with Paulina Firozi

THE PROGNOSIS

Move over, Medicare-for-all. Paid family leave enjoyed a moment in the spotlight at last night’s Democratic presidential debate.

But unlike the issue of expanding health insurance – where there will be sharp fault lines between President Trump and the eventual Democratic nominee -- family leave may be less helpful in distinguishing the two candidates. That’s because Trump has also called in the past for paid leave.

It took five Democratic debates – and an all-female panel of moderators – for the issue to get any airtime, even though paid family leave is popular among voters including Republicans. All the Democratic candidates on the stage have said they’d seek at least 12 weeks of guaranteed paid leave for workers caring for a newborn child, and some have gone further, saying new parents should get a minimum of six months off (check out The Post’s tracker to see where the candidates stand).

My colleague Carol Leonnig, noting the leave question was asked by The Post's White House reporter Ashley Parker. The Post sponsored the debate with MSNBC:

Trump has accomplished little on paid family leave during his presidency, but during his 2016 campaign offered a plan for six weeks guaranteed leave and has proposed it in his budgets to Congress. His daughter Ivanka has called for it repeatedly and visited Capitol Hill on multiple occasions to weigh in on some GOP family leave bills.

Trump campaign spokesperson Kayleigh McEnany:

Last night, two of the four female candidates — Sens. Amy Klobuchar (D-Minn.) and Kamala Harris (D-Calif.) -- spoke at length about why they feel paid family leave is crucial, while tech industry veteran Andrew Yang vowed it would be one of the first things he’d do as president.

The discussion didn’t spark fireworks among the candidates in the same way as Medicare-for-all at prior debates. But Klobuchar did use it to emphasize the importance of saying how any new benefits would be paid for — part of her pitch to voters that she’s the race’s pragmatic, electable moderate.

Klobuchar said she wants three months paid leave — versus something more generous — because she has “meticulously” shown how she would pay for it.

“My plan is three months. I think that’s good, I’d love to do more,” Klobuchar said. “As I’ve said before, I’d love to staple diplomas under people’s chairs. I just am not going to go for things….just because they sound good on a bumper sticker and then throw in a free car.”

Klobuchar has signed onto the leading family leave legislation in Congress, introduced by Sen. Kirsten Gillibrand (D-N.Y.). The Family Act would give both parents up to 66 percent of their income for three months, paid for with a small increase in payroll taxes. Other Democratic candidates have also co-sponsored it, including Harris and Sens. Bernie Sanders (I-Vt.), Cory Booker (D-N.J.) and Elizabeth Warren (D-Mass.).

But Harris said she wants to go further, although she didn’t answer a moderator question about how she’d pay for it. She stressed that more women are juggling multiple responsibilities as they have babies older in life while caring for aging parents.

“What we are seeing in America today is the burden principally falls on women to do that work,” Harris said. “And many women are having to make a very difficult choice whether they're going to leave a profession for which they have a passion to care for their family, or whether they are going to give up a paycheck that is part of what that family relies on.”

“So six months paid family leave is meant to and is designed to adjust to the reality of women's lives today,” she said.

Ilyse Hogue, president of NARAL Pro-Choice America:

Yang prompted a wave of audience laughter when he said Papua New Guinea is the only country besides the U.S. that doesn’t guarantee paid leave for women.

“There are only two countries in the world that don’t have paid family leave for new moms, the United States and Papua New Guinea,” Yang said. “That is the entire list. And we need to get off this list as soon as possible.”

Yang also explained how he’d try to tackle a related issue – the extraordinarily high cost of childcare in the U.S. He wants a universal basic income of $1,000 a month for every adult, which they could use to pay for childcare or scaling back work to spend more time at home with a kid.

“We should not be pushing everyone to leave the home and go to the workforce,” Yang said. “Many parents see that tradeoff and say if they leave the home and work, they're going to be spending all the money on childcare anyway. In many cases, it would be better if the parent stays home with the child.”

Author Jessica Valenti: 

Some of the other key health care-related moments from the debate:

— MEDICARE-FOR-ALL: The candidates once again highlighted their divisions over health care and clashed over the viability of Medicare-for-all — although the issue received notably less time than in previous debates.

Warren, who recently released two proposals on how she would pay for her health-care plan and how she’d transition to such a system more gradually, emphasized her approach. “So here is my plan. Let's bring as many people in and get as much help to the American people as we can as fast as we can,” she said.

Sanders defended his proposal, calling the current health-care system “dysfunctional” and taking a jab at his rivals onstage. “Now, some of the people up here think that we should not take on the insurance industry, we should not take on the pharmaceutical industry,” he said. “But you know what? If you think back to FDR and if you think back to JFK and Harry Truman and Barack Obama, as a matter of fact, people have been talking about health care for all. Well, you know what? I think now is the time.”

South Bend, Ind., Mayor Pete Buttigieg, who advocates expanding Obamacare, said, “whether we wait three years, as Senator Warren has proposed, or whether you do it right out of the gate," a Medicare-for-all system is “not the right approach to unify the American people." 

Former vice president Joe Biden, who also wants to expand Obamacare, said Medicare-for-all would not be politically feasible. “It couldn't pass the United States Senate right now with Democrats. It couldn't pass the House,” he said. “Nancy Pelosi is one of those people who doesn't think it makes sense.”

— ABORTION: The candidates were asked about abortion rights in the final minutes of the debate. When asked if the Democratic Party has room for a rare antiabortion Democrat like Louisiana Gov. John Bel Edwards, Warren said: “Protecting the right of women is fundamentally what we do and what we stand for as a Democratic Party,” later adding “I have made clear what I think the Democratic Party stands for. I’m not here to drive anyone out of this party.” She tied abortion rights to economic rights and said when abortion is outlawed, “rich women will still get abortions.”

Booker tied abortion rights to voting rights. “If voter suppression were nothing but the myth Republicans claim it to be, Gov. Stacey Abrams would’ve taken her veto pen to Georgia’s ‘heartbeat’ abortion bill the day it arrived at her desk,” he said. 

Sanders called on men to be actively involved in pushing for abortion rights. “Let me just tell you if there’s ever a time where the men in this country must stand with women in this country, this is the moment.”

Klobuchar called for codifying Roe v. Wade into law. She said abortion rights would be a big issue in the general election and said Trump is “off the track on this and he will hear from the women of America.”

AHH, OOF and OUCH

AHH: The Trump administration is pushing consumers on the Affordable Care Act individual marketplace to use private brokers as they’re signing up for coverage. Those brokers can sell cheaper but skimpier short-term health plans that Democrats have termed “junk” plans because they don’t provide comprehensive coverage.

On Healthcare.gov, there’s a “short-term plans” tab that people can click with a list of cheaper plans, our Post colleague Yasmeen Abutaleb reports. According to screenshots, the site offers a phone number for consumers to call to finish signing up if they pick one of these short-term plans.

“Critics say that both the sale of short-term plans through private brokers and consumers’ ability to select such plans directly on the marketplace website are the latest examples of Trump administration efforts to weaken the ACA after failing to repeal and replace the law in Congress,” Yasmeen writes. Because the rule allowing the sale of these plans was finalized just weeks before the last open enrollment, it’s the first year they’re widely available. 

OOF: President Trump’s pick to take over the Food and Drug Administration would not commit to moving forward with the ban on flavored e-cigarettes during his confirmation hearing.

Stephen Hahn faced numerous questions about youth vaping from members of the Senate Health, Education, Labor and Pensions Committee, who appeared to use the hearing to send a message to the White House that they were unhappy with the move to backtrack on a flavored e-cigarette ban that the president previously touted, our Post colleague Laurie McGinley reports.

Hahn told senators he was not part of discussions on the policy but supported “aggressive action to protect our children.”

Sen. Doug Jones (D-Ala.) accused the nominee of avoiding questions on the ban. “I will tell you that I am less than happy with many of answers you gave on vaping and the potential ban on e-cigarettes,” he said. “I just don’t think it was you. I think it was prep from handlers.”

Committee Chairman Lamar Alexander (R-Tenn.) said the committee is planning to vote on Hahn’s nomination on Dec. 3.

— Meanwhile, Trump is set to meet with vaping industry and medical officials at the end of the week. The White House said the meeting will also include advocacy and nonprofit groups as well as state officials as the administration “moves forward” on a vaping policy, the Wall Street Journal’s Alex Leary reports.

“As the president has said, there is a serious problem among our youth and their growing addiction to e-cigarettes,” the White House said in a statement. “The policy making process is not stalled — it continues to move forward.”

OUCH: A new study found gun victims continue to suffer mental harm for years, even when their physical injuries are minor, our Post colleague William Wan reports.

Researchers at University of Pennsylvania assessed a decade of medical records, and surveyed 183 gunshot wound patients who survived out of 3,088 gunshot patients who were treated at the university’s trauma center. 

“One of the most alarming findings came from screening the patients for post-traumatic stress disorder (PTSD). Even years later, almost half of the patients screened positive for probable PTSD,” William writes. “And among those who had been discharged from the hospital for seemingly minor injuries, 33 percent screened positive for PTSD.”

“The report, published Wednesday in the journal JAMA Surgery, is part of a new wave of gun research that has grown after a decades-long drought of funding, data and political support,” he adds. “Recent mass shootings have injected energy into the long beleaguered field, and a new generation of gun researchers are trying new approaches to understanding and reducing gun violence. And in the continuing absence of substantial federal funding, new sources of money are popping up — from private donors and foundations, insurance companies and state-funded initiatives.”

HEALTH ON THE HILL

— Warren scored the endorsement of influential healthcare activist Ady Barkan, our Post colleague Amy B Wang reports.

Barkan, who has ALS, said in an endorsement video that Warren “has the brains and the brawn and the moral clarity to overcome the challenges that we face. I’ve seen up close how she confronts a problem. She listens to the people most affected, she does her homework and then she comes up with a plan. A brilliant, workable plan.”

The endorsement gave Warren a boost hours before last night’s debate. In an op-ed in the Nation, Barkan praised the recent plan Warren released to finance her health-care proposal and another proposing a transition phase before Medicare-for-all.

“Barkan, who has been in contact with the Warren campaign, praised each of those plans despite the controversy around them, facing harsh criticism online from supporters of Sen. Bernie Sanders (I-Vt.), with whom Barkan is still close,” Amy writes. “On Wednesday morning, Sanders signaled to his supporters they should back down from attacking Barkan.

— Progressive leaders have been meeting to strategize on how to move forward amid attacks on the Medicare-for-all movement, especially as centrist Democrats attack Sanders and Warren and as the two candidates have been pitted against each other over the differences in their plans. 

Rep. Pramila Jayapal (D-Wash.), the chair of the Congressional Progressive Caucus, called on Medicare-for-all supporters during a closed-door meeting to instead unite against those centrists, Politico’s Alex Thompson, Holly Otterbein and Alice Miranda Ollstein reports. Jayapal also said having progressive Democrats gripe over whether Warren’s plan is not as aggressive as Sanders’s will only hurt the cause.

“I understand that people have favorites,” Jayapal told Politico after that meeting. “We are better off having two strong presidential candidates endorsing Medicare for All than having one.”

She added it was important to direct any ire toward Democratic candidates who don’t support Medicare-for-all.

“The enemy here is not one or the other of them,” Jayapal said. “It is the entrenched interests, and the groups that are rallying around them, including some of our Democratic presidential candidates who are really doing a disservice to the American people.”

AGENCY ALERT

— Seema Verma, administrator of the Centers for Medicare and Medicaid Services, spent $3 million of taxpayer funds on high-paid consultants brought on as part of an unusual campaign to boost her profile.

“This work over 19 months that provided ‘strategic communication’ services by a network of politically connected contractors and subcontractors, first reported by Politico, came as Verma spoke about the importance of fostering individual responsibility and self-reliance among the nation’s needy,” our Post colleague Amy Goldstein reports.

There were at least two dozen strategic communications consultants that “helped guide Verma where she wanted to go politically, oversaw some decisions by communication staff and attempted to elevate her profile in ways that go beyond what federal consultants usually are hired to do — and possibly beyond what contracting law permits, according to the documents, individuals familiar with the team’s role and an expert on government ethics."

Verma said the consultants were hired because when she entered the administration, “my vision for the comms division was very different from what we had.” “It was 1 a.m., and I was writing press releases because we did not have that expertise,” she told reporters last week. “I wanted to make sure we were communicating with the patient population and the provider population.”

Rep. Joe Kennedy (D-Mass.) recently questioned Verma about the consultants during a hearing, calling it “highly inappropriate.” “The fact that you’ve got people with a long track record of political campaigns in consulting roles belies any protestations that these were . . . in the interest of pursuing widely held, bipartisan beliefs about health care,” he said.

— And here are a few more good reads: 

TRUMP TEMPERATURE

STATE SCAN

MEDICAL MISSIVES

INDUSTRY RX

DAYBOOK

Today

  • Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) will participate in a Committee for a Responsible Federal Budget event on health care.

SUGAR RUSH

Elizabeth Warren, Joe Biden, Bernie Sanders and seven other Democratic presidential candidates debated how to beat President Trump on Nov. 20 in Atlanta. (The Washington Post)