THE PROGNOSIS

Bernie Sanders – the senator who first coined the term “Medicare-for-all” – will unveil an updated, expanded version of his bill this morning. And it's one that would dramatically overhaul the U.S. health-care system and promise an even more generous array of benefits to Americans.

Sanders's new Medicare-for-all bill will propose to cover long-term care -- a steeply expensive health benefit that shows progressives’ increasing willingness to lay out their pie-in-the-sky dreams, even if they are unrealistic.

That goes far beyond what Sanders proposed when he first introduced Medicare-for-all in September 2017 -- and is much like a House version introduced in February by Rep. Pramila Jayapal (D-Wash.)

Sanders's new bill will again be cosponsored by 14 Democratic senators, including four running for president: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts (check out The Post's graphic charting where candidates stand on Medicare-for-all). Sanders's office said the number of national organizations in support of the bill has more than doubled, to 62.

Yet it’s clear from recent history how hard it is to create a sustainable program for seniors and people with disabilities who need ongoing care. Look no further than the Affordable Care Act.

Congress tried to set up a long-term care program as part of the 2010 health-care law. But the Obama administration was forced to suspend it just a year later, underscoring the enduring challenges of paying for ongoing care for seniors and people with disabilities.

The CLASS Act, short for the Community Living Assistance Services and Supports Act, offered daily cash benefits of at least $50 to beneficiaries who paid a monthly premium. It was aimed at solving a perplexing problem for the elderly in the United States, who currently must purchase a private plan or pay out of pocket until they’re poor enough to qualify for long-term care services through Medicaid.

But Kathleen Sebelius, secretary of Health and Human Services at the time, declared in 2011 that she couldn’t find a way to make the program pay for itself and suspended it indefinitely. Congress later repealed the program as part of a 2013 budget agreement.

Sanders’s office said its proposal for long-term care isn’t the same approach as CLASS. But its addition certainly won’t make the Medicare-for-all proposal more palatable to House Speaker Nancy Pelosi, who controls the fate of such legislation in her chamber and has so far resisted committing to a vote on it. Yesterday she told hospitals that she’s more interested in improving the ACA than in passing Medicare-for-all -- which would upending the existing, largely private health insurance system.

“We all share a common goal: affordable quality health care coverage for all,” Pelosi said in a speech at the American Hospital Association conference. “There are many paths to this goal. You’ve heard of some of them.”

“Medicare-for-all, single-payer, whatever it is, all of that creative tension is valuable as we go forward,” she added. “But we can’t go down any path unless you strengthen the Affordable Care Act.”

There certainly appear to be some headwinds behind Medicare-for-all bills. In addition to the 2020 candidates who have endorsed Sanders's bill, more than 100 House members have signed onto Jayapal’s bill. 

But the leaders of the top House committees with health-care jurisdiction – House Ways and Means and House Energy and Commerce – have been working on drug pricing legislation instead. Any serious attempt to pass a Medicare-for-all bill would almost certainly involve hearings before both those panels.

And House Rules and House Budget – two other committees that have said they’d consider such proposals – have yet to move on Medicare-for-all. A Budget spokesman told Health 202 no such hearings have yet been scheduled.

Capitol Hill Republicans are clearly happy for the health-care conversation to swing back towards Medicare-for-all, after President Trump went on his recent tear pressuring Congress to again try to repeal and replace the ACA. Speaking at the same hospital conference yesterday, Senate Majority Leader Mitch McConnell earned applause when he referred to Medicare-for-all as “Medicare-for-none.”

“This radical scheme would be serious bad news for America’s hospital industry,” McConnell told the hospital leaders. “You should not be the guinea pigs in some far-left social experiment.”

McConnell was speaking to a receptive audience. Hospitals have partnered with other corners of the health-care industry specifically to oppose any form of Medicare-for-all.

"Medicare for all is the opposite of practical, and it destroys our system rather than building on its successes," said Lauren Crawford Shaver, executive director of the Partnership for America's Health Care Future, in a statement on Sanders's bill shared in advance with Health 202. "That is the wrong way forward for America."

The Hill's Peter Sullivan:

Larry Levitt, a vice president at the Kaiser Family Foundation:

AHH, OOF and OUCH

AHH: Attorney General William Barr defended the administration’s refusal to defend the Affordable Care Act, telling lawmakers on a House Appropriations subcommittee that it’s his job to argue the case, and declining to comment on the merits of policy, our Post colleagues Karoun Demirjian and Matt Zapotosky report.

“I’m a lawyer. I’m not in charge of health care,” Barr told lawmakers.

“I can’t imagine that you would take that kind of a dramatic, drastic action without even trying to evaluate the consequences for the American consumers, the people using the health care,” Rep. Matthew Cartwright (D-Pa.) told Barr.

But Barr dismissed policy concerns from Democratic lawmakers. “If this was such a hokey position to take, what are you worried about?” Barr asked. “You say that administration’s position is hokey and then you say the sky is falling?”

He also dismissed charges from Democrats that the lawsuit would gut health-care protections. “The president’s made clear that he wants strong health-care legislation and he wants to protect preexisting conditions, in the event that the court accepts the legal arguments we’ve presented,” Barr said.

— Meanwhile, the U.S. Court of Appeals for the Fifth Circuit yesterday granted the request from Wisconsin to withdraw from the Texas-led coalition of states seeking to invalidate the health-care law.

Wisconsin Gov. Tony Evers (D):

— Back in Washington, the chairmen of five House committees sent letters to the White House, Justice Department and top Trump health officials demanding information about the administration’s call for the ACA to be invalidated.

“The Department owes Congress and the public an explanation as to why it refuses to enforce the law,” the Democrats wrote in a letter to Barr.

OOF: The Trump administration is considering a revised version of its family separation policy. The new policy would "force parents to choose whether to remain detained as a family or agree to a separation to keep their children out of custody, according to administration officials," our colleagues Nick, Josh Dawsey and Rachael Bade report. 

The administration considered the policy as Trump yesterday denied reports that he has plans to separate families again. “We’re not looking to do that, now,” Trump said about whether plans to revive the "zero tolerance" policy. He added: "But it brings a lot more people to the border when you don’t do it.”

Our colleagues write: "Administration officials said Tuesday that while a return to the previous family separation tactic, known as 'zero tolerance,' is not in the works, the White House is considering a 'binary choice' policy, which would give parents the option of remaining in detention with their children or allowing their children to be separated and placed with another caregiver." 

Trump also falsely claimed that his predecessor carried out the same policy, telling reporters that he was the one who stopped it. “I’m the one who stopped it...President Obama had child separation," Trump said in a claim our colleague and Post Fact Checker Salvador Rizzo writes is a "four Pinocchio claim, yet Trump keeps repeating it when he's pressed on family separations." 

OUCH: New York City officials declared a public health emergency yesterday, ordering mandatory measles vaccinations amid an outbreak in Brooklyn. At least 285 people have contracted the disease in the city since September, and many of the reports have been in Brooklyn’s Williamsburg neighborhood, our Post colleagues Alex Horton, Lindsey Bever Lena H. Sun, Lenny Bernstein and Gabrielle Paluch report. It's the broadest vaccination order in the nation in nearly three decades, they add. 

“This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately,” Mayor Bill de Blasio (D) said at a news conference. “The measles vaccine works. It is safe, it is effective, it is time-tested … The faster everyone heeds the order, the faster we can lift it.”

Anyone who resists the mandatory vaccine order could be fined up to $1,000. The orders include four Zip codes in the region, which includes a concentration of Orthodox Jews, some of whom have resisted vaccines. On Monday night, city health officials said yeshivas in Williamsburg that do not comply will face fines and possible closure.

“Officials at the Centers for Disease Control and Prevention also announced Tuesday that they were setting up a special team to oversee and manage the agency’s response to ongoing measles outbreaks," our colleagues write."The agency said it 'continues to be seriously concerned about the accelerating numbers of measles cases being confirmed nationally.'"

HEALTH ON THE HILL

— Pharmaceutical benefit manager executives got their turn yesterday before the Senate Finance Committee, whose members grilled the leaders about why they can’t do more to create transparency in their negotiation process. But overall, the PBMs came out of the hearing relatively unscathed. 

During his opening statement, the top Democrat on the Committee Sen. Ron Wyden (D-Ore.) criticized the secrecy around the industry.

“The committee is looking at one of the most confounding, gnarled riddles in American health care today,” he said. “What these pharmaceutical benefit managers actually do to take in all of these profits is a mystery. The deals they strike with drugmakers and insurers are a mystery, how much they’re pocketing out of the rebates they negotiate is a mystery… Whether PBMs bring any real value to taxpayers is a mystery.”

Later, as our colleague Christopher Rowland writes, Wyden referenced an example where CVS Caremark required patients to get special approval to purchase an Amgen cholesterol treatment with a lower list price than a more costly version of the same drug. CVS Caremark Executive Vice President Derica Rice explained Amgen gave a bigger rebate for the costlier version, which made the net price lower. Wyden called this an example of PBM “gouging.” "It sure looks like you all are taking deliberate action to pad your bottom line at the expense of patients,’’ Wyden said.

Some other highlights from the hearing: 

  • The committee's leaders, chairman Chuck Grassley (R-Iowa) and Wyden, expressed interest in working on legislation related to PBM transprency. Grassley said he and Wyden are committed to "working on a bipartisan basis to bring drug costs down. Our next step is to work with Committee members to develop policies to help Medicare and Medicaid patients and protect the taxpayers."
  • Wyden also asked the executives if they would support legislation to ban spread pricing in Medicare and Medicaid. Three executives signaled they would support it, one said the company would be neutral and another said they would not oppose.

S&P Global News's Donna Young: 


  • Grassley signaled he did not believe it was right to eliminate the PBMs from the drug pricing chain. “This system of private entities negotiating is what I envisioned as an author of the Part D program,” Grassley said. “I still believe that this is absolutely the right approach." He added: "It’s our duty to understand how the system is working today and what we can do to improve it.”
  • Sen. Sheldon Whitehouse (D-R.I.) seemed to point fingers at the drug makers during his questioning. “It’s got to be interesting to you all to witness how the pharmaceutical industry has been able to take political pressure on their pricing and turn it into, with political jiujitsu of an almost magical variety, pressure on their greatest adversary, the most powerful force for pushing prices down,” he said to the PBM executives. “I appreciate the scrutiny of the PBMs but let’s not go away without remembering they are a $23 billion out of a $480 billion problem.”

— The House Ways and Means Committee advanced bipartisan drug pricing legislation yesterday that aims to increase transparency for consumers. The Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act would require drug makers to justify price hikes for existing drugs and require the HHS Secretary to disclose rebates, discounts and other price concessions PBMs get on a public website, among other requirements.

In a statement, Pharmaceutical Care Management Association (PCMA), the lobbying group for PBMs commended lawmakers efforts to increase transparency on drug prices, but expressed concern that “the current version of the legislation requiring additional reporting on negotiated rates may inadvertently provide drugmakers and drugstores access to competitive information, such as negotiated rebates, discounts, or price concessions.”

House Majority Leader Steny Hoyer (D-Md.) praised movement on the measure: 

— Pelosi called on the Trump administration to keep the president's campaign promise to bring down drug prices, urging him to sign a bill to allow Medicare to negotiate drug prices.

During remarks at the American Hospital Association conference, she said she wants to “insist that [HHS Secretary Alex Azar] negotiate for lower drug prices,” The Hill’s Peter Sullivan reports.  

“Together we must hold the president to his campaign promises to ensure that he signs this legislation when it reaches his desk,” Pelosi said. “Every time I speak to him he says, ‘Yes, yes we've got to lower the cost of prescription drugs.’ We want to enable him to do that.”

— And here are a few more good reads: 

AGENCY ALERT
WASHINGTON (AP) — Federal agents on Tuesday broke up a billion dollar Medicare scam that peddled unneeded orthopedic braces to hundreds of thousands of seniors. Two dozen people were charged, including doctors accused of writing bogus prescriptions.
Associated Press
INDUSTRY RX
Health
Answers to your questions about measles and the current outbreaks.
Lena Sun
Technology
Pregnancy-tracking apps such as Ovia have climbed in popularity as fun, friendly companions for the daunting uncertainties of childbirth. But they have also become powerful monitoring tools for employers and health insurers.
Drew Harwell
OPIOID OPTICS
D.C. Politics
Barbara Bazron will take the helm of the Department of Behavioral Health.
Peter Jamison
Sackler and Purdue Pharma gifts to Tufts generated goodwill for the family and amplifed arguments about opioids that dovetailed with their business aims.
Stat
STATE SCAN
Health
One food-borne illness expert said it's "perplexing" the CDC has yet to pinpoint the source to a specific food item, grocery store or restaurant chain.
Michael Brice-Saddler
MEDICAL MISSIVES
Local
A $30 million gift will bring the pediatric research center to 12 acres formerly occupied by the U.S. Army.
Justin Wm. Moyer
HARTFORD, Conn. (AP) — Facing a newly revived wrongful death lawsuit in Connecticut over the Sandy Hook Elementary School shooting, gun-maker Remington is going to the U.S. Supreme Court to argue...
Associated Press
REPRODUCTIVE WARS
Morning Mix
Though it faces steep odds, the measure earned a hearing amid a larger legislative push in GOP-controlled states for new restrictions on abortion rights, in a direct challenge to Roe v. Wade.
Isaac Stanley-Becker
DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on the rising cost of insulin.
SUGAR RUSH

Stephen Colbert on the president's claim that the Obama administration is to blame for family separations: