with Paulina Firozi


If you want to sell Americans a bill expanding the government’s role in health care, be sure to include “Medicare” in the title.

A crop of health-care legislation named after the popular and well-known federal insurance program for the elderly has sprung up over the past six months. The trend is happening as Democrats and progressives seek to move the conversation away from repealing Obamacare and excite the public about scaling up government benefits instead.

You’ve probably heard of Sen. Bernie Sanders’s (I-Vt.) “Medicare for All,” a measure one-third of Democratic senators are backing. But there are other options, too, such as “Medicare X” from Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.), or “Medicare Extra for All” from the liberal Center for American Progress.

Another Senate duo added their own bill to the mix yesterday. Sens. Chris Murphy (D-Conn.) and Jeff Merkley (D-Ore.) rolled out their “Choose Medicare Act,” touting it as a way to prove Medicare is the best, most efficient way to provide people with coverage by allowing virtually everyone to choose a public plan alongside private options.

“There are some Democrats who have proposed legislation that all Americans move to a Medicare plan,” Murphy told reporters yesterday. “Our bill essentially puts this theory to the test … if Medicare is indeed the best benefit for Americans, then consumers and businesses will make that choice.”

The government health-care program for seniors, Medicare enjoys public support — polls show six in 10 Americans feel it’s working well — plus broad recognition, so it makes sense Democrats would use its terminology to explain how they want to expand federal insurance offerings.

To varying degrees, all the Medicare buy-in bills would give more Americans more access to some type of government coverage. Sanders’s plan would go furthest, essentially converting the U.S. insurance industry into a federal, single-payer system. A scaled-back version offered by CAP would still allow employers to continue offering private coverage, but the coverage would have to comply with prices and benefits set by the government.

The Kaine-Bennet plan proposes a more moderate approach, allowing anyone to buy into a public plan using Medicare's network of providers and physicians. But it phases in that option in slowly while still allowing employers to offer private coverage.

Murphy and Merkley are proposing to allow people to buy a Medicare plan on the marketplaces set up under the Affordable Care Act and use the ACA’s subsidies to help pay for it. Employers could also choose a “Medicare Part E” option to offer their employees instead of the chance to buy private coverage.

“We have here in America a system right now called Medicare in which we have a popular, affordable, high-quality health-care option,” Merkley said. “Shouldn’t every American deserve the opportunity to participate in such a plan? Why reserve such a plan to individuals who are 65 or older?”

There’s little evidence the sweeping overhaul proposed by Sanders would go anywhere under the GOP-led Congress and White House — or even any of the more measured proposals from Democrats.

But it’s telling that Democrats are trying to gain ground on the health-care issue in an election year, showing they feel it’s fertile terrain after Republican plans to repeal and replace Obamacare nosedived last summer. As I wrote in Monday’s Health 202, polls show a majority of the public wants to move toward more government control of health care, and health care is a top issue for voters this year.

So Democrats are laying down some markers with these bills, which give them a platform to start testing whether voters can be moved further to the political left on health care. Four  Senate Democrats with 2020 presidential hopes — Elizabeth Warren (Mass.), Kamala Harris (Calif.), Cory Booker (N.J.) and Kirsten Gillibrand (N.Y.) — are on record supporting Sanders's bill. Harris and Booker are also backing the Murphy-Merkley bill.

They're betting that in the end, Americans will rally behind the affordable, generous coverage that many seniors enjoy on Medicare. “We have faith that over time, consumers will migrate to the choice that’s best for them,” Murphy said.

But it remains to be seen whether the political pendulum -- which swung against even the more modest government involvement in health care under the ACA -- is really moving leftward on health care.


— Health and Human Services Secretary Alex Azar was readmitted to an Indiana hospital Tuesday evening for further treatment and observation for his case of diverticulitis, The Washington Post's Lena H. Sun and Amy Goldstein report. The readmission came about 48 hours after Azar was admitted overnight to St. Vincent’s Hospital after receiving intravenous antibiotics and was later discharged with plans to return to Washington. An HHS spokesman said yesterday that Azar was continuing to receive antibiotics but did not disclose whether he was getting other treatment.

“Diverticular disease is the formation of tiny pouches that bulge out through weak spots in the colon. When they become inflamed or infected, the condition is known as diverticulitis,” Lena and Amy note. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a longtime friend of Azar’s, said he communicated early Wednesday with the secretary, who told him that he was receiving intravenous antibiotics and that doctors “didn’t think there was any need for surgery.”


AHH: A team of 13 drug policy experts set out across a series of conferences in 2015 and 2016 to answer a question: In a perfect world, what would drug policy look like in the United States? Our colleague Christopher Ingraham explains their findings, just published in the International Journal of Drug Policy.

The experts analyzed a range of drug regulation: 1. Absolute prohibition, where use and possession of a drug is illegal for all purposes; 2. Decriminalization, where use and possession are a civil, not criminal offense, but the drug is otherwise illegal; 3. State control of the market, which can include everything from age limits on drug purchases to government control of production and sale; 4. Unfettered free market, where drugs are treated no differently than any other consumer good.

They also looked at how regulating alcohol differs from marijuana, minimizing health risks, protected human rights and individual liberty and reduced crime and incarceration. These were the results:

The researchers found state control is the best approach for regulating both alcohol and marijuana. Absolute prohibition led to the worst outcomes for both substances, but outcomes were dramatically worse for marijuana. "You don't have to look far to see why: each year, hundreds of thousands of Americans are arrested for simple marijuana possession," Chris writes. "Civil liberties are violated, sometimes egregiously, in the interest of policing a plant. Users often opt to experiment with dangerous “synthetic” marijuana substitutes, which have led to mass hospitalizations and some fatalities. Medical use is fraught with legal worries."

OOF: Just as scientific momentum was building around testing lower doses of cancer treatments to save patients money, companies came up with a way to keep the cost of drugs high, our colleague Carolyn Y. Johnson reports.

Carolyn explores a striking example: Early clinical evidence found the cancer drug Imbruvica could work at lower doses, and patients could do just as well on one or two pills a day after an initial round of treatment at three pills. But then Janssen and Pharmacyclics -- the companies that sell Imbruvica through a partnership -- came up with a new strategy to sell the drug at tablets in four strengths, instead of the original 140-milligram capsule. And those tablets would sell for the same flat price of $400, or triple the original cost of the pill.

So if a patient were taking one of the old capsules each day, their out-of-pocket costs under Medicare would be close to $5,000 -- roughly doubling their burden of the cost for the same dosage. The difference in the cost to Medicare would be about $100,000. “Pill-splitting is done all the time in the developing world, where these drugs are not that affordable,” Mark Ratain, an oncologist at the University of Chicago Medicine, told Carolyn. “We're not that far from these drugs being unaffordable in the U.S.”

OUCH: Democrats are universally refusing to support a GOP plan to strengthen work requirements for food stamps, excoriating the proposal as an “ideological crusade” that would hurt the poor, burden state governments and endanger the passage of major food and farming legislation.

In a 26-to-20 vote on party lines, the House Agriculture Committee moved yesterday to advance the farm bill containing the proposal to the House floor, The Post's Caitlin Dewey reports. The measure would dramatically expand mandatory state workfare programs in the Supplemental Nutrition Assistance Program (SNAP) -- otherwise known as food stamps -- and require most adults between 18 and 59 enroll or work at least part time to receive benefits.

Republicans have pitched the change as a commonsense way to shift tservices to the neediest families while giving adults who can more incentive to reenter the workforce. But over the course of more than five hours, Democrats on the usually placid committee denounced the Republican plan as “heartless” and “deceitful” and accused Committee Chairman Michael Conaway (R-Tex.) of shutting them out of negotiations.


— Patrick Kennedy, the former Democratic congressman who served on President Trump’s opioid commission, is raking in more than $1 million as a middle man for companies looking to benefit from the administration’s response to the opioid crisis, Politico’s Adam Cancryn reports.

Kennedy stepped down from Congress in 2011 amid his own battle with addiction and mental illness, founding the behavioral health nonprofit Kennedy Forum -- where he earned more than $1.1 million in total compensation between 2014 and 2016. Adam writes the group is funded in part by major drugmakers and addiction-treatment companies. Kennedy also sits on the boards of eight corporations, collecting fees and holding equity stakes in the firms. As he has advocated for more congressional spending on the opioid crisis, those same firms stand to benefit from efforts to expand treatment and push anti-opioid drugs to the market.

“The many entanglements make Kennedy a one-man nexus of government, private-sector and patient-advocacy work, which he defends as an expression of his lifelong goal to erase the stigma surrounding mental health and addiction,” Adam writes. “He acknowledged that his battles for more government funding and broader use of medication dovetail with the financial interests of the firms he advises and several of the Kennedy Forum’s corporate backers, but said the treatments are also medically sound.”


— Yesterday, the Senate unanimously passed a rule permitting senators to bring children under 1 year old to the chamber floor. Sen. Tammy Duckworth (D-Ill.), who last week became the first sitting senator to deliver a child, had been pushing for a change to the rules.

“With 23 women now serving in the Senate, the issue quickly was resolved,” our colleague Paul Kane reports. “Duckworth has been home since giving birth, and her colleagues realized that it might be easier for her to work if they changed the rules.”

“I would like to thank my colleagues on both sides of the aisle, particularly those in leadership and on the Rules Committee, for helping bring the Senate into the 21st Century by recognizing that sometimes new parents also have responsibilities at work,” Duckworth said in a statement.

— A few more good reads from The Post and beyond:



  • The Senate Appropriations Subcommittee on the Departments of Labor, Health and Human Services and Education and Related Agencies on the budget for HHS.
  • The Tatia Oden French Memorial Foundation will host a hill briefing on two bills on making childbirth safer.
  • The Senate Finance Committee holds a hearing on the opioid epidemic.

Coming Up

  • The Better Medicare Alliance holds a briefing on improving consumer understanding of Medicare Advantage on Friday.

"A wonderful, wonderful person:" Trump pays tribute to Barbara Bush:

President Trump on April 18 spoke about former First Lady Barbara Bush, who died on April 17. (The Washington Post)

"I have no fear of death:" In a 2013 C-SPAN interview, former first lady Barbara Bush explained her faith:

In a 2013 C-SPAN interview, former first lady Barbara Bush explains her "great faith" in God, saying "George and I pray every night." (C-SPAN)

From The Post's Department of Satire: Katy Perry doesn’t get the Post newspaper at her house. So, we took care of that.