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Good morning ... Situational awareness: Ronny Jackson's nomination to lead the Department of Veterans Affairs continues to implode.

1 big thing: health care and the midterms
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Data: SurveyMonkey poll conducted April 2–23, 2018Poll Methodology; Chart: Axios Visuals

More than half of voters in Arizona, Nevada and Tennessee want Congress to modify the Affordable Care Act, while less than a third want it to be completely repealed and only 6% think Congress should “let it fail.”

Why it matters: Arizona and Nevada are seen as the states where Democrats have the best chance in November to take Senate seats currently held by Republicans, and Tennessee is working its way up the list. One of Democrats' most unifying and effective messages this cycle is health care, and they'll be sure to campaign hard against the GOP's repeal effort in these states.

2. When a critical treatment disappears

There's a pump, which can be implanted in cancer patients' abdomens, that sends high doses of chemotherapy straight to patients' livers, adding years to the average patient's lifespan. At least, there is for now. Its manufacturer, Johnson & Johnson, plans to quit making the device, The New York Times reports.

The big picture: The Codman pump is a medical device, not a drug, but it still raises some of the same issues that could confront the next generation of highly personalized treatments — products that work better for a smaller number of people, probably at a higher price.

The details, per the NYT:

  • Patients at Memorial Sloan Kettering Hospital who got the pump lived about two years longer than patients who didn't.
  • The manufacturer said it had to quit making the device because of increases in the cost of raw materials. The device costs between $7,000 and $11,000.
  • “There’s a group of patients where we can’t figure out what to do. This thing really does work," Myron E. Schwartz, a liver surgeon at Mount Sinai, told the paper.
3. Q1 earnings lightning round

My colleague Bob Herman is here to catch you up on some of the most important nuggets from the health care industry’s Q1 earnings spree this week.

  • Amgen: The maker of blockbuster drug Enbrel recorded a 42% profit margin, and Wall Street mostly shrugged.
  • Anthem: Stock rose 6% yesterday on bigger-than-expected profits of $1.3 billion and $22.5 billion of revenue. The lofty earnings were helped in part by Anthem’s decision to bail on many ACA marketplaces.
  • Biogen: CEO Michel Vounatsos said there has been “absolutely no impact” thus far from new copay accumulator programs that restrict how consumers can use coupons for their drugs. Quarterly profit soared to $1.2 billion.
  • LabCorp: Medicare cuts didn’t decimate profits, similar to what its rival Quest reported, although CEO David King said the company continues to work aggressively with lobbyists to “fix the error” it believes Medicare made. LabCorp’s earnings fell 5% to $173 million.
4. FDA vs. Juul

Teens vaping at a 2017 Vapexpo in Russia. Photo: Sergei Konkov/TASS via Getty Images

The e-cigarette manufacturer Juul says it’s on the FDA’s side in the campaign against youth access to e-cigarettes.

The latest: The FDA earlier this week announced a multi-pronged crackdown on e-cigarettes — specifically the ones most popular among teens, which includes Juul.

  • The FDA's enforcement measures included a nationwide sweep of retailers suspected of selling the products to children, as well as document requests to Juul designed "to better understand the reportedly high rates of youth use and the particular youth appeal of these products."

What's next: The company will begin running a series of full-page ads today in Washington, New York and Boston, casting itself as an ally of the FDA and a positive force for change among adult smokers.

  • "Underage use is never acceptable. However, neither is it acceptable for those of us at JUUL to not fully commit ourselves to helping the 38 million smokers in the U.S," CEO Kevin Burns says in the ad.
5. New, big health care CEO pay numbers

Bob has tallied up the 2017 pay packages of 30 health care CEOs so far this proxy season, including the five newly released figures below, and those executives have made a combined $976 million — or double the annual budget of the National Institute on Alcohol Abuse and Alcoholism.

Regeneron

  • CEO Leonard Schleifer: $95.3 million
  • Pay ratio: 772:1 (median employee made $123,418)

UnitedHealth Group

  • CEO Dave Wichmann: $83.2 million
  • Pay ratio: 1,425:1 (median employee made $58,378)

PRA Health Sciences

  • CEO Colin Shannon: $38 million
  • Pay ratio: 593:1 (median employee made $64,051)

BioMarin Pharmaceutical

  • CEO Jean-Jacques Bienaimé: $18.5 million
  • Pay ratio: 132:1 (median employee made $140,140)

HealthEquity

  • CEO Jon Kessler: $17.1 million
  • Pay ratio: 432:1 (median employee made $39,657)

What we're watching today: A dozen health care companies report earnings today, including pharma giants AbbVie and Bristol-Myers Squibb and device companies Stryker and Zimmer Biomet.

Senate homeland security panel hearing on HHS' efforts to combat human trafficking. House Ways and Means Committee hearing on innovation in health care.