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David Shulkin: Trump fired me hours after scheduling a meeting for the next day. Former Veterans Affairs secretary David Shulkin admitted Sunday that his firing over social media was “a surprise” given he had spoken with President Trump “just a few hours before” to schedule a meeting. “We actually spoke the day that he sent the tweet out, just a few hours before,” Shulkin told NBC. “We had set up a meeting for the very next day where I was going to meet with him at 11 in the morning.” “I had no intention of giving up,” Shulkin continued. “There would be no reason for me to resign. I made a commitment, I took an oath, and I was here to fight for our veterans.” Trump announced Shulkin’s departure on Twitter Wednesday, adding Navy Rear Adm. Ronny Jackson, who has served as White House physician for former Presidents George W. Bush, Barack Obama, as well as Trump, would be nominated as Shulkin’s replacement.

While reiterating his denial that he misused taxpayer money for a trip to Europe with his wife in July, Shulkin acknowledged limiting VA political appointees’ access to him if they had demonstrated that they were no longer “willing” to work “effectively” with his team. Shulkin also described his successor as “a good man.” “I think that he should continue to have the veterans’ interests at heart. This is a very tough job.”

Shulkin on his dismissal: ‘I don’t think that this was the president.’ Shulkin doesn’t think Trump wanted him to leave his post, but a cabal of political appointees undermined his position. “I don’t think that this was the president. The president is committed to improving the care for veterans,” Shulkin told CNN’s “State of the Union.” “These appointees had a belief that there was a different way to do it than I was approaching it.” Shulkin, who has been accused of improperly spending taxpayer dollars on travel and accepting improper gifts, said the real reason he was forced out of his job — he refused to say he was fired, only saying “I did not resign” — was a push toward privatization. Shulkin said his process was anathema to Trump’s political appointees in the VA, who wanted more privatization faster.

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Ron Johnson: Trump ‘deserves’ a VA secretary who agrees with him on policy. Sen. Ron Johnson, R-Wis., said Sunday that Trump was right to fire Shulkin. “Well, I think the IG report’s pretty troubling,” Johnson told NBC, referring to VA inspector general Michael Missal’s finding that Shulkin improperly used taxpayer dollars for the Europe trip. “Presidents do deserve and have advisers that actually agree with them on policies. And apparently, there were some policy disputes,” Johnson continued in reference to alleged disagreements between Trump and Shulkin over the direction of the VA, particularly regarding whether aspects of the department be privatized. But Johnson added he would not have dismissed Shulkin via social media. “The president does need to understand the effect it has on attracting other people,” he said.

Experts question medical claims in Jim Mattis’ transgender study. Defense Secretary Jim Mattis is misrepresenting the effectiveness of healthcare treatment for transgender people as a justification for a new policy that would bar many from serving in the military, two leading associations of psychiatrists and psychologists say. The Pentagon’s claim that the scientific evidence is at best “unclear” for treatment of gender dysphoria, the condition of being unhappy in your current gender, and that treatment may not reduce serious risks such as suicide is not the current medical consensus, according to the American Psychological Association and the American Psychiatric Association.​ ​

Drug industry, opponents ratchet up their attacks with eye on HHS. Insurers and drug middlemen squared off with the pharmaceutical industry this week in a pitched battle over blame for high drug prices as the Trump administration crafts a plan to tackle the issue. The pharmaceutical lobby released new ads Monday that blame practices by insurers and drug middlemen for high drug costs. That was met with a response that Big Pharma is just trying to distract the public and lawmakers from the real reason for high drug prices, which is the list price set by drug companies. “We’ve been through this before,” tweeted insurance lobby America’s Health Insurance Plans. “The original list price of a drug drives the entire pricing process, and that price is determined and controlled 100% by Big Pharma.”

Hawaii about to pass doctor-assisted suicide law, while other states face starts and stops. Hawaii is poised to become the first state this year to pass a law that would allow terminally ill patients to request prescriptions from doctors to end their lives, making it the seventh state to have such a law on the books. Advocates are hoping New Jersey and Delaware will follow suit later this year, said Khalid Pagan, senior communications associate for Compassion and Choices, a nonprofit supporting the practice, which the group calls “aid-in-dying.” Hawaii’s Our Care Our Choice Act had broad support from the legislature after decades of advocacy by proponents, and Democratic Gov. David Ige has said he would sign it into law. Hawaii will join California, Colorado, Oregon, Vermont, Washington state, and the District of Columbia in legalizing the practice. Hawaii’s law would go into effect Jan. 1, 2019.

Federal judge temporarily blocks Trump administration from prohibiting pregnant, unaccompanied immigrant teens from getting abortions. A federal judge has temporarily prevented the Trump administration from preventing pregnant, unaccompanied immigrant teenagers in federal custody, or who will be in federal custody, from receiving an abortion. Judge Tanya Chutkan of the U.S. District Court for the District of Columbia ruled that the Office of Refugee Resettlement cannot take away the “right to make their own reproductive choices” from unaccompanied minor children. The preliminary injunction, issued Friday, prevents HHS Deputy Secretary Eric Hargan and other administration officials from cutting off unaccompanied immigrant teenagers’ access to abortion, counseling, medical appointments, and other maternity care.

Trump says opioid crisis linked to ‘sanctuary’ cities. Trump used his weekly address to associate a surge in opioid overdose deaths with local governments not cooperating with federal immigration authorities. “Every day, an average of 116 Americans die from an opioid-related overdose. This is a national crisis that demands immediate action,“ Trump said. After discussing his recently announced administration strategy of drug-use prevention, tougher penalties for dealers, and more drug treatment, Trump said opioid abuse is linked to local immigration-enforcement policies. “If our brave federal agents are going to be successful in stopping this deadly epidemic, then we must stop lawless sanctuary cities. Sanctuary cities release thousands of dangerous criminal aliens into our communities — including drug traffickers, drug dealers, and vicious gang members,” he said.

California accuses hospital network of price gouging. California’s attorney general is suing a major hospital network for jacking up healthcare prices in the northern part of the state. Attorney General Xavier Becerra announced the lawsuit Friday against Sutter Health, a northern California nonprofit network that includes doctors’ offices, surgery centers, and acute care hospitals. “The consolidated market in northern California has driven up prices for consumers,” Becerra said. The cost of an average inpatient procedure in northern California is $223,000 or more, compared to $131,000 or more in southern California, he said. “That is more than a $90,000 difference on where you live for the hospital procedures,” Becerra said. Sutter Health, whose network includes 24 hospitals, responded that it is aware of the lawsuit but hasn’t seen it so “we cannot comment on specific claims.” The network said it has “held average overall rate increases to health plans to the low single digits since 2012 in spite of our actual expenses for labor, facilities and technology increasing more than 37 percent during the same time period.”

Questions surround viability of New York’s approach to cut Medicaid drug spending. New York is expected to hit a statutory limit on Medicaid drug spending this year. It would be the first time the cap has been exceeded since New York passed it under a law in 2011. A new brief from Pew Charitable Trusts said that policymakers should consider whether New York’s approach to Medicaid drug spending is effective at lowering spending. Once the spending cap is met, a commission identifies specific drugs contributing to major costs. The commission then seeks to negotiate supplemental rebates with the manufacturer. If a deal is not struck, the commission can require the drug maker to submit proprietary information on the product to establish target supplemental rebate amounts. If state Medicaid expenditures are still expected to exceed the cap, the commissioner may institute use restrictions and cost containment efforts such as prior authorization for expensive prescriptions. But Pew questions whether the cap can survive legal challenges from the drug industry. “The impact of the drug cap will depend on whether the law is implemented as described as well as manufacturers’ willingness to offer additional rebates. The law creates new state authorities to regulate Medicaid prescription drug spending but it is not yet clear to what extent [the Department of Health] will leverage these authorities to negotiate deeper rebates and potentially remove drugs from the state’s formulary,” Pew said.

RUNDOWN

Axios The drug pricing contract Express Scripts doesn’t want you to see

The Hill Trump declares April 2 World Autism Awareness Day

NPR Scientists say you may live longer by severely restricting calories

STAT News NIH rejected a study of alcohol advertising while pursuing industry funding for other research

New York Times Massachusetts, a health pioneer, turns its focus on drug prices. It’s in for a fight

Wall Street Journal Hospitals fear competitive threat from potential Wal-Mart-Humana deal

Associated Press Studies link legal marijuana with fewer opioid prescriptions

Washington Post Opioid company blames government for Native American crisis