDA commissioner Ned Sharpless, who can serve until his acting term expires on Nov. 1 and who was also a contender for the permanent gig. Hahn is expected to be named next week.

“Dr. Hahn previously was chairman of radiation oncology at the University of Pennsylvania Hospital, before heading to the University of Texas-affiliated M.D. Anderson. In those roles he gained experience with federal regulations governing the development of medical devices and of diagnostic equipment,” Thomas writes. “Colleagues at M.D. Anderson credit the FDA nominee for a positive turnaround in faculty morale during recent years there—and for a raucous laugh that can be heard well down the hallways.”

Hahn, currently the chief medical executive at MD Anderson Cancer Center in Houston, would come into an agency as it looks at more than 1,000 reported cases of a vaping-related illness that has spread across the country amid heightened scrutiny over e-cigarette use.

OOF: The FDA is proposing that manufacturers of breast implants more explicitly spell out possible complications, such as rare cancers and other issues, with a boxed warning, which our Washington Post colleague Laurie McGinley writes is the agency’s “strictest caution.”

The boxed warning would explain that implants are linked with a rare lymphoma; that some patients have experienced fatigue, muscle aches and joint pains; that the devices are not meant to be for a lifetime; and that any risk of complications increases over time.

The agency’s proposal follows years of criticism from women who say they were harmed by the implants and were not properly warned about problems before surgery.

“Over the past few years, patients who say they were harmed by the devices have become increasingly active on social media sites that have enabled tens of thousands of patients to exchange information,” Laurie writes. “The emergence of a rare cancer linked to implants in recent years also has drawn more attention to potential health problems associated with implants.”

OUCH: The American health-care system is fueling widespread burnout among doctors and nurses, according to a more than 300-page report from the National Academy of Medicine. That leaves health-care providers who are prone to errors, indifferent toward their patients and who may turn to alcoholism or suicide, our Post colleague William Wan reports.

The analysis from the prestigious medical institution found “as many as half of the country’s doctors and nurses experience substantial symptoms of burnout, resulting in increased risks to patients, malpractice claims, worker absenteeism and turnover, as well as billions of dollars in losses to the medical industry each year.”

One especially alarming statistic that William notes: The suicide rate among doctors is twice that for the general population and one of the highest among all professions.

“What this report is saying is that this is a systemic problem that requires systemic solutions,” said Christine K. Cassel, professor of medicine at University of California at San Francisco, who co-chaired the committee that wrote the report. “You can’t just teach doctors meditation, yoga and self-care. We need big, fundamental changes.”

OPIOID OPTICS

— First lady Melania Trump made her first solo trip to Capitol Hill yesterday for a roundtable with lawmakers on the opioid crisis. Her visit was meant to mark one year since the president signed the SUPPORT Act that provides funding and guidance for combating opioid abuse, as CNN’s Kate Bennett reports.

There, Trump met with lawmakers including Sens. Joe Manchin (D-W.Va.), Chuck Grassley (R-Iowa), Joni Ernst (R-Iowa) and Marsha Blackburn (R-Tenn.).

“Because of the SUPPORT Act, we are able to look at ways to reduce opioid use during pregnancy and recognize early childhood issues related to substance abuse,” she said during the event.

Manchin told CNN that lawmakers were “very pleased to have First Lady Melania Trump.” He added: “It's a shame that it took a crisis to bring us together.”

— The Drug Enforcement Administration announced a proposed rule meant to curb the overproduction of opioid medications that could be diverted for illegal distribution.

The rule would change the agency’s quota system, which sets how many opioid pills can be manufactured. The changes are based on the SUPPORT Act passed last year, which “requires that appropriate quota reductions be made after estimating potential for diversion,” the DEA said in a news release. “This estimate is based on rates of overdose deaths and abuse, the overall public health impact related to specific controlled substances and may include other factors as appropriate.”

The public now has 60 days to comment on the proposed rule, which was published yesterday in the Federal Register.

HEALTH ON THE HILL

— The House Ways and Means Committee approved a bill that would impose the first tax on nicotine liquids.

In a 25-to-14 vote, the panel passed legislation that would impose a tax on nicotine in vaping products of $50.33 per 1,810 mg, the Washington Examiner’s Cassidy Morrison reports. “For reference, the average Juul pod, with 5% nicotine content and 0.7 ml of liquid, would be taxed at $1.15,” she writes. A majority of Republicans on the panel voted against the tax.

Bill co-author Rep. Tom Suozzi (D-N.Y.) said the bill looks to up vaping product prices to make them less accessible to teenagers. “Younger people are more sensitive to price changes,” Suozzi said. “We know that this will help. Will it solve the whole problem? Absolutely not.”

“The tax would apply to all nicotine vaping liquids, similar to the current tax on tobacco products including regular cigarettes. It would not, however, apply to products meant to help people quit smoking and using tobacco products, including nicotine gum,” Cassidy adds.

— And here are a few more good reads: 

Facebook CEO Mark Zuckerberg was grilled on anti-vaccine content by Congressman Bill Posey who is a vaccine skeptic and talks about links to autism.
Roll Call
Stop bill is first in the US to focus exclusively on illnesses that impair the lives of up to 12 million Americans
The Guardian

MEDICAL MISSIVES

Only polio virus Type 1 persists, and only in Pakistan and Afghanistan. But now mutant vaccine viruses are paralyzing some unvaccinated children.
New York Times

AGENCY ALERT

The NIH and the Gates Foundation aim to develop gene-based cures for sickle cell disease and HIV that are accessible by the world's poor.
Stat
A flagship Medicare program that HHS expected to engage up to 110,000 people annually each year in measures to help them avert Type 2 diabetes only managed to enroll about 200 people last year, according to an analysis of CMS data.
Politico

REPRODUCTIVE WARS

Health
Learning about your body is good, experts say, but a "premarital exam" makes sex sound like a medical condition, and it implies women need preparation for sexual intimacy that men do not.
Marisa Iati

DAYBOOK

Today

  • The Senate Finance Committee holds a hearing on substance misuse and scams, shortfalls and solutions. 

Coming Up

  • The House Veterans' Affairs Subcommittee on Health holds a hearing on native veterans' access to healthcare on Oct. 30. 

SUGAR RUSH

Trump says he's building a 'beautiful' wall in Colorado, a state that doesn't border Mexico: