THE PROGNOSIS

Rep. Pramila Jayapal (D-Wash.) is seeking buy-in from more fellow Democrats for a sweeping Medicare-for-all bill she is poised to release near the end of the month.

It's a proposal that has become a rallying cry for progressives and 2020 presidential candidates, but it is also exposing deep rifts in the Democratic Party over exactly how to achieve universal health coverage in the United States.

The Medicare for All Act of 2019, which Jayapal had planned to roll out this week but delayed because she was seeking more co-sponsors, would create a government-run single-payer health system even more generous than the current Medicare program. Her office hasn’t publicly released the details of the upcoming measure, but Democratic members told me it would cover long-term care and mental health services, two areas where Medicare coverage is sparse.

The bill also proposes to add dental, vision, prescription drugs, women’s reproductive health services, maternity and newborn care coverage to plans that would be available to people of all ages and would require no out-of-pocket costs for any services, according to a letter Jayapal sent to colleagues on Tuesday asking them to consider co-sponsoring the effort.

“Medicare for All is the solution our country needs,” the letter said. “Patients, nurses, doctors, working families, people with disabilities and others have been telling us this for years, and it’s time that Congress listens.”

The 150-page bill had 93 co-sponsors as of Tuesday, although Jayapal spokesman Vedant Patel said more Democrats have signed on since then. That’s still fewer than the 124 Democrats who co-sponsored a much less detailed Medicare-for-all proposal from then-Rep. John Conyers (D-Mich.) last year. A strategist who has been working with Democrats on health-care ideas told me there have been some frustrations that more members haven’t yet signed on to Jayapal’s bill, despite the fact that there are 40 more Democrats in the House this year.

But Jayapal said she’s confident she’ll have 100 co-sponsors by the time of the bill’s planned Feb. 26 release, explaining she’s not surprised members would take more time to consider it given its length.

“It’s a 150-page bill … it’s not an eight-page resolution,” Jayapal told me yesterday. “Now we’re actually putting detail into it, and so we feel confident we will continue to add cosponsors even after introduction.”

Patel also noted it’s still early in the year, saying he “disagrees” with the notion that it’s taking a long time to bring Democrats on board.

“It’s the second week of February and we are at more than 95 co-sponsors,” he said. “Coalition building is a process, but we are on track to introduce this historic legislation with resounding support at the end of the month.”

Yet differences are emerging among Capitol Hill Democrats over how to expand coverage, part of a larger debate roiling the party as 2020 candidates, many of them senators, and a new class of freshmen House Democrats move the party left not only on health care but also on the environment.

The cracks were especially apparent yesterday, as a separate group of lawmakers gathered to re-introduce their own proposal to allow people to buy in to Medicare starting at age 50. That measure, offered by Sen. Debbie Stabenow (D-Mich.) and Rep. Brian Higgins (D-N.Y.), would take a more incremental approach to expanding health coverage — one that could play better with voters who would stand to lose private coverage under a single-payer program.

Their bill, dubbed the “Medicare at 50 Act,” would allow people to buy Medicare plans instead of purchasing private coverage on the Obamacare marketplaces if they are uninsured or prefer it to coverage offered in their workplace.

And today, Sen. Brian Schatz (D-Hawaii) and Rep. Ben Ray Luján (D-N.M.) are reintroducing their State Public Option Act, which allows people to buy a Medicaid plan regardless of their income. That measure has broad backing from not just lawmakers (20 senators co-sponsored it last year) but also well-known health policy wonks including former Centers for Medicare and Medicaid Services Administrator Andy Slavitt.

Higgins is one of several Democrats on the House Budget Committee who have proposed a total of three separate and contrasting bills to expand Medicare to more people. The others are Reps. Rosa DeLauro (D-Conn.) and Jan Schakowsky (D-Ill.), who have a bill to expand Medicare to all ages while still preserving employer-sponsored coverage, and Jayapal.

The Congressional Budget Office is expected to release an analysis by the end of March or the beginning of April on design and policy considerations in developing single payer proposals, Budget Committee Chairman John Yarmuth (D-Ky.) told me. At that point, the committee will hold a hearing with the CBO to go over the potential costs of the measures offered by Jayapal and others and their impact on the federal budget.

That conversation is where Jayapal could run into roadblocks. Given the extensive benefits she’s proposing, her bill would probably come at a steep cost to taxpayers — and paying for things is almost always Congress’s trickiest task. Of course, supporters of the legislation stress its benefits would fill in much-needed gaps in coverage under the current Medicare program.

“The biggest change I give her so much credit for is it has long-term care,” said Rep. Ro Khanna (D-Calif.), who is a co-sponsor of Jayapal's Medicare-for-all bill. “This is huge.”

And then there’s also the question of how voters might react if told they would lose their current coverage. Sen. Kamala Harris (D-Calif.), who has gone the furthest of all the 2020 candidates in pushing for an overhaul of the U.S. health-care system, attracted widespread attention recently when she suggested she’d be fine with entirely eliminating private coverage in favor of government-run plans.

“We’re very aware that there is anxiety about — however imperfect — a system you know and doctors you know, and that is going to be all part of the hearing process, public input into: How do we build a system in this country that really cares about all Americans?” said Rep. Katherine Clark (D-Mass.), another co-sponsor of the Jayapal bill.

AHH, OOF and OUCH

AHH: For more than five decades, members of the Sackler family have donated to museums worldwide including the Smithsonian's Arthur M. Sackler Gallery. But now, the Smithsonian is one of “several blue-chip cultural institutions dealing with the blowback from the Sackler family’s other legacy — the American opioid crisis,” our Post colleague Peggy McGlone reports.  The Sackler name has increasingly become tied to the public health crisis and pharmaceutical giant Purdue Pharma, which manufactures the addictive painkiller OxyContin. 

Photographer Nan Goldin started the anti-opioid group Prescription Addiction Intervention Now after she became addicted to OxyContin, and the group has been staging demonstrations at museums and calling on arts institutions to take down the Sackler name and denounce the family and its gifts. But officials at the Smithsonian, for one, said the gift agreement with Arthur Sackler “included naming rights in perpetuity and that they had no plans to remove the name or return the donated money or art.”

“The issue of toxic donors is even more complicated in the case of the Sackler family, which is worth an estimated $13 billion,” Peggy writes. “Its three branches and multiple generations are often — and, according to some descendants, unfairly — lumped together as a single entity.”

In a statement to The Post, Jillian Sackler said it’s a “gross injustice to blame my late husband, Arthur Sackler, for the public health crisis surrounding opioids…Arthur was never involved in Purdue Pharma, a company owned by his brothers Mortimer and Raymond and their families; he had nothing to do with OxyContin.”

OOF: Facebook is struggling to deal with the tens of thousands of users spreading false information about vaccines on its platform, which has become a space for part of the anti-vaccination movement as a measles outbreak continues to spread in the United States.

“The World Health Organization recently named ‘vaccine hesitancy’ as one of the biggest global health threats of 2019,” our Post colleague Taylor Telford reports. “But on Facebook, in public pages and private groups with tens of thousands of members, false information about vaccines — largely stemming from a now-debunked 1998 study that tied immunizations to autism — is rampant and tough to pin down.”

Part of the issue for the company is a lot of the anti-vaccination content being shared doesn’t violate its community guidelines for inciting “real-world harm,” a spokesman told Taylor.

“While we work hard to remove content that violates our policies, we also give our community tools to control what they see as well as use Facebook to speak up and share perspectives with the community around them,” Facebook said in an emailed statement. “If the content they’re posting crosses the line and violates our policies, we would remove the content as soon as we become aware of it.”

Facebook is in the early stages of figuring out how it can make accurate vaccination information available to its users. “In the meantime, Facebook sees factually accurate counter-speech by users as a possible safeguard,” Taylor writes.

OUCH: Hours after Lindsey McFarland underwent the country's first successful uterus transplant, she was back in surgery with a life-threatening infection that meant the organ had to be removed.

While McFarland learned the issue was Candida albicans, a fungus common in women’s reproductive tracts, what she didn’t know was “the transplanted uterus had come from a donor suffering from a Candida infection in her bladder — a fact made clear by routine tests conducted by the Miami organ group that provided the uterus,” our Post colleague Lenny Bernstein reports.

Life Alliance Organ Recovery Agency said it alerted the woman’s surgeons soon after the infection soon was discovered. But officials at Cleveland Clinic, where the transplant was performed, say they weren’t told for weeks, until after the organ was removed. And McFarland, 29, only learned about the allegations from a Post reporter.

“The alleged missteps that preceded McFarland’s failed transplant — which have not been previously disclosed — illustrate what critics say is a lack of public accountability in the U.S. transplant system that undermines patient safety,” Lenny writes. “They say the system’s main actors are not required to reveal most mistakes to the government, the rest of the medical establishment or the public. Largely free of such oversight, they are rarely held publicly responsible for errors.”

Safety standards for organ procurement organizations, like LAORA, are enforced by UNOS, which works under contract with the government. When McFarland’s transplant took place, LAORA was a “member not in good standing” of the transplant network, which signals a “serious lapse in patient safety or quality of care,” according to UNOS.

HEALTH ON THE HILL

— Abortion rights group NARAL Pro-Choice America criticized Sen. Kyrsten Sinema (D-Ariz.) for her remarks supporting Trump’s nominee to be a judge for the U.S. District Court for the District of Arizona. During a Senate Judiciary Committee hearing, Sinema praised Michael Liburdi’s qualifications.

“Mike and I do not share all the same political beliefs, but I believe the role of the Senate is to evaluate every nominee based on whether he or she is professionally qualified,” Sinema said, “and can be trusted to faithfully interpret and uphold the law.”

But Ilyse Hogue, NARAL president, called Sinema’s comments “beyond troubling,” criticizing Liburdi’s “anti-choice record.”

“You can’t claim you are an advocate of women and our reproductive freedom just because you vote correctly on some legislation if, at the same time, you help elevate right-wing judges who will inflict long-term damage to our cause,” Hogue said in a statement.

“Senator Sinema, like so many Democrats, was elected last year in large part due to a wave powered by women voters who wanted to put a check on this runaway Administration,” she continued. “So to use one of her first acts in office to help elevate a judge with a clear anti-choice record is beyond troubling.”

— Sen. Brian Schatz (D-Hawaii) and Rep. Barbara Lee (D-Calif.) have introduced legislation that would authorize Veterans Affairs doctors to prescribe medical marijuana.

The bill, which would apply to the 33 states where medical marijuana is already legal, also calls for research into how medical marijuana can help alleviate opioid abuse among veterans and manage pain.

“In 33 states, doctors and their patients have the option to use medical marijuana to manage pain—unless those doctors work for the VA and their patients are veterans,” Schatz said in a statement. “This bill gives VA doctors in these states the option to prescribe medical marijuana to veterans, and it also promises to shed light on how medical marijuana can help with the nation’s opioid epidemic.”

INDUSTRY RX

— CVS Health has opened three health-focused concept stores in Houston, which include expanded clinics, blood-testing labs and health screenings as well as dietitians and rooms for yoga, CNBC’s Angelica LaVito reports.

The pilot “HealthHUBs” are part of CVS Health’s approach following the $70 billion acquisition of health insurer Aetna.  

“As part of the acquisition, which closed in November, CVS promised to transform its stores and make customers healthier and to lower health-care costs,” Angelica writes. “The new services in the stores are available to all customers, not just Aetna members. One feature unique to some Aetna members is the type of care they receive at the pharmacy counter. Aetna identified about 100 patients who regularly come to the CVS store in Houston that will get a special consultation every time they pick up a prescription.”

CVS Pharmacy President Kevin Hourican told Angelica that not all CVS locations will become HealthHubs but the concept could expand to more stores if the pilots are successful.

— And here are a few more good reads:

National
The House Judiciary Committee debated a measure Wednesday that would require background checks for all gun sales nationwide.
Katie Zezima
For the project “Since Parkland,” teenage journalists wrote profiles for every child killed by gun violence in the year since the Florida school shooting.
New York Times
Those at Marjory Stoneman Douglas High School knew their lives would be transformed by the massacre. Many had no idea of the many ways that would happen.
New York Times
The American Medical Association (AMA), the nation’s most prominent doctors’ group, is putting its muscle behind efforts to pass gun violence legislation in Congress, highlighting their advocacy on one of the country’s most politically divisive issues.
The Hill
MEDICAL MISSIVES
Health
Keith Smith never thought he’d see it where he lives and works — not in his “Norman Rockwell-esque, all-American small town."
Reis Thebault
World
Bethan Simpson — and her unborn baby — underwent fetal surgery for spina bifida at University College Hospital in London.
Lindsey Bever
DAYBOOK

Coming Up

  • The American Enterprise Institute holds a discussion on "If one part of the Affordable Care Act is ruled unconstitutional, what is the proper remedy or resolution?" on Friday.
SUGAR RUSH

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