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Happy Friday and happy spring! A huge thanks to KHN Executive Editor Damon Darlin for stepping in last week as yours truly did a bit of sightseeing in the Windy City. (I now have some very shallow but gruesome trivia about Chicago’s gangster history to pull out at parties.)

Now on to what has been a rather busy health care week.

President Donald Trump handed (very delighted) Democrats a gift-wrapped talking point this week when he had the Justice Department tell the courts that the whole health law — and not just parts of it — should be nullified. It’s widely accepted that the Democrats rode a blue wave in the midterms in part because they capitalized on the popular aspects of the health law, so some (not so delighted) Republican lawmakers were caught off guard by the president’s pivot.

The announcement also set off a passive-aggressive game of “nose goes” between Senate Republicans and the president. Trump assured everyone that the lawmakers would come up with a “spectacular” replacement for the health law. Smash cut to Senate Majority Leader Mitch McConnell, who said he “looks forward to seeing what the president is proposing and what [Trump] can work out with the speaker.”

With timing that could not have been better if they’d planned it, House Democrats happened to unveil the next day their new proposal to shore up the health law. There’s not much new or different in the plan itself, but the optics of it made for some happy Dems.


And on top of all that, the Trump administration’s efforts to chip away at the Affordable Care Act took a battering in the courts this week.

First, in twin decisions, a judge rejected both Kentucky and Arkansas’ Medicaid work requirements. Kentucky’s had been, in theory, reworked from a previous rejection, but U.S. District Judge James Boasberg said he didn’t see anything new of substance that would justify giving them the green light.

The Arkansas decision wasn’t as emphatic in tone, but it might have more of an immediate impact. To comply with the judge’s order, the state immediately closed the online portal for people to report their work hours. Officials also said that even though they were about to announce a new round of cutoffs in a few weeks’ time for people who hadn’t logged their hours, no one going forward would be dropped from the rolls. The first-in-the-nation requirements, put in place last year, have resulted in more than 18,000 people in Arkansas losing coverage.

The future may be uncertain for the rules, but this on-the-ground story about how they’re playing out in Arkansas, which is desperately hurting for jobs, is still worth a read. “I am just putting it in God’s hands,” said one woman  who had lost her Medicaid coverage. “He is going to let me stay on this Earth to see my grandbaby be raised.”

The second court blow to the administration came as a judge ruled that association health plans — which offer less coverage than required under the health law — are illegal. The rule is “clearly an end-run around the ACA,” said Judge John D. Bates


CMS Administrator Seema Verma might be the latest administration official to find herself in some ethical hot water over spending. Politico has the scoop about how Verma directed millions in taxpayer dollars to Republican communications consultants, whose job, in part, was to write her speeches and polish her own brand. The decision came, at times, over the objections of CMS staffers. Everything is aboveboard legally, but experts say the ethics involved are more murky.


“Medicare-for-all” might seem like the buzzword you can’t escape these days (and I don’t think it’s going anywhere soon), but what exactly would our very complicated, complex, unwieldy mess of a health system look like if we shifted to that model? The thing is, whatever ours would look like, it would still be so different from those of other countries with universal health coverage that it’s hard to know.


Once the Sackler family (who founded opioid maker Purdue Pharma) saw the writing on the wall with the opioid crisis — not to mention the financial reckoning that was barreling their way — they started shifting money into offshore accounts, according to the latest lawsuit against the family. New York Attorney General Letitia James is using that as a new legal angle to go after the Sacklers and Purdue, both of which are already facing a barrage of suits.

Speaking of: The company settled the Oklahoma case, which was a bellwether for how the rest of the lawsuits may play out. Purdue will pay $270 million — a number that many have called “woefully inadequate” — which let the opioid maker avoid the spectacle of a televised trial.


The $50 million research behind PrEP, which helps prevent at-risk people from contracting HIV, was almost fully funded by the U.S. taxpayers. Yet it’s Gilead, the company that makes the drug, and not the federal government that raked in $3 billion in sales from it last year. So what happened? (Spoiler: It involves patents and the government’s failure to reach a royalty deal with the drugmaker.)

Also make sure to check out this great read about what San Francisco has done to make such great strides at eliminating the HIV epidemic.


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In news designed to enrage you: An Indian Health Service doctor who will be serving a prison term stemming from allegations that he sexually abused Native American boys in his care will still be collecting his pension while incarcerated. The total amount he’ll receive during that time: $1.8 million. And it would take an act of Congress to change that.


Three apparent suicides tied to both the Parkland and Sandy Hook mass shootings stunned already devastated communities this week and highlighted just how long-lasting and complicated traumatic grief can be. The deaths sparked an outcry for more mental health help for anyone who has been touched by such an event.


In the miscellaneous file this week:

• A new report paints a grim picture of the quality of care at VA hospitals despite the amount of attention that has been given to the issue.

• In a heartbreaking story I couldn’t look away from (even on deadline!), Stat explores what the parents of babies who die of SIDS have to go through during one of the most traumatic moments in their lives. That includes things like hospital bills and paperwork, but also questions from detectives and judgment from friends and strangers alike.

• In the midst of one of the worst outbreaks in the country, Rockland County, N.Y., took the unprecedented step of banning unvaccinated children from public spaces. Within the Orthodox Jewish community that this affects most, it puts a strain on an already tense relationship with the local governments.

• The anti-abortion movement has been invigorated not only under President Trump, but also by what it sees as a friendly Supreme Court. But will the cases play out as abortion opponents expect? Recent decisions throw cold water on the enthusiasm.

• Following yet another disappointment with potential Alzheimer’s drugs, experts are left wondering where to go next. But some say the thinking that there’s one magic cure is the problem.


That’s it from me! Have a great weekend!

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