THE PROGNOSIS

Democrats successfully made health care the linchpin of the 2018 campaign. The issue has now moved to center stage of the 2020 race, too, but this time it's Democrats who are fighting about it.

Former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.) are sparring over whether to dramatically overhaul the health-care system and get rid of the Affordable Care Act. Sanders wants to replace the current system with Medicare-for-all, while Biden wants to keep the ACA with some big changes, including offering a public option.

The issue has become a proxy for the larger one dividing the 2020 field: whether to tack left and embrace bold progressive ideas in order to knock off President Trump, or to hew closer to the center to appeal to voters.

My colleague Sean Sullivan writes that the Biden-Sanders dispute is becoming “hostile,” with Biden yesterday releasing his proposal to expand the ACA and warning it was too risky to eliminate it in favor of Medicare-for-all. Sanders is planning a speech in Washington tomorrow to confront critics of his Medicare-for-all proposal.

Sanders joined hospital employees and union leaders outside Hahnemann University Hospital in Philadelphia yesterday, decrying the planned closure of the 171-year-old institution there and using it as an example of why his push for a Medicare-for-all system is so critical.

“Biden, pitching his plan to a crowd in Iowa on Monday, warned that transitioning hundreds of millions of people to an entirely new Medicare-for-all plan would be 'totally risky,' raising the possibility that coverage could lapse for some people, at least temporarily,” writes Sean.

Sound familiar? From a New York Times reporter:

In Philadelphia, Sanders called the current system “dysfunctional.” “And one of his closest aides issued a sharp attack on Biden’s plan. 'What Vice President Biden is proposing at one time in history might have been a big step forward, but you can’t be Rip Van Winkle and wake up this year and say what was cutting edge 12 years ago is cutting edge today,'" said Jeff Weaver, according to Sean.

“At the heart of Biden’s health-care plan, which senior campaign officials said would cover more than 97 percent of Americans, is a proposal to let people choose a government-run health system like Medicare if they aren’t happy with private insurance. President Barack Obama initially set out to include such a public option in the ACA legislation, but later backed away from the idea amid political resistance,” writes Sean.

“The former vice president also would bolster other parts of the ACA designed to help people buy insurance. It would get rid of the income limit — 400 percent of the federal poverty level — used to determine who qualifies for tax credits that help Americans pay insurance premiums.

“Biden’s plan also would seek to circumvent the resistance by many Republican-led states to accepting the expansion of Medicaid, a program for low-income and disabled Americans. In the 14 states that have not expanded Medicaid as allowed by the ACA, Biden’s proposal would let people who would otherwise qualify for assistance buy into the public option without premiums.”

The cost, according to Biden's campaign officials, would be $750 billion over 10 years, to be paid for by raising taxes on investment income of wealthy Americans.

The fight between the two leading contenders for the Democratic nomination — Biden typically leads in both polls, with Sanders coming in the top tier of the crowded field behind him — is only likely to intensify as the 2020 primary continues. Polling shows that 77 percent of Democratic-leaning adults want a universal, single-payer system envisioned by a Medicare-for-all program; while only 52 percent of al adults support such a system.

The Democratic field, however, has moved toward Sanders on the issue, with most candidates backing some form of Medicare-for-all, with or without allowing private health insurance to coexist with it.

Note to readers: Paige Winfield Cunningham is on vacation and will be back on Tuesday, July 23. Meanwhile, we have a lineup of Post writers to keep you up-to-date on the health-care news of the day. Thanks for reading.

AHH, OOF and OUCH

AHH: The Trump administration said yesterday it would begin immediately enforcing a new rule banning family planning clinics that receive federal funding from referring women for abortions.

“Ahead of a planned conference Tuesday with the clinics, the Health and Human Services Department formally notified them that it will begin enforcing the ban on abortion referrals, along with a requirement that clinics maintain separate finances from facilities that provide abortions,” the Associated Press’s Ricardo Alonso-Zaldivar reports. “Another requirement that both kinds of facilities cannot be under the same roof would take effect next year.” HHS said there are no court orders that would prohobit the administration from immediately enforcing the new rule while any lawsuits continue.

"Known as Title X, the family-planning program serves about 4 million women annually through independent clinics, many operated by Planned Parenthood affiliates, which serve about 40 percent of all clients. The program provides about $260 million a year in grants to clinics," Ricardo writes. The rule is a major blow to Planned Parenthood, which receives millions a year in federal funding to provide family planning and health-care services to low-income women, and that also provides abortion services that are paid for separately. 

In a statement, Planned Parenthood President Leana Wen said clinic doors “are still open.” “We will not stop fighting for all those across the country in need of essential care," she said.

Meanwhile, proponents of the administration’s new rule praised the latest decision. “Ending the connection between abortion and family planning is a victory for common-sense health care," said Kristan Hawkins, president of Students for Life, in a statement.

OOF: The state of Oklahoma and Johnson & Johnson faced off during an impassioned set of closing arguments in the first state trial in what’s become a nationwide effort to hold drug companies accountable for the opioid epidemic.

“The stakes are high for both sides and dozens of other states suing the pharmaceutical industry. A win for Oklahoma and a penalty in the billions of dollars — the state wants $17.5 billion over 30 years to 'abate' the epidemic — would be a big blow to Johnson & Johnson. It might also establish a settlement threshold for future defendants," our Post colleague Lenny Bernstein reports. “A verdict in the company’s favor could signal that even with a home court advantage, states may have trouble pinning responsibility on drug makers for more than 400,000 overdose deaths and the costs of treatment, emergency care and law enforcement.”

During closing arguments, state attorneys argued that Johnson & Johnson was the “kingpin” of Oklahoma’s opioid crisis and that the company and a subsidiary “deceptively exaggerated the safety and effectiveness of opioid products and downplayed the risk to patients as they aggressively marketed their drugs to doctors. The motivation was greed, they said.”

Meanwhile, the company’s lawyer argued the state “had not proved its allegation that company sales reps lied to doctors to sell the drugs, and contended that without the medications, many Oklahomans would be condemned to lives of debilitating chronic pain.”

OUCH: An estimated 20 million children across the globe did not get vaccines meant to protect against life-threatening diseases like measles, diphtheria and tetanus last year, according to a new report released by the World Health Organization and the United Nation’s Children’s Fund.

The United Nations agencies found more than one in 10 children missed out on the vaccines, and the problem is especially acute for children in poor countries.

“The WHO/UNICEF report found that since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (whooping cough) vaccine and one dose of measles vaccine has stalled at around 86 percent,” Reuters reports. “The report said this was too low, since 95 percent coverage is generally needed to provide "herd immunity" to those who are not vaccinated.”

"Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe," the WHO's director general, Tedros Adhanom Ghebreyesus, said in a statement. "It's often those who are most at risk – the poorest, the most marginalized, those touched by conflict or forced from their homes - who are persistently missed."

HEALTH ON THE HILL

— Sen. Kamala Harris (D-Calif.) announced a plan to address skyrocketing prescription drug costs by setting a “fair price” for drugs that cost more in the United States than they do in other developed countries. Her latest plan comes as a health-care debate heats up among candidates for the Democratic presidential nomination. 

The “fair price” set by the Department of Health and Human Services would “not exceed the cost of the drug in member countries of the Organization for Economic Cooperation and Development, a group of industrialized nations that includes Canada, the United Kingdom, Germany, Japan and others,” our Post colleague Chelsea Janes reports. “Companies whose prices are too high would have to send customers a rebate.”

The plan also details possible executive actions Harris could take as president in the case of an impasse in Congress. “Should legislation stall, Harris promises to launch investigations into higher-priced drugs and publish the findings, then demand that drug companies drop those prices within 30 days,” Chelsea reports. “If they do not comply, Harris says she would direct HHS to import those drugs.”

MEDICAL MISSIVES

— Joe Biden’s cancer nonprofit, the Biden Cancer Initiative, is suspending operations indefinitely, the organization announced on Monday.

The nonprofit was founded by Biden and his wife, Jill, in June 2017 after the former vice president left the White House, where he oversaw the efforts of the Obama administration’s Cancer Moonshot. The pair stepped down from their roles as the co-chairs and members of the board of directors on the day Biden announced his bid for the Democratic presidential nomination.

“The Biden Cancer Initiative did not fund cancer research. Rather, it tried to harness the Bidens’ ‘convening’ power to prod researchers, companies and patient groups to collaborate and move faster to improve data sharing, clinical trials and cancer-care accessibility, Greg Simon, the group’s president, said in an interview,” as our Post colleague Laurie McGinley reports. “…Without them at the helm, Simon said, it was difficult for the organization to maintain the visibility and financial support needed to continue.”

AGENCY ALERT

— The Trump administration announced a new proposal to have Medicare cover acupuncture for individuals who participate in research on whether the treatment can help with chronic low back pain.

The studies, which must be sponsored by the National Institutes of Health or approved by the Centers for Medicare and Medicaid Services, “will allow the government to assess whether there is enough evidence to offer Medicare coverage of the controversial treatment to a wider group of people age 65 and older who are afflicted by chronic low back pain,” our Post colleague Lenny reports. “The proposal is part of the government’s effort to develop alternatives to narcotics as treatment for pain.”

“By focusing on older adults and addressing the limitations of previous published research, evidence derived from this initiative would assist [the Centers for Medicare and Medicaid Services] in determining future Medicare coverage for acupuncture,” the administration said in the announcement.

— And here are a few more good reads: 

Despite all the inflammatory rhetoric from presidential hopefuls, lawmakers and President Trump, the drug industry is still winning in Washington.
Stat
The record number of families entering the U.S. and requesting asylum has overloaded a border enforcement system not designed to safely and quickly process them. Here is a step-by-step look at the process families go through and where the system is straining.
Wall Street Journal
INDUSTRY RX
Politics
Warren’s campaign says she was “a consultant to ensure adequate compensation for women who claimed injury” from the implants. But participants on both sides of the matter say that description mischaracterizes her work.
Annie Linskey
Sen. Rick Scott (R-Fla.) is calling out the Pharmaceutical Research and Manufacturers of America (PhRMA), accusing the nation's top lobby for drugmakers on Monday of failing to provide "a single answer or solution to our questions" on lowering prescription drug prices.
The Hill
Joe Biden grew emotional while evoking the importance of personal care givers.
Politico
A growing number of San Francisco companies offer paid time off after a miscarriage — prompted in some cases by executives’ own losses.
San Francisco Chronicle
Scientists are reporting progress on blood tests to screen people for possible signs of Alzheimer's disease or other forms of dementia.
Los Angeles Times
STATE SCAN
Maryland Politics
The division charged with providing services failed to monitor groups to which it gave grants, the audit found.
Rachel Chason
National
By the time someone checked the old account in May, 321 emails had piled up — including 104 with concerns about children being mistreated, an official said.
Hannah Knowles
DAYBOOK

Today

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on the spread of fentanyl.
  • The House Education and Labor Subcommittee on Civil Rights and Human Services holds a hearing on strengthening federal support to end youth homelessness.

Coming Up

  • The Bipartisan Policy Center holds an event on surprise medical bills on Wednesday.
SUGAR RUSH

Four Democratic congresswomen of color responded to President Trump's tweets saying they should "go back" to the countries they came from: