THE PROGNOSIS

A coalition formed by former Obama administration officials to fight Obamacare repeal efforts is urging House Democrats to take a pragmatic approach to health care in the new Congress, rather than pushing for a more sweeping plan such as Medicare-for-all.

Protect Our Care says a poll it commissioned and is releasing today shows Democrats will please more voters if they focus on legislation to ease steep costs for health insurance and prescription drugs versus trying to overhaul the insurance system. Moderates and liberal Democrats are diverging over this very question, as they try to figure out how to wield their new powers in Congress and what agenda to lay out in the 2020 elections. The poll was conducted among 1,002 voters nationwide between Jan. 8 and 11.

While Americans are curious about what a Medicare-for-all-type approach might look like, they’re a lot more concerned with improving the coverage they already have, Protect Our Care leaders Leslie Dach and Brad Woodhouse wrote in a memo provided to Health 202.

“Our polling … shows that voters, including many Republicans and Independents, are open to a conversation about both Medicare-for-all and expanding the Affordable Care Act with significant new public options (e.g. Medicare/Medicaid buy in),” the memo says. 

“However, when it comes to priorities for this year, voters — including progressive Democrats — clearly prioritize the agenda described above,” the memo continues, referring to a list of incremental measures such as limiting surprise medical bills or requiring drug companies to justify big price hikes to the government.

It looks so far like Democrats — and Republicans, for that matter — are heeding the advice from the coalition, which spent heavily in the midterm elections to pressure Republicans over their efforts to repeal and replace the Affordable Care Act and includes top liberal advocacy groups such as Families USA and the Center for American Progress.

Two top congressional committees — House Oversight and Senate Finance — have scheduled simultaneous hearings Tuesday on the high cost of prescription drugs. Oversight Chairman Elijah Cummings (D-Md.) and Finance Chairman Chuck Grassley (R-Iowa) have both vowed to make health-care costs a priority this year.

Both panels will include parents of patients with Type 1 diabetes who will speak about the especially massive price hikes for insulin. Antroinette Worsham, who will testify before Oversight, had a daughter with diabetes who died after rationing her insulin because she couldn’t afford the medication.

"What we're trying to do is get some sound action and truly reduce drug prices," Cummings told me.

There’s lots of excitement among health-care advocates about these hearings, as numerous polls have shown the high cost of drugs is a top concern for American voters. In Protect Our Care’s new survey, which was conducted by Democratic polling firm Hart Research, most respondents chose “reducing health insurance premiums” and “cracking down on excessive drug prices” as their top two health-care priorities for the new Congress.

The survey also indicated Democratic voters are more interested in shoring up existing health-care law than passing a new law. Sixty-eight percent said lawmakers should improve or expand current law to cover more people, while 29 percent said they should pass a new law such as Medicare-for-all to provide universal coverage.

Dach acknowledged there’s “a conversation to be had” around the broader goal of expanding coverage to all Americans through a massive expansion of Medicare or Medicaid. That conversation should begin, he told me, but it shouldn’t distract Democrats from taking on issues right  in front of them — especially considering that House Democrats will have to work with the GOP-led Senate and the White House to actually write any new laws.

“If you want to build the political support for [Medicare-for-all], politically this is a time for conversation and education on those issues,” Dach said. “It’s not a time where those things are going to pass. This is going to take time.”

Protect Our Care has distributed a guide to lawmakers advising them to become the “Health Care Congress” by working on several key goals such as countering the Trump administration’s moves to undermine the ACA, strengthening Medicare and Medicaid and striving to lower health-care costs.

The guide suggests some policies Republicans would almost certainly balk at, such as allowing the government to negotiate lower prices for Medicare drugs and rolling back the administration’s expansion of leaner coverage options.

But considering Republicans control the Senate and the White House, a key question is whether Democrats will play ball on policies that could get bipartisan support for the purpose of getting something done. Given the public concern about health-care costs, the issue could finally be in a sweet spot where members of both parties find it in their political interests to tackle.

"I'll tell you I told Secretary Azar that all of us in government, including  [President] Trump, need to get something done," Cummings said, referring to a recent meeting between him and Health and Human Services Secretary Alex Azar.

AGENCY ALERT

— Hundreds of thousands of federal workers will return to the jobs today after the president signed a bill to reopen the government for three weeks. It may take weeks or months for operations to return to normal after the 35-day partial shutdown, our Post colleagues Juliet Eilperin, Lisa Rein and Sarah Kaplan report.

The first order of business for the furloughed workers "will be simple office tasks, like new passwords for computers,” they write. “Timecards will need filling out, so payroll staffs know who was furloughed, worked without pay, called in sick, earned overtime or a combination.”

The Food and Drug Administration will start accepting new drug and medical device applications, now that the agency can resume collecting new user fees to pay for the applications. But officials warn it could take up to a year to finally catch up with backlogged work, our colleague Laurie McGinley reports.

— For some federal workers, their missed paychecks may have future repercussions. Scores of government employees who went without pay also struggled to make child-support payments usually withdrawn directly from their paychecks, our Post colleague Samantha Schmidt reports.

Still, even with the government at least temporarily reopening, workers may not receive a paycheck for days, Samantha writes, meaning workers and their children and former spouses who rely on child-support payments will still feel the squeeze.

“Family law experts said there could be ripple effects after the shutdown for non-custodial parents who already missed a child-support payment, making them vulnerable to administrative sanctions or even contempt of court,” Samantha writes. “Furloughed parents obligated by the state to pay child support could face back payments and administrative sanctions for missing a child support payment during the shutdown. Depending on the state, parents could theoretically lose their driver’s licenses or professional licenses. Eventually some of these cases could find their way to the court for failure to pay child support on a timely basis.”

But Samantha writes in some areas, officials are planning to limit or suspend enforcement in “cases in which people fall behind in payments because of the shutdown and urged federal workers to contact the local office to arrange payment plans as soon as they return to work after the shutdown.”

 — The Blue Cross and Blue Shield Federal Employee Program announced it would donate $1 million to help federal employees who went unpaid during the shutdown. In addition, CareFirst BlueCross BlueShield, the company serving the Washington area, is pledging $1 million to the Federal Employee Education and Assistance Fund and $500,000 in donations to regional food banks and human service organizations. The donations are meant to offer cash grants and no-interest loans to help workers who were furloughed.

— Even with the shutdown at least temporarily over, some employees are still struggling to pay for life’s basic necessities, including diapers, tampons, pads and adult incontinence products, our Post colleague Katie Zezima reports. Diapers alone can cost a family $70 to $80 a month, according to the National Diaper Bank Network.

“At least 20 diaper banks across the country have provided diapers, feminine and incontinence products, formula and more to federal employees during the shutdown and in the few days since Congress and President Trump agreed to reopen the government,” she writes. “Diaper banks started to receive calls for help in mid-January, and the entreaties became more and more desperate the longer the shutdown went on, according to organization officials.”

Those calls continued even as the government is set to reopen, Katie writes,  and groups plan to hand out products throughout the week while federal workers wait to finally get a paycheck.

— Our colleagues Aaron C. Davis and Neena Satija write of contracting firm Unispec Enterprises, whose employees’ health insurance remains in limbo even as federal offices reopen, an example that “reflects the razor-thin profit margin and unsettled nature of business for government contracting firms and their employees.”

“Unlike the 800,000 career federal employees who have been promised full back pay in coming days, government contractors — who are thought to number in the millions — have no legal claim to the five weeks of lost wages,” they write.

Federal contractor Janice Morgan, who works for Unispec, had her insurance coverage canceled during the shutdown, and she worried when she wasn’t able to fill the prescription for the $7,600- per month medication for her husband who has multiple sclerosis. Wesley McClure, Unispec’s founder and president, told the Post that before the shutdown, he hadn't missed a payroll or had to terminate insurance for his employees in 15 years.

“It feels like we are still hostages,” Morgan told our colleagues. “I’m just so happy to be going back to work and to be able to get on with our lives because I need our health insurance to fill these prescriptions. But who knows if this will all happen again in three weeks.”

AHH, OOF and OUCH

AHH: Politico’s Sarah Karlin-Smith reports from a small hilltop village in Butaro, Rwanda, where she writes about the University of Global Health Equity that aims to be a model for equitable health care by training doctors to reach people in places without access to pricey resources and technology.

Butaro is “lifetimes away from the bustling cities that medical schools and their students gravitate toward — and hardly seems a place that would hold lessons for rich countries awash in high-tech medicine like the United States,” Sarah writes. “That’s precisely why the university’s founders picked Butaro. Most people in the world live in rural areas like this, eking out a living on meager sums. To bring them health care, the medical school staff here believe, you have to go where they are, immerse yourself in their lives.”

The program will merge public-health training with traditional medical school teachings to train health-care professionals who can care for patients properly even if they don’t have water or electricity.

The new university is also uniquely set in the poorest area of a nation still working to rebuild after a genocide and civil war in 1994. “The 100-day bloodbath killed about 1 million people and devastated the country's health infrastructure, leaving Rwanda with the lowest life expectancy in the world,” Sarah writes. “The university embodies the global community’s renewed commitment to Rwanda, after it failed to intervene against the genocide.”

OOF: Some nonprofit hospitals are looking to patients for donations, using software and interactions with patients to determine potential large donors, Kaiser Health News’s Phil Galewitz reports.

The software checks to see if patients have contributed to charities or to political campaigns, and some hospitals train doctors and nurses to have patients who express gratitude for their care contacted by hospital fundraisers.

“Those who seem promising targets for fundraising may receive a visit from a hospital executive in their rooms, as well as extra amenities like a bathrobe or a nicer waiting area for their families,” Phil writes. And despite concerns about such programs, they are becoming more common. A 2016 survey by consulting firm Advisory Board found out of 108 hospitals, 68 had so-called “grateful patient programs.”

“A 2013 change in federal health privacy law made it easier for hospitals to target their patients for donations,” Phil writes. “It enabled hospital records departments to share with staff fundraisers some personal details of patients, including their health insurance status, the department treating them, the name of their physician and the outcome of their care.”

Bill Littlejohn, chief executive officer of the San Diego-based Sharp HealthCare system’s fundraising foundation, told Phil the practice of having doctors speak with select patients about their experience led to 20 percent of patient donations there.

OUCH: Federal regulators identified a cancer-causing contaminant that tainted millions of bottles of a commonly used blood pressure and heart failure drug. Agency officials have said 1 to 2 million people may have taken the tainted medicines.

The generic medication has been recalled by drug companies over the past seven months, our Post colleague Carolyn Y. Johnson reports. The FDA announced the contaminant in the drugs was a “chemical byproduct of the process used to synthesize the active ingredient in the drugs, which include valsartan, losartan and irbesartan,” Carolyn writes. Patients who took the medication may have been exposed to trace amounts of the carcinogen for at least four years, after a shift in how the drug’s active ingredient was manufactured.

The FDA said the byproducts would not have been detected in routine inspections. But David Light, chief executive of Valisure, an online pharmacy that chemically validates drugs before sending them to consumers, told Carolyn: “The manufacturers know, or should have known, about the contamination. Common precision tools exist to analyze these contaminants, and there are standard procedures for getting rid of them.”

In a statement, FDA Commissioner Scott Gottlieb and Center for Drug Evaluation and Research Director Janet Woodcock said the officials are “making important strides at understanding how these impurities occurred, mitigating the risk to patients and learning what steps need to be taken to prevent this from occurring again in the future … While the total exposure to these impurities for most patients was small, we are deeply concerned that patients were exposed to this impurity in the first place and that the presence of nitrosamines went undetected for a period of time.”

— And here are a few more good reads: 

TRUMP TEMPERATURE
Business
The shutdown is causing thousands of disabled contract workers to lose their jobs while others have seen their work cut back, nonprofit managers say.
Aaron Gregg
Politics
The president has insisted he did not concede in reversing course and agreeing to end the shutdown without funding for his proposed border wall.
Mark Berman and Brady Dennis
Business
By leading the country through the longest government shutdown in American history, President Trump inadvertently revealed how intertwined the government is with millions of households, businesses and the entire U.S. economy.
Damian Paletta
HEALTH ON THE HILL
PowerPost
The landmark 1994 law expired in late December, a blow to lawmakers and activists who have sought a long-term reauthorization.
Elise Viebeck
Politics
The California Democrat appeared before thousands gathered in a sun-swept plaza in Oakland, Calif., where she was born.
Matt Viser
OPIOID OPTICS
A lawyer for STAT and other media organizations argued for immediate unsealing of allegations against Purdue in a lawsuit filed by Massachusetts.
Stat
WASHINGTON (AP) — President Donald Trump has declared the opioid epidemic a national public health emergency and urged prosecutors to seek the death penalty against drug dealers. Congress has provided targeted grants for treatment, recovery and prevention and made numerous policy changes to help people struggling with addiction get access to services. From the National Institutes of Health to Veterans Affairs and the Agriculture Department, government agencies are deploying their own specialized skills. Still, the addiction crisis will not easily release its grip on the nation, even as progress is made providing resources and improving coordination.
Associated Press
STATE SCAN
As of Saturday, there are 32 confirmed cases of measles in Washington state. Gov. Jay Inslee has already declared a state of emergency.
CNN
If his health care innovations work, Newsom could emerge as a hero of the Democratic Party.
Politico
MEDICAL MISSIVES
Local
Manager Michael Scott and his employees learn CPR to the tune of the Bee Gees' "Stayin' Alive" in one well-known scene from the American sitcom.
Alex Horton
Animals
Think twice before you nuzzle little Spike, Sonic or Shaquill O'Neal.
Amy Wang
Health & Science
Experts say studies could reveal discoveries about our anatomy, including cures for illnesses.
Rachel Damiani and Ted Spiker
INDUSTRY RX
Pfizer is seeking a new round of growth by treating cancer and is among the big pharmaceutical companies trying to expand in oncology. ​
Wall Street Journal
DAYBOOK

Today

  • FDA Commissioner Scott Gottlieb speaks alongside former agency commissioners at a Bipartisan Policy Center event.

Coming up

  • The Senate Finance Committee holds a drug pricing hearing on Tuesday.
  • The House Oversight and Reform Committee holds a hearing on drug companies and rising drug prices on Tuesday.
  • The House Ways and Means Committee holds a hearing on preexisting conditions on Tuesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health care access on Tuesday.
  • The House Energy and Commerce Committee holds a hearing to examine the impact of the shutdown on federal workers and public health on Thursday.
SUGAR RUSH

Watch House Speaker Nancy Pelosi signing a bill to temporarily end the government shutdown:

'Hope for the best': Federal workers relieved but uncertain as shutdown temporarily ends: