with Paulina Firozi


Those hoping for specific answers on the costs and benefits of moving to a Medicare-for-all-type health-care system may have been disappointed yesterday.

Congressional Budget Office analysts testifying before the House Budget Committee answered basically every question from lawmakers like this: It depends.

The carefully couched responses from CBO Deputy Director Mark Hadley and two other officials appeared to frustrate some lawmakers, who tried at times to bait them into offering value judgments on whether Medicare-for-all would help or hurt Americans.

“I understand we make policy, but I would imagine you have views and would hope you’d share with us,” Rep. Rosa DeLauro (D-Conn.) said to Hadley near the beginning of the two-hour hearing.

Conservative health policy wonk Chris Jacobs:

It was the second House hearing this year regarding a single-payer health-care system, a direction many Democrats on the presidential campaign trail and in Congress want to move as a way of closing the country’s persistent uninsured gap and guaranteeing Americans a full range of benefits.

Their movement toward Medicare-for-all has engendered pushback from many corners, not just from congressional Republicans, but also from industry leaders and top officials in the Trump administration. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has been particularly vocal in her opposition to the idea — and yesterday reiterated her views to reporters.

“I’m the head of the Medicare program … When I see policies that I think could harm the program and harm its beneficiaries, then I think it is my duty to speak out about that and inform the public about that,” Verma said, per my Washington Post colleague Amy Goldstein.

Verma pointed as an example to the innovative CAR T-cell cancer therapy, saying Medicare’s difficulties in deciding how much to pay for the expensive new treatment show the challenges presented by a system in which the government would pay for everyone’s treatment.

“I’m sitting every day in this chair unraveling problems in the Medicare program, dealing with bureaucracy and regulation that actually thwart innovation,” Verma said. “It’s important for the American public to understand the implications of a government-run program.”

Verma is at least right about this: There are lots of implications of Medicare-for-all that lawmakers would need to wrestle with. That was the ultimate message from Hadley and his colleagues to Budget Committee members.

“Moving to a single-payer system would be a major undertaking,” Hadley told the committee. “It would involve significant changes for all participants … lawmakers would need to make many decisions with complex trade-offs.”

His sober testimony mirrored a report the CBO issued earlier this month on single-payer systems, which detailed the huge range of considerations lawmakers would face — such as how generous the benefits would be, how much doctors and hospitals would be paid, and how to structure taxes to pay for the whole thing.

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

Yet a Medicare-for-all hearing would hardly be complete without some fiery exchanges, as Republicans sought to portray the program as disastrous for U.S. health care and Democrats passionately defended their goals of more-generous health coverage for everyone.

“Out-of-control health-care costs are impacting families who have employer coverage,” said Rep. Lloyd Doggett (D-Tex.). “Americans have so much skin in the game they’re getting third-degree burns.”

Hadley kept his cool as legislators tried to corner him into affirming their own positions. Rep. Chip Roy (R-Tex.) said Democrats “believe in the magic health-care fairy” and that there would be unlimited funding and no rationing in a Medicare-for-all system.

“Mr. Hadley, may I ask you a question? Where in the Constitution is the phrase ‘dental plan’ found?” Roy said.

“It’s not,” Hadley replied.

“How about prescription drugs? Standard of care? Co-pay?” Roy asked. “No,” Hadley responded.

“Right,” Roy said.

In another exchange, Rep. Ro Khanna (D-Calif.) plied Hadley on whether Medicare-for-all is socialism, as Republicans are fond of claiming.

“We haven’t drawn a conclusion about socialism,” Hadley responded.

Khanna kept at it. “Do you think anyone would pass Economics 101 with if they gave that answer in any major university in this country? MIT, University of Chicago?” he said.

Hadley responded that the CBO “doesn’t have its own definition of socialism.”

New York Times reporter Margot Sanger-Katz:

The Hill's Peter Sullivan:


— In pockets across the country, people are continuing to die in record numbers after overdosing on the potent opioid fentanyl, and resources for treatment are not arriving fast enough. 

“President Trump has taken a number of steps to confront the crisis, stem the flow of fentanyl into the country from China and Mexico, and step up prosecutions of traffickers. Congress also has increased spending on drug treatment,” our Post colleagues Sari Horwitz, Scott Higham, Steven Rich and Shelby Hanssen write in this latest investigation in a series about the nation’s deadliest drug crisis.

“But health policy experts say drug treatment funding is not nearly enough, and the administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy," they write. The depth of the problem continues to overwhelm the government’s response, and the administration has yet to produce a comprehensive strategy that is legally required by Congress.”

Joshua M. Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health, said the “scale of death here is really unprecedented.” During the first year of the Trump administration, a record 28,869 people died of synthetic-opioid-related overdoses, and most from fentanyl. It was a 46.4 percent increase from 2016. Data for the first eight months of 2018 suggest the death rate is on pace to exceed the year before.

The president declared the opioid crisis to be a public health emergency in October 2017. But two things were missing: funding and a plan to address the crisis, our colleagues write.

“When you say this is an emergency, you would expect to hear what they plan to do about the emergency,” said Andrew Kolodny, co-director of opioid policy research at Brandeis University.

— Two members of Congress released a report alleging the World Health Organization’s guidelines on pain treatment were directly influenced by the pharmaceutical industry. The congressional report from the offices of Reps. Katherine M. Clark (D-Mass.) and Hal Rogers (R-Ky.) claims further that guidelines for prescribing powerful painkillers seem to mimic marketing from opioid maker Purdue Pharma.

“The web of influence we uncovered, combined with the WHO’s recommendations, paints a picture of a public health organization that has been manipulated by the opioid industry,” the report reads.

“The report alleges that two WHO reports that provide guidelines for treating severe pain — one in adults and the other in children — draw directly from Purdue’s strategies on how to market opioids,” our Post colleague Katie Zezima reports. “The report cites Purdue’s 1996 budget plans, which were posted online by Kaiser Health News… The report claims that both Purdue and the WHO played down the risk of addiction, with the global health organization saying there was an ‘unreasonable fear’ of opioids.”

For its part, Purdue “strongly denies the claims” in the report. WHO did not respond to a Post request for comment.


AHH: Members  of Rep. Dan Lipinski's own party are distancing themselves from the incumbent because of his antiabortion stance with renewed attention to abortion rights in the wake of new state laws in Alabama and Missouri. Rep. Cheri Bustos (D-Ill.), the chairwoman of the House Democrats’ campaign arm, withdrew from a fundraiser for Lipinski, one of the last Democrats in Congress to oppose abortion rights.

Lipinski is facing a primary challenge from the left, as our Post colleague Colby Itkowtiz reports, and Bustos was set to appear at a reelection event.

“Normally, a top Democrat appearing at one of his fundraisers would be little noticed, but abortion issues are incredibly fraught as some conservative states move to outlaw abortion in an effort to overturn Roe v. Wade,” Colby writes.

“I’m proud to have a 100 percent pro-choice voting record and I’m deeply alarmed by the rapidly escalating attacks on women’s access to reproductive care in several states,” Bustos said in a statement. 

OOF: The Department of Health and Human Services acknowledged that a 10-year-old migrant girl from El Salvador died while in federal custody in September, CBS News’s Graham Kates and Angel Canales report. She was the first of six migrant children to die in the past eight months while in U.S. custody or soon after being released.

HHS spokesman Mark Weber said in a statement the child had a history of congenital heart defects, and she was in a “medically fragile” condition when she came into the care of the agency’s Office of Refugee Resettlement in March 2018.

“Following a surgical procedure, complications left the child in a comatose state. She was transported to a nursing facility in Phoenix, Arizona for palliative care in May after release from a San Antonio hospital,” Weber said. “On September 26, she was transferred to an Omaha, Neb., nursing facility to be closer to her family. On September 29, the child was transported to Children's Hospital of Omaha where she passed due to fever and respiratory distress.”

The news of the girl’s death came the same week a 16-year-old migrant boy died at a Border Patrol facility in Weslaco, Tex. The boy was the fifth Guatemalan child to die since December after being apprehended by Border Patrol agents.

OUCH: A day after the 16-year-old boy in federal custody died after being diagnosed with the flu, a migrant detention center in McAllen, Tex., was put under quarantine after a “large number” of migrants were found to be suffering flulike symptoms.

It’s not clear how many individuals are ill, our Post colleague Meagan Flynn reports. She adds the outbreak “comes amid severe overcrowding problems at migrant detention facilities in South Texas and heightened scrutiny of the conditions within them, as five child migrants have died in U.S. custody since December. The ballooning numbers of people crossing the southern border to claim asylum has overwhelmed the immigration system, from border stations to the courts, and led CBP to take drastic measures.”

“To avoid the spread of illness, the Rio Grande Valley Sector has temporarily suspended intake operations at the [Central Processing Center],” U.S. Customs and Border Protection said in a statement. “Individuals apprehended in RGV Sector will be held at other locations until this situation is resolved.”

The latest migrant death has also raised questions about whether medical screenings conducted by CBP and treatments are adequate for the volume of people they’re seeing in these facilities.


— Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) will today release a joint bipartisan discussion draft focused on lowering health-care costs. According to aides, the draft will include five parts focused on ending surprise medical bills, reducing the prices of prescription drugs, improving transparency care, improving public health and improving the exchange of health IT.

It may contain as many as two dozen separate proposals, Alexander told reporters earlier this week. He plans to hold a markup of the proposals this summer in the Senate Health, Education, Labor and Pensions Committee, which he chairs.

— Democratic presidential candidate Kirsten Gillibrand (D-N.Y.) is proposing a Family Bill of Rights that would expand access to adoption and medical care and would also require insurance companies to cover costly fertility treatments. She pledged to implement the plan within 100 days of taking offices if she is elected as president.

In a post on Medium, Gillibrand says her Family Bill of Rights "guarantees a set of fundamental rights to give every child the chance to succeed — no matter what block they grow up on."

The plan looks to tackle, among other things, the issue of access to OB-GYNs in rural areas. The plan will also “provide a tax credit to ensure that a family’s ability to adopt and provide a stable home for a child isn’t dependent on their wealth.”

— Sen. Kamala Harris (D-Calif.) reintroduced a bill aimed at addressing maternal health and racial disparities in the nation’s maternal mortality rate.

“Black mothers across the country are facing a health crisis that is driven in part by implicit bias in our health care system. We must take action to address this issue, and we must do it with the sense of urgency it deserves,” Harris said in a statement.

Harris’s Maternal CARE Act will look to address the disparities with $25 million for a program that addresses racial bias in maternal care and provides training for medical and nusing schools to improve care and invests another $125 million in programs to identify and address high-risk pregnancies.

Fellow 2020 presidential contenders Sens. Cory Booker (D-N.J.), Amy Klobuchar (D-Minn.), Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) are among the 19 senators co-sponsoring the legislation.

— And here are a few more good reads:



  • The House Natural Resources Committee holds a hearing on the insular areas Medicaid cliff.

Abortion rights protests spread across the country

Thousands across the country in May decried restrictive new abortion laws in Georgia and Alabama. A similar law is headed to the Missouri governor’s desk. (The Washington Post)