THE PROGNOSIS

This much is crystal clear from last night’s Democratic debate: Health care is the 2020 presidential candidates’ marquee issue.

Just as in the first two debates, candidates wrestled right out of the gate over whether to overhaul the country’s health-care system with Medicare-for-all or instead close the uninsured gap by expanding the Affordable Care Act. The topic has occupied an extraordinary amount of airtime in all three debates, even as the very future of Obamacare is threatened in a high-profile case to be decided next month.

Vox's Dylan Scott: 

The Democrats’ sharp disagreements were clearest in the exchanges between former vice president Joe Biden and Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) on either side of him – the race’s three leading candidates who all shared a stage together for the first time.

Biden articulated one vision, of letting people of all ages – not just seniors – enroll in Medicare but still keeping the system of employer-sponsored coverage in place.

Sanders and Warren argued passionately for another vision, one where the government guarantees generous coverage for everyone with virtually no out-of-pocket costs, but taxes are higher to pay for it all.

The other candidates generally fall in between these two positions, favoring some level of Medicare buy-in but remaining generally unwilling to advocate for eliminating the private plans roughly 150 million Americans have through their jobs. They chimed in too, but most of the dustup was among the three leaders in the Democrati field.

A few takeaways from the evening:

1. Biden was raring to attack Medicare-for-all’s cost.

“It’s going to cost you in your pay — there will be a deductible, in your paycheck,” he said, adding that “someone making 60 grand with three kids, they’re going to end up paying $5,000 more, they’re going to end up paying 4 percent more on their income tax.”

“That’s a reality,” he said. “Now, it’s not a bad idea if you like it. I don’t like it.”

“I've actually never met anybody who likes their health insurance company,” Warren retorted.

MSNBC's Kyle Griffin: 

Sanders knocked the often-hefty monthly health insurance premiums currently paid by most Americans, which he wouldn’t include in Medicare-for-all.

“Maybe you've run into people who love their premiums, I haven't,” Sanders said to Biden. “What people want is cost-effective health care, Medicare-for-all will save the average American substantial sums of money on his or her health care bill.”

2. Warren didn’t want to explicitly acknowledge people would lose workplace coverage under Medicare-for-all.

ABC moderator George Stephanopoulos asked Warren several times to clarify whether private insurance would be eliminated under Sanders’s Medicare-for-all plan – and whether taxes would have to increase for middle-class families.

“[Biden] says that Sanders has been candid about the fact that middle class taxes are going to go up and most of private insurance is going to be eliminated,” Stephanopoulos said. “Will you make that same admission?”

She never directly answered the question, instead arguing that Medicare-for-all means lower costs overall and better care for Americans.

“Those at the very top, the richest individuals and the biggest corporations, are going to pay more,” Warren responded. “And middle-class families are going to pay less. That’s how this is going to work.”

When Stephanopoulos pressed her again, Warren responded, “Look, what families have to deal with is cost, total cost. That’s what they have to deal with. And understand, families are paying for their health care today.”

NBC New's Ali Vitali and Jim Swift, senior editor for The Bulwark:

Daily Beast's Gideon Resnick: 

3. Everybody loved on President Obama.

“I know that the senator says she’s for Bernie,” Biden said at the debate’s outset, referring to Warren. “Well, I’m for Barack. I think the Obamacare worked.”

Medicare-for-all advocate Ady Barkan, who has testified for Sanders' bill:

Sen. Kamala Harris (D-Calif.) said she wanted to give Obama credit for making the expansion of health coverage a top priority more than a decade ago.

“We would not be here if he hadn’t the courage, the talent or the will to see us this far,” Harris said.

Sen. Amy Klobuchar (D-Minn.) said she favors offering people a public option, saying it’s “what Barack Obama wanted to do from the very beginning.”

And Julian Castro, former secretary of Housing and Urban Development under Obama, invoked the former president’s name to attack Biden.

“Barack Obama's vision was not to leave 10 million people uncovered,” Castro said. “He wanted every single person in this country covered. My plan would do that. Your plan would not.”

4. The Democrats focused mostly on attacking each other, instead of President Trump.

Harris – who has been criticized for being squishy on how far Medicare-for-all should go – was the sole candidate to focus on Trump’s actions against the ACA. In particular, she noted his Justice Department is refusing to defend the law from an attack by GOP-led states, a case expected to get a ruling from a federal appeals court within the next few weeks.

“Let's focus on the end goal,” she said. “If we don't get Donald Trump out of office, he's going to get rid of all of it.”

Larry Levitt, vice president at the Kaiser Family Foundation:

Here are a few of the other key health care-related moments from the third Democratic debate:

GUN CONTROL

Former Texas Congressman Beto O’Rourke appeared to dominate the discussion around gun violence and defended his proposal to buyback assault weapons.

“If it’s a weapon that was designed to kill people on a battlefield, if the high-impact, high-velocity round when it hits your body shreds everything inside of your body because it was designed to do that,” O’Rourke said. “When we see that being used against children… Hell, yes, we’re going to take your AR-15, your AK-47.”

O’Rourke has been vocal about tightening gun-control measures in the wake of the mass shooting in his hometown of El Paso in August, and he gained the praise of his Democratic rivals on stage for his public statements on gun control following the shooting.  

Sen. Amy Klobuchar (D-Minn.) called on Senate Majority Leader Mitch McConnell to pass the gun control measures that have stalled in the Senate.

“You know what else unites us? And I'll tell you this. What unites us is that right now, on Mitch McConnell's desk, are three bills -- universal background checks, closing the Charleston loophole, and passing my bill to make sure that domestic abusers don't get AK-47s,” she said.

Biden was asked to defend the lack of action on gun violence prevention following the Sandy Hook Elementary school shooting in 2012 under the Obama administration.

"I'm the only one up here who's ever beat the NRA," Biden said, citing his work to pass the Brady Bill – which imposes a waiting period for buying handguns -- that went into effect in 1994 while he was senator.

Biden also argued it was unconstitutional to take away people's guns via executive action, to which Harris responded: "Well, I mean, I would just say, hey, Joe, instead of saying, no, we can't, let's say yes, we can."

— The moderators notably didn't ask any questions about abortion, although that issue will almost certainly play a role in the general election. Some of the Democratic candidates were critical.

 

AHH, OOF and OUCH

AHH: More than a quarter of high-school students across the country use e-cigarettes, according to preliminary data from the Centers for Disease Control and Prevention’s National Youth Tobacco survey.

It’s another sign in the trend of surging youth vaping rates, which have alarmed state and federal leaders and pushed the administration to move toward a ban on most flavored e-cigarettes.

The preliminary data found 27.5 percent of high school students reported using an e-cigarette in the last month, a marked jump from the 20.8 percent of high school students who used such products in 2018 and the 11.7 percent in 2017, CNBC’s Angelica LaVito reports. It also found 60 percent of teen reported using flavored e-cigarettes, including fruit, menthol or mint flavors.

OOF: New Jersey’s Democratic Gov. Phil Murphy signed an executive order to create a task force to make recommendations on vaping in as soon as three weeks.

Murphy said the task force will make recommendations for legislation or for administrative actions “to protect New Jersey residents – especially kids – from the hazards of vaping.”

“Let me be perfectly clear, many people have no idea what chemicals their vape pen is putting into their bodies,” Murphy. “As of this moment, there is no safe vape – the only safe alternative to smoking is not smoking. Period. Full Stop.”

Murphy is the latest state leader to take on e-cigarettes amid growing concerns about the risks of youth vaping. This week, health officials in Kansas confirmed that a sixth person died from a mysterious vaping-related lung disease that has popped up across the country. Earlier this month, Michigan became the fist state in the nation to ban flavored e-cigarettes.

— Meanwhile, the CDC released an update on the number of cases nationwide of the mysterious lung illnesses related to vaping, narrowing the number of suspected cases to 380 probable and confirmed cases, down from the 450 possible illnesses it reported last week. Those 380 cases were reported by 36 states and one territory.

OUCH: Gun control advocates had a swift reaction to the Trump administration’s announcement this week that it would move toward taking flavored e-cigarettes off the market. What about guns, they asked?

“Pointing out that the thousands of gun deaths in the United States vastly outnumber the six fatalities attributed to vaping, some activists and legislators bemoaned the lack of meaningful action on guns,” our Post colleague Brittany Shammas reports. “They renewed demands for gun-control measures such as bans on assault rifles.”

Here’s how Sen. Sanders responded:

And from Moms Demand Action founder Shannon Watts:

 

— The leaders of 145 companies sent a letter to Senate leaders urging them to act on gun safety, to pass legislation expanding background checks to all firearm purchases and to pass “red-flag” laws, which would allow family members to ask a judge to lock someone from having a gun if they are a risk to themselves or others.

House Democrats passed a background check bill earlier this year, but such efforts have stalled in the Senate, as our Post colleague Rachel Siegel writes.

“As leaders of some of America’s most respected companies and those with significant business interests in the United States, we are writing to you because we have a responsibility and obligation to stand up for the safety of our employees, customers and all Americans in the communities we serve across the country,” the executives wrote. “Doing nothing about America’s gun violence crisis is simply unacceptable and it is time to stand with the American public on gun safety."

AGENCY ALERT

— A 74-year-old patient was bitten 100 times by ants at a VA nursing home before he died days later.

Joel Marrable’s daughter Laquana Ross told local news station WSB-TV that the ants filled his room: “The ceiling, the walls, the beds. They were everywhere,” Ross said about her father’s experience at the Eagle’s Nest Community Living Center, part of Atlanta VA Medical Center in Decatur, Ga.

Ross urged hospital administrators to put her father in a new room after the ant problem was not resolved, and he died after the overnight move at the facility where he spent more than a year, our Post colleague Hannah Knowles writes.

“The Atlanta VA Health Care System, which did not respond to questions from The Washington Post on Thursday, said in a statement to news outlets that leadership is aware of the ant issue and that the staff ‘immediately cared for the Veterans and took action to ensure no other CLC residents were impacted,’” she writes.

A pest control company assessed the nursing center two days after Ross says Marrable died, and the Atlanta VA Health Care System’s statement says a regional VA expert will visit Friday and pest control staff are monitoring rooms there daily.

— And here are a few more good reads: 

Former housing secretary Julián Castro waged 13 attacks, the most of anyone onstage, according to an analysis of the third Democratic presidential debate.
Ashlyn Still, Kate Rabinowitz and Kevin Uhrmacher
TRUMP TEMPERATURE
Advocates bombarded officials with petitions, scored meetings and used an ex-gun lobby official as a conduit. Meanwhile, gun control advocates haven’t gotten in the door.
Politico
OPIOID OPTICS
The OxyContin maker nixed plans earlier this year to launch a foundation to fund opioid-addiction treatment and research as the company rethought its strategy amid hundreds of lawsuits and a possible bankruptcy filing.
Wall Street Journal
INDUSTRY RX
Companies and trade groups are weighing the risks of fighting a proposed ban on most flavored vaping products, to protect mint and menthol varieties.
New York Times
NDMA no longer has industrial uses—it was once added to rocket fuel—but it can form during industrial processes at tanneries and foundries as well as at pesticide, dye, and tire makers.
Bloomberg
STATE SCAN
Abbott stopped short of saying the Legislature should make the background checks mandatory.
Texas Tribune
The state’s growing homeless problem hasn’t been contained by similar policy initiatives in the past.
Scott Wilson
Louisiana has broadened access to hepatitis C therapies with a payment deal that has been likened to a Netflix subscription.
Wall Street Journal
A New York City law banning so-called gay conversion therapy would be repealed under legislation introduced Thursday over concerns that a pending federal lawsuit could lead to a decision unfavorable to the LGBTQ community if the case were to make it to the Supreme Court.
Associated Press
REPRODUCTIVE WARS
At the inaugural event Wednesday evening, Knorr spoke to a crowd of 60 or 70 at a church an hour outside Chicago, explaining her interpretation of the Reproductive Health Act.
CBS News
DAYBOOK

Coming Up

  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on the mental health needs of children in HHS custody on Sept. 18. 
  • The House Veterans Affairs Committee holds a hearing on how barriers to hiring at VA impact patient care on Sept. 18. 
  • The Joint Economic Committee holds a hearing on gun violence in America on Sept. 18.
SUGAR RUSH

‘It was almost elder abuse’: Late-night hosts tackle third Democratic debate:

Julián Castro said Joe Biden forgot his own health care position. Let's review: