President Trump will assail Democrats' Medicare-for-all proposals in a broad speech this afternoon as he issues an executive order advancing his administration’s own vision of how Medicare should work.

The address, which Trump will deliver from a Florida retirement community at 1 p.m., is expected to set a political marker ahead of 2020 -- as will the executive order, which is entitled “Protecting Medicare from Socialist Destruction.”

The president will seek to present his administration as forward-looking on the popular Medicare program, even as his potential Democratic rivals call for overhauling much or all of the country’s health-care system by dramatically expanding it.

As senior administration officials told me last week, the president plans to draw a sharp distinction between his own approach to health insurance and the single-payer system advocated by many Democrats. 

“Right now we have the Democrats beating each other up over Medicare-for-all, so I think we’re going to take the opportunity to contrast with that vision,” one official said. “I think you’ll see in that speech a discussion of an alternative vision for health-care reform.”

White House spokesman Judd Deere said that the president will defend his record on health care but didn't say much about the speech's content. “From day one, President Trump and his administration have worked to provide seniors with high-quality, affordable care in the Medicare program and improved options through Medicare Advantage,” he said.

Centers for Medicare and Medicaid Services Administrator Seema Verma tweeted this yesterday:

She spent some time previewing Trump's remarks:

Trump’s executive order — the second such order this year focused on health-care delivery — will direct the Centers for Medicare and Medicaid Services to propose ways to boost privately run Medicare plans and implement some of their secrets to success in the traditional Medicare program, according to several lobbyists and people with knowledge of the order.

These private plans, offered through what’s known as “Medicare Advantage,” could be described as Republicans’ favorite component of the Medicare program. And they’re right that it’s been hugely successful. About one-third of the program’s 60 million enrollees now enroll in Medicare Advantage plans run by private companies, instead of using traditional Medicare in which the government directly pays medical bills.

Verma frequently praises Medicare Advantage as a prime example of how the government can work with the private sector to offer the public affordable health coverage, noting the program's popularity and rapid growth over the past decade.

Likewise, the president will promise to strengthen Medicare Advantage as a way of improving health-care coverage for millions — even as his administration refuses to defend the Affordable Care Act in a high-stakes lawsuit in which a ruling is expected any day now.

Trump is expected to call specifically for Medicare Advantage plans to embrace virtual health care and more flexibility for the types of supplemental medical benefits they can cover. The order could also encompass more-technical operational changes such as adjusting provider network requirements for Medicare Advantage plans and leveling the playing field between what doctor offices and hospital outpatient facilities are paid.

The White House is holding a conference call with stakeholders at 8:40 a.m. to discuss the executive order, according to an invitation obtained by The Health 202.

It’s just the latest way the administration is trying to encourage enrollment in Medicare Advantage. In August, CMS rolled out a new “plan finder” helping seniors navigate and compare their plan options under the program.

The agency also announced that average monthly premiums for Medicare Advantage plans are projected to hit their lowest point in 13 years, decreasing 14 percent next year to $23. It projected enrollment will increase nearly 10 percent, to include 24.4 million seniors and people with disabilities.

As the president touts Medicare Advantage, he may also deploy a line used by Republicans last year to slam Medicare-for-all — the idea that it would destroy Medicare as seniors know it (my colleague Colby Itkowitz wrote about that in this Health 202).

"They want to raid Medicare to pay for socialism,” the president said at a campaign event in Indiana last year. "They're going to ruin your Medicare. Watch. They want to turn America into Venezuela. I don't think so," Trump said at another event in Montana. 

Trump's trying to appeal to voter concerns about how a national health-care program would work. And it could be a good strategy. Polls show that it's not only Republicans who don't want a Medicare-for-all-type system; majorities of Democrat and Democrat-leaning voters would prefer that the president strengthen the Affordable Care Act instead.

The Health 202 will be publishing on a limited schedule while Congress is on recess this week and next week. We will not be publishing Oct. 4, 7 or 11. We will return to our normal schedule on Oct. 14.


AHH: Planned Parenthood is opening a massive new 18,000-square-foot clinic in Illinois to serve 11,000 patients a year, as Missouri’s new abortion restrictions have left the state with just one abortion provider. The facility was also built in secret, our Washington Post colleague Kayla Epstein reports.

“The new facility would provide family planning as well as a wide array of women’s health-care services, including annual exams, breast cancer screenings and STD tests. It will offer both medical and surgical abortions,” Kayla writes.

“The new health center is a testament to the needs of the greater bi-state region and our commitment to provide, protect and expand access to health care, no matter what,” Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a statement.

In an interview with CBS News, Illinois Right to Life executive director Mary Kate Knorr contended Planned Parenthood’s goal with the facility was to make money.

“Make no mistake — this new mega-facility is not a response to an increased demand, nor is it a gesture of care for women,” Knorr said. “The construction of this new facility was a strategic business move — certainly not a defense of women.”

OOF: Trump accused House Speaker Nancy Pelosi (D-Calif.) of trying to shroud Democrats’ impeachment efforts by pledging to work with the president on lowering drug prices.

He tweeted this yesterday:

During a news conference, Pelosi opened her remarks by plugging her legislation to lower the cost of prescription drugs and urging the president to support it. She said the issue is one of two that lawmakers are talking about in their districts.

“In last year’s election this was a very high priority — it continues to be. So when the president says he can’t do anything if he has the threat of impeachment, or the consideration of impeachment, I hope he doesn’t mean he doesn’t want to work together to lower the cost of prescription drugs,” she said.

When asked by a reporter how she plans to work with the president on legislative priorities amid the impeachment inquiry, she said they have “nothing to do with each other." "We have the responsibility to the uphold our oath of office, to support and defend the Constitution of the United States. We also have a responsibility to get the job done for the American people," she told reporters. 

“It will take both sides acting in good faith to get bipartisan legislation done. That’s difficult in the best of times in a divided government. We are not in the best of times,” our Post colleague Amber Phillips writesShe added that any movement on drug pricing would be a “particularly unique nexus of cooperation between Pelosi and Trump.”

OUCH: Sen. Bernie Sanders (I-Vt.) underwent a heart procedure for an artery blockage and has canceled his upcoming campaign schedule for at least a few days as he recovers.

The Democratic presidential candidate was hospitalized after experiencing some chest pain during a campaign event this week, senior Sanders adviser Jeff Weaver said in a statement. “Following medical evaluation and testing he was found to have a blockage in one artery and two stents were successfully inserted," Weaver said. 

Weaver added the senator is “in good spirits.”

"Sanders thanked well-wishers Wednesday and used the moment to draw attention to his signature universal-health-care proposal," our Post colleagues Chelsea Janes and Sean Sullivan write. 

"The problem emerged at a critical moment for Sanders and the Democratic campaign. The senator had just announced he had raised an impressive $25.3 million in the year’s third quarter, giving him a boost at a time when rival Sen. Elizabeth Warren (Mass.) had been gaining ground. Now he’ll be off the campaign trail for an unknown period, with the next Democratic debate rapidly approaching on Oct. 15," Sean and Chelsea write. 

— How serious is Sanders’s heart problem? Our Post colleague William Wan reports the medical problem, “though it can be serious if untreated — is a common affliction in men his age. And the procedure he underwent is one of the most routine performed by cardiologists.”

“This is a common procedure. It’s very safe. People recover quickly,” said Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic. “I’ve treated businessmen who go back to work the next day. I’ve had patients in the U.S. Senate who have gotten right back to work. Although, if Bernie were my patient, I might tell him not to work 16 hours a day for a little while, just to make sure recovery goes well.”


— A federal judge rejected an argument from the U.S. government that a nonprofit’s bid to open a safe drug injection facility in Philadelphia violates federal law. The ruling could have major implications for the way cities address the nation’s opioid epidemic, our Post colleague Lenny Bernstein reports.

“U.S. District Judge Gerald A. McHugh wrote that a provision of the Controlled Substances Act aimed at closing crack houses does not apply to the nonprofit organization’s bid to aid opioid abusers in Philadelphia’s drug-ravaged Kensington section,” Lenny reports. McHugh wrote: “No credible argument can be made that facilities such as safe injection sites were within the contemplation of Congress” when the initial 1986 law was adopted or when it was amended in 2003.

So far, efforts have stalled to open such a facility in the United States, where people can inject drugs under medical supervision. Other city and state leaders in Seattle, San Francisco, New York and Massachusetts have sought to do so. The Justice Department filed a lawsuit in February to stop Safehouse, a nonprofit organization in Philadelphia, from opening a site, leading to McHugh’s ruling.

Deputy Attorney General Jeffrey A. Rosen said the Justice Department would continue to take action against any such facilities that open and that it’s “disappointed in the court’s ruling and will take all available steps to pursue further judicial review.”


— Dozens of research reports and early-stage studies have been delayed because of the relocation of two scientific agencies at the Agriculture Department from the District of Columbia to Kansas City. Tens of millions of dollars in approved grants are also stalled, our Post colleague Ben Guarino reports.

There are nearly 40 delayed reports including “studies into veterans’ diets, honeybee health and the opioid epidemic. Other reports address obesity, international markets and organic foods. These studies are completed but unpublished,” he writes.

“Staff numbers at both agencies have plummeted since the relocation. At [the National Institute of Food and Agriculture], the employees who approve the grant paperwork and release funds are gone. The publishing staff at [the Economic Research Service] did not accept the reassignment to Kansas City. The flow of research and grants from these agencies has slowed, employees said, piled up behind the logjam of empty desks.”

— And here are a few more good reads: 

A forum organized by Giffords and March for Our Lives, two years after a mass shooting in Las Vegas, aimed to bring gun policy to the forefront of the Democratic primary.
New York Times
Sen. Chuck Grassley, R-Iowa, charged Health and Human Services is taking the threat of Medicare fraud from genetic testing too lightly.
Fierce Healthcare
"These kids who are hooked on nicotine, they are going to have the withdrawal symptoms," said one doctor, and some may switch to traditional cigarettes.
Juul Labs Inc on Tuesday hired the head of regulatory affairs at its part-owner Altria Group Inc to take on a similar role at the e-cigarette maker, amid a regulatory backlash against the growth of teen vaping in the United States.
Retailer is suspending all over-the-counter ranitidine products, including Zantac and Equate, following FDA alert
CBS News
Gov. Andrew Cuomo raised payments to hospitals at a time when Medicaid spending was already drastically over budget.
New York Times
The project will allow 10 states to design wellness programs that could be incorporated into insurance plans people buy in the individual market.
Wall Street Journal


  • The Center for Strategic and International Studies hosts an event on the outcomes of the UN high-level meeting on health coverage.
  • The CATO Institute holds an event on patients, privacy and prescription drug monitoring programs.

Trump says Pelosi hands out subpoenas 'like cookies':