THE PROGNOSIS

Momentum appears to be building on both sides of the aisle for Americans to receive mandatory paid medical leave for new parents and maybe even for people to care for sick family members.

The White House told me President Trump's daughter Ivanka will meet today with Sen. Bill Cassidy (R-La.) and other key members on Capitol Hill to continue discussions on the issue. Ivanka Trump worked last year with Sen. Marco Rubio (R-Fla.) on a plan to provide parental leave benefits via the Social Security system, but the effort never gained real traction.

And as Republicans warm to the issue of family leave, a growing group of Democrats — particularly those seeking their party’s presidential nomination in 2020 — are also pushing paid leave as a top priority. Sen. Kirsten Gillibrand (D-N.Y.) and several House Democrats yesterday reintroduced their FAMILY Act, which would provide up to 12 weeks of paid leave and has become Democrats’ template for how the government could guarantee the benefit not just for new parents but also for those who are ill or providing care to a family member.

“It’s encouraging to see members on both sides of the aisle putting forward paid family leave proposals," Ivanka Trump said, a statement provided to The Health 202. "Twenty-five years after [the Family Medical Leave Act] was passed we finally have bipartisan agreement on the importance of paid leave for working parents. Now we are seeking to build consensus around policy that can garner enough votes to be passed into law."

Rubio and Rep. Ann Wagner (R-Mo.) plan to reintroduce their alternative family leave proposal within the next month, a measure that draws from existing Social Security benefits and is significantly less generous than what Democrats are proposing. It offers six weeks of paid leave that would be extended only to new parents.

And Trump, who called for paid family leave in his State of the Union address last year, again signaled in his address to Congress last week that he views the effort as a top priority. “I am also proud to be the first president to include in my budget a plan for nationwide paid family leave, so that every new parent has the chance to bond with their newborn child,” Trump said.

“My impression is the White House is increasingly engaged on this and making it a priority as they look forward to what is possible this year — assuming one thinks bipartisan legislation is possible in this climate,” a senior GOP aide told me. “It’s an increasing area of focus, so that’s encouraging.”

If there’s any issue ripe for bipartisan work, it could be paid family leave. While the number of women in the workforce is at an all-time high, the United States remains the only developed country with no mandatory paid leave offered by employers.

Most Americans say employers should provide workers with paid family leave, although there are sharp divides when people are asked whether it should be a requirement. In a 2017 survey by the Pew Research Center, 51 percent of respondents said the federal government should mandate that employers provide paid leave, while 48 percent said it shouldn’t.

Likewise, there remains division between some Republican members of Congress who feel paid leave is an essential benefit for a workforce increasingly led by women and others who argue it amounts to government overreach. The aide described it as an “evolving process” within the party.

“Generally, the Republican Party is still grappling with how to deal with this issue,” the aide said. “There are folks who know the party needs a position but are unsure of how to craft a policy, and there are still folks who don’t think there is a federal nexus to be played.”

Rubio’s measure, which he first introduced in August, would allow new parents to finance at least two months of paid leave by drawing from their Social Security benefits, which would result in a three- to six-month delay in receiving those benefits when they retire. While the measure wouldn’t cost anything because it draws on existing benefits, it hasn’t yet received any co-sponsors.

Democrats have called the bill deeply inadequate, noting it would apply only to new parents and not others in need of medical-related leave. Yet Rep. Rosa DeLauro (D-Conn.) said yesterday she’s grateful Republicans are willing to at least discuss the issue.

“We have our colleagues on the other sides of the aisle and the president who have come out with some form of paid leave,” DeLauro said at the news conference reintroducing the Democrats’ bill. “That’s good and it’s part of the national debate and this issue is at the center of our public discourse. … But I will just say to you their proposals fail to go far enough.”

Rubio said he “welcomes the discussion in Congress over paid family leave.” He said in a statement:“I am committed to seeing this effort through.”

Wagner shouted “yes” when Trump referred to paid family leave during his address to Congress. The reference also prompted applause from the crowd of House Democratic women clad in white, who sat in silence for much of the president’s speech. The FAMILY Act has 160 co-sponsors in the House and 34 in the Senate — including every senator and representative seeking the Democratic presidential nomination.

Some form of paid family leave is mandated in six states plus the District of Columbia, said Vicki Shabo, vice president at the National Partnership for Women and Families. California, which has the longest-standing leave requirements in the nation, may seek to expand its mandate to six months under a proposal expected from the state’s new Democratic governor, Gavin Newsom.

Shabo, who testified at a Senate Finance subcommittee hearing last summer on the topic, said it was striking to her that every witness before the GOP-led panel agreed that adopting guaranteed paid leave was “an economic imperative.” She said that wouldn’t have been the case five years ago.

“What’s been different and exciting over the last couple of years is seeing Republicans come on board with the issue,” Shabo told me. “It’s exciting to be in a place and time where we’re debating the ‘what’ and not the ‘if.’ ”

CORRECTION: Ivanka Trump did not help Sen. Rubio craft his family leave bill, as the piece originally and inaccurately stated. She has been more generally involved in discussions with Republican senators interested in family leave legislation.

AHH, OOF and OUCH

AHH: The wave of new Democrats on Capitol Hill is using policy and social media to push the party to the left on divisive issues like health care and climate change ahead of the 2020 presidential election.

“But the liberal shift, and the lawmakers driving it, are also creating challenges for Democrats in more-conservative areas, and they are giving President Trump and congressional Republicans fresh opportunities for political attacks,” our Post colleagues Seung Min Kim, Annie Linskey and Rachael Bade report.

Republicans are seizing the chance to portray Democrats as “radical” and out of touch with mainstream Americans, pointing to comments like Sen. Kamala Harris’s (D-Calif.) support for ending private insurance in the pursuit of Medicare-for-all.

Nearly all the Democratic senators who have declared they are running for president have backed Medicare-for-all legislation. “But each Democrat has described the goal differently,” our colleagues write. “Sen. Cory Booker (D-N.J.) said in his weekend stops across Iowa that he backed a ‘Medicare-for-all option,’ describing a government program into which people could buy while leaving private insurance in place.”

Meanwhile, on the Hill, Speaker Nancy Pelosi (D-Calif.) has been forced “to play damage control to keep progressive members — particularly freshmen — in line," they write. "On the policy front, particularly on health care, Pelosi is focusing the caucus’s attention on improving the Affordable Care Act, also known as Obamacare, which was her chief legislative accomplishment during her first term as speaker.”

OOF: In a call with donors last week, House Minority Leader Kevin McCarthy (R-Calif.) directly blamed his party’s midterm losses in the House on the issue of health care. He specifically called out the Republican effort to roll back protections for people with preexisting conditions, our Post colleague Mike DeBonis reports.

In the Feb. 6 conference call, McCarthy pointed fingers at the House Freedom Caucus, also noting several of its members lost, and made comments that “threaten to rekindle internal resentments inside the House Republican Conference,” Mike writes. The Post obtained partial records of the private call.

The California Republican’s remarks “represent a vindication of Democratic efforts to elevate health care as an issue in last year’s campaign,” Mike adds.

During the call, McCarthy offered a selective account of the health-care debates that took place in 2017. “When we couldn’t pass the repeal of Obamacare the first way through, an amendment came because the Freedom Caucus wouldn’t vote for” the initial House bill, McCarthy said. “That amendment put [the] preexisting condition campaign against us, and so even people who are running for the very first time got attacked on that. And that was the defining issue and the most important issue in the race.”

“McCarthy’s account accurately describes the dynamics of passing the American Health Care Act, the Republican ACA alternative, in 2017,” Mike reports. “But it sidesteps the Republican leadership’s role in backing what became known as the MacArthur Amendment and ultimately forcing a vote on a bill that faced uncertain prospects in the Senate and put scores of GOP lawmakers on the political defensive.”

McCarthy spokesman Matt Sparks told The Post the GOP leader “has been clear-eyed on what went wrong last cycle and no one is more committed to doing everything necessary to win back the House and execute an agenda that offers every American limitless potential to get ahead.”

OUCH: The Texas Department of Insurance is experiencing a serious backlog of requests from patients seeking the state’s help in dealing with surprise medical bills.

“It’s going to take us a while to get out of this backlog that we’re in, but we’re doing the things necessary to help more consumers,” Chris Herrick, the department’s associate commissioner, told the Texas Tribune’s Jay Root and Shannon Najmabadi.

“The overwhelmed state mediation program highlights the widespread problem of surprise emergency medical bills, an issue that has sparked bipartisan outrage in Washington and Austin alike,” Jay and Shannon write. They write the issue of surprise medical bills arises when insurers and health-care providers disagree on the price of a treatment, meaning patients are stuck with a bill to pay for costs insurers won’t cover.

It appears to be a major concern in Texas, where one in three emergency room visits leads to a surprise medical bill, the Texas Association of Health Plans says, which is twice the national average, Jay and Shannon write. And requests for help have spiked through the mediation program created in 2009.

“To put the demand in perspective, the Texas Department of Insurance received just 43 requests for mediation in 2013,” they write. “The following year, the number surged to more than 600 — and the numbers have climbed steeply ever since. The requests hit a record high of 4,519 in 2018, and regulators expect 8,000 this fiscal year.”

HEALTH ON THE HILL

— Stay tuned for the latest health-care proposal from Democrats. Sens. Debbie Stabenow (D-Mich.) and Tammy Baldwin (D-Wis.) and Reps. Brian Higgins (D-N.Y.) and Joe Courtney (D-Conn.) are planning to announce legislation allowing people the option of buying in to Medicare between the ages of 50 to 64.

They are scheduled to hold a news conference on the "Medicare at 50” act at noon. 

— First in The Health 202: A coalition of health-care industry groups called Partnership for America's Health Care Future is sending a letter to  congressional leaders urging them to quash that bill and any other Medicare-for-All-like efforts.  

"We want to work with you to improve what’s working and fix what’s broken – not start over," writes the group, which includes America's Health Insurance Plans and Pharmaceutical Researchers and Manufacturers of America. "We urge you to oppose single payer health care solutions and work with us to ensure the best of the free market and the strength of public programs can deliver real solutions that lower costs, increase patient choice, and improve quality."

— Meanwhile, Sen. Sherrod Brown (D-Ohio), who is considering a bid for the White House, signaled support for a Medicare option at age 50. Asked about his view of the “Medicare-for-all” proposals that have been pushed by others in the Democratic party, Brown said he believes in “universal coverage.”

“I want to get something done now,” he said at a breakfast event hosted by the Christian Science Monitor. “That’s why I don’t want to repeal Obamacare; I want to add to Obamacare, and I want to help people now.”

“If you … allow voluntary buy-in at 50, that’s not just practical and smart, it will help people today; it will make a difference in people’s lives as soon as it becomes law,” he continued.

He said after starting with such a Medicare buy-in option, “over time, people will see how well this works.”

“Eventually we probably get to something like ‘Medicare-for-all,’ ” he said, “but we start by expanding it and helping people now. It will make a huge difference.”

— Former Starbucks CEO Howard Schultz, who is considering running for president, expressed his opposition to Medicare-for-all during a CNN town hall, saying it “gives me another opportunity to talk about the extreme left and the extreme right.”

“We have a health care crisis in the country on many levels, but Republicans for 10 years … have done everything possible to eradicate the Affordable Care Act, and they’ve done that without offering any plan. This is the far right,” he said. “The far left is now suggesting Medicare-for-all. That is a $32 trillion number … Does anyone here really understand that Medicare-for-all means you will lose the choice of your doctor and insurance company?”

MEDICAL MISSIVES

— For the first time, a federal panel of health experts said it’s urging doctors to identify women who may be at risk for perinatal depression because counseling can help prevent it.

Up to one in seven women experience some form of depression during pregnancy or after childbirth, according to the U.S. Preventive Services Task Force, but it’s now saying it has found a method to prevent the symptoms from setting in, the New York Times’s Pam Belluck reports.

“The guidelines marked the first time a national health organization has recommended anything to fend off the most common complication of pregnancy, and they amounted to a public call for health providers to seek out at-risk women and guide them to treatment,” Pam writes.

Perinatal depression can increase a woman’s risk of suicidal symptoms and can also increase the chances of a baby being born prematurely or with a low birth weight, Pam reports.

“We really need to find these women before they get depressed," Karina Davidson, a task force member and senior vice president for research for Northwell Health, told Pam.

— And here are a few more good reads:

Politics
Reps. John Lewis (D-Ga.) and Fred Upton (R-Mich.) and House Speaker Nancy Pelosi (D-Calif.) led an “impromptu service” for Dingell aboard a military plane Tuesday.
Anna Clark and Felicia Sonmez
The House Administration Committee on Tuesday authorized the use of official funds to purchase tampons and other feminine hygiene products and ordered the House Office Supply Store to keep them in supply.
Washington Examiner
That reputation, deserved or not, could become a major political liability for Booker, particularly at a time of concern over drug prices.
Stat
Asia & Pacific
Authorities are rushing to immunize children after over 4,000 measles cases and 70 deaths were recorded since the start of the year. 
Regine Cabato and Shibani Mahtani
TRUMP TEMPERATURE
Business
Federal workers are preparing for another government shutdown with the bitter benefit of lessons learned from the last shutdown.
Todd C. Frankel, Kimberly Kindy and Lisa Rein
AGENCY ALERT
The active ingredients of ketamine, a popular club drug, show promise in battling deep despair.
New York Times
Alex Azar blasted the insurer practice of having a patient start over on step therapy if they switch insurance plans, as HHS aims to apply step therapy to Medicare Part B and D.
Modern Healthcare
As part of the proposed rules released by the Office of Management and Budget this week, the Trump administration has said it would give 125 million patients electronic access to their medical claims information by 2020.
Fierce Healthcare
The FDA found that McKesson responded inadequately and demonstrated a lack of understanding of key regulations, according to a Feb. 7 warning letter.
Stat
INDUSTRY RX
The president’s proposed replacement for the 25-year-old North American Free Trade Agreement is meant to win over Democrats by incentivizing factories to hire and expand in the United States. Yet the pact would also give pharmaceutical companies 10 years’ protection from cheaper competition in a category of ultra-expensive drugs called biologics, which are made from living cells.
Associated Press
STATE SCAN
Public Safety
Police said Bernard Betts-King, 60, worked as a behavioral specialist.
Dana Hedgpeth and Justin Jouvenal
DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Health holds a hearing on the ACA and protections for preexisting conditions.
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