THE PROGNOSIS

Federal workers interested in starting a family might consider waiting 10 months.

Under a defense spending bill Congress is poised to approve, more than 2 million Americans who work for the federal government will be guaranteed paid leave for the birth, adoption or foster care of a child for the first time ever, starting Oct. 1, 2020. The House has teed up a vote today, followed by likely Senate passage and a signing by President Trump next week.

The new benefit — though it was whittled down from what House Democrats originally wanted — represents a major step for the United States on an issue where it lags behind every other advanced economy in the world. Paid family leave has recently enjoyed more attention from lawmakers — even some Republicans and the White House — but there’s been little real action until now.

Democrats say they pushed to get the provision included in the defense bill by leveraging it against Trump’s desire for adding a Space Force as a sixth branch of the military, as my Washington Post colleagues detailed over the weekend. It would ensure federal employees are paid at 100 percent of their salary while taking the 12 weeks of parental leave they’re already guaranteed under the law.

“If this agreement is signed into law, it will be a tremendous victory for the more than 2.1 million employees across the country,” House Oversight Committee Chairwoman Carolyn Maloney (D-N.Y.) said at a hearing yesterday on the topic of paid leave.

“Parents finally will be able to have a baby without worrying about their paychecks suddenly coming to a halt,” she said.

Sen. Chuck Schumer (D-N.Y.): 

Sen. Maggie Hassan (D-N.H.): 

In a statement yesterday, the White House press secretary called the paid-leave provision one of the president's “priorities” and said she hopes Congress will send Trump the defense bill to sign.

House Democrats took an initial swing at the issue over the summer, passing more extensive language from Maloney within a July defense spending bill opposed by every Republican. It would have included 12 weeks of paid leave for a federal employee taking off work because of their own medical needs or those of a family member.

But negotiators stripped out medical leave from the current bill, which grants $658 billion to the Defense Department and other defense programs. That was disappointing to women’s advocates, who have pushing the issue for years.

“It’s really unfortunate the comprehensive leave was cut out,” Jessica Mason, a senior policy analyst for the National Partnership for Women and Families, told me yesterday. But she said the provision is nonetheless “an exciting signal on both sides of the aisle there is finally an appetite to tackle the paid-leave crisis in this country.”

Republicans, traditionally opposed to guaranteed paid parental leave, have shown a new openness to the idea during the current administration. They’ve been proposing unconventional ways of providing it, such as modest bipartisan legislation from Sen. Bill Cassidy (R-La.) that would allow families to collect future child tax credits early. 

Sens. Marco Rubio (R-Fla.), Mitt Romney (R-Utah) and other Republicans have introduced bills allowing new parents to collect Social Security benefits early and receive less when they retire. And conservative Rep. Chris Smith (N.J.) became the first Republican to co-sponsor a broad family leave bill that many Senate Democrats have championed.

Ivanka Trump is holding a summit at the White House this week to discuss the issue (although she has reportedly not invited the Democratic sponsors of the Senate bill).

Yet there’s still GOP opposition to even the pared-down provision in the defense bill. My Post colleague Jeff Stein reports: “Sen. Ron Johnson (R-Wis.), chairman of the committee that oversees government affairs, said he opposed the expansion of the federal benefit but does not expect to be able to stop it.

“ ‘I think it’s a done deal,’ Johnson said, adding that the provision has key national security measures he thinks should be approved. ‘I think it’s unfortunate. I think it sets a very dangerous precedent,’ he added, referring to the leave benefit.”

Bloomberg Newss Steven Dennis: 

Romney and Republican Sens. John Barrasso (Wyo.) and Roy Blunt (Mo.) also told Jeff they’re prepared to support the defense bill, dubbed the National Defense Authorization Act.

“I don’t think it stops the NDAA from passing. I’m certainly supportive of it,” said Blunt, a member of Senate Republican leadership.

Rep. Matt Gaetz (R-Fla.) is giving Ivanka Trump credit for the inclusion of family leave:

The National Partnership for Women and Families: 

AHH, OOF and OUCH

AHH: The U.S. Court of Appeals for the D.C. Circuit ruled the Food and Drug Administration may regulate e-cigarette products like it does conventional cigarettes. The three-judge panel unanimously rejected arguments from the e-cigarette manufacturer that brought forward the case and said such products are “indisputably highly addictive and pose health risks, especially to youth, that are not well understood.” 

The case was meant to determine whether the federal agency could regulate e-cigarettes as “tobacco products” and apply the same rules and regulations, our Post colleague Ann E. Marimow reports.

“In a 48-page opinion, the judges also disagreed with the industry’s position that the ban on the distribution of free samples of tobacco products, including e-cigarettes, is unconstitutional and violates the First Amendment,” Anne writes. 

Dennis Henigan, vice president of legal and regulatory affairs for the Campaign for Tobacco-Free Kids, called the ruling a “triumph for public health” and a “resounding judicial endorsement of the need for strong regulation of e-cigarettes.”

OOF: More top Trump officials are getting involved in the ongoing feud between Health and Human Services Secretary Alex Azar and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. 

Acting White House chief of staff Mick Mulvaney has called on the pair to attend a conflict resolution session at the White House, and Trump may attend the meeting, too, Axios’s Caitlin Owens and Jonathan Swan report.

The meeting is tentatively set for Thursday and is meant to be an “assessment of whether or not both of them are capable of working together like adults,” an official told Axios.

Politico’s Rachana Pradhan and Adam Cancryn also report that officials say “Azar and Verma must either pledge to make amends or otherwise resolve a conflict that's threatening Trump's health agenda and complicating his reelection prospects. Vice President Mike Pence already met separately with Azar and Verma this month, and Trump had a private meeting with Verma in mid-November.” 

— Verma reportedly hired a lawyer to bring complaints that her former boss, ex-HHS secretary Tom Price, created a hostile work environment, Rachana, Adam and Politico’s Dian Diamond report. But a spokesman for the administrator denies that she did so. 

“Verma’s alleged accusations about Price were outlined in an August 2017 memo based on an exit interview conducted with Brian Colas, who briefly served as Verma’s chief of staff that year,” they write. The memo stated Verma had “hostility and anger toward Secretary Price.” 

But a CMS spokesman denied the allegations, saying, “The administrator and then-Secretary Price had a fine working relationship.” The spokesman added: “These recent leaks are part of a targeted campaign to smear the Administrator and undermine the accomplishments of CMS. 

OUCH: House Speaker Nancy Pelosi (D-Calif.) reached a deal with progressive leaders to support her drug pricing bill ahead of a Thursday vote, Adam and Politico’s Sarah Ferris report.

Pelosi met with Congressional Progressive Caucus co-leaders Pramila Jayapal (D-Wash.) and Mark Pocan (D-Wis.) in a closed-door meeting yesterday to reach the tentative deal. 

The deal “includes an agreement to expand the government’s authority to directly negotiate drug prices under the legislation, ultimately requiring federal officials to hammer out the cost of at least 50 medicines a year, from the original 35,” they write. “… Top Democrats are also restoring a progressive provision previously cut from the bill that would mandate the federal government eventually issue regulations restricting drugmakers’ ability to raise prices above the rate of inflation in workplace health plans, the largest source of coverage in the country.” 

Democratic leaders had been worried about a revolt from the progressive faction of the party. 

Earlier in the day, before leadership brokered an agreement, Rep. Alexandria Ocasio-Cortez (D-N.Y.) told reporters she was planning to vote against the measure. “We need to flex our muscle,” she said. “We're the largest caucus in the Democratic Caucus, and I think that we should act like it.”

After the deal, Jayapal told Politico she feels “really good” about the bill. 

INDUSTRY RX

— In a hearing yesterday, the Supreme Court seemed open to the argument that insurers should get $12 billion from the federal government to cover losses from the early years of participating in the marketplaces created by the Affordable Care Act. 

During a lively hour-long argument, several justices suggested that the government had reneged on a promise, suggesting they may rule in favor of the insurers — who claim they are the victims of a ‘bait and switch of staggering dimensions,’ CNN’s Ariane de Vogue reports

In the early days of the Affordable Care Act, insurers agreed to offer lower premiums to encourage participation in health care exchanges because the law guaranteed partial reimbursement for their losses, she adds. But the payments never came after Congress, then controlled by Republicans, ultimately declined to appropriate the money.

The dispute over whether the government is obligated to keep its word on making the payments comes as a federal appeals court is separately weighing whether to strike down the entire health-care law. An opinion in the case will likely come in several months. By then, the fate of the entire law might be in question depending upon how an appeals court rules in the separate challenge, Ariane writes.

AGENCY ALERT

— Dozens of people, including doctors that practice in California, marched to a U.S. Customs and Border Protection facility in Southern California this week seeking to get approval to give flu shots to detained migrant children. 

The doctors and other marchers held signs that read “No more flu deaths,” a reference to the three children whose deaths in federal immigration custody last fiscal year were related to the flu. Some demonstrators said they wouldn’t leave until they were allowed to enter and provide the vaccinations, the Los Angeles Times’s Wendy Fry reports.

The CBP issued this response: “It has never been a CBP practice to administer vaccines and this not a new policy,” the statement read in part. “Individuals in CBP custody should generally not be held for longer than 72 hours in either CBP hold rooms or holding facilities. ... As a law enforcement agency, and due to the short-term nature of CBP holding and other logistical challenges, operating a vaccine program is not feasible.”

The demonstrators were members of Doctors for Camp Closure, Families Belong Together and Never Again Action. One doctor told the Los Angeles Times it would take less than 30 minutes to administer the flu vaccines to more than 100 children. 

— And here are a few more good reads: 

Politics
The list includes Blue Cross Blue Shield of Michigan and the Department of Defense, among other government agencies.
Chelsea Janes and Amy Wang
"Medicare for All" supporters scored a victory Tuesday with a long-awaited hearing in one of the House's most powerful committees, putting more focus on the health care proposal that has divided the field of 2020 Democratic presidential candidates
The Hill
Business
Americans are delaying treatment of serious medical conditions in record numbers because of out-of-pocket costs, Gallup research shows.
Christopher Ingraham

HEALTH ON THE HILL

The newly unveiled deal, commonly known as USMCA, will not have any protection for high-tech biologic drugs, which are made from living cells.
Stat

STATE SCAN

New York Life is negotiating with Cigna to acquire a unit that sells life, accident and disability-income insurance to employers.
Wall Street Journal

DAYBOOK

Today

  • The Senate Indian Affairs holds a business meeting to consider various legislation. 

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a business meeting to consider various legislation on Thursday. 

SUGAR RUSH