with Paulina Firozi


Rep. Pramila Jayapal’s sweeping Medicare-for-all bill embraced by more than 100 House Democrats reflects the influence of hard-line liberal groups and unions. These players don't form the typical lineup of mainstream Democratic think tanks and activist groups that often help shape Democratic policy.

Instead of consulting with influential organizations such as the Center for American Progress or Families USA — two groups deeply involved in the crafting of the 2010 Affordable Care Act — staff for the Washington Democrat invited feedback over the past few months from a slew of groups further to the left.

The result: Legislation that goes significantly further than the first Medicare-for-all bill laid out a year and a half ago by Sen. Bernie Sanders (I-Vt.), envisioning not only an even more generous array of benefits but also proposing to overhaul the very method by which Medicare pays clinics and hospitals.

To some progressives, this is a step (or steps) too far, as it would upend health coverage for tens of millions of Americans with workplace plans and could cost many times more than the ACA. While Jayapal’s bill and other Medicare expansion measures will get a hearing in the House Budget Committee (probably next month), the major health committees are staying away from the legislation and leadership hasn't said they will hold a vote on it.

But to the groups that were intimately involved in crafting the Jayapal bill, it’s a dream come true.

The measure bears the signs of close involvement by National Nurses United, the Center for Popular Democracy, the Consortium for Citizens with Disabilities, Public Citizen, Social Security Works and other organizations that say the ACA didn’t go nearly far enough in ensuring all Americans have access to a generous range of health benefits.

Jayapal’s bill would provide everyone in the United States — including undocumented immigrants — with a full set of health benefits including dental care, long-term care and vision care, all services the Medicare program doesn’t currently cover. Patients wouldn’t be charged co-pays for doctor visits, nor would they have to meet a deductible before coverage kicked in.

Sanders is expected to soon release an updated version of his Medicare-for-all bill, which his office confirmed will more closely mirror Jayapal’s bill than his initial version, including covering long-term care.

“As a union, we’re always coming at it from the perspective of the bargaining table,” Kelly Coogan-Gehr, assistant director of public advocacy at National Nurses United, said of the Jayapal bill. “So we went to the bargaining table with very best legislation … It’s incredible; it’s a huge, historic accomplishment in terms of its comprehensiveness.”

National Nurses United, the country’s largest nurses union and a big supporter of Sanders's 2016 presidential bid, and disability rights groups played a major role in ensuring the legislation includes long-term care. And NNU achieved another goal: Jayapal’s bill would essentially halt Medicare’s experimentation with value-based payments in which doctors and hospitals are paid based on their results and not just the volume of services provided.

Most health-policy experts stress a need for value-based payments as a way of encouraging better and more efficient care – especially considering the United States spends far more on health care per person than any other nation. Yet some advocates on the far left frown on this approach, charging that it penalizes doctors who treat the sickest and most vulnerable patients.

This component of Jayapal’s bill is just one way the measure tries to move Medicare in a drastically different direction. It would also upend Medicare’s reimbursement system — in which providers are compensated for each service they perform — by instead giving lump-sum payments to hospitals and nursing homes based on their estimated costs.

Regional directors would negotiate this annual “global budget” with each institution and reevaluate the sum every quarter. Facilities wouldn’t be allowed to use the funds for capital improvements, marketing, political donations or bonuses to employees. The bill would dramatically change the way Medicare pays providers, opening the door for hospitals in different parts of the country to receive different payments for the same service.

The Jayapal bill would overhaul the U.S. health-care system so dramatically that summoning broad public support for it seems like a tall order. That’s a big reason why groups such as CAP are a lot more interested in several bills proposing more modest coverage expansions, such as adding a Medicare-type “public option” plan to the marketplaces, for example.

“People are attached to the public option. They see it as unfinished business,” Jennifer Epps-Addison, co-executive director of the Center for Popular Democracy, told me. “There’s a pragmatism to that for sure. [But] I think it was pragmatism that led to a lot of the problems with the Affordable Care Act.”

Supporters of the Jayapal bill insist there’s a groundswell of grass-roots enthusiasm for a dramatic overhaul of the country’s patchwork of private and public insurance plans.

“These more incremental pieces of legislation the liberal think tanks feel safe with and concede as a step in the right direction – we’re finding that does not move everyday people,” Coogan-Gehr said.

Alex Lawson, executive director of Social Security Works, said that “the donor class has this idea about what is possible and what is not possible.”

“It doesn’t surprise or shock or worry me at all,” he said. “I don’t listen to the donor class. I don’t let them tell me what is possible. We’re going to define what is possible by what the people are demanding.”


AHH: An Oklahoma judge refused a request from defendants to delay the first major trial of whether drug companies are responsible for driving the opioid crisis, our Post colleague Lenny Bernstein reports.

“The wheels of justice . . . will continue to grind toward a trial date of May 28, 2019,” Cleveland County District Judge Thad Balkman said after a more than two-hour hearing Friday.

“Oklahoma is seeking payments that could exceed $1 billion from the companies to cover the costs of coping with the drug crisis,” Lenny writes. “The outcome there — whether by trial or settlement — may provide an indication of how about 1,600 other cities, counties and Native American tribes may fare against the same companies and others.”

Three drug companies and 10 of their subsidiaries asked for a 100-day delay to a jury trial, and lawyers for the companies plan to appeal the judge’s decision. OxyContin maker Purdue Pharma said it was “disappointed the court has denied its motion for a continuance. The facts show clearly that the state of Oklahoma has repeatedly failed to meet its obligations to produce critical information and documents to Purdue and the other defendants in this case.” But the state argued that Purdue wanted the postponement to prepare for a bankruptcy declaration that would move the case to bankruptcy court.

OOF: In the first two months of the year, 206 cases of measles were confirmed nationwide, according to data from the Centers for Disease Control and Prevention. It’s the highest year-to-date figure going back more than 25 years, our Post colleague Christopher Ingraham reports. It highlights “how anti-vaccine sentiment and the rising incidence of vaccine refusal threaten to bring back a public health threat that had been declared eliminated nearly 20 years ago,” he writes.

This year’s total is more than the yearly totals for all but three years since 2000, when measles was declared eliminated. But it doesn’t necessarily mean there will be a record total of cases by the end of 2019. “In 2015, for instance, there were 154 cases in the first two months of the year followed by 34 for the remainder of the year, putting it at right about average relative to the past decade’s annual totals,” Christopher writes.

Along with Washington state, which is the location of many of this year’s reported cases, there are ongoing outbreaks in New York, Texas and Illinois, according to the CDC.

Despite the evidence, the anti-vaccination movement is gaining strength. (Luis Velarde/The Washington Post)

OUCH: A new case study from the CDC revealed details of a 2017 case of an unvaccinated 6-year-old in Oregon who contracted tetanus and accumulated more than $800,000 in medical charges  — before that, it had been more than three decades since the state saw a case of tetanus in children.

“The child was playing on a farm when he cut his head on something, the report said. His parents cleaned and stitched the wound at home, but alarming symptoms emerged six days later,” our Post colleague Amy B Wang reports. “The boy’s jaw began clenching, and his neck and back were arched — a trademark indication of tetanus called opisthotonus that is caused by involuntary muscle spasms.”

The boy was taken to a pediatric hospital, where a tetanus diagnosis was just the start of what would be a lengthy hospital stay for the child. He was in the intensive care unit for 47 days, and 10 days later was transferred to a rehabilitation enter for another two-and-a-half weeks. “In all, the boy’s medical charges in the hospital amounted to $811,929 — which did not include the cost of being airlifted to the hospital or of inpatient rehabilitation, according to the CDC,” Amy writes.

“The complex and prolonged care led to the high treatment cost,” an author of the report, Judith Guzman-Cottrill, told The Post. “In contrast, the cost of one DTaP dose is somewhere around $24-$30 a dose, and this illness could have been prevented with five doses of DTaP vaccine.”

Amy adds the family, who was counseled on getting the child up to date on his vaccinations, declined to do so, and declined a follow-up dose of the DTaP vaccine that was given to the boy when he first arrived at the hospital.


— Puerto Rico has started reducing by an average of 25 percent the food stamp benefits used by more than 1 million residents, our Post colleague Jeff Stein reports, as federal lawmakers have not yet doled out additional emergency disaster funding to the U.S. territory still recovering after Hurricane Maria in 2017.

The food-stamp benefits have been cut as a way to sustain the program that has seen a growth in demand following Maria, a spokesman for Puerto Rico’s Department of Family Affairs told Jeff.

“The reductions bring the benefit levels back to where they were before the hurricane,” Jeff writes. “The benefit cut, caused by an impasse among federal lawmakers over aid funding for the U.S. territory, has sparked new fears among Puerto Ricans about a critical lifeline for poorer residents amid an explosion of hunger since the hurricane hit.”

Various proposals to fund the program have emerged, but none have been approved. The Trump administration supported a package by Sen. David Perdue (R-Ga.) that included funding for the territory’s food stamps in a separate bill to provide financial aid to farmers in states like Georgia. But there’s no vote scheduled. In January, Democratic lawmakers approved funding for Puerto Rico that goes beyond Perdue’s legislation, Jeff writes, adding that some Senate Democrats want similar measures included in Perdue’s package.


— More than 2,000 migrants have been quarantined at immigrant detention centers around the country because of mumps outbreaks and other illnesses.

U.S. Immigration and Customs Enforcement health officials have been notified about 236 confirmed or probable mumps cases among detainees in 51 facilities across the country in the last year, compared with no detected cases between January 2016 and February 2018, Reuters’s Mica Rosenberg and Kristina Cooke report.

Since January, there have been 18 detainees with confirmed or probable cases of mumps at the privately-run Pine Prairie facility in Louisiana, compared with zero cases last year. In February, 288 people were quarantined at the facility. In immigration detention facilities in Texas, there have been 186 mumps cases since October, the largest outbreak in centers in the state in years, Mica and Kristina report. At the Aurora Contract Detention Facility near Denver, Colo., 357 people have been quarantined after eight confirmed and five suspected mumps cases since February and six diagnosed chicken pox cases since the start of January.

“Internal emails reviewed by Reuters reveal the complications of managing outbreaks like the one at Pine Prairie, since immigrant detainees often are transferred around the country and infected people do not necessarily show symptoms of viral diseases even when they are contagious,” they write.

A group of 10 Democratic lawmakers sent a letter to ICE acting Director Ronald Vitiello at the end of last month calling for more information about viral diseases at immigration detention centers in Colorado, Arizona and Texas, Mica and Kristina write, though they did not mention the outbreak at Pine Prairie.

— And here are a few more good reads: 


Coming Up

  • The House Energy and Commerce subcommittee on Health holds a hearing on the HHS budget request for 2020 on Tuesday.
  • The House Education and Labor Subcommittee on Civil Rights and Human Services holds a hearing on examining federal child nutrition programs on Tuesday.
  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies holds a hearing on the HHS budget request for 2020 on Wednesday.
  • The House Energy and Commerce Subcommittee on Health will hold a hearing on lowering prescription drug costs on Wednesday.
  • The Senate Finance Committee holds a hearing on the president’s 2020 budget request on Thursday.

President Trump is expected to ask Congress for an additional $8.6 billion on March 11 to help pay for the wall on the southern border with Mexico:

President Trump is expected to ask Congress for an additional $8.6 billion on March 11 to help pay for the wall on the southern border with Mexico. (Reuters)

Trump meets with tornado survivors in Alabama:

President Trump and first lady Melania met with survivors in Alabama and toured the devastation after tornados tore through the area, killing 23 people. (Reuters)