THE PROGNOSIS

More than half of all House Democrats now support Medicare-for-all, but that’s not likely to prompt Speaker Nancy Pelosi to allow a vote on the floor. 

Rep. Hakeem Jeffries (D-N.Y.), the chamber’s No. 5 Democrat, signed on to the bill from Rep. Pramila Jayapal (D-Wash.) this week. He’s the 118th House member and the second-highest-ranking Democrat to back the legislation — showing the party’s growing aspirations to scrap much of the U.S. health-care system in favor of a single Medicare-like plan for everyone.

Jayapal, who has been working to bring more sponsors to her bill after introducing it in February, said getting the support of members of House leadership "is proof of the growing momentum for Medicare-for-all in Congress and in communities across America."

She also tweeted this yesterday:

Despite urging from the progressives in her caucus, Pelosi has resisted holding a floor vote on Medicare-for-all -- a vote that could be difficult for moderates in her party given that it would overhaul coverage for millions of Americans and is sharply opposed by industry. 

Assistant Speaker Ben Ray Lujan, the House's No. 4 Democrat, has also co-sponsored Jayapal's bill. But getting a thumbs-up from Jeffries is perhaps more significant, considering he’s viewed as a likely successor to Pelosi. In his announcement, Jeffries said Congress should first focus on improving the Affordable Care Act -- but that Medicare-for-all is a worthy goal lawmakers should keep in their sights.

“Given the enduring nature of our health care access and affordability crisis, more must be done,” Jeffries said in a statement provided to The Health 202, calling Medicare-for-all “bold and aspirational.”

But Jeffries distinguished himself from lawmakers who are demanding Medicare-for-all right now. He has also signed onto Medicare X, legislation adding a public-option plan to the Obamacare marketplaces. He echoed a sentiment expressed by many Democrats — that they’re all united behind the goal of universal health coverage, however that may be achieved.

“While these and other sweeping initiatives remain a work in progress, they are an important part of the ongoing debate as to how we strengthen our healthcare delivery system,” he said.

Jeffries is right about this: Medicare-for-all remains decidedly aspirational for the Democratic Party. The idea has played an outsize role in the Democratic primary, but as the 2020 presidential candidates have been forced to talk details, most have backed a less aggressive approach than the overhaul envisioned by Jayapal and, on the Senate side, Bernie Sanders (I-Vt.).

South Bend, Ind., Mayor Pete Buttigieg and Sen. Kamala Harris (D-Calif.) originally said they favor a Medicare-for-all approach, and Harris even co-sponsored Sanders’s bill. But both candidates have since softened their stance, with Buttigieg proposing “Medicare-for-all-who-want-it,” which would allow people to keep workplace coverage, and Harris suggesting private plans should still play a role in administering Medicare benefits. And former vice president Joe Biden was never on the Medicare-for-all train, instead advocating a public-option approach.

So of the top-polling candidates, that leaves just Sanders and Sen. Elizabeth Warren (D-Mass.) willing to back Medicare-for-all and its virtual elimination of all private forms of health coverage.

House committees held three hearings earlier this year on Medicare-for-all and single-payer approaches in general. But over the last few months, the Medicare-for-all debate moved to the campaign trail -- and will stay there through 2020.

AHH, OOF and OUCH

AHH: Stephen Hahn, a radiation oncologist and top official at MD Anderson Cancer Center, has emerged as a top contender to lead the Food and Drug Administration.

He met with President Trump this week to discuss the possibility of being nominated to lead the agency, our Post colleague Laurie McGinley reports. But she adds the president hasn’t made a final decision.

Laurie wrote earlier this week that former agency heads and dozens of health groups sent a pair of letters to Trump and Health and Human Services Secretary Alex Azar to urge that the agency needed a permanent leader, and to call for the president to nominate Norman “Ned” Sharpless, who has served as the acting leader since former commissioner Scott Gottlieb resigned in March. Sharpless can only serve as acting commissioner until Nov. 1.

Alexa Boer Kimball, a Harvard dermatology professor and president and chief executive of the Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston, is also in the running.

“Being commissioner of the FDA — an agency with sprawling responsibilities that include food safety, drug approvals and tobacco regulation — has long been a tough job. But the post is especially challenging now amid pressing concerns about high drug prices, the explosion of youth vaping and medical-device safety,” Laurie writes.

OOF: State and federal health officials found that a contaminant in marijuana vaping products is linked to the mysterious spate of lung illnesses that have been reported across the country. The contaminant is an oil derived from vitamin E, our colleague Lena H. Sun reports, citing several officials who took part in a call where FDA officials shared information with state health officials this week.

Investigators found the same chemical in products collected from individuals who fell ill across the country, including in almost all of the cannabis samples taken from patients who recently became ill in New York, according to a state health department spokeswoman. The FDA told state officials that tests had not found anything unusual in any nicotine products collected from ill patients.

Health officials said it's too early to know whether the oil is causing the injuries, although it's the first common element found in samples from across the country. Vitamin E is found naturally in certain foods, such as canola oil, olive oil and almonds.

“The oil derived from the vitamin, known as vitamin E acetate, is commonly available as a nutritional supplement and is used in topical skin treatments," Lena writes. "It is not known to cause harm when ingested as a vitamin supplement or applied to the skin. Its name sounds harmless, experts said, but its molecular structure could make it hazardous when inhaled. Its oil-like properties could be associated with the kinds of respiratory symptoms that many patients have reported: cough, shortness of breath and chest pain, officials said.”

OUCH: In a 53-page letter to Sharpless, Rep. Raja Krishnamoorthi (D-Ill.), the chairman of a House Oversight and Reform subcommittee, accused e-cigarette company Juul of making false medical claims about its products, calling on the FDA to investigate those claims.

The letter cites statements that Juul representatives made to lawmakers during a July hearing.

“Your predecessor, Scott Gottlieb, when he was Food and Drug Administration (FDA) Commissioner, pointed to JUUL as a primary cause of the epidemic,” Krishnamoorthi wrote. “Testimony from our hearing supports that conclusion. It demonstrates that JUUL appears to be violating FDA regulations against making unapproved express and implied claims that its product helps users stop smoking cigarettes and is safer than cigarettes.”

The Illinois Democrat says the Juul representatives made multiple claims that the nicotine products are a safer alternative to cigarettes.

“The Subcommittee urges FDA to evaluate the admissions and statements … and expeditiously take all appropriate enforcement action to protect the American public from the fraudulent and unapproved medical claims made by Juul,” the letter added.

An agency spokeswoman told CNBC's Angelica LaVito that the FDA will respond directly to Krishnamoorthi and will share more on the issue “early next week.”

HEALTH ON THE HILL

— Trump met with Sen. Joe Manchin (D-W.Va.) yesterday to discuss a range of gun policy, including background checks, the Wall Street Journal’s Andrew Restuccia and Natalie Andrews report.

A 30-minute meeting occurred with the senator, who has long pushed for expanding background checks for gun purchases, after he was already at the White House for a Medal of Freedom ceremony.

A person familiar with the meeting told Andrew and Natalie that Trump did not give Manchin a clear signal about how he intends to move forward on such proposals. Meanwhile, a White House official said Trump “expressed interest” in some results on the issue and will continue to have conversations on background checks and other policy ideas.

“Lawmakers, and even some White House officials, remain skeptical that significant gun-control legislation can win congressional approval with the 2020 election looming,” they write. “Some of the president’s advisers have cautioned him against taking aggressive steps in response to the shootings, arguing that such moves could reduce support among conservatives.”

— And here are a few more good reads: 

STATE SCAN
When Kansas elected Laura Kelly as governor, Medicaid expansion looked like a shoo-in, with seemingly broad support across state government. It didn’t happen. A look at conservatives’ new health ca…
Kaiser Health News
A group of 23 Kentucky hospitals is suing major drugmakers, distributors and retailers for their role in the opioid crisis a few days after a group of Texas hospitals unveiled a similar suit.
Fierce Healthcare
AGENCY ALERT
The CMS will be able to revoke healthcare providers or suppliers' Medicare enrollment if they are affiliated with targeted "bad actors," a final rule issued Wednesday established.
Modern Healthcare
Civil rights groups sued President Donald Trump’s administration Thursday over its decision to stop considering requests from immigrants seeking to remain in the country for medical treatment and other hardships.
Associated Press
MEDICAL MISSIVES
Science
I made a video series on the history and science of vaccines. Here are some of the most fascinating things I learned.
Anna Rothschild
Five retailers have announced this week that they will start asking customers not to openly carry guns into their stores in states where open carry is legal. The moves represent a major shift in the way retailers are positioning themselves in the gun debate.
CNN
Readers shared their experiences of helping ailing relatives. For some, it brought crippling financial burdens and depression. Many also found moments of profound joy.
New York Times
DAYBOOK

Coming Up

  • The House Oversight and Reform Subcommittee on Civil Rights and Civil Liberties holds a hearing on "The Administration’s Apparent Revocation of Medical Deferred Action for Critically Ill Children" on Sept. 11.
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