As Sen. Elizabeth Warren often says, “personnel is policy.” And that's why the advisers drafting the 2020 Democrats' proposals to expand health coverage for 30 million uninsured Americans are so important.
The candidates have a deep bench to draw from. The top-polling campaigns have reached out to a host of alumni from the Obama and Clinton administrations, who have practical experience from rolling out the 2010 Affordable Care Act and making an initial pass at health-care restructuring back in the 1990s.
They include household names in the health policy world: Clinton veteran Chris Jennings, former Obama Health and Human Services secretary Kathleen Sebelius, Center for American Progress President Neera Tanden, and Andy Slavitt, former director of the Centers for Medicare and Medicaid Services. The former officials say they’re happy to distribute advice equally.
“I have agreed to be helpful to any campaign who wants me to review their health proposals,” Slavitt, who headed CMS in the Obama administration’s last few years, told me.
The best-funded candidates have also added health policy advisers to their payrolls and contacted academics and others as they’ve rolled out proposals to expand health-care coverage and improve rural and maternal health. Political campaigns generally seek to keep the focus on the candidate, so most were reticent to share names of staffers or outside advisers.
So The Health 202 did a little sleuthing -- and several campaigns confirmed names we sent their way. Here’s a look at some lesser-known individuals helping to shape policy for the top contenders.
Sen. Kamala Harris (D-Calif.):
Harris has struggled throughout the campaign to define exactly where she stands on the role of private insurance. She surprised many by releasing an alternative Medicare-for-all proposal that would preserve private plans by letting them contract with the government to administer medical benefits.
Harris's campaign confirmed that Rohini Kosoglu, her Senate chief of staff, volunteered her time to help develop that plan. Kosoglu served as senior health care adviser to Sen. Michael Bennett (D-Colo.) while the ACA was being debated and passed.
Brookings Institution fellow Kavita Patel said — and the campaign confirmed — that she also advised the campaign in a voluntary role. Patel served as a policy director in the Obama administration and advised then-Sen. Ted Kennedy (D-Mass.) on health policy.
Harris has also touted influence and support from Kathleen Sebelius for her plan.
South Bend, Ind. Mayor Pete Buttigieg:
Like Harris, Buttigieg is another candidate who has softened his stance on Medicare-for-all by saying he prefers something he calls “Medicare-for-all-who-want-it” — although he hasn’t yet released details on what such a system might look like.
The campaign has relied heavily on a group of volunteers to help develop its health policy proposals. That group is led by Cristal Thomas Gary, who, as former deputy governor of Illinois, helped the state set up its ACA marketplace and improve its Medicaid program. Andres Arguello, formerly a health research analyst at the New Jersey-based firm Mathematica, is also a key part of the group, according to the campaign.
Buttigieg has released a proposal for improving rural health (we detailed that here) and a proposal on mental health. The mental health paper was heavily influenced by Ben Miller, chief policy officer for the Well Being Trust. Miller released notable research in March finding “deaths of despair” from alcohol and drug abuse more than doubled since 1999.
Inside the campaign, Buttigieg draws ideas from his policy director Sonal Shah, who worked in the Obama White House leading its Office of Social Innovation and Civic Participation and most recently directed Georgetown University’s Beeck Center for Social Impact and Innovation.
Former vice president Joe Biden:
Biden was one of the first Democrats to offer his own health-care proposal, which would let anyone choose to buy a government-backed plan such as Medicare. He has the advantage of drawing from the expertise of policy staff who advised him during his years at the White House.
His campaign policy director is Stef Feldman, an adviser during his vice presidency on health care, energy and the environment. Feldman helped the Obama-Biden administration weather one of its toughest moments — the 2013 botched rollout of Healthcare.gov — as one of the White House staffers who helped triage resulting problems.
Feldman also led an Obama administration task force that put together 19 executive actions taken by the Defense Department and Veterans Affairs to improve the mental health of service members, veterans and their families.
Sarah Bianchi, a veteran policy staffer who worked in the Clinton and Obama White Houses and directed policy for the Kerry-Edwards presidential campaign, is also cited as a top influencer on Biden’s policies. She served as head of economic and domestic policy for Biden when he was vice president, and chairs the advisory board for the Biden Institute at the University of Delaware.
Bianchi wrote a Medium post last year after John McCain's death, praising the former Arizona Republican for his bipartisan work to pass the Patient's Bill of Rights with then-Sen. Ted Kennedy (D-Mass.).
She listed four “lessons” to be learned from McCain's actions, including “take issues but never take yourself too seriously; Enter the arena and fight for what you believe — even if it’s messy and imperfect; Be grateful for all the experiences, adventures and friendships — and even for the bad days; Own your failures. It’s okay to say, ‘I screwed up. I got this wrong’ and then learn and emerge stronger and better.”
No more decent, compassionate leader to lead us into the future https://t.co/s8r1EOsE1S— Sarah Bianchi (@SarahABianchi) April 25, 2019
Sen. Bernie Sanders (I-Vt.)
Sanders — author of the first Medicare-for-all bill — relies more heavily on longtime Senate staff than outside advisers, according to those in Democratic circles. As an independent who embraces the term “socialist,” Sanders has long forged his own pathway on health-care policy and is less likely to draw from mainstream Democratic ideas to inform his views.
Lori Kearns, who has worked for Sanders since 2012, served as Sanders’s health policy adviser as his office was writing Medicare-for-all back in 2015. She became his Senate legislative director in March.
to be fair, there are a lot of people who can't tell the difference between a premium and a deductible, and this is why arguing we need "choice" in health insurance plans is so useless https://t.co/xPTGX9yS1W— Lori Kearns (@lori_kearns) September 13, 2019
Every time I yell at the TV my dog demands belly rubs. It's a decent trade pic.twitter.com/PgkqxxZ5Vv— Lori Kearns (@lori_kearns) September 14, 2019
Other Senate staff who have worked for Sanders on health policy in the Senate include Marissa Barrera, who has been a health policy analyst since 2016 for the Budget Committee, where Sanders serves as the ranking Democrat. Kathryn Van Haste is the committee’s health policy director.
Sanders's most out-front policy staffer for 2020 is Warren Gunnels, who is a senior campaign adviser and was policy director in Sanders’s 2016 campaign. He has worked for Sanders for two decades.
Hey Joe: How do you propose to come up with the $50 trillion $750 billion you want to spend on health care over the next 10 years? Because that’s what the status quo and your damn public option is going to cost which will put profits before people. https://t.co/Kk9ClbYiCh— Warren Gunnels (@GunnelsWarren) September 13, 2019
Elizabeth Warren (D-Mass.):
Several health policy experts who advise multiple campaigns said they interact more directly with Warren than any of the other candidates, underscoring the Harvard professor’s deep involvement with the details of policy and reputation for having a “plan” for everything.
Andy Slavitt said he offered some help on her plan for maternal health, which would reward hospitals for reducing their maternal mortality rate among black women. "She is highly engaged personally on these topics," Slavitt told me.
And she is reported to pay her campaign’s policy director Jon Donenberg as much as the campaign manager and other senior leaders, reflecting her commitment to policy development. Jon was a health policy staffer for the Energy and Commerce Committee during passage of the ACA, where he worked on the part of the legislation involving Medicaid expansion and the Prevention and Public Health Fund.
One of Warren’s longtime go-to advisers is Ganesh Sitaraman, a law professor at Vanderbilt University and senior fellow at the Center for American Progress. He’s not paid by her campaign but is reported to heavily influence her domestic policies.
Warren hasn’t released her own plan for expanding health insurance, instead endorsing Sanders’s Medicare-for-all. But in August she posted ideas for improving rural health care beyond Medicare-for-all’s coverage expansions.
And last week her campaign posted a new Web page detailing legislation Warren has proposed to combat the opioid crisis and lower prescription drug costs, and laying out ideas for improving rural health.
AHH: Purdue Pharma, the company behind the opioid Oxycontin that’s accused of fueling the opioid epidemic, has filed for bankruptcy.
“The Chapter 11 filing is expected to lead to the ultimate demise of a company that sold a fraction of the opioid prescriptions in the United States but nonetheless is most closely identified with the epidemic because of its pioneering role in the sale of narcotic pain pills,” our Post colleague Christopher Rowland reports. “The company used aggressive, allegedly misleading, sales tactics to push physicians to prescribe millions of doses of its dangerously addictive pills."
The filing will lead to new discussions over how any proceeds from a settlement with thousands of complainants will be divided up as well as how much of the fortunes from the Purdue-owning Sackler family will be available to help pay plaintiffs.
“Under the settlement announced last week, more than 2,000 small government plaintiffs and 24 states have agreed to the dissolution of the company and a contribution from the Sacklers, valued at $10 billion to $12 billion. But the settlement valuation is in dispute, and a number of states have balked at those terms,” Christopher writes. Under the settlement, Purdue would shift during bankruptcy into a trust that aims to combat the opioid epidemic by producing opioid overdose rescue medicines that would be doled out to impacted communities.
The Sackler family called the settlement and bankruptcy a “historic step’’ to address a “tragic public health situation.’’ “It is our hope the bankruptcy reorganization process that is now underway will end our ownership of Purdue and ensure its assets are dedicated for the public benefit,’’ the statement said.
— The New York attorney general’s office disclosed that the Sackler family participated in 137 wire transfers totaling about $1 billion, the New York Times’s Danny Hakim reports. The revelation suggests the family was looking to protect its wealth in overseas bank accounts as it faces lawsuits.
"Letitia James, now the state’s attorney general, had issued subpoenas last month to 33 financial institutions and investment advisers with ties to the Sacklers in an effort to trace the full measure of the family’s wealth,” Danny writes. “…Forbes has estimated that the family fortune is worth $13 billion, a figure the family has not disputed, but many state attorneys general believe that the family has far more hidden away, as a safeguard against the cascade of litigation.”
“While the Sacklers continue to lowball victims and skirt a responsible settlement, we refuse to allow the family to misuse the courts in an effort to shield their financial misconduct,” James said in a statement.
OOF: Drug companies facing 2,000 lawsuits over their alleged roles in the opioid crisis now want the judge overseeing the case to be removed.
Lawyers for the companies filed a request on Saturday to remove U.S. District Judge Dan Aaron Polster in the landmark trial scheduled to begin next month, questioning his fairness, our Post colleagues Scott Higham and Lenny Bernstein report. The lawyers pointed to his statements made at the start of the trial that urged for both sides in the case to settle, citing the urgent need for funding from a settlement to benefit opioid-ravaged communities.
“Lawyers for the more than 2,000 cities, towns, counties and tribal communities suing the drug industry called the attempt to remove Polster a desperate move,” Scott and Lenny write. “The lead plaintiffs’ lawyers said in a statement they ‘remain confident the judiciary will swiftly respond to yet another attempt by the opioid defendants to delay the trial.’ ”
OUCH: A 58-year-old Navy veteran brought a $139,000 hospital bill to a campaign rally for Sanders, waving it in the air until it caught the attention of a campaign aide who passed the bill to the candidate. It led to a harrowing exchange between Sanders and one of his supporters, who has advanced-stage Huntington’s disease.
“John, I’m looking at a bill that says account balance $139,000. What is that about?” Sanders asked the veteran, John Weigel.
Weigel explained: “It’s because somehow after the fact they claim that my Tricare, I chose to end it, which I didn’t… They’re saying that I didn’t re-sign it or something.”
When Sanders asked how Weigel planned to pay off the bill, he answered: “I can’t, I can’t…I’m going to kill myself.”
“Hold it, John,” Sanders said. “Stop it. You’re not going to kill yourself.”
“Reached at his home Saturday afternoon, Weigel said he spoke to Sanders and his wife, Jane Sanders, after the event and they told him they would help, though they didn’t say how,” our Post colleague Colby Itkowitz reports. “Later Saturday, the Sanders campaign said it had ‘already reached out to a Nevada senate office for casework help.’ ”
Weigel told Colby that he was told by his Tricare health insurance, which he signed up for after retiring from the military, that the coverage was canceled because he hadn’t re-enrolled, despite having his coverage automatically renewed in past years. He’s back on his insurance, but still doesn’t know how he was kicked off.
“Since the town hall, Sanders has tweeted several times about Weigel, holding him up as an example of a broken health-care system,” Colby writes:
This is painful to hear. But there are millions of people like John facing an unimaginable burden due to the cost of medical care. This is why we fight for Medicare for All.— Bernie Sanders (@BernieSanders) September 14, 2019
Content warning: suicide pic.twitter.com/gtCtNykvqO
— House Republicans talked health care at their annual retreat in Baltimore over the weekend, our Post colleague Mike DeBonis writes.
“If Trump is reelected, the GOP recaptures the House and holds the Senate, the president and Republicans said they would try again to scrap the 2010 law that has provided coverage for tens of millions of Americans and ensured health care for those with preexisting medical conditions,” he writes.
But they'll run up against the same problem they encountered back in 2017: Coming up with an alternative that's markedly better than Obamacare and that voters don't hate.
The lawmakers also expressed concerns about how to deal with the national deficit made steeper by the Republican-passed tax cut. “But while acknowledging the need to appeal to voters concerned about those issues, GOP leaders stopped short of fully embracing any particular course correction," Mike writes..
— At least a dozen children diagnosed with autism were conceived using the same donor sperm, something Danielle Rizzo, a mother of two boys on the spectrum discovered while researching treatment options three years ago, our Post colleague Ariana Eunjung Cha reports in this extraordinary piece.
Experts say the revelation of an autism cluster that involves the group of children across the United States, Canada and Europe is unprecedented.
Rizzo searched online and found the man’s sperm was still being sold at four companies, contacting the companies but receiving a minimal response from representatives who told her she didn’t have “evidence” that the sperm was the cause of the autism cluster. She contacted health-care regulators in New York and California who also denied responsibility. And the Food and Drug Administration told her its oversight of the industry was limited to screening for sexually transmitted diseases. Finally, Rizzo filed a lawsuit in U.S. District Court for the Northern District of Illinois in July 2017.
“She says in the complaint that research, based on public documents and calls to his relatives, showed that the donor had no college degrees, had been diagnosed with ADHD, and ‘went to a school for children with learning and emotional disabilities,’ ” Ariana reports. “Moreover, her attorneys wrote in the filing, ‘Donor H898 is a prolific sperm donor who has fathered at least 12 children through sperm donation, and that each of those children has either been diagnosed with Autism, or suffers from signs and symptoms associated with Autism.’ In court documents, other mothers corroborated the story.”
Rizzo, who agreed to a settlement in March, said she wants her case to prompt greater oversight of sperm bank industry. “I did not sue because my children are autistic. I was suing to right a wrong,” she told Ariana.
— The Food and Drug Administration’s advisory committee voted 7 to 2 to greenlight a first-of-its-kind peanut allergy treatment, which could be a step toward more such allergy treatments that aim to prevent allergic reactions rather than just treat them, our Post colleague Carolyn Y. Johnson reports.
The biotech company behind the drug wants to get the therapy approved for kids ages 4 to 17.
The drug — called Palforzia — would not be a cure, but would desensitize children to what can be life-threatening allergies. After a year of treatment, children involved in a large trial could handle the equivalent of two peanuts, Carolyn writes.
— And here are a few more good reads:
- 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 Wednesday.
- The House Veterans Affairs Committee holds a hearing on how barriers to hiring at VA impact patient care on Wednesday.
- The Joint Economic Committee holds a hearing on gun violence in America on Wednesday.
Trump rebuffs calls for Kavanaugh's impeachment following new sexual misconduct report: