Reporter

THE PROGNOSIS

When Kara Eastman, a social worker and professed progressive advocate, decided to run for Congress in a lean-red district in a deep-red state, she was driven by her mother’s exorbitant medical bills for her cancer treatment.

Her mother died before she could see her 46-year-old daughter canvass Nebraska’s 2nd Congressional District advocating for “Medicare for all,” the latest catchall term for government-provided health care that is catching on in congressional races across the country, dividing Democrats from each other but also shaping the terms of a new health-care debate for 2018.

In her race, Eastman pressed for a single-payer system in which everyone would get health care paid for by the government, while her opponent, Brad Ashford (D), a well-known former congressman who lost his seat in 2016 and was trying to win it back, called that impractical and said the more politically reasonable approach was a public option in which Americans could opt to buy in to Medicare.

With her Bernie Sanders-esque platform, Eastman ultimately overtook party establishment-pick Ashford in a shocking upset and in November will face incumbent Rep. Don Bacon (R), who is slightly favored in a tough race. (Fun, albeit random, aside: At least Ashford will always have the memory of the time the wife of GOP kingmaker Sheldon Adelson dropped her purple Hermés on him from her perch in the gallery during a 2015 visit to Congress from Israeli Prime Minister Benjamin Netanyahu.)

Successes such as Eastman’s are occurring in Democratic primaries across the country. And unlike Alexandria Ocasio-Cortez, the overnight political sensation who bested 10-term incumbent Rep. Joe Crowley in last month's Democratic primary in New York — which basically secured her a seat in Congress in the solidly blue district — progressives are winning in conservative parts of the country, too.

They’re motivated by Sanders’s insurgent run against Hillary Clinton in 2016. They’re motivated to be as diametrically opposed to President Trump as possible. They’re even motivated by the tea party.

“I think there’s still a divide on the way back to power, the way back to a majority, but I think we are seeing a push to the left and a thinking that drawing a sharp contrast with the GOP is a better strategy than trying to beat them in the middle with a moderate message,” said Nathan L. Gonzales, a longtime elections analyst. “I think there could also be some envy of the tea party in pulling the party to the right by not compromising and standing on their principle and seeing the GOP still gain power.”

Using the popular Medicare program to sell a more expansive government-health care system is a newer strategy and hasn’t yet been road tested in a general election. But it's received so much traction on Capitol Hill and the campaign trail that Buzzfeed put it best when describing it as having "the potential to become a new litmus test for the Democratic Party.” 

Of the 57 Democrats, like Eastman, who have won primaries and will challenge GOP incumbents in swing districts this fall, 33 support some form of Medicare for all, according to data from the Progressive Change Campaign Committee (PCCC). Nearly two-thirds of that group use the term in their campaign materials and just over a quarter are running in districts that Trump won.

For Adam Green, co-founder of the PCCC, there is no Medicare for all purity test. There are many Democrats who aren't the entire way there on a single-payer system, and use the term Medicare for all to mean a public option, where Americans of all ages can buy into the program that is now limited to people over 65.

“Right now, we very much see a Medicare-for-all option as the floor and Medicare-for-all single payer as the ceiling,” Green said. “We want to make clear every Democrat can support some version and not shoot themselves in the foot by forfeiting that golden language.”

Public polling on some form of Medicare for everyone has already shown widespread support. A whooping 75 percent of Americans support Medicare becoming an option for any American who wants it, according to a Kaiser Family Foundation survey, and more than half are in support of a single government health-care program. 

High-profile Democrats, including several likely to make a bid for the White House in 2020, are signing on to the various Medicare-for-all bills being introduced in Congress. Unsurprisingly, Sanders (I-Vt.) has the most ambitious version, which would essentially turn Medicare into America's national health-care system. Possible presidential hopefuls, Democratic Sens. Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y), Cory Booker (N.J.) and Kamala Harris (Calif.), have signed on as co-sponsors.

Other senators have versions that make Medicare available as an alternative to private insurance. Sens. Chris Murphy (D-Conn.) and Jeff Merkley (D-Ore.) have a bill to allow anyone, regardless of age, to choose Medicare coverage. Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo,), have one called "MedicareX"  that would roll out such a program slowly in areas without many insurance options. During a recent Health 202 Post Live event, Bennet referred to such an effort as "more doable.”

Eric Patashnik, a professor of public policy at Brown University and the editor of the Journal of Health Politics, Policy and Law, told me in an email that the political viability of Medicare for all will ultimately depend on its details. 

"Some Medicare for all proposals would shift all Americans into a single, government-financed program and eliminate the private-insurance system," he said. "These proposals would require a massive increase in taxes. Many people would be fearful of giving up their existing coverage, and conservatives will inevitably argue that a federally financed plan will lead to rationing."

To Patashnik's point, in the aforementioned Health 202 Post Live event, GOP Sen. Bill Cassidy (La.) responded to Bennet's proposal to expand Medicare by simply saying, "Medicare for all would be Medicare for none."

Democrats have long been plagued by their inability to succinctly sell their policies. While Republicans can distill their platform to a few repeated words without offering more specifics, like “repeal and replace Obamacare,” Democrats tend to get lost in the weeds. (Everyone remembers former President Bill Clinton's winding lecture on health policy at the 2012 DNC convention that earned him the moniker "Secretary of Explaining Stuff.")

Wrapping the Democrats’ health-care message into a simple "Medicare-for-all" package is an effort to play that game, and Green hopes candidates don’t get bogged down in wonky semantics.

“There’s no more popular brand in American politics than Medicare. Republican grandparents like their Medicare as much as Democrats do,” Green said. “It’s political gold.”

AHH, OOF and OUCH

AHH: The Trump administration said it will suspend billions of dollars in annual payments to insurers under the Affordable Care Act’s “risk adjustment program" meant to even out the cost of sicker patients who need costlier medical services.

The Centers for Medicare and Medicaid Services made the announcement this weekend in the latest blow from the administration to Obamacare, our colleague Amy Goldstein reports. CMS said it would halt the $10.4 billion in payments due to insurers for expenses from last year.

“Risk adjustment is one of three methods built into the 2010 health-care law to help insulate insurance companies from the ACA requirement that they accept all customers for the first time — healthy and sick — without charging more to those who need substantial care,” Amy writes.

“The suspension of these payments is the most recent maneuver by the Trump administration to undercut the health-care law that President Trump has vowed since his campaign to demolish,” she continues. 

The payment freeze could lead to instability in the market and cause a premium spike by the fall, the New York Times’s Robert Pear notes. “Any action to stop disbursements under the risk adjustment program will significantly increase 2019 premiums for millions of individuals and small-business owners, and could result in far fewer health plan choices,” Blue Cross and Blue Shield Association senior vice president Justine G. Handelman told Robert. “It will undermine Americans’ access to affordable care, particularly for those who need medical care the most.”

OOF: The United States attempted to dismantle discussions about a resolution to promote breast-feeding at the U.N-affiliated World Health Assembly, the New York Times’s Andrew Jacobs reports. The efforts of the U.S. delegation included fighting wording on the resolution and even threatening nations that supported the measure.

The resolution, based on decades of research on the health benefits of breast milk, was expected to easily pass among the hundreds of delegates at the assembly. But the United States looked to remove language that called on nations to “protect, promote and support breast-feeding" and delegates then tried threatening countries that supported the resolution.

“Ecuador, which had planned to introduce the measure, was the first to find itself in the crosshairs,” Andrew writes. “The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.”

One country stood up to America: Russia. And when Russian delegates ultimately introduced the measure, the United States didn't fight it, Andrew reports.

The Department of Health and Human Services did not comment to the Times about the reported threat to Ecuador, but did offer this explanation:

“The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children,” an HHS spokesman told the Times. “We recognize not all women are able to breast-feed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”

OUCH: New federal data reveals most nursing homes overstated their number of nurses and caretaking staff in reports to the government. The data points to fluctuations and gaps in care, which can affect health code compliance and residents’ meals and medication needs, among other concerns, the New York Times’s Jordan Rau reports.

“The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends,” Jordan writes. “On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.”

“The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common,” Jordan continues. “Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.”

The federal data, analyzed by Kaiser Health News, is a result of analysis of payroll records now published by Medicare, compiling information from more than 14,000 nursing homes. Of those 14,000 nursing homes, seven in 10 reported lower staffing levels based on the new data evaluation with an average drop of 12 percent.

AGENCY ALERT

— The Trump administration late last week said it may need a deadline extension on reuniting immigrant families it separated as a result of its “zero tolerance” border policy.

A federal judge ordered the administration to reunite children under 5 years old with their parents within 14 days, which would be Tuesday. Justice Department attorney Sarah Fabian said in court Friday that additional time might be required to comply with the order, CNN reports.

Meanwhile, NBC News’s Julia Ainsley reports government lawyers said they could not locate the parents of 38 migrant children, as 19 have been deported and the locations of the other 19 who have been released are unknown. The lawyers said HHS would be able to reunify only half of the about 100 children under 5 with their families by Tuesday, according to Julia.

U.S. District Judge Dana Sabraw of the Southern District of California said Friday he would “agree to delay the deadline for reunifying the youngest children if the government could provide a master list of all children and the status of their parents,” Julia writes. “Sabraw ordered the administration to share a list of 101 children with the American Civil Liberties Union by Saturday afternoon.”

REPRODUCTIVE WARS

— While Republicans initially expressed enthusiasm about the opening on the Supreme Court following the retirement of Justice Anthony M. Kennedy, some supporters of a conservative pick are stopping short of saying Trump’s nominee will overturn Roe v. Wade, The Post’s Dave Weigel reports.

Now, conservatives have turned to dismissing questions about the fate of the 1973 Supreme Court ruling as scaremongering by Democrats, Dave explains.

“We only have a single individual on the court who has expressly said he would overturn Roe,” said Leonard Leo, a Federalist Society leader, during an interview on ABC News's "This Week." “So I think it’s a bit of a scare tactic and rank speculation more than anything else.”

After a Friday rally in Wisconsin, Republican Senate hopeful Leah Vukmir refused to answer to reporters whether she wanted the high court to overturn either Roe v. Wade or Planned Parenthood v. Casey, Dave reports. “The left is trying to politicize this by bringing up this case, that case; will you undo this, undo that. My focus is on somebody who will stand for the Constitution,” Vukmir said. “I’m not going to comment on those particular cases right now.”

Politicians also avoided the topic on Sunday shows yesterday, Dave writes. Meanwhile, abortion-rights activists continue to believe overturning Roe is a high priority for the president as he prepares to announce his SCOTUS pick at 9 p.m. tonight.

“He is certainly the first major-party nominee who went on to be president to put a litmus test on Supreme Court justices, and that was to actually overturn Roe v. Wade,” Ilyse Hogue, president of NARAL Pro-Choice America, said in a Fox News interview yesterday. “We believe him. He’s got a vice president who committed to, you know, throw Roe on an ash heap of history. So we think that’s the mind-set that many Americans are actually going into this with because it was such a vocal talking point for him.”

— Meanwhile, our colleague Amy writes while liberals have been focused on how Trump’s shortlist of SCOTUS picks stand on abortion rights, the White House has been focusing on the broader issue of religious freedom.

“During the past few years, questions of religion have rocketed in importance to those on the right as a response to the Obama era, which brought an expansion of gay rights, increased access to birth control and other liberal changes,” she writes. “Now the White House and its allies are eager for a justice who will give more deference to social conservatives eager to blunt the last administration’s policies through faith-based objections.”

She adds that “religious liberty has become a code among conservatives for the political tinder box of abortion rights.”

Politico’s Josh Gerstein reports the fate of one SCOTUS contender D.C. Circuit Judge Brett Kavanaugh could rest on his role in a case of a 17-year-old immigrant’s request for an abortion last year.

“To Kavanaugh's backers, his role in the legal showdown that played out over a couple of weeks last October exhibits the kind of judicial restraint conservatives have long called for from members of the bench,” Josh writes. “However, for Kavanaugh's critics, his actions in the teen-immigrant abortion case exude a tendency toward caution and compromise that could signal an unwillingness to make waves on the Supreme Court — and they worry that hesitancy could extend to reversing longstanding precedents, such as Roe v. Wade.”

— Trump told reporters on Sunday as he boarded Air Force One that he was “very close to making a decision,” but the New York Times’s Maggie Haberman, Adam Liptak and Michael S. Schmidt report the decision could be drawn out into the final hours today before his scheduled prime-time announcement.

HEALTH ON THE HILL

—  A Trump appointee who leads the administration’s Title X program compared abortion to slavery and the Holocaust, according to a memo prepared by the office of Sen. Patty Murray (D-Wash.).

Murray shared the memo with  Vice’s vertical Tonic, which reported on it late last week. The memo reveals remarks made by Diane Foley, the deputy assistant secretary for population affairs, at a 2016 presentation at a college in Colorado.

“People who are very adamant about abortion will say, ‘this is an issue of women’s rights.’ It’s which life has more value,” Foley said at the 2016 event, per Tonic. “That sounds a lot like what our nation went through in the 1800s, right? When somebody decided somebody’s life wasn’t worth living or they weren’t [worth] quite as much — they were worth what, three-fifths of a human? Is that right? What about what was happening in Europe during the World Wars, where there [were] groups of people that were determined they weren’t worth as much?”

Foley, a pediatrician, was previously the president and chief executive of antiabortion rights group Life Network.

"I am writing you today to ensure you are aware of the harmful, inaccurate views held by the political appointee President Trump and Vice President Pence recently put in charge of the federal family planning program known as Title X,” Murray wrote in a Friday letter to members of the Senate Health, Education, Labor and Pensions Committee.

In the memo, Murray charges that Foley has “been an outspoken opponent of abortion and advocate for abstinence-only education, and she too has spread misinformation about women’s health and sex education.”

— The American Action Network, a group backed by House Speaker Paul Ryan (R-Wis.),  launched a new ad to promote the package of bills passed overwhelmingly last month to combat the opioid crisis.

The group is spending $2.5 million in ads in 10 House districts, the Washington Examiner’s Al Weaver reportsThe House wrapped 60 smaller bills into one larger piece of legislation that included such proposals as the development of nonaddictive pain medication and the creation of opioid recovery centers.

“We thank the House for working in a bipartisan fashion to curb opioid addiction and provide resources for treatment and recovery,” Corry Bliss, the executive director of the group, said in a statement. “However, there is still more to be done, and AAN’s latest campaign urges both Republicans and Democrats to continue fighting on behalf of families across the country who are suffering because of this crisis every day.”

MEDICAL MISSIVES

— The Centers for Disease Control and Prevention says there have been 212 cases of an intestinal parasite, known as cyclosporiasis, linked with vegetables from Fresh Del Monte Produce vegetables, the New York Times’s Mihir Zaveri reports. The cases were reported in Iowa, Michigan, Minnesota and Wisconsin as of Thursday and were connected with purchases from Kwik Trip or Kwik Star stores in those states.

People infected with cyclosporiasis can experience symptoms about a week after consumption, and the infection can lead to stomach-related illnesses, fever and fatigue. Mihir reports from the CDC:

“Outbreaks of cyclosporiasis in the United States have been linked to imported fresh produce contaminated with a microscopic parasite called Cyclospora cayetanensis. The infection first gained prominence in the United States during an outbreak in the mid-1990s, and has shown up nearly every year since."

— And here are a few more good reads from The Post and beyond: 

To Your Health
Data from one of the largest fertility clinics in Europe shows that only 7 percent of women who froze their eggs for "social" reasons have come back for fertility treatments.
Ariana Eunjung Cha
Europe
Dawn Sturgess, 44, was one of five people who have become critically after being exposed to Novichok in the Salisbury area.
William Booth
Opioid crackdown, mental health crises aggravate violence in ERs.
Politico
Blood banks no longer need to test individual donations for the Zika virus, the Food and Drug Administration said Friday.
Washington Examiner
INDUSTRY RX
For the few drugmakers that haven’t given up on the decades-long, elusive quest for a cure of Alzheimer’s disease, each piece of news is a small signpost along a possible path to success -- and billions of dollars in potential sales.
Bloomberg
STATE SCAN
The program provides food to soup kitchens and food pantries that are part of the emergency food network.
The New York Times
DAYBOOK

Today

  • HHS Secretary Alex Azar speaks at the 340B Coalition Summer Conference.
  • The American Enterprise Institute holds an event on “The Affordable Care Act’s twisted path through implementation, litigation, and reinterpretation.”

Coming Up

  • The Senate Veterans Committee holds a hearing to consider the nomination of Robert Wilkie to be VA secretary on Tuesday.
  • The Pew Charitable Trusts holds an live webcast on state efforts to lower drug costs on Tuesday.
  • The House Energy and Commerce Subcommittee on Digital Commerce and Consumer Protection holds a hearing on examining drug-impaired driving on Wednesday.
  • The American Hospital Association holds a webinar on “An Innovative Way to Manage Radiation Dose Compliance Across Your Enterprise” on Thursday.
  • AHIP holds a webinar on value-based care on Thursday.
  • The Brookings Institution holds an event on “(De)stabilizing the ACA’s individual market: A view from the states” on Friday.
SUGAR RUSH

‘We know where you live, Mitch’: Anti-ICE protesters confronted Senate Majority Leader Mitch McConnell (R-Ky.):

Vice President Mike Pence: "We will never abolish ICE:"

The president says there’s a border crisis. This border city begs to differ.