with Paulina Firozi


President Trump could barely hide his glee when every one of his potential Democratic opponents shot up their hands at Thursday night’s debate when asked whether undocumented immigrants should be included in government health plans.

And for a clear reason. Extending public benefits to immigrants who are in the United States illegally has long been a fraught issue, even among Democrats. Nine years ago, the Democratic-led Congress banned such immigrants from the Obamacare marketplaces — even if they use their own money to buy a plan — and even the most liberal states have struggled to expand coverage to the undocumented population. Undocumented immigrants are excluded from the Medicare and Medicaid programs, with some exceptions for children and pregnant women.

This was the only time the president tweeted about that night’s debate:

It’s hardly the first time a Republican has pounced on a Democrat for appearing to support government health benefits to the undocumented. Many will recall the infamous moment in 2009 when Rep. Joe Wilson (R-S.C.) yelled, “You lie!” in the House chamber as President Obama told them health proposals wouldn’t cover undocumented immigrants.

Wilson was wrong — the eventual ACA did indeed exclude undocumented immigrants from health insurance expansions, as Obama had promised. But this is one of several issues on which the 2020 Democratic contenders are now moving quite a bit further leftward as they seek the presidential nomination. They’re certainly far from where the last Democratic presidential nominee — Hillary Clinton — stood on the issue.

In her 2016 health-care platform, Clinton would have allowed undocumented immigrants to buy marketplace plans, one step further than the ACA’s outright ban. But she would have still excluded them from getting the ACA’s income-based subsidies, increasing the likelihood undocumented immigrants still couldn’t find affordable coverage.

Rewind to two decades before that, to when Clinton as first lady was trying to get a health-care revamp passed from her perch at the White House. At the time, the first lady expressed concern that extending benefits to the undocumented could encourage more people to enter the country illegally.

“We do not think the comprehensive health-care benefits should be extended to those who are undocumented workers and illegal aliens,” Clinton told Congress in 1993. “We know now that too many people come in for medical care, as it is. We certainly don’t want them having the same benefits that American citizens are entitled to have.”

The Democrats onstage last Thursday sounded a lot different.

NBC moderator Savannah Guthrie posed this question to them after an extended discussion about the Medicare-for-all and public option plans they are proposing to offer Americans:

“A lot of you have been talking tonight about these government health care plans that you have proposed in one form or another,” Guthrie said. “Raise your hand if your government plan would provide coverage for undocumented immigrants.”

All the candidates — which included the two front-runners, former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.) — raised their hands in response.

Sanders's raised hand wasn't a surprise -- he had tweeted this a few days prior:

But Biden's stance was notable, considering where mainstream Democrats used to stand on the issue. “You cannot let people who are sick, no matter where they come from, no matter what their status, go uncovered,” Biden said on the stage. “It’s just going to be taken care of, period … it’s the humane thing to do.”

Both Biden and South Bend, Ind., Mayor Pete Buttigieg noted that undocumented immigrants pay Social Security taxes if they have jobs and sales taxes when they purchase goods and services, arguing that’s another reason they should be included in public health-care programs.

“This is not about a handout,” Buttigieg said. “This is an insurance program. And we do ourselves no favors by having 11 million undocumented people in our country be unable to access health care.”

To Buttigieg’s point, there’s considerable evidence that helping people buy health insurance results in less spending in the long run. When hospital emergency departments care for uninsured patients, the hospitals end up passing along the costs to the insured patients, resulting in higher premiums for everyone.

Julian Castro, former HUD secretary under Obama, reiterated his support yesterday for giving health insurance to undocumented immigrants.

“What I’d like to Americans to know, right now, No. 1, undocumented immigrants already pay a lot of taxes,” Castro said on ABC’s “This Week with George Stephanopoulos.” “Secondly, we already pay for the health care of undocumented immigrants. It’s called the emergency room."

That’s a reason California — home to about one-fifth of the country’s undocumented immigrants — recently passed a budget extending Medicaid to some of the undocumented. But it’s the only state to do so, and it chose the most limited, least-costly option.

Last week, Gov. Gavin Newsom (D) signed a $214.8 billion budget into law that extends California’s Medi-Cal program to undocumented adults ages 19 to 26. That measure also expands on the federal health-care law in a number of ways, reinstating its individual mandate to buy coverage — which Congress repealed a few years ago — and raising the income threshold for getting marketplace subsidies.

But the Medi-Cal expansion is only a shadow of what many state lawmakers wanted. The state’s Senate passed a bill also opening its door to undocumented immigrants over age 65, while the Assembly’s version would have opened it up to everyone. Newsom insisted on expanding coverage only to young adults, a much less expensive option estimated to cover 138,000 undocumented immigrants.

The political obstacles to such a move were evidnet back in 2010 when Congress was constructing the ACA and barred people in the country illegally from participating in any part of the law.

California took some steps in 2016 toward asking the federal government for permission to let undocumented immigrants buy marketplace coverage but withdrew its request over fears the young Trump administration might use the request to target immigrants for deportation. New York lawmakers have proposed similar legislation, but it hasn’t gained traction.


AHH: President Trump is planning to appoint a health-care expert, Tomas Philipson, as the next leader of the White House Council of Economic Advisers.

“Best known for his research on health care, Philipson has been a key player in the Trump administration’s efforts to lower drug prices and push back against Democrats’ proposals for a Medicare-for-all system,” our Post colleagues Heather Long and Jeff Stein report. “Philipson would replace the outgoing council chairman, Kevin Hassett, a tax expert, potentially signaling an heightened focus ahead on health-care issues.”

It’s not clear when exactly the president will tap Philipson for his new role.

Philipson served as a top adviser to the head of the Food and Drug Administration under the George W. Bush administration and also worked at the Centers for Medicare and Medicaid Services. He also served on the steering committee for former vice president Joe Biden’s Cancer Moonshot Initiative.

OOF: The Smithsonian Institution has rejected a request from Sen. Jeff Merkley (D-Ore.) to take the name of the family behind opioid manufacturer Purdue Pharma off its Asian art museum in Washington.

In a letter last month, Merkley said the Sackler name “has no place in taxpayer funded public institutions,” citing ongoing lawsuits against the family over its alleged role in marketing the company’s blockbuster painkiller OxyContin amid the nation’s opioid crisis.

“In a letter to Merkley dated Friday, new Smithsonian Secretary Lonnie G. Bunch III reiterated the institution’s position that it is legally bound to keep the name of the late benefactor, Arthur M. Sackler, who, in 1982, donated 1,000 objects and $4 million toward the construction of the museum,” our Post colleague Peggy McGlone reports. “…Bunch also said that he shares the senator’s concerns about the opioid crisis and that he hopes Merkley recognizes that the Smithsonian takes the issue seriously. “

In the letter, Bunch also noted the Sackler gift was made in 1982, “nearly a decade and a half before the manufacture and marketing of OxyContin.”

Meanwhile, Purdue is facing falling sales, a declining workforce and other issues as it deals with the numerous lawsuits, the Wall Street Journal’s Jared S. Hopkins reports.

“Purdue’s revenue is expected to drop below $1 billion this year for the first time in more than a decade, as employees leave and a potential bankruptcy filing looms,” Jared writes. “…Purdue has also been reviewing the corporate structure of at least two dozen entities affiliated with the company that are under government scrutiny for possible fraud, according to some of the people familiar with the company. Purdue has previously said that it may file for bankruptcy but hasn’t made a decision.”

Purdue has also seen OxyContin’s position in the market fall amid awareness about addiction and a shift in how doctors prescribe the drug, even as the drug is now sold in a version that’s harder to abuse.

OUCH: The FDA is warning insulin pumps may be vulnerable to hacking.

Two pumps from the company Medtronic — the MiniMed 508 and the MiniMed Paradigm — are being recalled because of cybersecurity risks. The company sent a letter to patients and health-care providers warning that unauthorized individuals with “special technical skills and equipment” could hack into the device and change how much insulin is delivered, The Post’s Morgan Krakow reports.

The FDA is encouraging vulnerable individuals to talk to their health-care providers about switching pumps.

“While we are not aware of patients who may have been harmed by this particular cybersecurity vulnerability, the risk of patient harm if such a vulnerability were left unaddressed is significant,” said Suzanne Schwartz, an FDA official specializing in cybersecurity for medical devices, in a statement.


— Once again, there’s confusion around whether Sen. Kamala Harris (D-Calif.) supports eliminating private health insurance in the United States.

The Democratic presidential contender raised her hand during the second round of the first Democratic debate last week when the candidates were asked whether they would get rid of private health insurance in favor of a government single-payer plan.

But the very next day, the California Democrat said in an interview on “Morning Joe” that she had misheard the question from NBC’s Lester Holt when he asked: “Many people watching at home have health insurance through their employer. Who here would abolish their private health insurance in favor of a government-run plan?”

“Harris later said she would in fact preserve supplemental private insurance. Some journalists said on Twitter during the debate Thursday night that they also had understood Holt to be asking about the candidates’ personal health-care choices,” our colleague Jeff reports. “But some critics questioned Harris’s reversal, noting this is not the first time Harris or her campaign have clarified her remarks on private insurance after a live television performance.”

Harris seemed to support eliminating private health insurance when asked about the issue during a CNN town hall in January, but the next day a campaign aide said she would be open to health plans that preserved private insurers. The Harris campaign also did not respond to a specific survey question from The Post several months ago about whether she would support “essentially” getting rid of private insurance in moving to a single-payer system.  


— The fight over the fate of Missouri’s last abortion clinic will continue on at least until August.

A member of the state’s Administrative Hearing Commission granted an extension to allow the St. Louis Planned Parenthood to continue providing the procedures, and the commission scheduled a hearing to determine whether the state should have renewed the clinic's license on Aug. 1.

Administrative Hearing Commissioner Sreenivasa Rao Dandamudi also wrote there is a “likelihood” that the abortion clinic will succeed in its claim, the Associated Press’s Summer Ballentine and Jim Salter report.

“Planned Parenthood has said Missouri is using the licensing process as a weapon aimed at halting abortions,” they write. “The organization and its supporters celebrated Friday in St. Louis, where they also planned to unveil a banner that ‘sends a strong message’ to Republican Gov. Mike Parson and the state’s health director.”

— Abortion rights advocates and several providers filed a lawsuit in Georgia to stop the state’s new ban prohibiting abortion when a fetal heartbeat is detected, or as early as six weeks into a pregnancy.

The American Civil Liberties Union, the ACLU of Georgia, the Center for Reproductive Rights and Planned Parenthood are jointly challenging the constitutionality of the law, which is set to go into effect Jan. 1.

“This law is an affront to the dignity and health of Georgians,” the lawsuit reads. “It is in particular an attack on low-income Georgians, Georgians of color, and rural Georgians, who are least able to access medical care and least able to overcome the cruelties of this law.”

In a statement to the Atlanta Journal-Constitution, ACLU attorney Sean Young called the ban “blatantly unconstitutional under nearly 50 years of U.S. Supreme Court precedent . . . Politicians have no business telling women or a couple when to start or expand a family.”

“State Attorney General Chris Carr's office said it is reviewing the complaint and declined to comment on pending litigation,” the Atlanta Journal Constitution’s Maya T. Prabhu reports. She writes the lawsuit began “what is expected to be a lengthy court battle when they filed a lawsuit challenging the measure — setting the case on a path that the anti-abortion measure’s supporters hope will lead to a reversal of Roe v. Wade.”

— And here are a few more good reads: 







Coming Up

  • The HHS Presidential Advisory Council on HIV/AIDS convenes for a meeting on July 8 and 9.
  • The Washington Post will host Sen. Bernie Sanders (I-Vt.) as part of its interview series with the 2020 candidates on July 10.
  • The Bipartisan Policy Center holds an event on financial challenges for dual caregivers on July 18.


— Kate McKinnon was ready with her impression of Democratic presidential candidate Marianne Williamson on "Saturday Night Live":