The Washington PostDemocracy Dies in Darkness

The Health 202: Democrats are taking their turn using 'Mediscare' as a political tactic

with Paulina Firozi

THE PROGNOSIS

There’s a political pendulum that swings when it comes to reining in Medicare spending. If Democrats are in charge, it’s Republicans slamming any effort to curb the popular health insurance program for the elderly. The role reverses when Republicans have the wheel.

But, usually, the proposed trims to Medicare aren’t nearly as egregious as the opposing party makes them sound.

Democrats have cranked their Medicare attack machine to full blast over the latest budget from President Trump, which proposes a 5 percent reduction in spending for the health-care program for the elderly over the next 10 years, along with reductions to Medicaid and medical research funding.

Protect Our Care, a group formed in 2016 by top Democratic operatives to resist Obamacare repeal attempts, will launch a five-figure, health-care-themed ad buy this week targeting four senators and six House members considered to be vulnerable in 2020. The ad, provided first to The Health 202, paints the president as a hypocrite for promising during his campaign to “save Medicare and Medicaid” while proposing a budget to reduce spending for both programs.

“But now, Trump is turning his back on seniors and families — proposing over two trillion dollars in cuts to Medicare and Medicaid,” the ad says. “Breaking his promise. Slashing our health care to the bone. And for what? Tax breaks for the wealthiest corporations.”

The ad will run on cable stations in Washington, D.., and digitally target Sens. Martha McSally (R-Ariz.), Cory Gardner (R-Colo.), Thom Tillis (R-N.C.) and Susan Collins (R-Maine), along with Reps. Brian Fitzpatrick (R-Pa.), Rodney Davis (R-Ill.), Fred Upton (R-Mich.), Jim Hagedorn (R-Minn.), Don Bacon (R-Neb.) and John Katko (N.Y.).

The ad:

Democrats spent much of last week hurling similar criticisms at the administration. Sen. Brian Schatz (D-Hawaii) used Democrats’ weekly address on Saturday to slam the president’s budget for proposing “$848 billion in cuts to Medicare.”

“This budget makes very clear the difference between Democrats and Republicans,” Schatz said. “Republicans are all about tax cuts and paying for it by cutting health care.”

House Speaker Nancy Pelosi (D-Calif.) said the budget shows Republicans want to “make Medicare wither on the vine. House Minority Leader Chuck Schumer (D-N.Y.) said it’s “unbelievable that the Trump budget calls for … $850 billion cuts to Medicare.”

Sen. Amy Klobuchar (D-Minn.): 

Rep. Jim Himes (D-Conn.): 

But these charges from Democrats and progressives are not only overstated — they’re also aimed at some policies originally proposed by President Obama. Consider this:

1. The cuts proposed by the administration aren’t aimed at seniors’ medical benefits. Instead, they’re reductions in future Medicare spending and they’d be carried out mostly by reducing payments to health providers and rooting out inefficiencies and wasteful spending.

Furthermore, the proposed spending reductions will almost certainly not become law because Congress — including the Democratic-led House — would have to approve them.

2. The real reductions to future Medicare spending are considerably smaller than $845 billion. As the Committee for a Responsible Federal Budget explains, it’s closer to $575 billion because the administration’s budget moves two parts of Medicare — payments to hospitals that treat higher shares of uninsured patients and payments to hospitals that educate medical residents — to another part of the budget.

And $575 billion in spending reductions sounds less sizable when it’s put in context. As Post fact-checker Glenn Kessler notes, Medicare spending is projected to grow more than $10 trillion over the decade, so it’s essentially a 5 percent reduction in projected spending. The administration says the spending reductions would extend the solvency of the Medicare trust fund by eight years.

3. And, some of the Trump administration’s proposed changes to Medicare are taken from Obama’s own playbook. According to estimates by CFRB, 85 percent of the $575 billion in Medicare savings comes from reductions to provider payments — many of which mirror proposals from Obama, who in turnborrowed some of the ideas from President George W. Bush.

Glenn walked through several specific proposals in the Trump budget with CRFB Senior Vice President Marc Goldwein, who spotted a number of Obama-era proposals including a $131 billion savings item from equalizing payments for doctor visits in offices vs. hospitals and a $38.5 billion reduction in payments for bad debts.

Of course, Republicans pounced on the Medicare spending reductions in Obama’s 2010 Affordable Care Act. For a while, Medicare cuts were one of their top attack lines against the health-care law.  More recently, they've been charging the Medicare-for-all plans advanced by progressive Democrats would destroy the current Medicare program for seniors, a claim my colleague Colby Itkowitz examined in this Health 202.

Senate Majority Leader Mitch McConnell (R-Ky.): 

Democrats have rightfully protested these scare tactics — but now they’re doing the same thing.

“Now Trump is extending or following up on Obama’s efforts, and Democrats have decided that what’s good for the goose is good for the gander,” concludes Glenn, who awarded Democrats two “Pinocchios” for their claims. “But it’s a simplistic way to frame the policy debate, potentially making it more difficult to restrain the growth of entitlement programs.”

AHH, OOF and OUCH

AHH: For the transgender community in Maryland and Virginia, there are very few options for medical care, forcing people to drive hours to find critical services. Whitman-Walker Health, a D.C. provider specializing in LGBTQ care, served 1,837 patients last year, and more than half of them lived in Virginia or Maryland. About 50 traveled from as far as South Carolina and Alabama for care, our Post colleague Samantha Schmidt reports.

A local advocacy group, DC Area Transmasculine Society, or DCATS, wants to fix this issue.

It launched a digital database last year in which transgender individuals could review and recommend health-care providers based on how they treat transgender needs. The Trans Wellness Information Network, now with about 125 providers, requires each review be submitted and authorized by someone who identifies as transgender.

Meanwhile, in a move that aims to expand care for transgender individuals in the region, Planned Parenthood of Metropolitan Washington told The Post recently that it plans to offer hormone replacement therapy in each of its three regional health centers, in Northeast Washington, Suitland, Md., and Gaithersburg, Md.

OOF: A new study reveals rates of depression, psychological distress and suicidal thoughts and actions have markedly increased among people ages 26 and younger.

The report, published in the American Psychological Association’s Journal of Abnormal Psychology, analyzed a broad group of young Americans and found some of the highest increases were among women and higher-income groups, our Post colleague Tara Bahrampour reports.

“The changes probably were not connected to poor financial prospects or substance abuse, the report said, noting that they occurred during a period of economic expansion and at a time when drug and alcohol use among young people has been unchanged or decreasing,” Tara writes. “Instead, the report said, the increases may be linked to increased time spent on social media and electronic communication, along with a decrease in the sleep young people are getting.”

In the past 10 to 12 years, the number of people reporting symptoms tied to major depression increased 52 percent among 12- to 17-year-olds and 63 percent among 18- to 25-year-olds. Among young adults, psychological distress and suicide-related thoughts or actions also rose by 70 percent.

OUCH: A major study into how well the Apple Watch can determine critical changes to heart rhythm found the watch helped detect a disorder in some users but may have led to false alarms for others, the Wall Street Journal’s Peter Loftus reports.

The takeaway: The study’s results are mixed.

“The optical pulse sensor on Apple’s watch picks up heart rates, and researchers explored whether that tool could detect irregular heartbeats known as atrial fibrillation, a condition that can increase one’s risk for stroke,” Peter writes. For those involved in the study, if the watch detected suspected atrial fibrillation, users could consult with a doctor, who could advise the patients to get immediate treatment or would send electrocardiogram patches to help confirm whether the users actually had atrial fibrillation.

“In all, only about 2,160 people, or 0.5% of study participants, received notifications of irregular heart rhythms. The rate was higher in people 65 and older — 3.2%, versus 0.16% in people ages 22 to 39,” Peter reports. “Of those notified by the watch, only about 450 people received and returned the wearable ECG patches to the researchers … Researchers found that the ECG patches confirmed atrial fibrillation in only 34% of the 450 people who returned patches. The remaining two-thirds had no confirmed atrial fibrillation during the time they wore the patches — raising questions about the watch’s accuracy.”

AGENCY ALERT

— The Centers for Medicare and Medicaid Services has approved Ohio’s request to require thousands of Medicaid beneficiaries to work to qualify for benefits — it’s the ninth state to get such a greenlight.

State Medicaid officials say they want to implement the mandate starting in January 2021. Under the plan, certain adults ages 19 to 49 would be required to work at least 80 hours a month to maintain their Medicaid coverage. They will have 60 days to report compliance with the requirement before they are dropped from coverage. However, unlike other states, those who lose coverage can apply to re-enroll in Medicaid immediately.

“State officials project as many as 36,000 Ohioans could lose Medicaid coverage for failing to meet the requirement,” the Columbus Dispatch’s Catherine Candisky reports.

HEALTH ON THE HILL

— A bipartisan group of senators introduced a bill meant to increase competition for drugs as a way to lower prices.

The legislation from Sens. Chuck Grassley (R-Iowa), Amy Klobuchar (D-Minn.), Mike Lee (R-Utah) and Dick Durbin (D-Ill.) looks to authorize the Department of Health and Human Services to fast-track reviews and inspections and allow temporary imports in the case of a drug shortage or if there are fewer than five competitors in the market for medicines approved for at least 10 years.

Klobuchar, who is running for the Democratic presidential nomination in 2020, said the bill could encourage drugmakers to hold off on price hikes if they know there is a chance for competition in the market.

“As we’ve seen time and again, when there’s only one option on the market consumers can face exorbitant prices,” Grassley said in a statement. “Getting more options on the market, as this bill will do, can give consumers an option other than a single high-priced drug.”

— And here are a few more good reads: 

The CDC is studying e-scooter injuries (Luz Lazo)

MEDICAL MISSIVES

‘I have to perform to save my life’: Medical bills kept rock legend Dick Dale touring till the end (Kyle Swenson)

Deciding whether to have kids has never been more complex. Enter parenthood-indecision therapists. (Caitlin Gibson)

TRUMP TEMPERATURE

O'Rourke faces pressure from left on 'Medicare for all' (The Hill )

Legalizing Marijuana, With a Focus on Social Justice, Unites 2020 Democrats (New York Times)

Democrats Pledged to Lower Health Costs. They Just Haven’t Figured Out How. (New York Times)

STATE SCAN

Janet Mills submits bill to let medical professionals who aren’t physicians perform abortions (Bangor Daily News)

Ending HIV In Mississippi Means Cutting Through Racism, Poverty And Homophobia (NPR )

INDUSTRY RX

Death By A Thousand Clicks (Kaiser Health News)

Medicare wellness visits are supposed to be free — unless you call it a physical. (Michelle Andrews)

DAYBOOK

Today

  • The 2019 National HIV Prevention Conference in Atlanta, Ga. begins.

Coming Up

  • The Brookings Institution hosts an event with outgoing FDA Commissioner Scott Gottlieb on Tuesday.
  • The CATO institute holds an event on harm reduction on Thursday.
  • The Bipartisan Policy Center holds an event on overcoming health care challenges in immigrant communities on Thursday.
  • The Brookings Institution holds an event on emerging policy solutions to surprise medical bills on Friday.
SUGAR RUSH

Former vide president Joe Biden's slip of the tongue hints at 2020 presidential run:

Former vice president Joe Biden said March 16, "I have the most progressive record of anybody running." (Video: Reuters)

Sen. Kirsten Gillibrand (D-N.Y.)  to hold presidential campaign rally in front of Trump International Hotel:

Sen. Kirsten Gillibrand (D-N.Y.) announced March 17 that she will hold a rally in front of Trump International Hotel in New York City. (Video: Reuters)
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