Candidates seeking the 2020 Democratic presidential nomination got unusually specific in the first two primary debates about the differing ways they’d achieve universal health coverage if elected.

Former congressman Beto O’Rourke (Tex.) said people could keep their workplace coverage or get automatically enrolled in Medicare.

Sen. Kamala Harris (Calif.) said she’d let private insurers sell Medicare plans “if they comply by our rules.”

Former Colorado governor John Hickenlooper said he wants “a public option that allows some form of Medicare that maybe is a combination of Medicare Advantage and Medicare, but people choose it.”

South Bend, Ind., Mayor Pete Buttigieg said he backs “Medicare for all who want it.”

But do voters understand all these differences? New research suggests they might not. And it could have implications for the next debate and the race as a whole, where candidates are engaging in a pit fight over the details of their plans instead of focusing on the broad strokes that might actually sway voters. 

When respondents to an Urban Institute survey were asked how they feel about several approaches to expanding health coverage — including Medicare-for-all — more expressed ambivalence than expressed either opposition or support.

The participants were presented with four approaches to closing the country’s persistent uninsured gap:

  1. Increasing subsidies to lower premiums and out-of-pocket costs: 51.4 percent said they neither support nor oppose.
  2. Giving Americans the option to enroll in a government-run “public option” plan: 45 percent said they neither support not oppose.
  3. Enrolling all Americans in a single “Medicare-for-all” plan: 40.7 percent said they neither support nor oppose.
  4. Enrolling all Americans in either a government-run or private health plan: 46.2 percent said they neither support nor oppose.

The results are striking, because most polls on expanding health coverage have only gauged a favorable versus an unfavorable view and the strength of that view. This latest survey reveals there's a lot to learn by allowing respondents to indicate they don’t have a preference — and the extensive ambivalence is shared by both Republicans but also Democrats.

One could interpret the results a few ways. It could be that voters simply don’t care about how everyone gets health coverage — they just want assurance they can afford to visit doctors or hospitals when they or a family member needs help. Polls have shown Americans’ top concern is for elected officials to lower their out-of-pocket costs and ensure they can receive coverage despite any preexisting conditions.

Or the ambivalence could have to do with a lack of knowledge about how each approach would affect the cost, quality and availability of medical care. The Democratic candidates are backing a range of approaches, from a complete Medicare-for-all overhaul to merely adding a public option to the individual marketplaces. This is the first U.S. election in which these options are being extensively discussed, and there’s a huge learning curve for most voters.

That's how John Holahan, a health policy fellow for Urban, sees it.  

“I think it’s just uncertainty about what the policies would do and how they’d be affected by it,” Holahan told me. “For a whole lot of people, this is pretty mysterious stuff.”

And it’s unlikely the debates have brought voters much enlightenment, at least so far. They might be confused even more. While the topic of health care played a prominent role — consuming the first half-hour in both nights of debate last week — so many varying approaches to health insurance were aired that detangling them all practically requires a degree in health policy (if you want an easy overview on where the candidates stand, check this out).

Voters do tend to know a lot more about their own health insurance than about other policy issues, such as how much they pay in taxes, said James Kvaal, who served as policy director for President Barack Obama’s 2012 reelection campaign.

“They may not know the difference between Medicare and Medicaid, but they know a lot about what their current situation is and how that’s changed over time,” Kvaal said.

It might be an uphill battle for candidates to either explain different options for delivering insurance in a debate format -- even big picture. The recent debates featured 10 people onstage at once, and each had to compete for a few seconds of speaking. Their speaking opportunities will likely increase in the coming debates, as candidates start dropping out of the race. 


AHH: Ohio’s Republican governor proposed adopting a version of a red-flag law that would allow court-ordered removal of guns from individuals who are deemed to pose a threat to themselves or others because of factors such as mental health issues, substance abuse or threats of violence.

Two days after a gunman killed nine people in Dayton, Ohio, Gov. Mike DeWine called on state lawmakers to pass such a law on “safety protection orders,” as well as to increase gun background checks. He also urged improvements to Ohio’s mental health resources.

“We have to empower people to get help for family or loved ones who may be a danger to themselves or a danger to others, people who have mental health challenges, alcohol and drug problems, have violent tendencies and have access to firearms,” DeWine said. He called that a "deadly combination.”

“DeWine also emphasized the need for better mental health resources in his remarks Tuesday, echoing other Republican leaders’ responses to mass shootings,” our Post colleague Hannah Knowles reports. “President Trump has emphasized combating mental illness and called for ‘strong background checks.’ Democratic leaders have advocated expanded background checks as well as new restrictions on the kinds of guns civilians can own, challenging Senate Majority Leader Mitch McConnell (R-Ky.) to call lawmakers to Congress for an emergency session and pass more stringent gun-control laws after the weekend’s shootings.”

OOF: It took just minutes for emergency medicine doctor Nancy Weber to realize the University Medical Center of El Paso was about to be flooded with patients from a mass casualty incident. “EMS called two, three, four, five, six” patients on the way, she described to our Post colleague Yasmeen Abutaleb.

It’s the only Level 1 trauma hospital for 280 miles. By Sunday, after a gunman opened fire Saturday morning at a Walmart in El Paso, the hospital had treated 15 patients. Of the 15 brought in, 14 survived. “One young woman was alive when an ambulance took her from the scene of the shooting but died within minutes of arriving in the emergency room, doctors said,” Yasmeen writes. “… As of Monday afternoon, five patients remained in critical condition at University Medical Center with additional surgeries planned; five were in stable but serious condition; and two adults and two children had been discharged — including a 2-month-old infant boy whose parents had shielded him from a spray of bullets and were among the dead. He was treated for broken bones after his mother fell on him as she protected him.”

“You just got to get in, stop the bleeding . . . then come back and fight another day,” said Alan Tyroch, chief of surgery and trauma medical director.

“The 14 victims required 109 units of blood. On a typical day, Tyroch said, doctors might use 10 to 12 units,” Yasmeen adds. Weber, who is also vice chair of quality and patient experience, said anybody who “had skills to help came down, and we used every single one of them.”

OUCH: The Food and Drug Administration says a subsidiary of Swiss pharmaceutical giant Novartis was aware that data was manipulated as part of the application for its new gene therapy but didn’t inform the agency until the therapy was approved.

Still, the agency says the newly approved therapy, Zolgensma, should stay on the market, our Post colleague Laurie McGinley reports. Considered the costliest drug in the world at $2.1 million, the new therapy is meant to treat children under 2 years old with spinal muscular atrophy, a leading genetic cause of infant death.

“Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said the inaccurate information involved mouse data and was a “small amount of the totality” that was submitted. The faulty data didn’t raise concerns about the safety and effectiveness of the treatment, he said,” Laurie writes.

But Marks said the agency will investigate the matter and “will use its full authorities to take action, if appropriate, which may include civil or criminal penalties” against the manufacturer of the gene therapy, Novartis subsidiary AveXis.


— A federal judge issued a preliminary injunction to block three abortion restricting laws in Arkansas from taking effect, including an 18-week abortion ban and a measure that could have led to the closure of the last surgical abortion clinic in the state.

The latter law “imposes substantial burdens on a large fraction of women seeking abortions in Arkansas that ‘substantially outweigh’ any state interest or any benefits to those women,” wrote U.S. District Judge Kristine Baker, as the Wall Street Journal’s Jennifer Calfas reports.

She also blocked a measure that banned abortions pursued because of a fetal diagnosis of Down syndrome.

The injunction maintained a block on the measures after the judge granted a temporary restraining order two weeks ago.

“The American Civil Liberties Union of Arkansas, along with other abortion-rights groups, filed a lawsuit challenging the legislation in June. They argued the laws restricted abortion access and presented an undue burden on those seeking the procedure in the state,” Jennifer reports. “…A representative for Arkansas’s attorney general, Leslie Rutledge, said the office immediately filed an appeal to the decision to the Eighth U.S. Circuit Court of Appeals.”


— The Trump administration is looking into spaces in Northern Virginia and other parts of the country where it can house unaccompanied minors to relieve overcrowded detention centers at the southern border.

The General Services Administration said in a formal solicitation last week it's looking to lease space in Northern Virginia that can hold up to 440 children, a shift that could more than triple the number of children held in federally funded facilities in the state, our Post colleague Antonio Olivo reports. “The administration’s search for extra shelter space underscores the intense backlash in recent months over the squalid conditions in crowded federal shelters at the border, where visitors have described seeing unbathed children wearing clothes caked with snot and tears, toddlers without diapers and teenage mothers in clothes stained with breast milk,” he writes.

The Department of Health and Human Services is also looking into leasing space in Los Angeles and Central Florida. The GSA solicitation for leasing space in Virginia is “part of a plan by HHS to build permanent shelters in parts of the country where relatives of unaccompanied minors already live in hopes of eliminating the need to rely on temporary shelters when the flow of migrants at the border suddenly escalates, officials said.”


— Three major opioid distributors — McKesson, Cardinal Health and AmerisourceBergen — have made an initial bid to pay $10 billion to settle state lawsuits over their role in the nation’s opioid crisis, Bloomberg News’s Jef Feeley reports, citing people familiar with the offer.

“It’s the first time in two years of discussions that the three distributors put a dollar figure on the table to resolve lawsuits against them,” he writes. The distributors made a verbal proposal in discussions with a group of state attorneys general, and the National Association of Attorneys General has countered with a call for $45 billion to pay for the costs of the crisis. In an emailed statement, a McKesson spokeswoman told Bloomberg: “While we regularly engage with other parties about a pathway towards resolution, the company has made no settlement offer."

“Whether the distributors and attorneys general can agree to a deal remains uncertain. But reaching a compromise may not be the toughest hurdle,” Jef adds. “The distributors face almost 2,000 additional lawsuits brought by cities and counties across the U.S., with a separate group of lawyers leading the litigation. Getting them to sign on to any deal could prove challenging.”

— And here are a few more good reads: 

Prescriptions for naloxone have surged in recent years, as communities struggling with opioid addiction have embraced the overdose-reversing medication.
Stat News
Republicans cut Medicaid expansion from the proposed state budget and most have opposed the move since it became possible in 2014.
Wisconsin State Journal
The ranking member of the Senate health committee has complained for months about the Trump administration’s failure to look into Medicaid...
Dallas Morning New
In 2013, a bill expanding background checks fell short. Now only two Republicans are on record backing it after the recent mass shootings.
Paul Kane
The president said he has taken tough action on guns. His administration has mostly focused on expanding gun access through little-noticed regulatory moves.
Amazon’s PillPack mail-order pharmacy is accused by a health-technology company of improperly obtaining patient prescription data, in the latest sign that Amazon’s foray into healthcare is running up against industry incumbents.
Wall Street Journal
One-year-old Vaishnavi had a lead level five times what federal agencies consider safe.
Rebecca Tan
More auto makers are committing to install technology that alerts drivers if they have accidentally left a child in the back seat, but safety advocates and lawmakers say the effort isn’t enough to respond to the recent rise in car-seat fatalities.
Wall Street Journal


  • Stat hosts an online chat on vaccine hesitancy.

Coming Up

  • The Centers for Disease Control and Prevention hosts a seminar on “Genomics, Big Data and Data Science in Public Health” on Friday.

Some politicians aren’t happy with Trump’s plans to visit El Paso and Dayton: