THE PROGNOSIS

Democrats eyeing Medicare-for-all are trying to avoid the same trap Republicans fell into back in 2017 when they were trying to replace Obamacare.

The trap is this: a damaging analysis from the Congressional Budget Office, Congress’s official scorekeeper.

This afternoon, the CBO is expected to release a highly anticipated report on the potential structure and costs of transitioning the United States into a single-payer system. The report, requested by Budget Committee Chairman John Yarmuth (D-Ky.), will analyze a number of questions raised by Medicare-for-all proposals, including what services would be covered, what costs consumers would share, how much doctors and hospitals would be paid and how the whole thing might be paid for.

But Yarmuth notably didn’t ask the CBO for a specific cost-estimate of the Medicare-for-all bill proposed by Rep. Pramila Jayapal (D-Wash.), which the House Rules Committee examined yesterday and which more than 100 members of Congress have embraced.

That score could be sizable — and probably would fuel charges from Republicans and the health-care industry that Medicare-for-all is an impossible and rash scheme that would jeopardize health care for millions of Americans. The Jayapal measure, which would grant every American a comprehensive health plan with very little cost-sharing, probably would cost more than $30 trillion or even $40 trillion over the next decade, many times the cost of the 2010 Affordable Care Act.

“There is no avoiding the reality that the Medicare-for-all price tag would not only destroy our current health care system, it would blow up our budget and devastate our economy,” the Budget Committee's top Republican, Rep. Steve Womack (R-Ark.), said in a statement.

Democrats know well how CBO scores can be used as political ammunition. It was only two years ago that they glommed onto the agency’s estimates that GOP health-care bills would result in 22 million fewer people having health coverage. Over and over, they whacked Republicans with that figure until the whole repeal-and-replace effort crumbled.

The CBO report will keep Medicare-for-all on center stage this week, coming on the heels of yesterday’s five-hour Rules Committee hearing on Jayapal’s bill.

Tweets from Jayapal, who attended the hearing:

That hearing could easily have devolved into little more than a fight over government involvement in health care. But the panel’s nine Democrats mostly used it to raise detailed questions about the logistics of transitioning the country’s patchworked health insurance system into a single program run by the government.

Rep. Ed Perlmutter (D-Colo.) quizzed the witnesses on whether Medicare-for-all would result in doctor shortages because physicians would presumably be paid less.

Vox's Dylan Scott:

Rep. Joe Morelle (D-N.Y.) raised difficulties with paying for a single-payer system by hiking payroll taxes. “If we didn’t go into this with a clearheaded view of what this would mean, I think we’re doing a disservice,” Morelle said.

Rules Chair Jim McGovern (D-Mass.) wrapped up the hearing by saying that “some in the press and watching online have been surprised this was such a civilized and in-depth hearing.”

Even the committee’s four Republicans, who made clear they’re not on board with Medicare-for-all, praised the Democrats at times.

“You kept this focused and very civil,” ranking Republican Tom Cole (Okla.) told McGovern.

“I cannot support her legislation, but I support her,” Rep. Rob Woodall (R-Ga.) said at another point, referring to Jayapal, who was present for the hearing.

The hearing's seven witnesses mostly maintained measured tones. Two doctors, emergency room physician Farzon Nahvi and retired colonel Doris Browne, told lawmakers the country is already paying for care for the uninsured who visit emergency rooms -- and it's less efficient and more costly because they're not able to visit primary care physicians.

George Mason University economist Charles Blahous said he has estimated Medicare-for-all would add $32 trillion to $39 trillion to federal health-care spending -- but he agreed with Democrats that most of that would be offset by eliminating private health plans.

The most urgent Medicare-for-all advocate was Ady Barkan, a 35-year-old activist dying of amyotrophic lateral sclerosis, who delivered his testimony through a computer because he's no longer able to speak.

“The ugly truth is this: Health care is not treated as a human right in the United States of America,” said Barkan. “On the day we are born and on the day we die, and on so many days in between, all of us need medical care. And yet in this country, the wealthiest in the history of human civilization, we do not have an effective or fair or rational system for delivering that care.”

Via Vox's Dylan Scott: 

Yet the lawmakers didn't brush over their differences. Cole called Jayapal's Medicare-for-all measure "a radical bill,” saying Democrats have “not told us how much this massive new program would cost, who would pay for it and how much taxes would have to go up.” Meanwhile, McGovern stressed that "health care is a right for all, not a privilege for the lucky few."

"That dispute was part of the subtext that played out in a small House hearing room as congressional proponents of Medicare-for-all put forth their moral, political and economic case," my colleague Amy Goldstein writes. "The hearing offered single-payer proponents their moments in the sun without necessarily moving legislation closer to becoming law."

McGovern:

Stay tuned for more Medicare-for-all discussions on Capitol Hill. Ways and Means Committee Chairman Richard Neal (D-Mass.), who presides over one of the two key House committees with health-care jurisdiction, said he will also hold a hearing.

Inside Health Policy reporter Ariel Cohen:

AHH, OOF and OUCH

AHH: The Food and Drug Administration has cleared Philip Morris to sell a heat-not-burn tobacco device known as IQOS in the United States.

The device, meant to be an alternative to conventional cigarettes, includes a tube that heats up tobacco sticks instead of burning them, which makes the tobacco being inhaled less harmful, our Post colleagues Laurie McGinley and William Wan report.

As experts in the United States debate how IQOS would impact public health, the FDA said the device would be “appropriate” for public health because “the products produce fewer or lower levels of some toxins than combustible cigarettes,” the agency said in its announcement.

The FDA also noted that the product, while greenlighted for sale, has not been “approved” yet by the agency. “That’s because all tobacco products are potentially harmful and addictive, and people who do not use tobacco products should continue not to, the agency said,” Laurie and William write.

There are concerns that the device could attract minors or nonsmokers, or that people who currently smoke would use the device in addition to their regular smoking habits.

OOF: Three major health insurers received a combined $11.5 billion in drug rebates last year just through their Medicare businesses, according to an analysis from Axios.

The findings signal how the companies, CVS Health, Humana and UnitedHealth Group, which control a majority of Medicare’s prescription drug coverage, are “most at risk from the Trump administration's plan to eliminate rebates within Medicare,” Axios’s Bob Herman reports.

“These companies rely heavily on rebates to offset the costs of covering seniors' prescriptions. Losing those rebates would shift billions of dollars away from them, and they could lose customers if they raise premiums to make up the difference,” he writes, adding the plans pass Medicare rebates back to the federal government, though they do keep a small percentage of rebates from commercial plans.

According to filings with state insurance commissioners, UnitedHealthcare paid $7.3 billion in prescription drug claims and received $4.1 billion in rebates, Humana paid $7.1 billion in prescription claims and received $3.9 billion in rebates, and CVS paid $6.3 billion in prescription claims and received $3.5 billion in rebates.

If rebates are eliminated, companies like these may raise monthly drug plan premiums to avoid losses, which could dissuade seniors from keeping their plans.

OUCH: A working paper recently circulated by the National Bureau of Economic Research suggests raising the minimum wage and the earned-income tax credit could help reduce the growing suicide rate.

The suicide rate nationwide has increased 35 percent since 2000, our Post colleague Andrew Van Dam reports. But raising the minimum wage and the EITC by 10 percent each could prevent about 1,230 suicides each year, the report found.

"There are hints that these deaths are the result of worsening prospects among less-educated people but few immediate answers. But maybe the solution is simple: pursue policies that improve the prospects of working-class Americans," Andrew writes.

The report included analysis of 1999-2015 death data from the Centers for Disease Control and Prevention, examining states that raised their minimum wage or EITC in those years, measuring the change in suicide rates before and after the policies took effect. “[T]he number of suicides that weren’t related to drugs dropped noticeably,” he reports. “Among adults without a college education, increasing the EITC by 10 percent appears to have decreased non-drug suicides by about 5.5 percent. Raising the minimum wage by 10 percent reduced suicides by 3.6 percent.”

— More young people are attempting suicide using poison, according to new data published in the Journal of Pediatrics.

In the last decade in the United States, the rate of suicide attempts by poison has more than doubled for people under age 19 and more than tripled for girls and young women ages 10 to 24, our colleague William reports.

The study also found attempted suicides by poison for people ages 10 to 15 began to skyrocket from 2011 to 2018 after being relatively flat until 2010. During that time, the numbers increased by 141 percent overall, and 338 percent for girls ages 10 to 12.

“There’s something very alarming happening here,” said study co-author Henry Spiller, director of the Central Ohio Poison Center. “Even if we don’t know why it’s happening, it’s a major signal that there are big problems in children’s lives right now and we as a society need to address them.”

Spiller and co-author John Ackerman said while they can’t answer the “why” behind the new numbers, they “suspect the sudden increase in recent years has to do with the advent of smartphones and how they have made social media much more pervasive in young people’s lives,” William writes.

OPIOID OPTICS

— Three hospitals in the District of Columbia have launched programs to provide medication-assisted addiction treatment to overdose victims who come to their emergency rooms, our Post colleague Peter Jamison reports, the city's latest effort to cut its overdose deaths in half by the end of next year.

The new programs at Howard University Hospital, MedStar Washington Hospital Center and United Medical Center will allow overdose victims to take buprenorphine while they are in the emergency room. The treatment is meant to reduce cravings for opioids, including heroin.

These programs are part of a series of moves the district has made following a report by Peter in December that highlighted the city’s failed response to a growing opioid epidemic. “Since then, D.C. Mayor Muriel E. Bowser (D) has announced a dramatic expansion in the distribution of naloxone, a lifesaving overdose antidote. Federal officials also launched an audit, still ongoing, of D.C. officials’ use of $4 million in grant money to treat opioid addiction,” Peter writes.

The treatment program using buprenorphine was supposed to launch at United Medical Center, a public hospital in Washington, almost two years ago, but officials had not followed through on the plan, as Peter reported.

INDUSTRY RX

— There are serious discrepancies in the price of identical services common in health care, according to new data from the Health Care Cost Institute that looked at health insurance claims for 34 million Americans. For example, as the New York Times’s Margot Sanger-Katz reports, a metabolic blood panel test was found to cost $11 and $952 based on two negotiated prices paid by insurance companies in two U.S. cities.

Margot shares a graphic detailing how the cost of a basic blood test varies in different cities:

“Although hospitals are now required to publish a list of the prices they would like patients to pay for their services, the amounts that medical providers actually agree to accept from insurance companies tend to remain closely held secrets,” she writes.

The Trump administration, which has called for public comments on a proposal to mandate that doctors and hospitals publish negotiated prices, could put an end to the opacity in these prices.

STATE SCAN

 — New York Mayor Bill de Blasio (D) announced a ban on alcohol advertisements on city property, including at bus shelters and newsstands, citing concerns public health risks related to excessive drinking. 

The ban takes effect immediately, but spaces that are currently allowed to sell alcohol are exempt, such as restaurants, concert venues and stadiums. Advertisements currently up will be allowed to finish out their contract term.

“This order banning alcohol ads from City property reaffirms our commitment to health equity and our stand to protect the well-being of all New Yorkers,” de Blasio said in a statement.

“In New York City, we see far too many deaths related to alcohol,” city Health Commissioner Oxiris Barbot said in a statement. “We know exposure to alcohol advertising can lead to drinking more alcohol, more often — behavior that can be harmful and even fatal. Today’s ban of alcohol ads on city property will help protect communities from the burden of harmful alcohol advertising.”

 — And here are a few more good reads: 

PowerPost
State Rep. Greg Murphy, a urologist, and Joan Perry, a pediatrician, are seeking to succeed the late congressman Walter B. Jones Jr.
Mike DeBonis
The Alabama House voted overwhelmingly Tuesday to outlaw almost all abortions in the state as conservatives took aim at the 1973 U.S. Supreme Court decision that legalized abortion nationwide.
Associated Press
HEALTH ON THE HILL
Progressives are increasingly warning that they would forcefully oppose any effort to set up a system of arbitration to help lower drug prices.
Stat
The major Democratic presidential contenders have been vocal about the need to expand health-care coverage for more Americans. But they have split on how to do so.
Kevin Uhrmacher, Kevin Schaul, Paulina Firozi and Jeff Stein
MEDICAL MISSIVES
It's the worst year for measles since the disease was declared eliminated in the US in 2000.
BuzzFeed
Measles outbreaks have occurred in 22 states. Now adults are wondering if they are immune and whether they should get a shot of the vaccine. Here’s what you need to know.
New York Times
A language gap is making it harder for U.S. health officials to measure a teen-vaping epidemic.
Bloomberg
A federal judge in Miami removed himself from a lawsuit brought by a patient against UnitedHealthcare for the insurer’s denial of proton beam radiation therapy for prostate cancer.
Miami Herald
Monday set a new record in this outbreak of 27 confirmed cases in a single day, Congo’s health ministry said. Over the past four days 93 cases had been confirmed.
Associated Press
AGENCY ALERT
Local governments across the U.S. are testing how far they can reduce health benefits for their retirees as a way of coping with mounting liabilities and balancing budgets.
Wall Street Journal
DAYBOOK

Today

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

The evolution of Joe Biden’s comments on Anita Hill: