with Paulina Firozi


Congress probably won’t do any big health-care things this year. But it might take some smaller action.

Around Capitol Hill, pockets of legislators are partnering on incremental measures aimed at making health care more affordable for American consumers. In the past week, House and Senate members have released three separate bipartisan proposals to halt surprise medical bills. A fourth and more sweeping measure, rolled out yesterday by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would also make drug prices more transparent and remove barriers to cheaper generic drugs, among numerous other provisions.

“The steps we are taking on important issues like surprise medical billing, drug prices, maternal mortality and vaccine hesitancy show we can make progress when both sides are at the table ready to put patients and families first,” said Murray, the top Democrat on the Health, Education, Labor and Pensions Committee.

Former Food and Drug Administration commissioner Scott Gottlieb:

Farzad Mostashari, former national coordinator for health information technology at the Department of Health and Human Services:

Axios reporter Bob Herman:

Coming to the table is next to impossible for legislators on any major health-care proposals — measures that could close the country’s uninsured gap or force drugmakers to dramatically lower prices. The politics are just too charged.

Republicans are refusing to help shore up the Affordable Care Act. In retribution, Democrats attached Obamacare measures they want passed to bipartisan drug pricing bills in a House vote last week. And as Democrats examine Medicare-for-all proposals, Republicans are working to undermine those ideas at every turn by casting them as socialism or charging that they’d result in rationed, low-quality care.

Dissension is also brewing over how far to go on drug prices. Staffers for House Speaker Nancy Pelosi (D-Calif.) are working on a plan, first reported by Politico, to allow Medicare to directly negotiate lower prices for at least 25 drugs a year, but that idea appears to be a non-starter among Republicans.

But Alexander, Murray and others see opportunity on the margins, especially given the public’s overwhelming concern about health-care costs consuming ever more household income. Alexander, who chairs the HELP Committee, said his goal is to move the draft legislation through the committee next month and get it to the Senate floor in July.

“There’s one issue I hear a lot about from Tennesseans, and it is, ‘What are you going to do about the health-care costs I pay for out of my own pocket?’ ” Alexander said. “Well, we’ve got an answer.”

There’s a fifth bipartisan effort in the wings. Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), the leaders of the Senate Finance Committee, say they’re partnering on a health package aimed at lowering drug prices. Grassley has said he wants to have that package ready by June.

But it’s tackling surprise medical bills — the unexpected expenses that can arise when a patient gets treated by an out-of-network provider through no fault of their own — that is emerging as one of the most energized issues this year. In a speech earlier this month, President Trump called on Congress to pass surprise billing legislation and laid out some principles for how he would like it structured. On Tuesday, the House Ways and Means Health subcommittee held a hearing on the subject.

House Majority Leader Steny Hoyer (D-Md.):

Politico's Dan Diamond:

A key question legislators will have to answer is how to determine prices when patients receive unexpected out-of-network care. This can happen either during an in-network hospital stay — when they're seen by an out-of-network specialist — or if a patient has to suddenly visit an emergency department outside their plan’s provider network.

There’s broad agreement that patients shouldn’t have to bear these extra costs, but the various proposals have suggested somewhat different approaches for how insurers and providers should negotiate the such costs.

—The “STOP Surprise Medical Bills Act” — proposed by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.), Michael Bennett (D-Co.) and three others — allows for an arbitration method whereby a third party mediates between insurers and doctors to decide on the fairest price.

—The “No Surprises Act,” from Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and ranking Republican Greg Walden (Ore.), would link the payments to the market rate in the geographic area.

—The “Lower Health Care Costs Act of 2019,” from Alexander and Murray, offers three options for negotiating prices, including arbitration.

—The “Protecting People from Surprise Medical Bills Act,” which is just in outline form, was released yesterday by four House Republicans and four House Democrats. It also proposes an arbitration system.


AHH: Health officials in five states were so worried that patients infected with measles were going to travel and spread the virus that they warned those individuals about a rare federal authority -- a "Do Not Board" list -- that could stop them from getting on planes.

The warning worked, and the government authority was not invoked, our Post colleague Lena H. Sun reports. “All eight individuals agreed to cancel their flights after learning the officials could ask the federal government to place them on a Do Not Board List managed by the Centers for Disease Control and Prevention,” she writes.

Lawrence Gostin, a professor of global health policy at Georgetown University, told Lena that while the travel ban authority is less restrictive than public health strategies such as isolation or quarantine, it “is seen as a government using its power over the people and the states, which is kind of toxic in America right now … There is nothing unethical or wrong about it. It’s just plain common sense that if you have an actively infectious individual, they should not get on an airplane.”

New York's Rockland County Executive Ed Day wants a federal law requiring travelers to show proof of immunization. He wrote a letter asking the White House to “issue an Executive Order or task federal authorities to pass a law requiring visitors to present ‘certification of appropriate immunization,’ ” Lena reports. “A White House spokesman referred a request for comment to the Department of Health and Human Services, which referred the request to the CDC, which referred it back to HHS.”

 OOF: The family of the 18-year-old University of Maryland student who died of adenovirus last year has taken a step toward a lawsuit against the school.

The notice of claim against the University of Maryland was filed after our Post colleagues Jenn Abelson, Amy Brittain and Sarah Larimer revealed in a lengthy investigation that school leaders waited 18 days to inform students about the presence of adenovirus on campus.

The outbreak sickened 40 students, including 15 who were treated at hospitals, and left one student, 18-year-old Olivia Shea Paregol, dead.

“Ian Paregol said the family hopes to have discussions with college officials and will decide in coming weeks whether to file a lawsuit against the state’s flagship institution,” Jenn writes. “In the meantime, Paregol is calling for an independent investigation of the university and asking for the resignation or termination of President Wallace D. Loh.”

Meanwhile, Loh has defended the school’s response to the outbreak. “Our approach to reporting, testing, cleaning and communicating about the virus was coordinated with health officials, and exceeded” guidelines from the CDC, Loh said in a statement.

OUCH: New documents allege the patient in a vegetative state who gave birth at a long-term care facility in Arizona was repeatedly raped and may have been pregnant before, CNN’s Faith Karimi and Chris Boyette report.

The woman, who had been at the Hacienda HealthCare facility in Phoenix since 1992, has left the facility where she gave birth to a baby boy in December, though no one at the facility knew she was pregnant.

“Her lawyers filed a $45 million notice of claim to Arizona on Wednesday with allegations against the state along with Hacienda HealthCare,” Faith and Chris report. “The Maricopa County Medical Center examined the woman after she gave birth and concluded she'd been ‘violated repeatedly,’ the documents allege. Her giving birth was likely a ‘repeat parous event,’ which means she may have been pregnant before, the documents say. From the claim, it's unclear whether she carried the previous pregnancy her family believes she had to term.”


— The U.S. Court of Appeals for the 5th Circuit announced it would hear oral arguments on July 9 in the state-led lawsuit that is seeking to wipe out the Affordable Care Act. The appeals court is considering a federal judge's December ruling striking the ACA.

This week, the 21 Democratic attorneys general led by California defending the health-care law filed a brief arguing the challenge to the law lacks standing, that the individual mandate remains constitutional and that the mandate can be separate from the rest of the ACA even if it is deemed unconstitutional. “The Trump Administration has made clear that it will not defend Americans’ healthcare and the law that tens of millions of Americans across the country depend on — so our fight continues,” California Attorney General Xavier Becerra said in a statement.


— A bipartisan bill from Senate Majority Leader Mitch McConnell (R-Ky.) and Tim Kaine (D-Va.) to raise the age at which people can buy tobacco products is already facing hurdles, Politico’s Marianne Levine and Sarah Owermohle report. While lawmakers on both sides of the aisle want to raise the purchase age to 21, some Democrats say the bill would give the tobacco industry leeway to influence state laws on vaping and other tobacco products.

“They say a section of the bill that requires states to individually pass additional laws on the tobacco purchasing age would allow tobacco companies to influence the state legislative process and potentially water down related proposed regulations,” Marianne and Sarah write. Sen. Brian Schatz (D-Hawaii) is has threatened to vote against the bill. “There’s no reason that we can’t just do a clean bill, no loopholes, no tricks,” Schatz said.

“I don’t want to dismiss it because there’s so much of it that’s good,” said Sen. Dick Durbin (D-Ill.). He told Sarah and Marianne his staff is “taking a look at it to see if there’s anything that we ought to be mindful of that may be a loophole if we allow states to be lobbied by tobacco and vaping companies and modifications be part of it.”

Schatz and Durbin have their own bipartisan bill with Sens. Todd Young (R-Ind.) and Mitt Romney (R-Utah) that would raise the tobacco-purchasing age.


— A new analysis from U.S. News found 14 percent of public high school students in California said they dealt with bullying or harassment in the past 12 months because of their race, ethnicity or national origin. The report found 6 percent said they experienced such treatment because of their perceived immigration status and 7 percent over their religion.

Of the 395,000 students in grades 9 through 12 who were surveyed for the 2017-2018 school year, almost 53,000 said they experienced bullying over their race, ethnicity or national origin, while 24,000 left the question blank.

“Aside from in-the-moment suffering, there's evidence this discrimination takes a deeper toll: A further U.S. News analysis of data from the survey, which is managed by the state's education department, shows an apparent link between experiences of bias-related bullying among adolescents and risky health behaviors like smoking and drinking,” U.S. News’s Deidre McPhillips reports.

Students in public high schools in the state who experienced bias-related bullying also were twice as likely to have smoked cigarettes. And 40 percent of the students who experienced this treatment consumed alcohol, compared with 29 percent among those who didn’t experience such treatment.

— And here are a few more good reads: 


Coming Up

  • The Bipartisan Policy Center and the Healthy Schools Campaign hold an event on education and health on May 28.
  • The House Veterans Affairs Subcommittee on Economic Opportunity holds a hearing on the effectiveness of VA Vocational Rehabilitation and Employment (VR&E) Programs on June 4.
  • The Washington Post hosts a live event with key government officials, doctors and health experts to examine the impact of socioeconomic factors on the state of health on June 4.

Videos of House Speaker Nancy Pelosi (D-Calif.), manipulated to make her seem drunk, are spreading across social media:

Altered videos of House Speaker Nancy Pelosi (D-Calif.), slowed down to make her sound sluggish and slurred, are spreading across social media. (The Washington Post)