Trump's association health plan rule is imminent Presented by

TRUMP's ASSOCIATION HEALTH PLAN RULE IS IMMINENT — The president has touted the plans, which allow businesses to band together to buy health insurance, as a way to offer more coverage options at less cost than plans in the ACA market. As originally proposed, the association health plans could offer fewer benefits than Obamacare plans.

The Labor Department is expected to announce the final rule this morning.

— Among the provisions to watch: How the administration has crafted the rule to prevent fraud and abuse. Many association health plans in the years before the ACA were operated by scammers or quickly went bankrupt, something that's worried state regulators and AHIP.

— Possible impact: Avalere predicted that more than 3 million people would exit the ACA markets and enroll in association health plans by 2022, based on a February analysis of the proposed rule. The shoppers switching to association health plans would likely be healthier people seeking cheaper alternatives, which would damage the ACA markets and lead to higher premiums for the people left behind, Avalere projected.

— The Trump administration couldn't repeal and replace the ACA, but it's steadily chipping away at the law. A second, separate rule to encourage use of short-term health plans — which also would be exempt from many Obamacare requirements and likely siphon customers out of the ACA market — is expected in the coming weeks.

Donald Trump's long-promised association health plans are finally here.

GOP GOVERNORS URGE ADMINISTRATION TO 'REVERSE' STANCE ON ACA's CONSTITUTIONALITY — Three Republican governors joined five Democrats and Independent Bill Walker of Alaska in calling on the Trump administration to "reverse their decision" to ask a court to declare the ACA's safeguards for pre-existing conditions unconstitutional.

"Unbelievably, the administration has chosen to no longer defend the law of the land that protects those with pre-existing conditions," Ohio Governor John Kasich said in a statement. "Once again, both Republican and Democrat governors are standing side by side against this disappointing decision."

ONE QUESTION FACING HHS: WHERE ARE THE GIRLS? — Amid scrutiny of the child separation policy, one question emerged that the Trump administration hasn’t yet answered: Why don’t any of the government-released images of its shelters show any migrant girls?

Homeland Security Secretary Kirstjen Nielsen referred reporters on Monday to HHS for an explanation, saying “the vast majority of children are held” by the agency. POLITICO's Adam Cancryn asked HHS for an explanation, and for any images or video that shows migrant girls in the agency’s shelters. Yet as of Monday night, HHS couldn’t provide a straight answer.

An agency spokesperson first sent POLITICO a pair of YouTube videos of shelters in Florida and Arizona that showed migrant girls – but later clarified that the videos were from 2016 and so was trying to get updated footage.

An hour later, the spokesperson emailed a series of statistics on the shelters, including that two-thirds of children held by HHS in 2017 were boys. However, the email contained no explanation for where the agency is holding migrant girls.

HOUSE OPIOID VOTE-A-PALOOZA CONTINUES — The House this week enters the final stretch of its two-week vote-a-thon on dozens of measures to address the opioid crisis. Lawmakers today plan to consider at least 15 bills under suspension of the rules focused on expanding treatment coverage, beefing up oversight of opioid prescribing and preventing drug abuse among Medicare beneficiaries, POLITICO's Brianna Ehley reports.

— What's on tap today: One bill, H.R.4005, instructs HHS to offer guidance on how states can create a demonstration program to provide Medicaid coverage to inmates 30-days before they’re released from a public institution for better continuity of care. Another bill, H.R. 5773, requires Medicare prescription drug plans to create drug management programs for at risk-beneficiaries.

— What else to watch: Lawmakers later this week will consider the SUPPORT for Patients and Communities Act (H.R. 6), which will serve as the umbrella legislation that will be sent to the Senate.

That bill encourages the use of non-opioid analgesics for post-surgical pain management; aims to increase access to medication-assisted treatment by giving nurse practitioners and physician assistants permanent authority to prescribe MAT, and extends that authority to certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists for five years. It also allows certain providers to treat up to 100 patients with buprenorphine instead of a maximum of 30 in their first year.

The House will also vote on a patient privacy bill and a bill that allows states to get Medicaid reimbursements for opioid use disorder at certain inpatient facilities.

— The timing: House leaders plan to send their opioid legislation to the Senate as early as the end of the week. It’s unclear when the Senate will take up its own opioid legislation.

THIS IS TUESDAY PULSE — Where talk show host Jimmy Kimmel interrupted his charity basketball game with Sen. Ted Cruz to ask the Texas Republican why he didn't support the ACA's protections on pre-existing conditions. See video. ("I figured this was the closest we were going to get to a town hall," Kimmel joked after the heated exchange.)

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With help from Rachana Pradhan (@RachanaDixit), Sarah Karlin-Smith (@SarahKarlin), Victoria Colliver (@vcolliver), Adam Cancryn (@AdamCancryn), Brianna Ehley (@briannaehley) and Jennifer Haberkorn (@JenHab).

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

SENATE HELP LOOKS AT 340B PROGRAM — This morning's hearing will feature Capt. Krista Pedley of the Health Resources and Services Administration testifying about the drug discount program.

— What Lamar Alexander will say: The HELP Committee chairman will raise questions about the need to better understand how hospitals and clinics are spending their 340B-related savings, according to remarks shared with PULSE.

"We … heard that the reason we don’t have much data is because the agency that oversees the program – the Health Resources and Services Administration -- may not have the authority to actually collect data and conduct oversight over the program," Alexander plans to say. "I look forward to hearing from HRSA today … about what Congress can do to evaluate the 340B Program, measure the program’s performance, and ensure that the agency responsible for the program is conducting proper oversight."

CDC: NUMBER OF CIGARETTE SMOKERS AT ALL-TIME LOW — Just 13.9 percent of all American adults smoked cigarettes in 2017, down from 15.5 percent in 2016 and the lowest level ever recorded, according to National Center for Health Statistics data released today.

CDC, for the first year ever, analyzed people in metropolitan areas versus suburban and rural areas. Researchers found cigarette smoking was more prevalent for people not living in metropolitan areas (21.5 percent) compared to people in metropolitan areas (11.4 percent).

The data also found people living outside of metropolitan areas (classified as 1 million or more people) had the highest rates of obesity, diabetes and cases of serious psychological distress. This cohort also had lower rates than their metropolitan peers at meeting federal physical activity guidelines and were more likely to go without needed medical care due to cost over the past year.

The legal ping-pong over Medicaid in Maine continues. The state's health department doesn't want to formally accept Obamacare's Medicaid expansion and continues to seek court permission to not submit the relevant paperwork to the federal government, according to new filings reviewed by POLITICO's Rachana Pradhan.

— Background on the fight: Under the Maine ballot initiative approved by voters last fall, roughly 80,000 low-income adults are supposed to qualify for Medicaid benefits under the Affordable Care Act starting July 2. Gov. Paul LePage‘s administration ignored an early April deadline to formally notify the federal government it would expand, prompting the lawsuit from advocates who spearheaded the ballot measure.

… The Maine Superior Court earlier this month ordered LePage to file a Medicaid state plan amendment by June 11, formally expanding Medicaid as state residents voted to do. While the state appealed the court's order, the court reiterated that the deadline still holds.

… But Maine Health Commissioner Ricker Hamilton is pushing back again, arguing in a new motion to Maine’s highest court that it should not have to do so while an appeal is pending.

“The commissioner has been ordered to make a binding commitment with the federal government to implement a massive new benefit program that the legislature has not yet funded,” Patrick Strawbridge, the attorney representing the LePage administration in the case, wrote in a Monday court filing.

FIRST IN PULSE: Protect Our Care launches '130 Million Strong' campaign about risk to ACA protections. The monthlong campaign will highlight the Trump administration's request to have the ACA's safeguards for pre-existing conditions declared unconstitutional — a move that the pro-ACA group says will put as many as 130 million Americans at risk. More. Protect Our Care also roll out a digital ad slated to air in Alaska, Arizona, Indiana, Maine, Missouri, Montana, North Dakota, Nevada, Ohio, Pennsylvania, Tennessee, Wisconsin and West Virginia. Watch the ad.

California: Physician misconduct bill up for key vote. A bill that would make California the first state to require doctors who are on probation for sexual misconduct or other offenses to disclose that to their patients comes up for a vote today in an Assembly committee, POLITICO's California correspondent Victoria Colliver reports. Olympic gymnast Jamie Dantzscher, who helped bring down former USA Gymnastics team doctor Larry Nassar, and other female athletes will appear at a press conference today to urge committee members to advance Senate Bill 1448, state Sen. Jerry Hill’s third attempt of trying to pass similar legislation.

The bill originally called on physicians to inform their patients about any probationary offense, but the language was watered down to get it through the Senate. It now covers serious offenses that could lead to patient harm.

Nevada: Report sheds light on pharma sales reps. The state released its first findings from a 2017 price transparency law (SB 539) that offers an interesting glimpse into drug reps' promotions and strategy, POLITICO's Sarah Karlin-Smith reports.

— Diabetes drugs were the largest category of medicine handed out as samples (27 percent), followed by drugs for lung conditions like asthma and COPD (15 percent). Opioid and opioid abuse treatment samples accounted for only 3 percent of samples, and other pain relief medicines like migraine drugs and muscle relaxers accounted for 1 percent of samples.

— About two-third of the compensation provided by sales representatives in the states took the form of drug samples, with most of that compensation ( 60 percent) given to doctors. Nurse practitioners received 12 percent of the sales and compensation reported, and physician assistants received another 12 percent. Read the report.

FIRST IN PULSE: United States of Care adds 12 members to its Founder's Council. The new group dedicated to universal access to health care has added advisers from a variety of professions and from both Republican and Democratic administrations. Those advisers include Donald Berwick, a former CMS administrator; David Brailer, who served as the nation's first national coordinator for health IT; Thomas Priselac, the CEO of Cedars-Sinai Health System; and Meena Seshamani, the director of clinical performance improvement at MedStar Health.

By Brianna Ehley

The largest school system in Virginia will include lessons on pre-exposure prophylaxis — PrEP — used to prevent HIV as part of their high school health education curriculum, the Washington Post's Debbie Truong reports. More.

A new NIH study reveals coordination between scientists and the alcohol industry on a study that could have changed America’s drinking habits, Roni Caryn Rabin reports in the New York Times reports. More.

The family separation crisis on the border is also a public health crisis, Dylan Scott writes for Vox. More.

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