THE PROGNOSIS

A strong economy usually means more children have health insurance. Instead, precisely the opposite is happening right now in the U.S.: Kids are losing coverage.

A small but significant decline in the number of insured children has started attracting the notice of lawmakers and policymakers, who are partly blaming actions — or inaction — by the Trump administration for why 400,000 fewer kids had health coverage last year than in 2016.

U.S. census data indicate that 5.2 percent of those under 19 now lack health insurance, up from 4.7 percent two years ago. The coverage loses are detectable in 15 states and most sizable in southern states that didn’t expand their Medicaid programs and already have above average uninsured rates, according to a report released today by Georgetown University’s Center for Children and Families. Just one state, North Dakota, saw an increase in health coverage in that age group over the two-year time frame.

The trend is not exactly what experts had expected, given how the economy is thriving and recent legislation expanding coverage. The unemployment rate is at a nearly 50-year low of 3.5 percent, which means more American families have access to employer-sponsored plans. And the country has seen coverage gains over the past decade because of the Affordable Care Act, which roughly cut the uninsured rate in half.

“Things will likely get worse for children before they get better,” said Joan Alker, the center’s executive director. “These losses came amid strong economic growth and low unemployment … should an economic downturn occur the losses would accelerate.”

Top administration officials, increasingly facing questions about the trend, have tried to advance a positive message: that more children are moving from public insurance programs for the low-income to employer-sponsored coverage as their parents get jobs.

“What is happening is under the Trump economy, the economy is the best that we’ve had in 50 years, unemployment is down, there’s less people living in poverty,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said at a congressional hearing last week in response to questions from Rep. Yvette Clarke (D-N.Y.).

Verma was partly right. The share of kids with employer-sponsored coverage has increased by nearly a full percentage point, from 46.7 percent in 2016 to 47.6 percent last year, according to census data.

But that improvement is more than erased by a more sizable increase in the share of children dropping off both public health programs and the Obamacare marketplaces.

Between 2016 and 2018, children’s enrollment in Medicaid and the Children’s Health Insurance Program dropped from 35 percent to 34.3 percent. Enrollment in health plans purchased on the individual market declined from 5.8 percent to 5.2 percent during the same time period.

There are a number of possible reasons for this decline. For one thing, Americans are no longer penalized if they lack health coverage, after Congress repealed that part of the Affordable Care Act at the end of 2017. So families who find marketplace coverage unaffordable, especially if they're ineligible for federal subsidies, might be deciding to forgo it altogether.

Researchers and activists also pointed to Republican-led states that are requiring more documentation from Medicaid-eligible families, putting them at risk from being dropped from the program. For example, Texas allows only 10 days from the time it mails a notice to families to when they must return requested documents, said Adriana Kohler, a senior health policy associate with Texans Care for Children.

“One of the problems here in Texas that state leaders should tackle is the extra round of red tape that knocks eligible kids off Medicaid,” Kohler said.

Those concerned about the coverage declines have also described a “chilling effect” on Latino families as President Trump has tightened regulations around immigrants and public benefits. The coverage declines have been most pronounced among Latino and white children, according to the Georgetown report.

“These findings should be a clear call for action among our political leaders if they care about children’s health,” Alker said.

Democrats in Congress are increasingly seizing on the data to mount a new line of health-care attacks on Trump. Two committee chairmen blamed the administration for the coverage declines in a letter sent yesterday to Health and Human Services Secretary Alex Azar. The letter said the administration has “applauded” the enrollment declines among children.

“We believe that these historic coverage loses among children are the result of overly burdensome and faulty eligibility and renewal processes, diminished resources for outreach and enrollment assistance and policies that instill fear and confusion among immigrants and mixed status families,” wrote Senate Finance Committee Chairman Ron Wyden (D-Ore.) and House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.).

AHH, OOF and OUCH

AHH: A federal judge temporarily blocked Alabama’s near-total abortion ban from going into effect. The law, passed in May, would not allow exceptions for victims of rape and incest and would make it a felony for doctors to perform the procedure unless a women’s life was at risk.

Republican state Rep. Terri Collins, the author of the bill who has said it was meant to challenge Roe v. Wade, called the judge’s ruling “both expected and welcomed.” Collins said it was “merely the first of many steps on that legal journey. I remain confident that our mission will be successful and appreciate the support of millions of citizens who support our effort to preserve unborn life.”

“The Alabama bill was tumultuous from the start, with an argument breaking out during one of its introductions,” our Washington Post colleagues Ariana Eunjung Cha and Emily Wax-Thibodeaux report. “The bill, which did pass 25-6, is even more restrictive than prior state-level abortion laws, and it includes a penalty of up to 99 years in prison for doctors who perform abortions.”

The American Civil Liberties Union, which has filed lawsuits against numerous abortion restrictions in multiple states, noted that multiple laws have now been blocked in the courts:

OOF: A handful of top executives have left Juul Labs, a change that comes as the company is grappling with the fallout of growing concerns about e-cigarette use.

The company’s chief executive, K.C. Crosthwaite, replaced the company’s chief financial officer. “Several top executives have left the company, including Chief Administrative Officer Ashley Gould and Chief Financial Officer Tim Danaher, two veteran employees at the young start-up,” CNBC’s Angelica LaVito reports. “Newcomers Craig Brommers, chief marketing officer, and David Foster, senior vice president of advanced technologies, are also gone.”

Before the shake-up was announced in an email to staff, the Wall Street Journal reported Juul planned to cut about 500 jobs – or from 10 to 15 percent of the current workforce — by the year’s end.

Crosthwaite, who is only a month into his time at the company, “is tasked with turning Juul’s fortunes around. Under his leadership, the company has suspended all product advertising in the U.S. and stopped selling Juul’s sweet flavors like mango and fruit. Juul has also said it will not lobby the Trump administration on its looming flavor policy,” Angelica writes.

OUCH: Former vice president Joe Biden was reportedly denied Communion during a visit over the weekend to a church in Florence, S.C., because of his views on abortion.

“Holy Communion signifies we are one with God, each other and the Church. Our actions should reflect that,” the Rev. Robert E. Morey of Saint Anthony Catholic Church said in a statement to the Morning News, a local newspaper. “Any public figure who advocates for abortion places himself or herself outside of Church teaching.”

Biden was making a campaign stop at the church for 9 a.m. Mass, our Post colleague Sarah Pulliam Bailey reports. Biden said in 2012 that he personally opposes abortion. During a debate he said: "But I refuse to impose it on equally devout Christians and Muslims and Jews. … I do not believe that we have a right to tell other people that — women they can’t control their body."

“The Catholic Church opposes abortion, but local priests and bishops in the United States have varying policies regarding whether to give Communion to someone who supports an issue such as abortion rights,” Sarah writes. “… Publicly, Biden has a complicated relationship with Catholic leaders. After he announced his presidential run in 2008, several U.S. bishops insisted he should be refused Communion in their diocese.”

She also notes that Biden has previously been barred from receiving communion over his position on abortion. A bishop in Scranton, Pa., also reportedly stopped him from receiving Communion.

— Personal grief has been a key part of Biden’s identity, and he often talks to voters on the campaign trail about reflecting on moments of grief, including his own, our Post colleague Cleve R. Wootson Jr. writes.

“It has bookended his career; his wife and infant daughter died in a car crash shortly before he entered the Senate in 1972, and his son Beau, a rising political star in his own right, died at age 46 of cancer in 2015,” Cleve writes.

These personal moments on the trail have humanized him -- and while he may be benefiting from discussing his grief, his supporters insist it’s still genuine.

 “The former vice president is hardly the only presidential candidate to try to humanize himself for voters, especially in states like Iowa or New Hampshire, whose residents value their one-on-one interactions with candidates,” our colleague adds. “But no other candidate weaves grief into his personal message the way Biden does. He weeps when talking to audiences about his son. He calls and writes to bereaved voters. He asks crowds how many of them, or their relatives, have had cancer.”

“I have been with people where Joe Biden was not looking for their vote, could not ever be helped by them — complete strangers from other parts of the country at times when he was clearly not running again,” Sen. Christopher A. Coons (D-Del.) told Cleve. “I’ve just been blown away that this guy took not just five minutes, but 45 minutes, with, like, a Republican from Alabama.”

HEALTH ON THE HILL

— Sen. Bernie Sanders (I-Vt.) brushed off the idea that he should release details about how he would fund his Medicare-for-all plan.

“You’re asking me to come up with an exact detailed plan of how every American — how much you’re going to pay more in taxes, how much I’m going to pay. I don’t think I have to do that right now,” he said in an interview with CNBC’s John Harwood.

He was asked about Sen. Elizabeth Warren (D-Mass.) who has said she plans to release more details about how she would finance a single-payer Medicare-for-all system, which is something her Democratic rivals have at times pushed her to explain.

Asked by Harwood if it’s “foolish” that Warren is trying to detail the financing, Sanders said: “I’m not saying it’s foolish. All that I’m saying is that we have laid out a variety of options that are progressive. We’ll have that debate. At the end of the day, we will pay for every nickel of Medicare for All, and it will save the overwhelming majority of the American people, who will no longer pay premiums.”

REPRODUCTIVE WARS

— During a hearing to determine the fate of Missouri's only abortion clinic, the state's health director said he kept a spreadsheet of medical data for unnamed Planned Parenthood patients to identify who had undergone failed abortions, the Kansas City Star’s Crystal Thomas reports.

Health director Randall Williams said he directed state investigators to compile the information using available medical records. Williams said he began the inspection of the Planned Parenthood clinic in St. Louis after state inspectors found evidence of a failed abortion that didn’t have a corresponding complication report logged with the state.

The spreadsheet, which was based on medical records the investigator had access to during the state’s annual inspection, included medical identification numbers, dates of medical procedures, dates of the women's last menstrual period and the gestational ages of fetuses.

Yamelsie Rodriguez, CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region called the revelation "deeply disturbing." “This is government overreach at its worst,” she said.

"Williams, who testified he was 'pro-life' and had never performed an abortion, was pivotal to the state’s investigation as he provided some of the medical knowledge to investigators for flagging issues with the care of the four patients," Crystal writes. "Williams drew national attention earlier this year over a state policy requiring that physicians perform a pelvic exam three days before a woman receives a surgical abortion, even though physicians already do the exam immediately before the procedure....Williams eventually reversed the rule."

— And here are a few more good reads: 

Moderate and progressive House Democrats are clashing with each other over changes to Speaker Nancy Pelosi’s (D-Calif.) signature plan to lower drug prices.
The Hill

INDUSTRY RX

Ever since Johnson & Johnson disclosed this month that a government test had tur...
Reuters

SECOND OPINION

Opinions
Warren should level with voters: This is not feasible.
Jennifer Rubin

AGENCY ALERT

Detentions have surged as the Trump administration’s aggressive policy toward migrants has collided with an exodus of children fleeing Central America.
New York Times

DAYBOOK

Today

  • The House Veterans’ Affairs subcommittee on health holds a hearing on “Native Veterans’ Access to Healthcare."

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a business meeting on Thursday.

SUGAR RUSH