THE PROGNOSIS

Health care is expected to be a major pressure point between the incoming class of House Democratic freshmen and their leadership.

During the 2018 campaign, about two-thirds of the incoming House Democratic class supported a big change to the U.S. health care system in the form of a "Medicare-for-all" program; a Medicare buy-in option for all; or an expansion of Social Security, according to the Progressive Change Campaign Committee. Specifically looking at Medicare-for-all, the PCCC says 26 out of 60 incoming Democrats from races that have been called so far supported such a policy. That means they back a system in which all health-care bills are paid for by one entity -- in this case, the federal government.

And those Democrats intend to bring their rhetoric from the campaign trail to Congress.

Rep.-elect Rashida Tlaib (D) of Michigan told me she’s “very much” committed to pushing Medicare-for-all going forward. “For many members, [health care] is the priority issue.”

One problem for them may be that House Minority Leader Nancy Pelosi (D-Calif.) and her deputies have said they would first work on improving the Affordable Care Act rather than embracing a single-payer health plan.  

Pelosi is currently embroiled in a pitched battle to regain the House speakership that has exposed rifts between the old Democratic guard and newer members, some of whom campaigned on progressive priorities like health care.

A group of 17 Democratic members, led by Rep. Seth Moulton (Mass.), have said they won’t support her bid to retake the speaker's gavel, my colleagues have reported. At least one member — Rep. Marcia L. Fudge of Ohio — has emerged as a potential competitor. For her part, Pelosi declared Thursday that she has “overwhelming support in my caucus to be speaker of the House.”

And Democrats have said that, at this point, health care is not one of the issues that is cleaving their caucus in the leadership battle.

Rep. Pramila Jayapal (D-Wash.) said it would be something the Medicare for All Caucus, which she co-founded, would tackle once the new majority is settled in January. And they'll have plenty of opposition from the right. President Trump and others in the Republican Party repeatedly attacked Democrats on the issue in the campaign, with President Trump saying Democrats "want to raid Medicare to pay for socialism." 

“We created the Medicare for All Caucus to really be able to sit down with members, help educate them on what this would look like, get comfortable with the research and some of the concerns they hear, some of the attacks they’re going to get,” Jayapal told me. “So we’ll work through that process, and I feel good about that.”

“We’re pushing really hard in all kinds of ways with the Medicare for All [political action committee] outside, and also with the Medicare for All Caucus.”  

How to approach health care is likely to be a problem for whoever assumes the speakership. Supporters of a single-payer system are already agitating and pushing a national strategy. Jayapal has taken the lead on the House’s single-payer bill, the Expanded & Improved Medicare for All Act. She, along with Sen. Bernie Sanders (I-Vt.) and leaders of National Nurses United, held a call with supporters this week to urge a widespread effort to push the policy forward.

“When we have that majority, we need to make sure that we put it to use,” Jayapal said during the call.

For his part, PCCC co-founder Adam Green said that voters care about making changes to health care. “The overwhelming majority of incoming freshman Democrats ran on Elizabeth Warren-style, economic populist issues, which shows that voters want to see boldness from House Democrats — not small-bore, technocratic thinking,” Green said.

Speaking generally about some of the incoming Democrats, Jayapal, vice chair of the Congressional Progressive Caucus, told reporters Thursday a priority was largely in “making sure they can go back to the people who elected them who want to see the caucus reflective of a progressive majority that really helped drive these races.”

“I think members just want to be able to go back and say we feel really good that progressives are going to have a real say in the direction of policy in this next session,” she said.

AHH, OOF and OUCH

AHH: The Food and Drug Administration launched a sweeping effort to combat the rising rate of youth vaping and smoking, with new restrictions on sales of flavored e-cigarettes and a plan to ban menthol cigarettes and flavored cigars.

“The FDA says it will limit sales of many flavored e-cigarettes to bricks-and-mortar outlets that have either age-restricted entry or areas inside stores that are not accessible to people under 18,” my Post colleagues Laurie McGinley and Lenny Bernstein report. “The agency also will require stepped-up age verification for online sales.”

McGinley first reported last week the plan from the FDA to crack down on e-cigarette products. The Health 202’s Paige Winfield Cunningham wrote this week that FDA Commissioner Scott Gottlieb defended the agency’s actions despite criticism from conservatives.

The new restrictions from the FDA reflect concerns about how the electronic products can serve as a gateway to nicotine addiction, McGinley and Bernstein report. Even more notable are the potential restrictions on cigarettes and cigars. “Such prohibitions will require new regulations that could take years to go into effect and could be derailed by opposition from the cigarette industry,” my colleagues write. “If successful, though, the bans could have an especially large impact on African American adults and youth, who smoke menthol cigarettes and flavored cigars at higher rates than other groups.”

OOF: In the last three months, more than 12,000 people have lost their Medicaid coverage in Arkansas because they failed to comply with the state's new work requirements.

According to data released by the state, more than 3,800 beneficiaries lost coverage in just the last month. The rule requires beneficiaries to work 80 hours a month or lose coverage if they don’t meet that standard for three months out of the year.

“The agency said another 6,000 people will lose coverage if they don’t meet the work requirement by the end of this month,” the Associated Press’s Andrew DeMillo reports. “Arkansas was the first state to enforce the requirement after the Trump administration allowed states to tie Medicaid coverage to work. The requirement is being challenged in federal court, and a federal advisory panel last week urged the U.S. Department of Health and Human Services to temporarily stop Arkansas from enforcing the rule.”

OUCH: There is an increasing rate of suicide among working Americans, according to new data from the Centers for Disease Control and Prevention. The suicide rate for the working-age population in the United States, or people ages 16 to 64, increased 34 percent from 2000 to 2016.

The report compiles information from 17 states, CNN’s Naomi Thomas reports.

The CDC found the highest suicide rate was among men who work in construction and extraction, with 53.2 suicide deaths per 100,000 working people in 2015, Thomas reports. For women, the highest rates were among individuals working in arts, design, entertainment, sports and media, with a rate of 15.6 per 100,000 working people in 2015.  

“For both sexes, the occupational group with the lowest rate of suicides was education, training and library. This includes jobs such as teachers, professors and archivists,” Thomas adds. 

STATE SCAN

— Gavin Newsom, the next governor of California, represents Democrats’ dilemma on Medicare-for-all, Politico’s Victoria Colliver reports.

He declared his support for such a system during the campaign, but now, “how much of his stand is principle and how much is policy is not totally clear. And no matter how he handles it, he'll inevitably anger part of his base,” Colliver writes. “That, in a nutshell, is a preview of the Democrats' health policy dilemma heading into the 2020 election cycle.”

"Since he has promised so much, and since he has talked about California as national model and since he’s going to be the principal architect against President Trump from 'Left Coast,' anything he does on health care — managed care, Medicare-for-all or something in between — will serve as a model to catapult him into the national conversation," David McCuan, a strategist and political science professor at Sonoma State University, told Politico.

— Nearly two dozen people staying in an emergency shelter in Northern California have been sickened by norovirus, an official said Thursday.

Lisa Almaguer, a spokeswoman for the Butte County Public Health Department, said in a statement that 21 people tested positive for the extremely contagious virus at the Chico Neighborhood Church Shelter, my Post colleague Lindsey Bever reports. The virus spreads easily and commonly causes vomiting and diarrhea. “Earlier, Almaguer had told the Sacramento Bee that the virus may have also sickened evacuees at a second shelter in nearby Oroville, but said that the diagnoses had not been lab confirmed,” Bever reports.

AGENCY ALERT

— Get America Covered sent a memo to newly elected House and Senate members as well as governors this  urging them to encourage constituents to sign up for a health plan during the current Affordable Care Act open enrollment period.

“As you know best, Americans have been intensely focused on the election and turned out in droves to protect their care and coverage,” the group wrote in the memo, which was sent to The Health 202. “Now it’s time for everyone to get covered and stay covered.”

Get America Covered cites “challenges due to actions by the Trump administration to undermine" the ACA. “The only way to make sure everyone who wants health coverage knows how to sign up and can get covered is by spreading the word.”

— And here are a few more good reads: 

MEDICAL MISSIVES
For months, members of the panel investigating Florida’s high school massacre have called the sheriff’s deputy assigned to guard the campus “a coward” for hiding and not rushing inside in an attempt to stop the shooter.
Associated Press
Smoke masks. Eye drops. No outdoor exercise. This is how Californians are trying to cope with wildfires choking the state, but experts say an increase in serious health problems may be almost inevitable for vulnerable residents as the disasters become more commonplace.
Associated Press
Porter, a law professor and consumer advocate, ran on a platform that included: Medicare for All, passing a ban on assault weapons, overturning President Donald Trump and the GOP's tax plan along and curtailing the amount of outside money in congressional races.
Politico
National
The feel-good story drew a surge of donations and media coverage from coast to coast. But it was too good to be true, officials said.
Eli Rosenberg
National
More than 600 remain unaccounted for, an ever-changing list of names amid the frenzy of new and canceled missing persons reports.
Tim Craig
TRUMP TEMPERATURE
The plan sets up a clash with Democrats, who say the administration is thwarting congressional intent and will starve the VA health system to pay for private care.
ProPublica
Checkpoint
Thousands of veterans using the GI Bill have been put under financial strain after VA's computer systems buckled under complex new rules.
Alex Horton
INDUSTRY RX
Millions embrace e-cigarettes as smoking cessation aids. Will restricting the devices for teenagers put former adult smokers who vape at risk to start again?
The New York Times
DAYBOOK

Coming Up

  • The American Enterprise Institute holds an event with CMS Administrator Seema Verma on "The new Medicare physician payment regulation" on Nov. 27.
  • The Heritage Foundation holds a discussion about fetal tissue research on Nov. 27.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on reducing health care costs on Nov. 28. 
SUGAR RUSH

Democratic leader Nancy Pelosi again reiterated that she has the votes to become House speaker in the 116th Congress:

Fact-checking President Trump's claims on voter fraud: