Democrats newly in control of the House are sending quivers of fear throughout the U.S. health-care industry as they begin advancing Medicare-for-All measures that could result in a big financial blow to private health insurers, hospitals and doctors.
Industry leaders — who have united to fight what they view as a threat to the country’s existing patchwork system of public and private payers — told me they're planning to ramp up advertising and lobbying efforts this year to argue against such a dramatic overhaul of the health insurance system, saying education is all that’s needed to turn more Americans against the idea.
“I get the sense that progressives have gotten a total free pass. There is no pushback against those calling for Medicare-for-All,” said David Merritt, executive vice president for public affairs at America’s Health Insurance Plans.
“The people who are going to be impacted, like patients, like doctors who treat patients, like insurance plans that cover patients — no one has started to say in an organized and sustained way, ‘Here are the consequences if we do go down that path,' ” Merritt said.
Last summer, AHIP joined with the Federation of American Hospitals, the American Medical Association, the Pharmaceutical Research and Manufacturers of America, and 14 other groups in what they’ve named the Partnership for America’s Health Care Future.
Their mission: to convince Americans that a single-payer system would deeply hurt their access to vital health-care services. Their aim is to dissuade Democrats from fully embracing Medicare-for-All -- once a progressive hobby horse that has moved mainstream as House Democrats announced they'll hold hearings on such proposals this year.
Their argument goes like this: If the government is the sole payer, it could deny coverage for certain services and demand lower rates from providers, potentially forcing them out of business altogether. A single-payer option, especially one as dramatic as the Medicare-for-All plan offered by Sen. Bernie Sanders (I-Vt.), would also cost the government considerably more money, probably requiring tax hikes.
“It became quite clear [Medicare-for-All] was something a small but increasing number of policymakers were pushing for,” said Jeff Cohen, executive vice president for public affairs at the Federation of American Hospitals. “And so we all looked at each other and said, ‘We might have a problem on our hands if we’re not doing the education and awareness campaign we need to be doing.' ”
As the Intercept detailed in November, a leaked planning document from the group says its campaign is intended to “change the conversation around Medicare for All” and “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”
The U.S. Chamber of Commerce has also vowed to use its deep lobbying pocket to fight single-payer proposals. Government-run health care “just doesn’t work,” Chamber CEO Thomas Donohue said in his annual “State of American Business” address this month. “We’ll use all our resources to make sure that we’re careful there.”
It’s certainly true there’s an unprecedented level of enthusiasm among Democrats for making publicly backed health insurance more widely available. About half of all Democrats in contested House races backed a Medicare-for-All approach, according to a count by National Nurses United.
Fifteen Senate Democrats and 124 House Democrats have signed onto Medicare-for-All bills. Included among them are all four members of Congress who have so far announced presidential bids: Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Kamala Harris of California and Rep. Tulsi Gabbard of Hawaii. Aides to Harris, who was the first senator to sign onto Sanders's bill, said Medicare-for-All will be included in her campaign platform, per my colleague Jeff Stein.
And polls have found a majority of voters favor the idea of Medicare-for-All — although support fades somewhat when respondents hear arguments that it could give the government too much control over health-care or require more taxes.
But industry leaders contend that Medicare for All didn’t sell nearly as well on the campaign trail as some have imagined.
They point to the most competitive House districts, where the winning Democrats largely didn’t run on — or even support — the idea. Of the the 35 Democrats who seized Republican-held seats, 23 didn’t support Medicare-for-All, and seven more who did support it nonetheless didn’t run on it, according to an analysis by Forbes Tate Partners, a public affairs and lobbying firm founded by former Democratic administration officials that is managing part of the coalition.
Highly publicized candidates such as freshmen Reps. Alexandria Ocasio-Cortez of New York and Rashida Tlaib of Michigan embraced Medicare for All. But in moderate districts and swing states, Democrats such as Reps. Lauren Underwood of Illinois and Donna Shalala of Florida kept the idea of a single-payer system an arm's length away.
Republicans helped contribute to the narrative that Democrats are overwhelmingly in favor of Medicare-for-All, running ads on the issue against even candidates that hadn’t endorsed it, as my colleague Dave Weigel reported in the fall.
Some backstory here: At the start of the cycle, many Rs thought that D voters would back only the most left-wing candidates in primaries. In nearly every swing race, they didn't. Solution: Pretend they did!— Dave Weigel (@daveweigel) September 26, 2018
There are a variety of Medicare-for-All ideas being floated by lawmakers, ranging from a dramatic shift to a single-payer system to merely lowering the age for Medicare eligibility. The partnership is opposed to virtually any idea that would result in fewer people getting private coverage — for the obvious reasons that the government would then pay providers and insurers a lot less money.
But they also make this point: Why upend a system in which 92 percent of Americans already have health coverage to expand it to the 8 percent who don’t? Merritt and Cohen said they’re pushing Congress to focus on expanding coverage to the remaining uninsured while advancing measures to improve care and cut costs for everyone else.
“It’s not sexy, it doesn’t fit on a bumper sticker, and perhaps it’s hard to rally around,” Cohen said. “But there are things Congress can do that will begin to chip away at the anxieties people currently have regarding their health care. There are things people will see materially, sitting at home at the kitchen table, I think we shouldn’t discount.”
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AHH: The Centers for Medicare and Medicaid Services has approved Arizona’s request to implement work requirements for its Medicaid beneficiaries, making it the eighth state with federal permission to do so. Work requirements in the state will take effect on Jan. 1, 2020, at the earliest, and will affect about 120,000 residents, the Arizona Republic’s Stephanie Innes reports.
The rules will mandate that able-bodied beneficiaries work or undergo an approved activity for at least 80 hours a month. Those who do not complete 80 hours will be dropped from coverage for two months, followed by automatic reinstatement, Stephanie reports.
"By aligning educational and employment incentives, and providing robust job search support services and educational opportunities, Arizona can create pathways toward better health outcomes and employment opportunities for our citizens,” Gov. Doug Ducey (R) said in a statement.
Critics of work requirements say such rules will lead to vulnerable, low-income residents losing coverage. “With today’s approval, Arizona appears poised to move forward with new restrictions in Medicaid, despite mounting evidence that it will lead thousands of residents to lose coverage, including working people and people with serious health needs,” Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, said in a statement. She cited the more than 18,000 Medicaid beneficiaries who have lost coverage in Arkansas, the first state to establish work requirements.
Politico’s Rachana Pradhan reports the administration decided to exempt most Native Americans who are enrolled in Medicaid in Arizona from the requirements, “a move that likely defuses a yearlong controversy over tribal sovereignty that had split HHS leadership and alarmed some members of Congress.”
OOF: Here's one particular group that’s been hurt by the ongoing partial government shutdown: Victims of domestic violence and sexual abuse who turn to women's shelters. Because of the shutdown, some of these organizations have had to furlough staff, turn away new people seeking shelter and cut back on life-saving services for those currently in the shelter, our Post colleague Katie Zezima reports.
For the Eastern Panhandle Empowerment Center in West Virginia, the “center’s ability to help domestic violence victims pay for prescriptions was gone, and home visits to people in rural areas had to be canceled. There could be no more free rides for women to get to new jobs, leading to one woman’s firing.” For women who seek shelter to escape from perilous events, “having to turn people away can be a matter of life and death," Katie writes.
OUCH: Food and Drug Administration Commissioner Scott Gottlieb threatened to pull e-cigarettes off the market over concerns about rampant youth vaping. At a public hearing on Friday in Silver Spring, Md., Gottlieb explicitly called out e-cigarette start-up Juul and referenced data showing youth vaping has increased markedly in the last year.
"I’ll tell you this. If the youth use continues to rise, and we see significant increases in use in 2019, on top of the dramatic rise in 2018, the entire category will face an existential threat," he said.
Gottlieb lamented that e-cigarettes have halted progress in reducing rates of cigarette smoking.
“I’m deeply troubled that we find ourselves at this crossroads today. In recent years, we’ve appeared poised to slay one of the most pernicious public health challenges of our times — the death and disease caused by cigarette smoking,” he said. “Significant strides had been made to reduce conventional smoking among both youth and adults … Sadly, this progress is being undercut — even eclipsed — by the recent, dramatic rise in youth vaping.”
— Vice President Pence spoke at the March for Life in Washington on Friday, thanking participants — including white evangelicals who are an influential voting bloc for Republicans — for their continued support of the administration.
“It was a reminder that while Trump’s popularity with the American public seems to be declining, the president still enjoys relatively significant support among one of the most influential voting blocs in Republican politics,” our Post colleague Eugene Scott writes. He added Pence’s presence was also a reminder that “ultimately, the administration’s stances on immigration, foreign policy, the economy or other issues are less important to white evangelicals and other conservative Christians than issues related to abortion.”
At the event, Pence called President Trump “the most pro-life president in American history” and listed the administration’s efforts to appoint conservative judges and block funding from groups that advocate for abortion rights.
— Lawmakers in Virginia, a state whose history with tobacco dates back to the 1600s, are considering a bill to raise the minimum age to buy cigarettes and vaping products from 18 to 21.
A bipartisan effort has sprung up in both the Virginia House and the Senate as lawmakers expressed concern over teen vaping. If such a bill passed, Virginia would join six other states and the District of Columbia in limiting tobacco product sales to people 21 and older.
Richmond-based Altria Group, one of the largest producers of tobacco products in the world, is supportive of such legislation to combat underage vaping, our Post colleagues Laura Vozzella and Gregory S. Schneider report.
“We adapt as we move forward, and we recognize it’s something that needs to be done. We certainly are a product of our history, but I don’t think we’re bound by our history,” Republican Del. Christopher P. Stolle told Laura and Gregory.
— The emergency room at Zuckerberg San Francisco General Hospital charges patients higher prices than anywhere else in the city, Vox’s Sarah Kliff reports in her latest investigation.
Sarah compares costs in Zuckerberg hospital and the University of California San Francisco hospital four mile away. ”For an especially serious visit, Zuckerberg General charges a facility fee of $11,176, 46 percent more than UCSF, which charges an average of $7,635,” she reports. “The hospital is also out-of-network with all private insurance, leaving patients responsible for the fee and the cost of treatment. UC San Francisco, meanwhile, accepts insurance from most big providers. Insurers generally negotiate lower prices for patients, and many plans cover ER visits in part or in full.”
The report is the latest in a series Sarah has reported on Zuckerberg hospital, after an initial report earlier this month that revealed the hospital doesn’t participate in the networks for any private health insurers.
Privately insured patients at Zuckerberg hospital, Sarah reports, see markedly higher bills compared with patients at other emergency rooms, and a review of 49 bills Vox received from five hospitals in San Francisco found Zuckerberg “consistently has the highest facility fees in the area.”
— The payments drug companies make to doctors may be linked to the number of opioid overdose deaths, a new study published in JAMA Network Open has found.
The report found counties that receive such payments to doctors can later see higher overdose death rates, our Post colleague Lenny Bernstein reports, noting the study merely found an association between the two but not a cause-and-effect relationship.
“The study also suggests that consistent, trust-building visits — such as periodic lunches sponsored by drug sales reps — do more to promote prescribing of a company’s drugs than high-dollar payments to physicians,” Lenny writes. “Previous research has linked drug company marketing to opioid prescribing, but the researchers said their study was the first to extend the comparison to overdose deaths.”
The report found 435,754 payments totaling $39.7 million made to 67,507 doctors, or about 1 in every 12 doctors, Lenny writes.
— And here are a few more good reads from The Post and beyond:
- RAND Corporation holds a congressional briefing on the impacts of single-payer health care on Wednesday.
- The Pew Charitable Trusts holds a live webcast on the opioid crisis and access to medication-assisted treatment in cities on Friday.
- The National Institute for Health Care Management Foundation hosts a webinar on addressing inappropriate care on Friday.
Five ways the shutdown is affecting the economy