THE PROGNOSIS

The silence from some progressive activists and lawmakers as House progressives unfurled an expansive new Medicare-for-all bill was perhaps more telling than the applause it received.

Don’t get us wrong — there’s undoubtedly fresh, unprecedented energy behind what was once regarded as a liberal fringe idea of replacing the country’s largely privately run health-insurance system with a single government-run plan. Rep. Pramila Jayapal (D-Wash.) touted support from 107 House co-sponsors as she rolled out her bill outside the U.S. Capitol, promising it would fix a host of ills by providing all Americans with a broad array of benefits.

“We have a bill, and it is a real plan,” Jayapal said to cheers from onlookers. “First of all, we cover everyone, not just children, not just seniors, not just those who are healthy …everyone, because health care is a human right.”

But Democrats’ internal disputes starting poking through the debate over how to expand health coverage to more people, if you read between the lines. Key players whose support would be vital to the success of Jayapal’s bill were muted, while a group of moderate House Democrats called for instead improving the Affordable Care Act and expanding existing private channels of health coverage.

A spokesman for House Speaker Nancy Pelosi (D-Calif.) didn’t respond to a question about whether she would bring the bill to the floor. Influential groups on the political left, including the Center for American Progress, AARP and Protect Our Care, declined requests for comment about Jayapal’s bill.

And a group of 101 centrist Democrats dubbed the New Democrats asked House leaders in a letter sent Wednesday to focus on improving the ACA marketplaces by reinstating extra subsidies for out-of-pocket costs, providing reinsurance dollars to help insurers with the sickest patients and letting states auto-enroll patients in the individual marketplaces. Those ideas stand a chance of some Republican buy-in, in contrast to Jayapal’s proposal.

“We think we can drive the caucus agenda because we are open to working with Republicans,” Rep. Ami Bera (D-Calif.) told reporters. “There is an urgency to addressing this issue.”

Jayapal’s bill has yet to gain as much support as the Medicare-for-all bill proposed in the last Congress, which had 124 co-sponsors. Twenty-six Democrats who signed on to that shorter, vaguer measure from then-Rep. John Conyers (D-Mich.) haven’t yet thrown their backing behind Jayapal’s more specific and extensive legislation. They include Rep. Ann Eshoo (Calif.), the top Democrat on the Energy and Commerce Health subcommittee, along with House Majority Whip Jim Clyburn (S.C.) and Budget Committee Chairman John Yarmuth (Ky.).

Jayapal did pick up 17 new co-sponsors for her bill from among the 64 House Democratic freshman. But just seven of the 42 Democrats who flipped Republican seats in the midterm elections — Reps. Ann Kirkpatrick of Arizona, Jared Golden of Maine, Susan Wild of Pennsylvania, and California’s Josh Harder, Katie Hill, Katie Porter and Mike Levin — are co-sponsors of the Jayapal bill.

Jayapal delayed introducing her bill for two weeks as she worked to get more co-sponsors. But yesterday, she appeared buoyant over the support it has received so far and predicted she’ll keep making inroads among her House colleagues.

“I am confident we will just continue to increase that number,” she said.

The Hill's Peter Sullivan:

Reporter Matt Laslo:

Ryan Grim, D.C. bureau chief for the Intercept:

The Washington Democrat’s bill incorporates key policy demands of single-payer activists, aiming to overhaul the country’s health-care system even faster and more dramatically than the first Medicare-for-all bill proposed a year and a half ago by Sen. Bernie Sanders (I-Vt.), my Washington Post colleague Jeff Stein notes in a piece explaining the measure.

“Jayapal’s Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost,” Jeff writes. “Similar proposals have been projected to increase federal expenditures by at least $30 trillion but virtually eradicate individuals’ health spending by eliminating payments such as premiums and deductibles.” 

Jayapal didn’t propose how to pay for her bill, which includes a massively expensive proposal not even Sanders included in his Medicare-for-all measure: coverage of long-term care to help aging Americans and those with disabilities.

“The number of Americans who require long-term care is expected to explode over the next few decades as the baby-boom generation ages, with the number of Americans with a disability projected to more than double from 2015 to 2065,” Jeff notes. “Jayapal’s new Medicare-for-all bill, unlike the one Sanders introduced in the Senate in 2017, would guarantee free long-term care, including home health care, for Americans with disabilities as part of the single-payer system.”

That provision — combined with several other elements in Jayapal’s plan such as the promise of zero co-payments for health services — raises challenging questions about how the government could manage to pay for such a generous measure.

It’s an argument Republicans, industry heads and other opponents of Medicare-for-all will keep hitting over and over again.

“I look forward to hearing from the members … about how they plan to pay for a $32 trillion proposal,” said Rep. Steve Womack (Ark.), the ranking Republican on the House Budget Committee, which is expected to hold a hearing this spring on the impact of Medicare-for-all measures.

Womack isn't referencing an official cost estimate. The Congressional Budget Offfice is expected to review and estimate the price tag of a number of Medicare-for-all proposals.

AHH, OOF and OUCH

AHH: House Democrats and gun-control advocates celebrated the passage of a bill expanding federal background checks for firearm purchases and transfers, even with a veto threat from President Trump and little likelihood it will be be considered in the Republican-controlled Senate.

The Bipartisan Background Checks Act of 2019 passed 240 to 190 with mostly Democratic votes, our Post colleague Mike DeBonis reports, adding it is the “first major new firearm restrictions to advance in a generation.”

The bill amends federal gun laws to mandate background checks for all gun sales and most gun transfers, requiring federally licensed dealers to run background checks on buyers. Private sellers who are not federally licensed would not be required to do so.

“In an embarrassment for Democratic leaders, Republicans successfully used a floor maneuver to amend the bill — requiring the notification of U.S. Immigration and Customs Enforcement if an illegal immigrant seeks to buy a gun,” Mike adds. “Twenty-six Democrats joined Republicans to support the amendment.”

But Pelosi said the move is "not to eclipse a tremendous victory." 

“We’re grateful, again, to the young people, parents, survivors across America who have told their stories, marched for their lives and demanded change," Pelosi said on the House floor. "This bill delivers that change: ensuring that people who are a danger to themselves and others cannot purchase a gun and perpetuate violence in our communities.”

OOF: A new report from the Centers for Disease Control and Prevention found the decline in HIV infections nationwide has stalled in recent years.

The report comes just weeks after President Trump vowed during his State of the Union address to end the HIV epidemic within the next decade.

“Together, we will defeat aids in America. And beyond,” Trump said.  

After about five years of marked declines, the number of new infections has remained steady at about 39,000 each year since 2013, the CDC reports.

In a news release, CDC Director Robert Redfield praised the president’s plan. “Now is the time for our Nation to take bold action. We strongly support President Trump’s plan to end the HIV epidemic in America,” he said. “We must move beyond the status quo to end the HIV epidemic in America.”

OUCH: In the past year, at least 17 people have been hospitalized after getting injected with products derived from umbilical cord blood, an unproven treatment that’s marketed as a miracle cure for various conditions. Such products, which are not approved by federal regulators or backed by clinical research, are a little-known but growing part of the stem cell industry, our Post colleagues William Wan and Laurie McGinley report in an extensive look at this growing trend.

After people got sick in five different states, health officials are warning about the risks.

“All but two of the illnesses have been linked to a single company: Liveyon of Yorba Linda, Calif,” William and Laurie write. “The Centers for Disease Control and Prevention issued a report in December tying 12 cases in multiple states to treatments sold by the company. Three additional patients in Texas and Maine have filed lawsuits against Liveyon claiming the company’s product infected them with bacteria.”

The company, which sells vials of a solution it says is derived from umbilical cord blood, issued a recall after the Food and Drug Administration and other health officials inquired about infected patients last September. But internal company records show Liveyon received reports of ill patients, and some who tested positive for E. coli, as early as four months before the recall.

After the recall, Liveyon executives blamed the manufacturing company. “We’re a victim as much as the patients who were infected,” Liveyon’s founder and chief executive, John Kosolcharoen, told our colleagues.

HEALTH ON THE HILL

— Trump’s former fixer and personal lawyer Michael Cohen testified before the House Oversight Committee yesterday, at one point explaining details of his $1.2 million contract with Swiss pharmaceutical giant Novartis.

He told lawmakers the company wanted him to lobby, which he said he refused to do. “Novartis sent me their contract, which stated specifically that they wanted me to lobby. … That paragraph was crossed out by me,” he said. 

When pressed by Rep. Mark Meadows (R-N.C.) about Cohen's consulting contracts with various companies, including Novartis, Cohen insisted it was “not something that’s unusual in Washington.”

“They came to me based on my knowledge of the enigma Donald Trump,” Cohen said of Novartis. He estimated he spoke to company officials six times.

“Meadows tried to portray the situation as one in which the firm used Cohen as an unregistered lobbyist, a characterization Cohen denied,” Stat’s Matthew Herper writes. “Novartis’ relationship with Cohen has become a repeated reputational headache for the drug giant … Initially, Novartis said that it had ceased contact with Cohen immediately after having a first meeting in which it became clear that he did not understand health policy well.  The case cropped up again last July, when a congressional investigation revealed that the contacts between Novartis and Cohen had been more numerous than had been previously suggested.”

— Meanwhile, the House Energy and Commerce Oversight subcommittee gathered to discuss the nationwide measles outbreak in a hearing that at times turned rowdy. Rep. Diana DeGette (D-Colo.) banged her gavel and called twice for order over shouts from anti-vaccination activists in the audience, some dressed in red, who voiced their disagreement with two experts who testified. 

Many of the outbreaks have occurred in close-knit communities with lower vaccination rates, said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. She said unvaccinated people risk contracting measles while abroad and bringing the disease back home. She emphasized the safety of the vaccine that protects against measles, mumps and rubella, saying the most common side effect is a sore arm.

Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases at the National Institutes of Health, agreed the measles vaccine is highly effective. During his testimony, he also warned social media plays a large role in perpetuating misinformation.

“People refer to things that have been proven to be false,” he said about the spread of claims that vaccines can cause complications such as autism. “I think that’s a major contribution to the problem that we’re discussing.”

Fauci said vaccination levels need to be high to eradicate measles. He referenced the current outbreak in Madagascar, where vaccination rates are low and measles has caused over 900 deaths since September, according to the World Health Organization.

Fauci also warned about the loss of herd immunity if vaccination rates drop too low, explaining high vaccination levels in a community help protect those who are too young or medically vulnerable to get vaccinated themselves.

— Ilana Marcus

AGENCY ALERT

— FDA Commissioner Scott Gottlieb said he would support raising the minimum age to purchase tobacco products from 18 to 21.

“We would support that," Gottlieb said during a hearing before the House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies. “A lot of the youth access isn’t just 14-year-olds and 15-year-olds going into convenience stores and buying these products. This is enterprising 18-year-olds in high school buying them legally, and creating a business in their high school selling them back to 16-year-olds and 15-year-olds.”

He said raising the purchase age to 21 could help address that issue and help combat youth tobacco use.

Gottlieb was also grilled about youth e-cigarette use. House Appropriations Chair Nita Lowey (D-N.Y.) pointed fingers at Gottlieb for delaying a regulation that would have removed e-cigarettes from the market this year, a move she said contributed to the booming rate of teen use. “The FDA’s decision to take its foot off the gas while thousands of products have entered market has led to the epidemic we face today,” Lowey said.

Gottlieb stressed that addressing youth e-cigarette use is a priority at the agency. “We’re trying to thread a public health needle here where we preserve some element of the availability of these products for adults while foreclosing them for kids, or at least really dramatically curtailing the availability of kids to access these products,” he said.

— And here are a few more good reads: 

TRUMP TEMPERATURE
Fact Checker
Here's a roundup of claims and statements made during hearing featuring testimony by the former attorney for President Trump
Glenn Kessler and Salvador Rizzo
REPRODUCTIVE WARS
Lawyers seeking to block the Trump administration’s decision to alter rules for the Title X family planning program say their efforts will not be stymied by the Supreme Court’s approval of similar …
Kaiser Health News
MEDICAL MISSIVES
The reassuring finding contradicts an earlier study by the same researchers that raised questions about the safety of getting a flu shot during pregnancy.
Stat
Health
The force of the bullet pushed the bra wire into her body like "a scythe," doctors say.
Amy Wang
Hospital leaders released the scathing government inspection report on Tuesday, along with a plan to correct significant lapses in patient care. The changes follow a yearlong investigation by ProPublica and the Houston Chronicle.
Houston Chronicle and ProPublica
INDUSTRY RX
One of Bristol-Myers’s largest shareholders is opposing the company’s $74 billion deal to buy rival Celgene, becoming the latest investor to express its unhappiness with the transaction.
Wall Street Journal
DAYBOOK

Today

  • The House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies holds a hearing on female veterans access to VA.
  • The Alliance for Health Policy holds a briefing on Capitol Hill on biosimilars.
SUGAR RUSH

During his public congressional testimony, President Trump's former lawyer Michael Cohen repeatedly clashed with Republican lawmakers:

Rep. Rashida Tlaib (D-Mich.) said Rep. Mark Meadows (R-N.C.) use of a Housing and Urban Development employee during a House Oversight hearing was a “racist act":