THE PROGNOSIS

Medicare-for-all advocates argue enacting their plan would lift a heavy burden off employers to provide their workers with health-care coverage, which is the way 180 million Americans get their insurance.

But large employers are just fine with being the suppliers of insurance and don’t want to give up that role, according to an association that represents them.

Overwhelmingly they would like to continue doing it,” Jim Klein, president of the American Benefits Council, told me. “They think they’re doing a good job.”

The American Benefits Council — which represents the country’s largest employers including Walmart, ExxonMobil and Apple — hasn’t joined the large industry coalition of insurers, pharmaceutical makers and hospitals who are vigorously fighting every iteration of Medicare-for-all proposals coming from Capitol Hill (we’ve written about that partnership here).

But its leaders are plenty skeptical of the prospect of a single-payer system, stressing it would upend the way most people in the United States get their coverage and potentially subject employers to big new taxes so the government could pay for the whole thing.

“I think they’re very concerned about sort of a blank check which the government would be filling in the blank, in terms of cost,” Klein said of his members.

The future of employer-sponsored coverage is one of the stickiest questions raised by the Medicare-for-all debate. The shortcomings — and merits — of the system got a lot of airtime during last month’s Medicare-for-all hearing at the House Rules Committee and probably will be part of the debate at a similar hearing House Budget Chairman John Yarmuth (D-Ky.) has scheduled for Wednesday.

Just look at how some of the Democrats running for president have recently danced around the issue.

Sens. Cory Booker (D-N.J.) and Kamala Harris (D-Calif.) are co-sponsors of the latest Medicare-for-all bill from Sen. Bernie Sanders (I-Vt.), which would upend the country’s health insurance system, replacing virtually all private plans with a generous set of benefits provided by the federal government. But both candidates have tried to take a softer stance on what would happen to workplace coverage.

—“I stand by supporting Medicare-for-all, but I’m also that pragmatist that, when I’m chief executive of the country … I’m going to find the immediate things that we can do,” Booker told CNN’s Jake Tapper this month.

“Because I’m telling you right now, we’re not going to pull health insurance from 150 million Americans who have private insurance who like their insurance — my union friends, brothers and sisters, who have negotiated for their health insurance,” Booker added.

—Sen. Kamala Harris (D-Calif.) told Tapper last week “that’s not what I meant” when he asked her to clarify previous comments in which she said she supports eliminating the private insurance industry.

“I support Medicare-for-all but I really do need to clear up what happened on that stage,” Harris said. “It was in the context of saying let’s get rid of all the bureaucracy.”

— Yarmuth poured cold water on the idea of Medicare-for-all being law anytime soon, despite the hearing he’s holding on the issue this week.

“A lot of people, I think, co-sponsored Pramila's bill for the same reason they co-sponsored H.R. 676; it was the metaphor for Medicare-for-all,” Yarmuth told my colleague Dave Weigel last week. Yarmuth was referring to the House bill proposed by Rep. Pramila Jayapal (D-Wash.).

“Now, people have seen some of the details and said, 'Okay, we need to look at this.' There doesn't seem to be much of a sense of urgency because it's not going anywhere,” Yarmuth added.

Rep. Donna Shalala (D-Fla.), former Health and Human Services secretary under President Bill Clinton, is also a Medicare-for-all skeptic:

Perhaps these Democrats recall President Barack Obama’s infamous “if you like it, you can keep it,” pledge, where Obama learned the hard way what happens when people lose insurance they wanted to keep. Obama repeatedly promised people they could retain coverage they liked under his 2010 Affordable Care Act. When around 4 million people got notices their plans were being canceled — because they weren’t ACA-compliant — the administration came under heavy fire. The website PolitiFact dubbed Obama’s promise its “Lie of the Year” in 2013.

Yet employer-sponsored plans are still far from perfect. In fact, many health policy wonks have said many of the problems with health insurance in the United States stem from people getting it through the workplace instead of shopping for it on their own.

Costs are a big problem for both employers and their workers. For years, employers have grappled with rapid health-care cost inflation, resulting in higher monthly premiums and annual deductibles. Last year, health benefits for the average employee at a large company cost more than $13,000, according to a Mercer survey of employer-sponsored plans.

In response, employers have trended toward high-deductible plans or asked their workers to contribute more to their monthly premiums. Some have also invested in workplace wellness programs, in hopes of creating a healthier, lower-cost workforce.

“It puts a huge burden on employers,” House Rules Committee Chairman James McGovern (D-Mass.) said at his committee’s Medicare-for-all hearing.

Then there’s the issue of portability — the problem created when people change jobs and are forced to also change their health plan. This can be especially costly for those with chronic health conditions, who can’t afford any gaps in coverage and may find themselves having to satisfy an annual deductible for the second time in one year.

Yet to those enmeshed in the system, such as large employers, overhauling the whole thing is a daunting prospect. While health-care costs continue to rise, employers are more fearful of having to help fund the expensive single-payer system proposed in the Sanders and Jayapal bills.

Sanders argues his Medicare-for-all plan would be net cheaper for employers. He has proposed charging them either 75 percent of what they’re paying for each of their employees enrolling in Medicare-for-all or a 7.5 percent payroll tax, whichever is higher.

This would result in a net savings for employers, Sanders argues. Large employers don’t appear convinced.

Klein said the council isn’t necessarily opposed to expanding Medicare to more people — and stresses that its members are deeply interested in reining in cost growth.

But he said employers don’t want a health insurance overhaul, arguing they spend more than $4 on health benefits for every dollar the government loses by exempting the benefits from taxes.

“Our employers are not calling for Uncle Sam,” he said.

AHH, OOF and OUCH

AHH: In a Saturday night Twitter missive, the president signaled the recently signed Alabama abortion law that virtually bans abortions in the state goes too far, though he insisted he is “strongly pro-life.”

The president didn’t directly refer to the newly signed Alabama bill, which makes performing abortions a felony except in cases where a pregnany is a risk to a woman's health. Nor did he cite other measures in Republican-led states to restrict abortion.

Instead, the president said he supports three exceptions to such abortion restrictions, in cases of rape, incest, and when the mother's life is at risk, writing that his view is "the same position taken by Ronald Reagan,’” our Post colleagues Amy Goldstein and Seung Min Kim report.

But Amy and Seung Min note that Reagan wasn't as conservative on abortion as Trump made it sound. “In aligning with the memory of the popular GOP figure, Trump disregarded that Reagan had, as California governor, signed a liberal abortion law. And as president, Reagan nominated to the U.S. Supreme Court the first female justice, Sandra Day O’Connor, who voted to uphold Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide, in later challenges to the ruling.” (The Post's Alex Horton has more on how the president's tweets and the comparison to Reagan bend reality here.) 

— Trump would hardly be the first Republican to signal concern about the Alabama law. Sen. Mitt Romney (R-Utah), explicitly said he was opposed to the law and Senate Majority Leader Mitch McConnell (R-Ky.) said he has long supported exemptions for rape, incest or when a women’s life is at risk.

“I don’t support the Alabama law,” Romney said in an interview Sunday on CNN. “I believe that there ought to be exceptions. I'm pro-life, but there ought to be exceptions for rape and incest and where the life of the mother is at risk.”

Romney also criticized what he described as “extreme” views of the issue being represented in recent state abortion legislation.

“You're seeing laws on both sides of this argument that are in the extreme. And whether it's New York and Virginia, or whether it's Alabama and Missouri, people have gone to the — to the wings, if you will,” he continued. “I don't think that's productive. I think something much more toward the center makes a lot more sense.”

On Friday, Republican National Committee Chairwoman Ronna McDaniel said she would prefer such a law to include some exemptions. “Personally, I would have the exceptions,” McDaniel said in a CNN interview. “That's my personal belief. But we are a party that is a broad tent. If you agree with us 80 percent of the time, I want you to be a Republican. We don’t have a litmus test as to whether you can belong to our party.”

OOF: A Republican Missouri state lawmaker apologized after he said some rape cases are “consensual” during remarks about an antiabortion measure.

State Rep. Barry Hovis, who spent three decades with the Cape Girardeau Police Department, was speaking on the state House floor about a measure that would ban abortions in the state at eight weeks. He was talking about sexual assault cases he came across as a police officer.

“Let’s just say someone goes out and they’re raped or they’re sexually assaulted one night after a college party — because most of my rapes were not the gentleman jumping out of the bushes that nobody had ever met,” Hovis said. “That was one or two times out of a hundred. Most of them were date rapes or consensual rapes, which were all terrible.”

Hovis later told The Post that he misspoke and he believes there is “no such thing as consensual rape,” as our Post colleague Orion Donovan-Smith reports. “I’m not trying to make excuses,” Hovis said. “Sometimes you make a mistake and you own up to it.”

OUCH: A new report from independent nonprofit FAIR Health found mental health care – including claims linked to depression, anxiety and other conditions – makes up an increasing number of private health insurance claims.

“There were notable increases in those claims among young people, who accounted for a disproportionate share of mental health claims. Experts said the findings could reflect increased access to treatment — but cautioned that it’s difficult to determine the factors at play,” Stat’s Megan Thielking reports. “The report’s findings among adolescents and young adults were particularly striking. Mental health claims also rose among young people, which the report defined as age 22 or younger. The report also found that young people accounted for a growing share of the claims for major depressive disorder. In 2007, young people accounted for 15% of all claims tied to serious depression. By 2017, they accounted for 23%.”

Another notable finding from the report was that claims related to generalized anxiety disorder increased 441 percent among people ages 19 to 22 from 2007 to 2017, and claim lines for behavioral health diagnoses spiked 108 percent during that time. 

Study authors examined insurance claims related to behavioral health care, which includes mental health care and treatment for substance abuse, specifically assessing individual claim lines for use of treatment services or procedures.

HEALTH ON THE HILL

— Protect Our Care, a leading ACA-advocacy organization led by top Democratic operatives, is today launching a new seven-figure ad campaign to bolster lawmakers in 20 congressional districts.

The campaign is meant to help those House Democrats hold on to their seats in 2020 by helping educate voters about what they have accomplished to address health care.

“Two years ago, the Republican Congress voted for health care repeal — gutting protections for people with pre-existing conditions, slashing coverage and raising premiums and prescription drug costs for millions of Americans,” Protect Our Care Chair Leslie Dach said in a statement sent to The Health 202. “Now President Trump and his allies are trying to do the same thing in court. The Democratic health care Congress is working to protect health care for people when they get sick and lower costs for hard working Americans. We’re going to make sure that despite the clutter and noise of Washington, constituents know when their Member of Congress stands up for health care and fights to lower costs and improve care.”

Most of the 20 districts included in the campaign are those of lawmakers who flipped Republican seats in 2018, including Rep. Angie Craig (D-Minn.), a former medical device company executive who flipped a Republican seat; Rep. Lauren Underwood (D-Ill.), who flipped a Republican district that was held by former Rep. Randy Hultgren; as well as Reps. Ann Kirkpatrick (D-Ariz.), Lucy McBath (D-Ga.), Jason Crow (D-Colo.), Abby Finkenauer (D-Iowa), Cindy Axne (D-Iowa), Jared Golden (D-Maine), Conor Lamb (D-Pa.), Dean Phillips (D-Minn.), Elissa Slotkin (D-Mich.), Haley Stevens (D-Mich.), Andy Kim (D-N.J.), Susan Wild (D-Pa.), and Colin Allred (D-Tex.).

— Sen. Bernie Sanders (I-Vt.) became the latest 2020 Democratic contender to pledge to nominate only Supreme Court justices who support the landmark Roe v. Wade abortion ruling. Sen. Kirsten Gillibrand (D-N.Y.) has done the same.

During an interview on NBC’s “ Meet the Press,” host Chuck Todd asked Sanders whether he would have a “litmus test” for judges. Sanders also condemned the new Alabama abortion law.

“I believe what they did in Alabama is unbelievable. Other states are doing it – the idea that women in this country shouldn’t be able to control their own bodies is beyond belief,” he said. “If you’re asking me would I ever appoint a Supreme Court justice who does not believe in defending Roe vs. Wade, who does not believe that a woman has the right to control her own body, I will never do that.”

— And here are a few more good reads: 

REPRODUCTIVE WARS
Health
Several states have passed anti-abortion legislation this year. Here's a rundown of what it all means.
Marisa Iati and Deanna Paul
TRUMP TEMPERATURE
Behind the scenes, Pence has developed his own sphere of influence in an agency lower on Trump’s radar: Health and Human Services.
Politico
AGENCY ALERT
Military
The lists were uncovered through a Freedom of Information Act request by Military.com.
Deanna Paul
MEDICAL MISSIVES
Overall, the year has not lived up to expectations.
Politico
STATE SCAN
Education
The students are trying to erase the stigma attached to talking about reproductive health.
Debbie Truong
PowerPost
The investigation reached no ‘conclusive determinations’ on whether the Republican lawmaker or most other coaches at the school decades ago knew of misconduct by a school doctor.
John Wagner and Mike DeBonis
National
States are debating whether revenge porn is free speech.
Deanna Paul
OPIOID OPTICS
The rise of the more potent fentanyl in its place has put a generation of older users, who had managed their addiction, at far greater risk of overdose.
New York Times
DAYBOOK

Coming Up

  • The House Armed Services Subcommittee on Military Personnel and the House Veterans’ Affairs Subcommittee on Health will hold a joint oversight hearing on military and veteran suicide on Tuesday.
  • The House Ways and Means Subcommittee on Health holds a hearing on surprise medical bills on Tuesday.
SUGAR RUSH

Stacey Abrams and four Democratic women running for president appeared in a Fair Fight Action video on social media, rallying against antiabortion laws:

Check out Saturday Night Live's cold open: