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Democrats seize on Republican inaction on Obamacare. Republicans seem to have resigned themselves to moving on from repealing and replacing Obamacare. But by failing to deliver on an alternative, Republicans aren’t merely enshrining the status quo of Obamacare, they are providing the space that Democrats need to plot their next big expansion. The latest effort, introduced by Sens. Jeff Merkley, D-Ore., and Chris Murphy, D-Conn, would dramatically expand Obamacare and Medicare as part of an effort to transition the system toward a single-payer, or government-run, program. In addition to allowing everybody to buy into Medicare, the program would set a maximum for out-of-pocket spending, and make Obamacare subsidies more generous and available to higher income levels. The proposal leaves out many key details. For instance, the senators do not include an estimate of how much the bill costs or how they would propose to pay for it. It also would struggle with inevitable tradeoffs. If the plan aims to keep costs down by paying doctors and hospitals the same lower rates as traditional Medicare, it will lead to massive losses for providers that will make it harder for Americans to access care. If payment rates are higher, costs can easily spiral out of control. The proposal leaves out many key details. For instance, the senators do not include an estimate of how much the bill costs or how they would propose to pay for it. It is also open to many criticisms and will struggle with inevitable tradeoffs. If the plan aims to keep costs down by paying doctors and hospitals the same lower rates as traditional Medicare, it will lead to massive losses for providers that will make it harder for Americans to access care. If payment rates are higher, costs can easily spiral out of control. These questions and more would no doubt have to be litigated. But for the purposes of looking at the broad trends in healthcare policy, it’s significant to note that Democrats are not in defensive mode. They aren’t, for instance, focusing on ways to scale back Obamacare or ease off on its regulations. With this proposal and others, they are focusing on ways to make its insurance more comprehensive and widely available and less dependent on the private insurance market. And it’s all been made possible by Republican stumbles.

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FDA chief: ‘A lot of blame’ to go around on high drug prices. The head of the Food and Drug Administration said many people are to blame for high drug prices, including the agency itself. “I don’t know that there is one culprit,” FDA Commissioner Scott Gottlieb said Thursday. “There is probably a lot of blame to go around.” Gottlieb spoke before an event in Washington of the Pharmaceutical Care Management Association, a group that represents drug middlemen called pharmacy benefit managers. Gottlieb has levied criticism in recent weeks on the drug supply chain, but Thursday he touched on the agency’s own failings. He said the FDA needs to do more to entice competition in the generic drug market. Chief among important actions it could take is improving the drug approval pathway for generic drugs, which are cheaper versions of a brand name drug. Gottlieb said the agency is moving to improve competition for complex brand name drugs, including regulatory guidance two years before a patent for a brand-name drug expires to help generic companies prepare their own version. He also renewed his criticisms of the drug supply chain, especially efforts to forestall generic competition. Gottlieb also called out the pharmacy benefit managers for their role in limiting access to generic drug samples.

Judge rules HHS broke law in cutting off teen pregnancy funds. A federal judge has ruled that the Trump administration broke the law when it cut off grants to the Teen Pregnancy Prevention Program two years early. The actions resulted in multiple lawsuits. On Thursday, Judge Ketani Brown Jackson of the District Court for the District of Columbia ruled in one of the cases, telling HHS it must accept and process grants from Policy and Research LLC, Project Vida Health Center, Sexual Health Initiatives for Teens and the South Carolina Campaign to Prevent Teen Pregnancy. The order is stayed until April 26, after which it will become final and can be appealed. HHS said it was “disappointed” with the ruling. “As numerous studies have shown, the Teen Pregnancy Prevention Program is not working,” said spokeswoman Caitlin Oakley. “Continuing the program in its current state does a disservice to the youth it serves and to the taxpayers who fund it. Communities deserve better, and we are considering our next steps.”

Opioid prescribing drops largest amount in 25 years. The number of opioid painkillers prescribed last year dropped by the largest rates in 25 years, new data show. IQVIA Institute for Human Data Science, a health data firm, released a report that showed an 8.9 percent drop on average in the number of prescription opioids, such as OxyContin or Vicodin, that were filled by retail and mail-order pharmacies. All states and the District of Columbia were evaluated for the study and had declines of more than 5 percent. Eighteen states had declines above 10 percent, including Pennsylvania and West Virginia, two states that are among the top five in the country with the highest rates of drug overdose deaths. The prescribing drop was 2 percentage points lower than the drop in 2016 and represented a 7.8 percent decline in new patients receiving prescriptions for opioids.

House Democrats urge HHS to reinstate guidance on Medicaid family planning. Democrats on the House Energy and Commerce Committee sent a letter to HHS Secretary Alex Azar expressing concerns about the administration’s actions in January when the Centers for Medicare and Medicaid Services pulled Obama-era guidance saying that states could not limit the ability of Medicaid enrollees to access reproductive services from certain providers, such as Planned Parenthood. “This decision is a complete reversal of prior guidance and stands in stark contrast to the longstanding principle that individuals enrolled in Medicaid should be afforded the same basic rights and privileges as those with private coverage when choosing from whom to receive covered health services,” they wrote. They also pointed to reports suggesting that HHS worked with the Alliance Defending Freedom, which opposes abortion, to craft the guidance. “The apparent coordination between HHS and Alliance Defending Freedom raises serious ethical questions and makes clear that this document should not be relied upon.”

No evidence transgender troops have hurt morale, Navy and Marine Corps say. The uniformed leaders of the Navy and Marine Corps said Thursday they have heard no reports that transgender troops have disrupted cohesion in their units or caused morale or disciplinary problems. Gen. Robert Neller, the Marine Corps commandant, testified to the Senate Armed Services Committee that the only issues reported up to him involved some of the service’s 27 transgender troops being unavailable for duty because of medical treatment. “So, for commanders, some of them have said ‘No, it’s not a problem at all.’ Others have said there is a lot of time where this individual may or may not be available,” Neller told the committee. Neller and Adm. John Richardson, the chief of naval operations, were questioned about unit cohesion, disciplinary problems and morale as the Pentagon is proposing a new policy that would bar many transgender people from serving.

Marijuana activists behind last major White House smoke-in give Trump a breather. Cannabis activists paraded down Pennsylvania Avenue with flags, banners, a 51-foot inflatable joint, and a plan to get high at 4:20 p.m. two years ago in a last-ditch bid to convince President Barack Obama to administratively legalize marijuana. But the rally didn’t sway Obama, who left office with pot still a Schedule I drug under the Controlled Substances Act, meaning illegal for any purpose outside limited research. “I think he will go down among potheads as fitting the stereotype as someone who was lazy. He just sat on the couch,” said Ed Forchion, a New Jersey activist who attended the rally, but who currently is jailed awaiting trial for jury tampering after clashes with Trenton authorities. This year, local activists have a different approach, hosting a National Cannabis Policy Summit at the Newseum on Friday, the annual 4/20 pot holiday, with buttoned-up panels with members of Congress, journalists, and nonprofit leaders. There’s no plan to march on the White House.

Schumer introduces bill to legalize pot. Senate Minority Leader Chuck Schumer introduced legislation on Friday that would decriminalize marijuana at the federal level and establish “dedicated funding streams,” for women and minority businesses to grow and distribute the drug. “The time has come to decriminalize marijuana,” the New York Democrat saidt. “My thinking, as well as the general population’s views on the issue has evolved, and so I believe there’s no better time than the present to get this done. It’s simply the right thing to do.” Schumer’s legislation would maintain laws that prevent trafficking of marijuana across state lines in cases where the drug is legal in one state but not in a neighboring state.