Overnight Health Care: Trump poised to roll back transgender health protections | House Dems plan 'Medicare for All' hearing next week | Walgreens, Rite Aid raise tobacco-buying age to 21 | Drug distributor faces charges for role in opioid crisis

Overnight Health Care: Trump poised to roll back transgender health protections | House Dems plan 'Medicare for All' hearing next week | Walgreens, Rite Aid raise tobacco-buying age to 21 | Drug distributor faces charges for role in opioid crisis
© The Gender Spectrum Collection

Welcome to Tuesday's Overnight Health Care.

Court watchers and advocates think the Trump administration is poised to roll back rules that protect transgender individuals from discrimination in health care. Also on today's docket: Drug stores are raising the tobacco age to 21, and House Democrats will hold the first hearing on "Medicare for All" next week.

We'll start with transgender health:


Trump poised to roll back transgender health protections

A proposed rule from the Department of Health and Human Services (HHS) expected in the coming days would make it easier for doctors, hospitals and insurance companies to deny care or coverage to transgender patients, as well as women who have had abortions.


The proposal in question is likely to be a reworking of an anti-discrimination section of ObamaCare.  

The worry: Advocates fear the administration will eliminate the gains made in ensuring transgender people have equal access to care. Coming on the heels of the military transgender ban, there are fears the administration could go even further and use the proposal as an opportunity to narrow the definition of gender.

How did we get here: The Obama administration in 2016 issued a rule that, among other provisions, prohibited health care providers and insurers from discriminating against a person based on gender identity and "termination of pregnancy." A coalition of conservative states and faith-based providers sued to challenge the rule. They won, but the lawsuit was put on hold in July 2017 when HHS said it was developing a rule that would fix the issues addressed in the suit.

Still waiting: The Trump administration has been saying this rule is coming for the better part of two years. The proposal from HHS has been under regulatory review at the White House Office of Management and Budget for over a year. Before that, the Department of Justice (DOJ) said it was reviewing a rule that had already cleared HHS.

What's changed: The administration hinted in a recent court filing that new health regulations could be published as soon as next week. At the beginning of this month, the DOJ asked for a three-week extension to file a motion. This delay would have allowed enough time for the White House to finish reviewing the rule and publish it. But DOJ suddenly withdrew the extension request and filed a motion anyway. Still, experts think this means the proposal could be published by the end of the month.

Read more on the lawsuit and proposal here.


House Dems to hold hearing on Medicare for All next week

Get ready for a Medicare for All hearing next week! Just not where you'd expect.

The House Rules Committee announced it will hold a hearing on the Medicare for All bill from Reps. Pramila JayapalPramila JayapalDemocrats urge Biden to commute sentences of 4K people on home confinement Manchin keeps Washington guessing on what he wants The Hill's Morning Report - Presented by National Industries for the Blind - Schumer: Dem unity will happen eventually; Newsom prevails MORE (D-Wash.) and Debbie DingellDeborah (Debbie) Ann DingellVirginia Democrat introduces tax credit for electric commercial vehicles More than 100 Democrats back legislation lowering Medicare eligibility age to 60 The Hill's 12:30 Report - Presented by AT&T - Texas's near abortion ban takes effect MORE (D-Mich.) on Tuesday.

What it means: Take note that the hearing is happening in the Rules Committee. There's a reason for that: The main health care committees, Ways and Means and Energy and Commerce have so far declined to commit to holding hearings on the legislation.

But Rules Committee Chairman Jim McGovern (D-Mass.) is more supportive of Medicare for All.

GOP ready to attack: Republicans, eager to attack Democrats over Medicare for All, quickly got in some trolling, questioning why other committees were not holding hearings.

"Will @EnergyCommerce be next? That's where a debate about health care ought to be," Republicans on the Energy and Commerce panel tweeted on Tuesday.

Read more here.


Walgreens, Rite Aid change tobacco purchasing policy

Both companies announced Tuesday customers would need to be 21 or older to purchase tobacco products in their stores.

Walgreens and Rite Aid framed the changes as a public health decision but it's likely more of a PR move.

Here's why:

Momentum is gaining in the states and in Congress to raise the minimum purchasing age for tobacco age to 21.

Twelve states have already done so, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnell'Justice for J6' rally puts GOP in awkward spot Republicans keep distance from 'Justice for J6' rally House to act on debt ceiling next week MORE (R-Ky.) said last week he would introduce legislation next month to raise the national minimum purchasing age to 21.

Businesses likely see that change is coming and are looking to get ahead of it. It remains to be seen how the companies will succeed. Earlier this year, the Food and Drug Administration put both companies on notice for having extremely high rates of underage tobacco sales.

Read more on Walgreens here and Rite Aid here.


PBM lobbying spikes as industry faces pressure

Lobbying by the pharmacy benefit manager (PBM) industry -- the so-called "middlemen" in the supply chain-- spiked in the early part of this year as the industry has fought regulation from the Trump administration as well as bipartisan scrutiny from lawmakers over the cost of prescription drugs.

The Pharmaceutical Care Management Association, which is the main trade group for PBMs, spent nearly $1.5 million during the first three months of the year. At the same time last year, the group reported about $741,000.

Some of the largest individual PBMs also reported large expenditures. Cigna spent $1.76 million in the first quarter, compared to $1.5 million in 2018. CVS Health (and its subsidiaries) reported spending $2.4 million so far this year. They spent about $1.8 million at the same point last year.

Why so much money: PBMs are bracing for a Trump administration rule that could upend their business model. And lawmakers have indicated they are working toward legislation that could limit how PBMs make money and bring transparency to the system.

The industry is also engaged in a war of words with drug companies, as both sides try to shift the blame for high drug prices. Drugmakers blame PBMs and insurers, while those groups say pharmaceutical companies are responsible for high prices.


Drug distributor faces federal charges for role in opioid crisis

The federal government is ramping up prosecutions of the people and companies it holds responsible for the opioid epidemic.

Rochester Drug Cooperative (RDC), the nation's sixth-largest pharmaceutical distributor, has become the first major distributor to face federal criminal charges in connection to the opioid crisis, authorities announced Tuesday.

The U.S. Attorney's Office in Manhattan charged the Rochester, N.Y.-based distributor on Tuesday with failing to report thousands of suspicious orders of oxycodone, fentanyl and other controlled substances and defrauding the federal government, according to the complaint.

Drug distributors have come under fire from lawmakers for their alleged oversight failures in cases of pill dumping, especially in West Virginia. Distributors are required by law to submit suspicious drug orders to the Drug Enforcement Administration

Between 2012 and 2016, RDC is accused of distributing tens of millions of doses of oxycodone, fentanyl and other opioids to pharmacies that its own compliance department found had no legitimate need for them.

Read more here.


Dem primary voters rank health care as top issue

Twenty-five percent of likely Democratic primary voters rank health care as their top issue heading into 2020, according to a Morning Consult Poll released Tuesday.

The poll only broke down these numbers for the supporters of four Democratic presidential candidates: South Bend, Ind. Mayor Pete ButtigiegPete ButtigiegOn The Money — Presented by Wells Fargo — Pelosi plows full speed ahead on jam-packed agenda Blumenthal calls on Buttigieg to investigate American Airlines-JetBlue partnership LGBT film festival to premiere documentary about Pete Buttigieg MORE, Sens. Elizabeth WarrenElizabeth WarrenFederal Reserve officials' stock trading sparks ethics review Manchin keeps Washington guessing on what he wants Warren, Daines introduce bill honoring 13 killed in Kabul attack MORE (D-Mass.) and Bernie SandersBernie SandersSunday shows preview: Coronavirus dominates as country struggles with delta variant Democrats urge Biden to commute sentences of 4K people on home confinement Briahna Joy Gray: Push toward major social spending amid pandemic was 'short-lived' MORE (I-Vt.) and former Vice President Joe BidenJoe BidenSunday shows preview: Coronavirus dominates as country struggles with delta variant Did President Biden institute a vaccine mandate for only half the nation's teachers? Democrats lean into vaccine mandates ahead of midterms MORE, who is entering the race on Thursday.

Buttigieg supporters are more likely to say health care issues are most important to them (34 percent) than supporters of the other three candidates.

Twenty-seven percent of Warren supporters, 26 percent of Sanders supporters and 24 percent of Biden supporters rank health care as their top issue.

But for Biden supporters, seniors' issues actually top the list as the most important issue (26 percent.)

Why it matters: It's early in the 2020 campaign, but it's no surprise that health care is at the top of everyone's minds. Sanders, the frontrunner for the Democratic nomination, has made his Medicare for All plan a centerpiece of his campaign and the Trump administration is trying to dismantle ObamaCare in court.

Read more here.


Kamala HarrisKamala HarrisRepublicans caught in California's recall trap Harris facilitates coin toss at Howard University football game Far-right rally draws small crowd, large police presence at Capitol MORE on Medicare for All

Republicans found an easy attack line for Harris when she said earlier this year about private insurance (in the context of her support for Medicare for All): "Let's eliminate all of that. Let's move on."

She is a co-sponsor of Sanders' bill, which would essentially end the private insurance industry as we know it.

But she it seems like she's taking a new approach to describing what Sanders' bill would actually do to private insurance. From her town hall on CNN Monday night (transcript from CNN.):

CNN anchor Don LemonDon Carlton LemonTucker Carlson says he lies when 'I'm really cornered or something' CNN's Chris Cuomo taking birthday vacation as calls for brother's resignation grow The Hill's 12:30 Report - Presented by AT&T - What happens to Cuomo now? MORE: So the bill that you co-sponsored, it would effectively eliminate private insurance.  Is there room for private insurance in a...

HARRIS:  Of course there is.  For supplemental insurance, absolutely.  

LEMON:  For companies, for private insurance companies?

HARRIS:  Absolutely.

LEMON:  There's room in your administration for that?

HARRIS:  Yeah.


And more...

LEMON: Yes, were a co-sponsor with Bernie Sanders, Medicare for all would effectively eliminate private insurance.  It would essentially phase out private insurance companies...

HARRIS:  As the -- as the main source.  

LEMON:  ...in four years, as the main source.

HARRIS:  But there will still be supplemental.  There would still be access to supplemental insurance.


Thought bubble: Sanders' bill would actually make it illegal for companies to sell health plans that cover the same services as the new government plan. But there's not much Sanders' bill wouldn't cover, aside from unnecessary medical procedures, like cosmetic surgery. Sanders himself has said insurance companies could still offer coverage for these types of services. Maybe that's what Harris is trying to get at.

We think Jonathan Cohn from HuffPost put it succinctly in a tweet:

"Harris is technically correct that M4A would allow supplemental coverage for what the public program doesn't cover. But the public program would include every medically necessary service, so that doesn't really leave much for supplemental to cover."

-- Jonathan Cohn (@CitizenCohn) April 23, 2019


What we're reading

Medicaid expansion tied to positive gains for black babies (CNN.com)

Surprise medical bills: Two babies, two very different price tags (NBC News)

As calls for measles vaccination rise, it's crickets from the White House (Stat)

Centene's ObamaCare enrollment soars as WellCare deal faces regulators (Forbes)


State by state

Maine House approves bill removing religious, philosophical vaccine exemptions (Portland Press Herald)

While most states are expanding Medicaid, Florida Legislature aims to shrink it (Miami Herald)

Alabama politicians compare abortions to the Holocaust in proposed legislation (CBS News)

Medicaid expansion could reduce benefits to some 25,000 Nebraskans now on the program (Omaha World Herald


From The Hill's op-ed page

Top-down government efforts to corral drug prices will fail

The next FDA chief has big pro-consumer shoes to fill