We’re at the point in this contentious election cycle where candidates from both parties are practically predicting hellfire and brimstone should their opponents win.

And they’re using health-care policy to make their arguments.

Listen to Democrats on the Senate floor yesterday, and you might think President Trump was ripping away health coverage from droves of Americans with serious health conditions, leaving them with no insurance options that don’t involve crushing medical bills.

“These junk plans would reduce access to quality coverage for millions and increase costs,” said Sen. Tammy Baldwin (D-Wis.), who advanced a resolution to reverse the administration’s rule expanding cheaper but less-generous short-term health plans. “No family should be forced to choose between helping a loved one get better or going bankrupt.”

And if you read Trump’s USA Today op-ed, you might come away with the impression that Democrats are setting out to blast Medicare to bits, destroying the popular insurance program that millions of seniors rely on.

“Democrats would gut Medicare with their planned government takeover of American health care,” the president wrote. “The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised.”

Let’s step back for a minute and inject a bit of rationality into this heated back-and-forth. Regardless of what you hear politicians claiming, millions of Americans probably aren’t going to lose their coverage anytime soon -- regardless of who controls the House and Senate come January.

While there are nuggets of truth to both sides' arguments, it's worth breaking down what's realistic. In his op-ed, Trump made it sound like Congress is on the verge of passing the most extreme version of Medicare expansion, a plan put forward by Sen. Bernie Sanders (I-Vt.). While Sanders’s bill does have substantial sign-on from Democrats, it would be so extraordinarily expensive (around $33 trillion over 10 years, multiple analysts say) that it’s hard to imagine any realistic path forward for the bill.

Nor did Trump make any mention of a host of less-dramatic Medicare expansion bills put forward by a number of House and Senate Democrats, even though such legislation would cost a lot less money and stands a better chance of gaining momentum under a future Congress. The Kaiser Family Foundation and the Urban Institute released some useful comparisons and analysis of these bills this week.

The president argued that expanding Medicare from just seniors to more Americans — as these Medicare-for- all bills propose to do — would essentially destroy Medicare as we know it. But nearly every sentence contained a misleading statement or falsehood, as Glenn Kessler, The Post’s fact-checker extraordinaire, pointed out.

Senate Minority Leader Chuck Schumer (D-N.Y.) tweeted that he'd done his own version of a fact check:

As for Democrats, they spent yesterday beating their own health-care drum in the Senate, accusing Republicans of hurting Americans with preexisting health conditions.

Baldwin was able to bring her resolution to reverse the short-term plan rule to the floor after obtaining more than the 30 signatures required to bypass the committee process and force a full Senate vote, as my colleague John Wagner reported. While she won over a single Republican, Sen. Susan Collins (R-Maine), the resolution still fell one vote short of passage.

Even so, it gave Democrats another opportunity to slam Republicans for pushing what they call “junk” insurance that could leave unsuspecting Americans saddled with large medical bills.

From Senate Finance Committee ranking Democrat Ron Wyden (Ore.):

From Sen. Elizabeth Warren (D-Mass.):

It’s true that some people could buy short-term plans not realizing how few benefits they cover — and then suffer financially should they encounter unexpected bills. And, as I noted in this Health 202, these plans could attract some healthy consumers away from the marketplaces, putting upward pressure on premiums for those left behind.

But let’s also remember that all the protections offered under the Affordable Care Act — requirements for insurers to cover those with preexisting conditions and cover a range of essential health benefits — are still in place for all the marketplace plans. Trump’s rule doesn’t change that — it just means people can buy cheaper, less-generous plans if they want to.

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, made this point:

Furthermore, states have the power to regulate short-term plans. Indeed, four states ban short-term policies entirely (California passed its ban in August this year) while 25 states plus the District require them to cover at least some state-mandated benefits, according to research by the Commonwealth Fund. Last spring, Maryland Gov. Larry Hogan (R) signed a law limiting short-term plans to three months instead of the year allowed under the Trump rule.  

Now, the election outcome certainly does hold some implications for health policy.  Republicans still say they want to repeal and replace the Affordable Care Act, which would make dramatic changes in the number of people covered. But as we've seen this past congressional session, the political realities make that a tall order. 

And if Democrats win back the House, they may try to advance bills cracking down on the pharmaceutical industry and would surely use their oversight powers to put heat on the Department of Health and Human Services. 

But if that happens, there will be a divided government -- meaning more immediate changes to the coverage available to Americans would be likelier to come from the courts, where there are a number of cases challenging the administration’s policy moves and the ACA itself.

So why the sweeping and dramatic threats from candidates all along the political spectrum? Health care is a top issue for voters this year, even edging out the economy in some polls. A recent Pew poll found that health care and Medicare were two of the top five issues driving votes. As my colleague Philip Bump notes, more than 40 percent of political ads last month mentioned health care, up from less than a third in the first half of this year. And Sean Sullivan and John Wagner write that politicians are using health care and the rule of law to stoke fears about the opposing party.

Senate Minority Leader Charles E. Schumer (D-N.Y.) is even calling health care the single issue that will decide the election.

“There is one issue above any other that is going to define the results of the November 6 election, and that is health care,” he told reporters yesterday. “That is why we felt it was so important to get the issue before the American people today.”

Keeping up with the news in President Trump’s Washington is exhausting — whether you live here, work in the nation’s capital, or are just watching from afar. That’s why next Tuesday, we’re launching Power Up by Jacqueline Alemany. It's a new newsletter from The Washington Post that will land in your inbox before you reach for that first cup of coffee. It will bring you Washington, fast.

Click here to sign up.


AHH: The Justice Department has approved the $69 billion merger between CVS and Aetna, the nation’s third-largest health insurance company, a deal that could make major waves in the health-care industry.

The DOJ gave its approval pending the companies’ sale of Aetna’s Medicare Part D prescription drug business. The insurer disclosed last month that it planned to sell its prescription drug business to WellCare Health Plans.

“The tie-up will allow CVS — whose retail pharmacy business serves 5 million customers a day — to turn more of its brick-and-mortar locations into front-line clinics for basic medical services and patient monitoring,” The Post’s Brian Fung reports. “By deepening its knowledge of and relationships with patients, CVS has said the combination could help Americans stick with medication regimens and stay out of the hospital.”

Analysts also predict the merger will give CVS more leverage in negotiating drug prices with drug manufacturers, Brian reports.

OOF: Democrats are furious over ads from Republicans in swing districts that tie their Democratic challengers to the push for a universal health-care system.  

Not all Democrats have supported a “Medicare-for-all” concept, and more specifically, some of those targeted in ads have not come out in support of such a system at all, Politico’s Adam Cancryn reports.

“In battleground districts from California to Kentucky to New York, Democrats have gone out of their way to distance themselves from Sen. Bernie Sanders' (I-Vt.) $32 trillion single-payer proposal, only to be attacked for endorsing the plan anyway in Republican ads that range from misleading to outright false,” Adam writes. “The effort to tie swing-district candidates to a single-payer concept — which Democrats are deeply divided on — illustrates the GOP's major disadvantage on health care after failing last year to pass unpopular Obamacare repeal bills.”

OUCH: Twelve additional suspected cases of acute flaccid myelitis have been reported in children, with three cases in Pennsylvania and nine in Illinois.

The additional cases follow reports of six cases in children in Minnesota in the past several weeks. The rare condition, that has been compared with polio, "targets the spinal cord, which can lead to weakness in the muscles. Symptoms can include facial-muscle weakness, seen as droopiness; issues moving the eyes or droopy eyelids; issues swallowing; or slurred speech," The Post's Lindsey Bever has reported.

“The three children in Pittsburgh have not yet been confirmed by the CDC to definitely have the illness,” BuzzFeed News’s Theresa Tamkins reports, citing a spokesperson at the Allegheny County Health Department. “The children are ‘currently undergoing diagnostic procedures and treatments,’ according to a statement from UPMC Children’s Hospital of Pittsburgh, where the patients are being treated. 'Isolation protocols and infection control procedures are in place and we are working with the CDC and the Allegheny County Health Department to further monitor and evaluate the patient conditions.'"

The Illinois Department of Public Health said in an news release it had “received recent reports from health care providers of nine sporadic, clinically diagnosed cases of acute flaccid myelitis” and was “working with the health care providers to collect necessary information to send to the Centers for Disease Control and Prevention.”


— Yesterday Trump signed two bills into law that will eliminate “gag clauses” that pharmacists say stop them from telling when there's a cheaper way to buy prescription drugs. "This is very strong legislation to end these unjust gag clauses once and for all," Trump said during the ceremony as he signed the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act.

It’s the first piece of legislation the president has signed that address drug pricing and that has accomplished  an idea set out in the administration’s blueprint released in May. Stat’s Nicholas Florko wrote that neither bill will directly lower the cost of prescription drugs, as The Health 202 noted last month. But you wouldn’t know that based on the president’s explanation of the legislation.

“Obviously, based on the name, you can tell that this gives people knowledge as to prices at different locations, where to buy the drugs,” Trump said. “They’ll be able to see pricing, they’ll be able to see where they should go and as they start leaving certain pharmacies, those pharmacies will be dropping their prices.”

But removing gag clauses probably won't lead to patients to do more shopping around for a new pharmacy, nor will it actually lower the list price of drugs. "While Trump’s remarks might be in line with his propensity for sentiment over substance, they  also highlight real questions about how exactly these laws would lower drug prices," Nicholas writes.


—Leaders of the House Ways and Means Committee are calling on hospitals across the country to answer questions about why so many mothers are dying or being injured from childbirth and what can be done to change it, USA Today’s Alison Young reports. 

Committee chairman Rep. Kevin Brady (R-Tex.), the chairman of the Oversight subcommittee Rep. Lynn Jenkins (R-Kan) and the chairman of the Health subcommittee Peter J. Roskam (R-Ill.) announced the investigation on Wednesday.

As Alison points out, the launch of the investigation cites her extensive reporting from July that found “thousands of women suffer life-altering injuries or die from childbirth because hospitals and medical workers skip safety practices known to save lives.”

“Bringing a new baby into this world should be one of the most exciting and rewarding times in a woman’s life,” the congressmen said in a statement. “It is absolutely unacceptable that preventable failures are the cause of avoidable, unnecessary, and absolutely tragic deaths. America needs to be the health care leader of the world, and women across the country need to know they will be safe and in good hands while giving birth. With this investigation, we are committed to finding out why these deaths are happening and where Congress can take action to not only prevent these deaths, but also reverse this trend.”


— A new study has found that flu vaccines reduce pregnant women’s risk of flu-related hospitalization by an average of 40 percent.

The study, which the CDC co-authored and was  published in the journal Clinical Infectious Disease, is the first study the show how the vaccination can protect against flu-associated hospitalization for pregnant women, according to a CDC news release.

Our colleague Lena H. Sun reported last month that experts said it was important to highlight the lesser-known benefits of flu vaccination, rather than focusing just on estimates that the vaccine is about 40 percent effective in reducing a person’s risk of getting sick enough to need to see a doctor.

“The vaccine can reduce flu illness and hospitalizations, protect pregnant women during and after pregnancy and be lifesaving in children, [Daniel Jernigan, head of the CDC’s influenza division] said,” per Lena. “For older people with chronic health conditions, getting a flu shot is as effective in preventing a heart attack as quitting smoking, taking cholesterol-lowering drugs or taking blood pressure medications, recent studies show.”

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

To Your Health
It's a rare condition that's also called cake kidney or doughnut kidney.
Kristine Phillips
To Your Health
A sweeping study says the global food system is pushing Earth beyond safe "planetary boundaries."
Joel Achenbach
Morning Mix
Liz Kleinrock, a teacher at Citizens of the World Charter School Silver Lake in Los Angeles, developed a simple lesson to teach 8- and 9-year-olds what consent is and how to give it.
Allyson Chiu
Unlike the president, the Senate majority leader doesn’t think she has been hurt politically by her vote against Brett M. Kavanaugh.
John Wagner and Mike DeBonis
Sen. Chuck Grassley asked the FTC to investigate whether contracts between insurers and hospital systems are limiting competition and pushing up costs.
Wall Street Journal
The FDA is working with Apple, Fitbit and others on a plan to relax rules for medical software like apps. At least three Democrats are already concerned.
Republicans are rushing to say they would protect those with preexisting conditions.
Colby Itkowitz and Paulina Firozi
A nonprofit in Philadelphia is making plans to open a supervised drug injection site — which is against the law. Their response to justice department threats of a crackdown? "Bring it on."
Centene plans to add four states to its Affordable Care Act business and expand in six others, in the latest sign of insurers’ improved fortunes under the health law.
Wall Street Journal
The argument is built on the idea that Medicaid expansion gives people more access to opioids.
Pope Francis on Wednesday compared having an abortion to “hiring a “hit man” to eliminate a problematic person, in comments sure to be welcomed by conservative Catholics who have accused the pontiff of not speaking out enough on “cultural war” issues.

Coming Up

  • The American Enterprise Institute holds an event on “Nurse practitioners and America’s primary care shortage” on Oct. 15.
  • The Brookings Institution holds an event on “Crafting public policy to address the nation’s opioid epidemic” on Oct. 15.

Jimmy Kimmel calls out the president for falsehoods in his USA Today op-ed: 

Jimmy Fallon goes after Trump's op-ed, too: