| Good Monday morning, where we're hoping you're finding ways to beat the heat. Send your coolest tips to rachel.roubein@washpost.com. Today's edition: The Senate parliamentarian is expected to hold a bipartisan meeting on Democrats' drug pricing plan Thursday. Doctors treating monkeypox patients say they're facing "daunting" paperwork. But first … | Abortion fight moves to terrain least favorable to Republicans |  Abortion rights demonstrators outside the Tampa venue for a summit of the conservative group Moms For Liberty. (Octavio Jones/Reuters) | | | Republicans hoped public backlash to the Supreme Court's decision overturning Roe v. Wade would soon fade from the spotlight, and campaign season would once again turn to the prices of gas and groceries. But over the past week, the abortion debate has focused on terrain least favorable to the GOP — whether the procedure should be legal in the instances of rape and incest, as many conservatives push for bans without those two exceptions, Michael Scherer and I report. Though the nation remains divided on abortion policy, excluding exceptions for rape runs counter to public opinion. About 69 percent of Americans — including 56 percent of Republicans — say abortion should be legal when the pregnancy is a result of rape, according to a March Pew Research Center poll. The recent controversies over maternal health and the consequences of rape are validating the thinking of Democratic midterm strategists who have argued that the Supreme Court's decision would lead to months of public debate over the least popular parts of Republicans' proposals to limit abortion. On Capitol Hill, Democrats will continue to make Republicans take uncomfortable votes, such as one this week in the House on protecting access to contraception. THE LATEST Here's the abortion debate that has dominated the public spotlight over the past week. | | | | | | | | Optum Rx's Genoa Healthcare is embedded in community health centers & offers customized pharmacy services for people with behavioral health & other complex, chronic health conditions. Learn more. | | | |  | | | | - Ohio Gov. Mike DeWine (R), who is facing reelection, hasn't commented on the law he signed that prompted a 10-year-old rape victim to travel to neighboring Indiana for the procedure.
- Indiana Attorney General Todd Rokita (R) had said he was looking at prosecuting the Indiana doctor for failing to report the case. Records show the OB/GYN did report the case as required under Indiana law.
- Texas Attorney General Ken Paxton filed a lawsuit to block Biden administration guidance reminding doctors they must terminate a pregnancy if doing so is necessary to stabilize a patient in an emergency medical situation.
| | This comes as roughly a dozen state restrictions on abortion are now in place following the high court's decision last month. All of the newly implemented limits include exceptions for life of the mother, but most don't include an exception for rape or incest. The exceptions are South Carolina — which has exemptions for both — and Mississippi's trigger law has an exception for rape, according to the Guttmacher Institute, a research group that supports abortion rights. Republicans will likely continue to face scrutiny over their positions on exemptions — some of which may differ from the laws they've signed while in office. For instance: Arizona Gov. Doug Ducey, a Republican, was asked yesterday on CNN's "State of the Union" whether he supported a total ban on abortion. | - "What I ran on in 2014 is that I am pro-life, with exceptions for life of the mother, rape and incest," Ducey responded. "And that's what I remain."
- Ducey signed legislation earlier this year banning the procedure after 15 weeks, which didn't include exemptions for rape and incest. (A spokesperson didn't respond to The Health 202 on why he signed the legislation without the exemptions he supports.)
| | EYE ON THE MIDTERMS Among many leading antiabortion groups, there's general agreement around banning abortion in the cases of rape and incest, but including exceptions for life of the mother. Some major groups say they've supported legislation in states that choose to allow all three exceptions to garner enough political favor to pass new restrictions. "Substantively, the movement was never in favor of rape and incest exceptions," said Mary Ziegler, a professor of law at the University of California at Davis. "What's changed, I think, is just the political willingness to say that that's what the movement wants." Democrats think such positions will give them a political edge. "It's inevitable that the worst manifestations of these extreme laws are going to start surfacing in many states," David Axelrod, a former strategist for President Barack Obama, told The Post's Colby Itkowitz. Yet, Republicans remain confident that abortion won't upend their hopes of winning control of Congress come November. They point to polls showing Americans' concerns with the economy and inflation rates that have continued to climb at their fastest pace in four decades. | | "While abortion is an issue people care about, the data makes clear that it is not among the top issues that will drive voting behavior in November," a recent memo from the Republican State Leadership Committee advised candidates. "Instead, this election will remain about Biden's failing economy." | | |  | On the Hill | | Drug pricing Byrd Bath meeting expected Thursday |  Sen. Joe Manchin III (D-W.Va.) delivered an ultimatum to Democratic leaders last week in the quest to pass the party's long-stalled economic package. (Sarah Silbiger/Bloomberg News) | | | The Senate parliamentarian on Thursday is expected to hold arguments between the two parties on Democrats' plan to allow Medicare to negotiate drug prices, a Senate aide told The Health 202. Earlier this month, Democrats sent the latest version of their drug pricing bill to the parliamentarian, who is the arbiter of what policies can be included in the fast-track budget maneuver the party is using to pass its economic package without any GOP votes. This comes after Sen. Joe Manchin III (D-W.Va.) dealt a major blow last week to Democrats' plans for an economic package. The long-stalled measure will no longer include efforts to combat climate change or raise taxes on wealthy Americans or corporations, per Manchin's demands. Instead, it has turned into a health-care bill, with Manchin open to the party's drug pricing bill and a two-year extension of enhanced Obamacare subsidies. On Friday, President Biden called on congressional Democrats to adopt a package soon that aims to lower Americans' health-care costs. Democrats are set to confront the impasse directly during their weekly lunch on Tuesday, our colleague Tony Romm reports. | | Sen. Bernie Sanders (I-Vt.) on ABC's "This Week": |  | | | | | |  | From our reporters' notebooks | | | Our colleague Dan Diamond writes to us: | | Doctors treating monkeypox say they've faced 'daunting' paperwork and obstacles. Infectious-disease experts fighting the record U.S. outbreak say they continue to encounter barriers with tests, vaccines and treatments. One challenge: trying to prescribe an antiviral called Tpoxx, which the Food and Drug Administration approved to fight smallpox and has been encouraged for use against monkeypox too. In interviews, four physicians last week each described an hours-long process to prescribe the treatment to a single patient. Advocates and experts, including former New York City health official Jay Varma, wrote to senior Biden officials on Friday, urging them to expedite access to Tpoxx. Others have voiced persistent complaints about ongoing test delays and the Centers for Disease Control and Prevention's vaccine-sharing formula, with New York Mayor Eric Adams writing a letter to Biden saying that his city — a monkeypox hot spot — has received too few doses. Federal officials on Friday said the outbreak is being aggressively managed, and more tools are coming. "While this work is not what you're seeing across the headlines, it is happening," CDC Director Rochelle Walensky said on a media call, where officials touted more testing and announced that 131,000 additional doses of vaccine would soon be distributed. The CDC also posted a new page of resources intended to simplify access for doctors seeking to prescribe Tpoxx. But confirmed U.S. monkeypox infections surpassed 1,800 on Friday, and Walensky acknowledged that they're bracing for cases to potentially rise into August. | | Scott Gottlieb, former FDA commissioner: |  | | | | | |  | Reproductive wars | | Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care |  In the wake of the Supreme Court ruling overturning Roe, doctors face murky state laws when treating patients in need of lifesaving pregnancy care. (iStock) | | | Physicians and patients are navigating a new reality in a post-Roe world in which the standard of care for incomplete miscarriages, ectopic pregnancies and other common complications is being scrutinized, delayed and even denied, jeopardizing maternal health in the process, The Post's Frances Stead Sellers and Fenit Nirappil report. Without treatment, pregnant people experiencing complications risk severe bleeding, infection and even death. And while state abortion bans typically include exceptions when a patient's life is endangered, the laws can be murky, prompting some obstetricians to consult lawyers and hospital ethics committees. Those decisions become even harder for patients suffering from complications that can be difficult to confirm, like some ectopic pregnancies. In cases where it's difficult to confirm, performing an abortion could violate state laws even if the pregnancy isn't viable. | - As many as 30 percent of pregnancies end in miscarriage, which are treated with the same medication or surgical procedures used in elective abortions.
- Doctors in Texas, where abortions have been illegal after the detection of fetal cardiac activity since September, report that pharmacists have begun questioning patients about miscarriage medications, suspecting they may be used instead for abortions.
| | Meanwhile, some antiabortion groups and conservative lawmakers have characterized doctors' concerns as overblown, saying that the abortion restrictions wouldn't prevent them from responding to medical emergencies. | | More from Fenit: |  | | | | | |  | In other health news | | - The Biden administration is proposing to raise payments for certain hospitals to buy N95 masks produced domestically.
- Three Republicans joined House Democrats on Friday to pass legislation protecting patients traveling over state lines for abortion care. Lawmakers also approved the Women's Health Protection Act to codify abortion rights almost entirely along party lines, with every Democrat but Rep. Henry Cuellar (Tex.) in favor.
- A cohort of House Democrats hailing from states that haven't expanded Medicaid sent a letter Friday pushing party leaders to include a measure closing the coverage gap in the economic package.
| | |  | Daybook | | | Tuesday's hearings: A House subcommittee on the coronavirus on the health and economic consequences of long covid; a House Energy and Commerce subcommittee on the impact of overturning Roe v. Wade. Wednesday's hearings: A Senate Appropriations subcommittee on food safety and the FDA; the Senate Commerce, Science and Transportation Committee on the nomination of Arati Prabhakar for director of the White House Office of Science and Technology Policy; the Senate Veterans' Affairs Committee on VA's electronic health record modernization program. And on Friday, our Washington Post Live colleagues will sit down with CDC Director Walensky to discuss coronavirus variants and other public health issues. | | |  | Health reads | | | By Timothy Bella and Kim Bellware | The Washington Post ● Read more » | | | | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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