THE PROGNOSIS

There’s another key corner of the universe Democrats running on Medicare-for-all would need to win over: The country’s largest labor unions.

Eliminating employer-sponsored coverage — as Medicare-for-all proposes to do — holds major ramifications for the country’s unions, which negotiate health benefits on behalf of millions of workers every year. And the unions are not at all unified over how they feel about that prospect.

Union participation has been diminishing for years, with just 1 in 10 American workers belonging to unions, down from 2 in 10 in the 1980s. But organized labor still holds sway in elections, particularly when it comes to the outlook for Democratic candidates.

Some unions have jumped enthusiastically on the Medicare-for-all train. The most notable of those is National Nurses United, the country’s largest nurses union, which played a significant role in influencing the House version of Medicare-for-all. The American Federation of Government Employees, which has more than 300,000 members, is also on board. So is the Association of Flight Attendants. 

But some union leaders, while stressing they support the idea of universal health coverage, have expressed hesitancy at the prospect of decoupling health insurance from the package of benefits workers have come to expect from many employers.

— The AFL-CIO, which represents the interests of unions in Washington, voted two years ago on a resolution supporting a single-payer system. But its president, Richard Trumka, has thrown his support behind legislation to marginally expand Medicare by allowing people to enroll down to age 55.

“While we would like to see universal health care, we want to make sure that there is a role for employer-bargained plans in that plan,” Trumka told reporters after the last Democratic presidential debate.

— Randi Weingarten, president of the American Federation of Teachers, said her union expects an ongoing role for private coverage even in a Medicare-for-all system. She said AFT will “fight for any plan that offers universality and affordability,” whether it’s Medicare-for-all or incremental options such as "Medicare for America" or a public option in the current system dominated by Obamacare.

“Make no mistake: unions bargain for our members, but that also means fighting for the chance for everyone to secure a better life, and that includes access to quality, affordable health care,” Weingarten said in a statement.

The issue has also become one of the biggest sticking points between Democratic presidential candidates who want Medicare-for-all and those who don’t.

“I'm trying to explain that these union members are losing their jobs, their wages have been stagnant, the world is crumbling around them — the only thing they have is possibly really good health care,” Rep. Tim Ryan (D-Ohio) said at least month’s Democratic presidential debate.

“And the Democratic message is going to be, we're going to go in, and the only thing you have left we're going to take it and we're going to do better,” he continued. “I do not think that's a recipe for success for us; it's bad policy and it's certainly bad politics.”

Medicare-for-all proponents have countered that unions shouldn't have to ensure people get good health coverage. From Rep. Ro Khanna (D-Calif.), referring to former vice president Joe Biden:

Some unions are holding their fire, stressing that Democrats should keep their overarching goal of universal coverage in sight without getting too caught up in exactly what a future system might look like.

“The choice here is not between Medicare-for-all or employer-sponsored care,” said Mary Kay Henry, international president of the Service Employees International Union. “It’s between expanding health-care coverage or watching the president and Republican congressional leaders rip it all away from working people.”

“There’s no reason why we can’t ensure everyone has the same benefits that some have been able to bargain for,” she added.

This isn't the first time unions have displayed mixed feelings about health reform. They largely supported the 2010 Affordable Care Act for its coverage expansions but had concerns about some of its smaller elements. Those concerns included the ACA’s exclusion of subsidies from the multi-employer health plans arranged between unions and smaller employers and its “Cadillac” tax on high-cost health plans — a tax Congress may soon repeal.

The differences boiled over in the July debate more than once. At one point, former Rep. John Delaney (D-Md.) mentioned his father, a union electrician whose coverage was negotiated by the International Brotherhood of Electrical Workers.

“He would never want someone to take that away,” Delaney said.

There was also a sharp exchange between Sanders and Ryan, prompted after a question from debate moderator Jake Tapper.

“Can you guarantee those union members that the benefits under Medicare-for-all will be as good as the benefits that they're representatives — their union reps fought hard to negotiate?” Tapper asked Sanders.

“Well two things,” Sanders replied. “They will be better because Medicare-for-all is comprehensive — it covers all health-care needs. For senior citizens it will finally include dental care, hearing aids and eyeglasses."

“But you don't know that, Bernie,” Ryan countered.

“I do know it; I wrote the damn bill,” Sanders shot back. “And second of all, many of our union brothers and sisters — nobody more pro-union than me up here — are now paying high deductibles and co-payments. When we do Medicare-for-all, instead of having the company putting money into health care, they can get decent wage increases, which they're not getting today.”

Correction: An earlier version misstated where the Association of Flight Attendants stands on Medicare-for-all. The organization supports the approach.

Note to readers: The Health 202 will publish on Tuesdays, Wednesdays and Thursdays this week and next and will take a break the week of Aug. 26 before returning full-time in September.

AHH, OOF and OUCH

AHH: Planned Parenthood is planning to formally withdraw from the federal family planning program over the Trump administration’s rule change prohibiting recipients of Title X grants from performing abortions or referring patients for them. The organization will halt any plans to withdraw if a court intervenes by Aug. 19, it said in a letter to the U.S. Court of Appeals for the Ninth Circuit.

Planned Parenthood had planned to refuse federal funding, but still remain in the program, while it continues to challenge the rule in court.  "But Health and Human Services officials recently required all participants in the program, known as Title Xto sign a pledge by Aug. 19, saying they would make a 'good faith' effort to comply with the rule," our Post colleague Ariana Eunjung Cha reports. "..Planned Parenthood attorney Alan E. Schoenfeld wrote that as a result and with 'deep regret,' the grantees “now have no option but to withdraw from the Title X program” from which Planned Parenthood has participated in for decades."

Planned Parenthood is the largest single recipient of Title X funds, providing birth control to more than a million low-income women. The organization says the impact of the withdrawl will vary state by state. "Some states have pledged to make up the funds. But in others where that isn’t the case, especially rural areas where providers can be many miles from one other, the effect is likely to be 'chaos,' [spokewoman Erica Sackin] said," Ariana writes.

OOF: D.C. Mayor Muriel Bowser (D) says she has "no intention" of approving the opening of a new shelter for unaccompanied migrant children in the District, to be run by the Department of Health and Human Services.

HHS has confirmed to The Post that it “granted a $20.5 million contract in August to a contractor to operate a 200-bed facility in the District for children ages 12 to 17,” our colleague Fenit Nirappil reports. “Dynamic Service Solutions, a federal contractor, applied to for a permit to open a shelter, a request that city officials said they found ‘inadequate’ but which is still pending before the agency.”

But Bowser charged that HHS practices when it comes to migrant kids aren't acceptable. “Washington, D.C. will not be complicit in the inhumane practice of detaining migrant children in warehouses,” Bowser said in a statement.

HHS’s Administration for Children and Families defended its treatment of children and challenged what it called “erroneous and irresponsible stories" about the conditions in which the kids are living. “We treat the children in our care with dignity and respect, and deliver services to them in a compassionate and organized manner while we work expeditiously to unify each one with a suitable sponsor,” it said in a statement.

OUCH: Novartis fired two top scientists from its gene therapy subsidiary after the company's CEO learned that manipulated data was submitted as part of an application for the therapy Zolgensma, Stat’s Damian Garde and Matthew Herper report.

“In a statement on Wednesday, Novartis (NVS) said that it had appointed a new chief scientific officer for AveXis and that other scientists, Brian and Allan Kaspar, ‘have not been not been involved in any operations at AveXis since early May 2019,’ without elaborating,” they write. “…The news will likely only amplify questions as to why Novartis delayed notifying the FDA of concerns. The company has said that it was waiting on results from an internal investigation, but Novartis apparently knew enough about the issue to fire the Kaspars more than a month before informing regulators.”

Lawmakers have criticized Novartis for failing to quickly disclose the data issue and demanded an explanation from the FDA on how it deals with manipulated data.

“Had the agency known about the manipulation, it would have delayed the approval of Zolgensma, according to Dr. Wilson Bryan, the director of the FDA division that reviewed Novartis’s gene therapy,” Damian and Matthew write. “Both Novartis and the FDA have said that the falsified data have no bearing on the safety or efficacy of the approved version of Zolgensma.”

HEALTH ON THE HILL

— Sen. Sanders and House Oversight Chairman Rep. Elijah Cummings (D-Md.) have sent letters to three pharmaceutical companies — Mylan, Teva Pharmaceutical and Heritage Pharmaceuticals — accusing them of “coordinated obstruction” in a probe of generic drug prices that began in 2014. The letters to the pharmaceutical companies renew a request for documents about how the companies price generic drugs. 

“The lawmakers said they decided to open an investigation following findings in a lawsuit filed by 44 states in May that accused the drugmakers and others of inflating drug prices and stifling competition for generic drug versions,” CNBC’s Berkeley Lovelace Jr. reports. “… A spokesperson for Mylan said the company, with the help of outside counsel, is investigation the allegations made in the states’ lawsuit.”

“Not only did your company’s apparent obstruction undermine our investigation, but it may have caused further harm to patients and health care providers by delaying the discovery of evidence about the companies’ price-fixing,” Sanders and Cummings wrote in the letters sent Tuesday.

AGENCY ALERT

— The Food and Drug Administration approved a new treatment for tuberculosis, a disease highly resistant to drugs that is the world’s leading infectious cause of death. The drug is the third anti-TB drug approved by the FDA in more than four decades.

“The antibiotic, called pretomanid, was developed by a nonprofit group called TB Alliance at a time when few companies are investing in the expensive and unprofitable endeavor of creating next-generation antibiotics,” our Post colleague Yasmeen Abutaleb reports. “Some researchers hope that TB Alliance can serve as a model for antibiotic drug development as health authorities warn about the growing danger of drug-resistant infections.”

Antibiotics are very costly to develop and bring to market. And unlike drugs for chronic conditions, they don’t bring in as much revenue because they’re less expensive for consumers and taken for a shorter amount of time than drugs for chronic illnesses. “TB Alliance said it hopes the FDA’s approval will enable other countries, such as China, India and South Africa to okay the drug and make it available to their residents,” Yasmeen writes

— And here are a few more good reads: 

Politics
Comparing new state-by-state polling to results in 2016 and 2018.
Philip Bump
Democrats are warning the Trump administration not to move forward with a proposed rule that would undo an ObamaCare provision that prohibits health care discrimination based on sex.
The Hill
Vaping companies sue US government to delay review of electronic cigarettes
Associated Press
STATE SCAN
Business
The disconnect between Maine’s aging population and its need for young workers is expected to be mirrored throughout the country, demographic experts say.
Jeff Stein
Politics
The city of Missoula passed a background-check law. The state legislature is trying to get it tossed.
Laura Hughes
Illinois Gov. JB Pritzker has signed a law that would require insurance companies to cover costs for kids needing EpiPen injections for cases of severe allergic reactions.
CNN
Despite opposition from federal prosecutors, Joseph Curtatone is pledging to open a clinic where doctors and nurses would monitor illegal drug use and could reverse an overdose.
WBUR
In the past four years, Indiana, Arkansas, Ohio and Pennsylvania have passed laws allowing a parent to surrender an unwanted infant without needing to interact with any medical or emergency personnel, face-to-face or otherwise.
Wall Street Journal
TRUMP TEMPERATURE
The president can encourage Republicans to crack down.
Jacqueline Alemany
Politics
Former White House communications director Anthony Scaramucci and current press secretary Stephanie Grisham appeared back to back on the same news show.
Colby Itkowitz
MEDICAL MISSIVES
The nation’s first federal health care program served freedmen after the Civil War. From the beginning, white legislators argued it would breed dependence.
The New York Times Magazine
DAYBOOK

Coming Up

  • The Washington Post will host a live event in Boston on the latest developments in cancer treatment, prevention and detection on Sept. 4.
  • The American Enterprise Institute hosts an event on “The Fair Care Act and the 2020 campaign plans” on Sept. 10.
SUGAR RUSH

The vaccine fight: a mother’s battle to protect her daughter in California: