with Paulina Firozi


Congressional Democrats have proposed about 50 shades of Medicare-for-All plans – but their leaders are treading carefully around the bold idea because most Americans don’t yet have a firm grasp of what it would mean for them.

Fifty-six percent of Americans said they support the idea of a national Medicare-for-all plan in a new poll from the Kaiser Family Foundation. But support faded 20 to 30 percentage points when people were told such an approach could result in higher taxes or longer wait times to see a doctor.

“I do think these results create some constraint for policymakers,” KFF polling director Mollyann Brodie said. “I think what our data show here is it’s pretty easy to move the dial on support and opposition.”

Think of these next two years as a laboratory for Democrats leading the House and those running for president in 2020 to experiment with how various degrees of Medicare expansion might play with the public. Democrats are unified on this goal: extending health coverage to all Americans. What they’re divided about is exactly how to bridge the gap between the 13.7 percent uninsured rate and universal coverage.

“Every Democrat that I know believes in the principle of universal health care,” freshman Rep. Donna Shalala (D-Fla.), who headed the Department of Health and Human Services in  the Clinton administration, told me. “The question is how do we get there.”

The umbrella term Medicare-for-all is being used to describe a broad spectrum of proposals, ranging from simply lowering the program’s eligibility age to replacing the entire U.S. system of private health coverage with a single government-run plan. Democrats have zeroed in on describing additional government-backed health plans as "Medicare" because the program for the elderly and disabled is well-known and popular.

Some of the more modest proposals to expand Medicare or Medicaid, such as Rep. Brian Higgins's (D-N.Y.) Medicare Buy-In Act and Sen. Debbie Stabenow’s (D-Mich.) Medicare at 55 Act, play quite well with voters. Seventy-seven percent of respondents to the Kaiser poll — including 69 percent of Republicans — said they favor allowing people to buy into Medicare starting at age 50.

And 75 percent of respondents — including 64 percent of Republicans — said they favor allowing people who don’t get workplace coverage to buy into their state’s Medicaid program, an idea laid out in Sen. Brian Schatz’s (D-Hawaii) State Public Option Act.

There was almost as much support for including a government plan among the private plan offerings available in the individual insurance marketplaces. Higgins and Sen. Michael Bennet (D-Colo.) have plans that would create a Medicare plan option for those who purchase private Obamacare plans. Rep. Jan Schakowsky (D-Ill.) and Sen. Sheldon Whitehouse (D-R.I.) have similar bills to offer a “public option” plan.

Moderate Democrats tend to favor these incremental approaches, which would allow people to keep their employer-sponsored coverage if they like it. Rep. Abigail Spanberger (D-Va.), who in November unseated former Republican congressman Dave Brat, said she thinks a public option is the best way to close the coverage gap.

“That’s not because of any sort of grandiose negativity toward other plans,” Spanberger said. “I just think it’s the most effective, potentially — in theory, right? — option for expanding health-care access to more Americans.”

Rep. Ami Bera (D-Calif.), who helps lead a group of moderate Democrats called the New Democrat Coalition, pointed to the Medicare and Medicaid buy-in proposals.  He suggested they would be a lot more feasible in the current political environment than a full health insurance overhaul. “I think where we’re focused … is what’s doable right now,” Bera told my colleague Paulina Firozi.

Bera hasn’t signed on to the sweeping Medicare-for-all bill offered by Rep. Pramila Jayapal (D-Wash.), which would make the government the country’s sole health insurer. The Kaiser poll suggested far less support for this type of idea, especially when respondents were told about what they might view as downsides. Just 37 percent said they would support such a plan when told it could increase their taxes. Support dropped to 26 percent when they were told it could lead to delays in some people getting medical tests and treatment.

Granted, more House members back the idea of a single-payer system than ever before. House Rules Committee Chairman Jim McGovern (D-Mass.) and Budget Committee Chairman John Yarmuth (D-Ky.), who have both signed on to comprehensive Medicare-for-All legislation, have said they’ll hold Medicare-for-all hearings.

But House Speaker Nancy Pelosi (D-Calif.) seems very aware of the potential pitfalls should Democrats take a stance on a specific Medicare-for-all measure before the public is ready for it. These bills raise all sorts of sticky questions about the extent of coverage and how to pay for it. Pelosi told the Associated Press her priority is to first work on lowering drug prices and improving the Affordable Care Act.

Rep. Anna Eshoo (D-Calif.), a Pelosi ally who leads the Energy and Commerce Health subcommittee, also named those two topics as her top priorities. She told Paulina it would be “interesting” to examine various Medicare-for-all proposals but hasn’t announced she will hold such a hearing.

“You have to gauge what’s possible. What’s doable,” Eshoo said. “But I also think that you don’t want to — I never want to stomp on anyone’s dreams. Because no matter what’s taken place in our history, there was always a Greek chorus chanting on the side of the stage. ‘We can do more. We can do better. We can go farther.’ ”

It would make little sense for Pelosi to force her members to actually vote on that measure — or any of the others — considering Republicans leading the Senate would probably block it. So for now, it’s more likely Democrats will stick to putting out feelers on Medicare-for-all, through committee hearings and the like.

“Since we’re so far away from a real legislative vote on a Medicare-for-all proposal, the debate is much more about how the Democratic Party needs to position itself leading into 2020,” said Brodie, the KFF polling director.

Paulina Firozi contributed to this report.


AHH: The Senate unanimously approved a measure yesterday to temporarily extend the critical Temporary Assistance for Needy Families program, after states warned they were close to exhausting needed funds during what's now Day 33 of the government shutdown.

The National Governors Association sent a letter to lawmakers calling on the Senate to extend the $16.5 billion block grant that funds cash welfare benefits and other resources for low-income families, our Post colleague Felicia Sonmez reports.

“At least one state expects to exhaust its funding in early February while others will be able to cover the program for the next several months,” the NGA wrote. “States’ abilities to continue covering these costs may change based on caseload and enrollment. Payments to both individuals and families, in addition to support services funded by TANF, are at risk unless funding is restored.”

The measure, which had already passed the House, now heads to Trump's desk. It would extend the TANF program through June 30.

OOF: Health and Human Services Secretary Alex Azar has refused a request to testify before Congress on the Trump administration’s family separation policy, prompting criticism from House Democrats. Azar declined a request Tuesday by House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), who called the move “unacceptable." He said lawmakers “are going to get him here at some point one way or another.”

In a statement, an HHS spokeswoman said Azar “has spoken directly with Chairman Pallone about their shared commitment to the welfare of the children in HHS’s care.”

HHS said it has communicated with staff from the Energy and Commerce Oversight and Investigations subcommittee “to provide the department’s most knowledgeable subject matter experts to the subcommittee,” including Lynn Johnson, assistant secretary at the agency's Administration for Children and Families; Jonathan Hayes, the acting director of HHS's Office of Refugee Resettlement; and Jonathan White of the agency’s Office of the Assistant Secretary for Preparedness and Response.

OUCH: The forces behind a slew of lobbying activities aimed at stopping efforts to curb drug costs are not always clear. Some outside lobbying groups, like the Alliance for Patient Access and Patients Rising, have names that disguise their industry ties.

"Those names make it hard for people to understand their ties to industry, consumer advocates say,” our Post colleagues Christopher Rowland and Jeff Stein report. “The Alliance for Patient Access has launched digital and radio advertisements in recent weeks opposing the Trump administration’s plans to cut Medicare reimbursement for drugs administered in hospitals and doctor’s offices. Patients Rising has a strong presence on social media.”

One group, Citizens for American Ideas, launched a website in December and has criticized Democrats push to curb Medicare costs. “We must protect innovation and the development of new treatments and cures, and that means protecting patents,’’ reads a form mailing the group sent to voters.

“But the group has murky origins," Chris and Jeff write. It has taken steps to remain anonymous, even as it publicly rails against efforts in Congress to lower drug prices and urges voters to directly contact lawmakers. Its website was formed using an Internet service that conceals the actual owner,” our colleagues write. “Lobbyists and lawmakers who have reviewed the group’s activities say Citizens for American Ideas is the latest example of a corporate lobbying ‘ghost ship,’ a term of art for a corporate advocacy operation that is meant to remain anonymous. It could have been launched by any one of the hundreds of lobbying shops in downtown Washington, lawmakers say.”

— The Pharmaceutical Research and Manufacturers of America, the top trade group representing drug companies, spent a record $27.5 million on its lobbying efforts last year. It’s the most the lobbying group has spent since 2009, when PhRMA spent $25 million amid the debate over the Affordable Care Act, Stat’s Nicholas Florko reports.

The high-dollar spending comes as the Trump administration has focused efforts on tackling high prescription drug costs and as lawmakers have increased their criticism of the industry.

“The group’s eye-popping 2018 spending — sums that support some two dozen internal lobbyists as well as a crowd of external contractors — is a sign of the increasingly existential threat the drug industry faces in Washington,” Nicholas writes. “Among the laundry list of bills and regulatory issues that PhRMA lobbied on: the Trump administration’s idea to peg what Medicare pays for drugs to what other countries pay and a Medicare coverage gap known as the donut hole.”


— Next Tuesday will be a big day in health policy land. Two more congressional committees have announced health-related hearings -- one on drug prices in Senate Finance and another on protecting patients with preexisting conditions at House Ways and Means. Those panels, in addition to a previously scheduled House Oversight hearing on drug prices, make three hearings in one day where lawmakers will examine issues related to health-care costs -- a problem members of both parties have vowed to take on in the new Congress.

From Senate Finance Chairman Chuck Grassley (R-Iowa):


— The amount of money individuals with Type 1 diabetes spent on insulin doubled from 2012 to 2016, according to a new study. The cost for a patient with Type 1 diabetes went from an average of $2,864 in 2012 to $5,705 in 2016, according to an analysis by the nonprofit Health Care Cost Institute.

The institute said it found an increase in the price of insulin overall, rather than an uptick in use of the treatment. "It's not that individuals are using more insulin or that new products are particularly innovative or provide immense benefits," Jeannie Fuglesten Biniek, a senior institute researcher and co-author of the report, told Reuters. "Use is pretty flat, and the price changes are occurring in both older and newer products. That surprised me. The exact same products are costing double.”

— It seems we have not yet reached the mainstream advertising era of medical marijuana. CBS has vetoed a proposal for a 30-second Super Bowl LIII ad on its benefits, our Post colleagues Cindy Boren and Ben Strauss report.

The ad by U.S.-based cannabis firm Acreage Holdings — the firm former House speaker John A. Boehner (R-Ohio) recently joined — would have “advocated medical marijuana’s potential to alleviate pain and would not have promoted Acreage products,” and according to a Bloomberg News report was meant to be a “call to political action.”

“Although many states have legalized recreational and medicinal use of marijuana, it remains illegal federally and is banned by the NFL,” Cindy and Ben write. “Given the patchwork of state laws governing marijuana’s use, there are restrictions on how it can be advertised that have prevented national TV campaigns. Under CBS’s broadcast standards, for instance, the network does not currently accept cannabis-related advertising on any of its programming.”

The firm’s president, George Allen, told CNN Business the company is “disappointed by the news but somewhat unsurprised.” “Still, we developed the ad in the spirit of a public service announcement. We feel it’s our responsibility to advocate on behalf of our patients,” Allen said. Acreage plans to have a 60-second version of the ad on its website.


— In New York, state legislators passed a bill Tuesday to allow women the right to abortion under the state’s public health law, a move that came on the anniversary of the landmark Roe v. Wade ruling.

The Reproductive Health Act is meant to establish a right to abortion under the state law and take abortion language out of the penal code, the Wall Street Journal’s Jimmy Vielkind reports, allowing the procedure in the first 24 weeks of pregnancy or later if the pregnancy is deemed a risk for the woman’s health.

"The bill cleared the New York state Assembly and Senate, which Democrats dominate, in largely partisan votes. Gov. Andrew Cuomo, a Democrat, signed it minutes later," Jimmy reports. "Advocates are advancing legislation in Rhode Island and New Mexico to repeal antiabortion statutes that could take effect if Roe is overturned and said the New York vote would give them momentum."

— 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.

Coming Up

  • 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.

Four ways the shutdown is hurting President Trump's priorities: 

President Trump said he would be “proud” to shut down the government. Now the longest government shutdown in history is jeopardizing some of his top priorities. (JM Rieger/The Washington Post)

From the Fact Checker: President Trump spins asylum restrictions as humanitarian relief: 

The president's proposed changes to asylum laws keep would-be migrants in Central America. (Meg Kelly/The Washington Post)