THE PROGNOSIS

Medicare-for-all is getting a historic House hearing this morning. But the Democrats running it appear eager to avoid looking too extreme as they examine a bill that would dramatically overhaul the country’s health-care system.

The witnesses testifying before the House Rules Committee mostly aren’t the enthusiastic Medicare-for-all cheerleaders you might have expected Democrats to invite to such a highly anticipated hearing. Instead, they’ve largely expressed support for more measured ways of achieving universal health coverage – or have at least raised serious concerns about the difficulties of setting up and paying for a single-payer system.

There’s no doubt Medicare-for-all is one of the hottest ideas on the left right now, as many of the 2020 presidential candidates embrace the idea and progressives in the House and Senate rally around bills from Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.). Both measures would offer generous benefit packages with few out-of-pocket costs, eliminate employer-sponsored coverage and likely require extensive new taxes to pay for it all.

Rules Committee Chairman Jim McGovern (D-Mass.):

But House Speaker Nancy Pelosi and moderate Democrats aren’t so jazzed about the idea, instead preferring to shore up the Affordable Care Act or expand government-backed insurance incrementally. Newly declared presidential candidate Joe Biden yesterday endorsed a public option to allow Americans to buy into a Medicare-like plan, instead of backing the Sanders and Jayapal proposals.

“You should have the choice to buy into a public option plan for Medicare – your choice,” Biden said during a campaign event in Pittsburgh. “If the insurance company isn’t doing right by you, you should have another choice.”

The internal divisions over Medicare-for-all were evident even in the process of organizing today’s hearing on Jayapal’s bill. McGovern announced four initial witnesses: Dean Baker, a senior economist at the Center for Economic and Policy Research; The Commonwealth Fund’s Sara Collins; former National Medical Association President Doris Browne and Farzon Nahvi, an emergency room physician.

Sources involved in the hearing’s planning told HuffPost the witnesses were specifically selected based on whether they were activists for Medicare-for-all and whether they had said anything negative about the ACA.

Nahvi has called a universal health-care system “long overdue.” But Baker told HuffPost he favors a more moderate Medicare buy-in option and Collins has spent much of her time analyzing a range of options for expanding health insurance. A spokeswoman for Collins told The Health 202 she’ll focus on costs and the current landscape of insurance in her testimony.

Democrats later added a fifth witness, Ady Barkan, a Center for Popular Democracy activist who was diagnosed with ALS in 2016 and has been advocating for Medicare-for-all. Pelosi spokesman Henry Connelly, who characterized the HuffPost reporting as “completely inaccurate,” said McGovern invited Barkan after Pelosi received a text from him asking to be included on the panel.

Barkan tweeted about his trip to Washington:

Rules Committee Democrats:

McGovern notably didn’t invite the author of one of the most comprehensive Medicare-for-all reports. Bob Pollin, an economist at University of Massachusetts Amherst, wrote a 200-page analysis of the first version of Sanders’s Medicare-for-all bill, longer than two other highly referenced reports by the Urban Institute and the Mercatus Center.

Pollin, who worked with the offices of both Sanders and Jayapal to craft their bills, said he wasn’t invited by the committee to serve as a witness. He’s more supportive of Medicare-for-all than Baker, who has written that moving to a single-payer system would require a “massive rechanneling of resources, which is difficult to envision going smoothly.”

“I wish I had a chance to take a crack at the discussion,” Pollin told me yesterday.

Even if the hearing disappoints the most vocal Medicare-for-all advocates, Democrats skeptical of a single-payer system might get the kind of detailed discussion they’re hoping for. Medicare-for-all raises all sorts of hard questions, such as what benefits would be covered, what kind of cost-sharing would be involved, how much providers would be paid and how to pay for it all.

“I consider this an opportunity to discuss one strategy for getting to universal coverage,” said Rep[. Donna Shalala (D-Fla.).

Members of Congress have proposed a number of bills aimed at providing universal coverage, like adding a public option plan to the marketplaces or lowering Medicare’s eligibility age. Today, Rep. Rosa DeLauro (D-Conn.) will introduce an expanded version of her Medicare for America Act, which would allow people to keep their employer-sponsored coverage while moving everyone else onto a generous government-backed plan.

Republicans have a somewhat easier task during the Medicare-for-all hearing: Try to shoot as many holes in the concept as possible and make Democrats look extreme. For their witnesses, they’ve invited Galen Institute President Grace Marie-Turner and the Mercatus Center’s Charles Blahous, who previously estimated Sanders’s plan would cost around $32 trillion over 10 years.

Expect GOP lawmakers to focus on the potential upheaval for roughly $158 million Americans with workplace coverage and how consumers would no longer be able to shop for a variety of plans with different coverage levels and premiums. Rep. Michael Burgess (R-Tex.), a Rules Committee Republican who also leads the Energy and Commerce health subcommittee, told me he couldn’t sleep Sunday night after rereading the Jayapal bill in preparation for today’s hearing.

“I couldn’t believe what I read the first time, and it got worse the second time,” said Burgess, who is an obstetrician-gynecologist. “It’s unbelievable the stuff that happens to folks.”

Shalala insisted the hearing is “not going to make us look crazy.” “It’s going to make us look thoughtful,” she said. “Even someone like me who prefers other strategies wants to make sure we have a thoughtful discussion.”

Rules Committee Republicans:

Doug Andres, press secretary for Senate Majority Leader Mitch McConnell, noted that Medicare-for-all isn't being heard by the committees with health-care jurisdiction, which would indicate Democrats were actually serious about moving forward:

AHH, OOF and OUCH

AHH: Vermont's failure to implement the nation’s first single-payer health system after former Gov. Peter Shumlin (D) signed one into law symbolizes struggles at the national level, as a growing group of Democrats running for president embrace Medicare-for-all ambitions.

Our Post colleague Amy Goldstein explores in this deep dive why the state’s effort failed -- largely because of cost. “The choices Shumlin favored would essentially have doubled Vermont’s budget, raising state income taxes by up to 9.5 percent and placing an 11.5 percent payroll tax on all employers,” Amy writes. Other obstacles included getting financial help from lawmakers in Washington and the fact that health-care costs were growing too fast for public financing to tame.

“Many of those same dilemmas would confront those building a national single-payer model,” Amy adds. “But as the 2020 campaigns get underway, few Democrats show signs of acknowledging, let alone wrestling with, the gritty complexities.” Even Sanders, Vermont’s independent senator who has championed the cause, rarely mentions the failed effort in his state.

OOF: About 200 demonstrators gathered yesterday outside the headquarters of the Pharmaceutical Research and Manufacturers of America, the trade group representing the country’s top drug companies, to protest its opposition to Medicare-for-all.

Several groups, including the National Nurses United and the American Postal Workers Union swarmed the street in downtown Washington. Darius Gordon, a national field organizer with the Center For Popular Democracy, told Stat’s Nicholas Florko he was there because the drug companies “believe that they can stop us from passing ‘Medicare For All.’" "They are wrong. We will beat them. We will whoop their butts," Darius said.

Participants said the drug industry has lobbied to create hurdles to block Medicare-for-all from moving forward, Nicholas writes. Some pointed to the way the current health-care system allows the industry to profit off high costs that could be curbed through a Medicare-for-all system.

A clip of the protestors, via Politico’s Dan Diamond:

OUCH: The number of measles cases in the United States has official hit a 25-year record, with at at least 704 people sickened in 22 states, according to the Centers for Disease Control and Prevention.

More than 500 of those people were not vaccinated, and more than a third of the cases were reported in children younger than 5 years old, our Post colleague Lena H. Sun reports. Sixty-six people have been hospitalized, including two dozen who had pneumonia.

“In recent years, anti-vaccine groups have spread discredited claims about the safety of the vaccine and downplayed the dangers of measles,” Lena writes. “CDC officials blamed misinformation for low vaccination rates in some communities now hard hit by the outbreaks.”

— In a briefing with reporters, HHS Secretary Alex Azar said federal officials are “very concerned about the recent troubling rise in cases of measles.”

“Vaccine-preventable diseases belong in the history books, not in our emergency rooms. The suffering we are seeing today is completely avoidable,” he said. “Vaccines are safe because they are among the most-studied medical products we have.”

Asked about the president’s previous embrace of discredited claims about vaccines, Azar instead praised Trump’s statement last week urging parents to vaccinate their children. Azar called the statement “very firm” and said he was “delighted by the president’s very strong leadership.”

HEALTH ON THE HILL

— Democratic lawmakers are trying to block the Trump administration’s new restrictions on family planning dollars for abortion providers with language in a new spending bill to stop the rule from taking effect.

The move follows a ruling last week by a federal judge in Washington state granting a nationwide preliminary injunction against an administration rule prohibiting health providers that get federal family planning funds under the Title X program from performing, promoting, supporting or referring patients to medical providers that perform abortions.

Along with language addressing the so-called “gag rule,” Democrats also included $50 million for preventing gun violence in the spending bill, our Post colleague Erica Werner reports, a move that was praised by gun control advocates. The provisions are both part of a major $190 billion spending bill for HHS, Education, Labor and other related agencies.

In a statement, Robin Lloyd, the managing director of gun violence prevention group Giffords, praised lawmakers for “finally allocating money for researchers to properly study this public health and public safety crisis” and called it a “critical step to fully understanding gun violence, how to address it, and how best to implement the solutions to keep our families and communities safe.”

“With both moves, Democrats served notice that they will try to use must-pass spending legislation to promote favored social policies or overturn provisions they oppose now that they control the House,” Erica writes. “But policy riders included by House Democrats could make it more difficult for spending legislation to pass the Republican-controlled Senate or win support from President Trump, potentially increasing chances for another shutdown when existing government funding expires Oct. 1.”

REPRODUCTIVE WARS

— A federal judge in Oregon granted the second nationwide preliminary injunction against the administration’s Title X rule change, siding with 20 states and groups including Planned Parenthood and the American Medical Association.

The Health 202 wrote last week that U.S. District Judge Michael McShane indicated he would halt the rule.

In a more than 30-page opinion, McShane wrote the rule would “handcuff” medical providers from counseling women who don’t want to continue a pregnancy. “The Gag Rule is remarkable in striving to make professional health care providers deaf and dumb when counseling a client who wishes to have a legal abortion or is even considering the possibility,” he wrote.

In a statement, AMA president Barbara L. McAneny called the ruling a “victory for patients, physicians and the open conversations that are essential to improving health outcomes. In siding with patients and doctors in this case, the judge decisively said the free exchange of medical information is an essential patient right.”

The Trump administration is weighing an appeal of a first preliminary injunction ordered by a federal judge in Washington state, the Oregonian’s Maxine Bernstein reports. Attorneys on behalf of the Justice Department had “urged McShane to hold off issuing a ruling, unless the Washington judge’s preliminary injunction is vacated or placed on hold. But McShane said the motion before him deserved a separate ruling.”

AGENCY ALERT

— A new poll from Gallup found Americans are still remarkably split over the ACA, with 50 percent who approve of the health-care law and 48 percent who disapprove.

But the firm notes that in each of its last five surveys, the approval rating for the ACA has outnumbered the disapproval rating by at least one percentage point. The findings from the latest poll are similar to the most recent Gallup survey from November, when 48 percent of Americans approved of the ACA, compared with 47 percent who disapproved.

— And here are a few more good reads from The Post and beyond: 

Candidates in the crowded field are backing a range of proposals, creating a muddy picture for voters ahead of the presidential debates this summer.
Wall Street Journal
STATE SCAN
A plan to create a public health insurance option in Washington cleared the state Legislature Saturday evening, and it is heading to Gov. Jay Inslee for his signature.
Associated Press
TRUMP TEMPERATURE
Politics
Republicans are less enthusiastic about Trump’s handling of health care than they are about other issues, with less than half — 46 percent — of GOP voters saying his management of the issue makes them more likely to vote for him.
Seung Min Kim and Scott Clement
Politics
The move is an attempt to address one of the most confounding aspects of the surge of Central American migrants — families seeking safe passage using long-standing protections.
Maria Sacchetti, Felicia Sonmez and Nick Miroff
MEDICAL MISSIVES
Suicide rates for teens saw a sharp increase in the month following the release of the Netflix drama "13 Reasons Why," according to a study.
CNBC
INDUSTRY RX
The last year has been the worst on record in the US for measles outbreaks since the disease was declared ‘eradicated’ in 2000. Even though vaccination rates across the country are still high, (according to the CDC) there remains some communities where disinformation campaigns which cla…
Tech Crunch
Juul has told the F.D.A. it will do all it can to stop youth vaping. But in state capitols and city halls around the country, the company is embracing measures that undermine that vow.
New York Times
DAYBOOK

Today

  • The House Rules Committee holds a hearing on Medicare-for-all.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on prescription drug coverage in Medicare.
  • The Atlantic hosts its summit on health care in Boston.

Coming Up

  • The Washington Examiner holds an event on the future of American healthcare policy on Wednesday.
  • Brookings Institution holds an event on funding strategies to improve community health and economic mobility on Wednesday.
SUGAR RUSH

The fight for access to birth control and abortion, explained: