Good morning ... At long last, this cruel world is starting to address the real problems.
Illustration: Sarah Grillo/Axios
President Trump's health care agenda is making more enemies than friends, hitting brick walls and fierce opposition in the courts, in Congress and even within his own administration.
Driving the news: Yesterday was a bad day for two of Trump's biggest health care priorities.
The big picture: These are different kinds of setbacks, and there's still a long way to go in all of these legal proceedings. But together, the crosswinds — the political resistance on one side and substantive losses on the other — leave Trump's agenda in a precarious place.
This will keep happening. The administration appears close to finalizing the part of its drug-pricing plan that calls for including drugs' sticker prices in their TV ads. The pharmaceutical industry will likely challenge that proposal in court.
Of all the policies the Health and Human Services Department has actually finalized under President Trump, it's hard to think of a more significant rightward turn than the approval of Medicaid work requirements.
But Judge James Boasberg is still not having it. He ruled against Kentucky's work requirements yesterday for the second time, citing many of the same reasons from his first opinion — namely, that HHS is not living up to Medicaid's legally defined purpose as a health care program.
Arkansas didn't fare much better, though that case is still earlier in the process than Kentucky's.
What's next: New Hampshire's work requirements are also being challenged in court.
Congressional Republicans are not happy about President Trump's decision to up the ante in the latest legal challenge to the Affordable Care Act.
The intrigue: Acting White House Chief of Staff Mick Mulvaney was the driving force behind the White House's new legal positioning.
The bottom line: Republicans are in this boat now, like it or not.
If Trump ultimately prevails here — which legal experts still consider a long shot — Republicans' decision to go nine years without ever coming together on an alternative to the ACA, while still putting themselves in a position to need one, may finally catch up to them.
FDA commissioner Scott Gottlieb. Photo: Drew Angerer/Getty Images
The Food and Drug Administration is planning to impose tougher safety requirements on the ingredients in prescription drugs, following an investigation by Bloomberg's Anna Edney into safety and quality issues at overseas facilities.
Details: The active ingredients in many pharmaceuticals, especially generics, come from China and India, but the FDA has few inspectors on the ground in those countries. So it requires drugmakers to self-report safety or quality issues.
"We've seen a lot of instances of adulterated products — contamination, impurities — recently," FDA commissioner Scott Gottlieb told Bloomberg. "The underlying causes have been traced back to manufacturing, inadequate quality controls and generally poor management oversight."
Once-off-limits drugs are gaining a bigger foothold in the health care market as scientists reassess how they work and what they're capable of.
Cannabis is the leader on this front. Marijuana is a booming business, and the FDA approved a drug last year derived from cannabis.
Psychedelics are also getting a closer look from pharmaceutical companies.
Between the lines: CBD and psychedelic medicine are very different. Cannabis oil doesn't produce a high like smoking marijuana does. Psychedelic drugs do still have profound effects on the brain, which is why they're so tightly regulated and scarcely used.
Centene's plan to buy WellCare will create a new, consolidated powerhouse for privately administered government programs.
By the numbers: Centene and WellCare are both major players in Medicaid managed care, combining for over 12 million enrollees.
The bottom line: Privately run, government-funded health care is stable and lucrative. Medicare Advantage and Medicaid managed care are both growing, and this deal will also help Centene diversify away from the ACA's exchanges at a time of stagnant enrollment and existential political threat.
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