THE PROGNOSIS

Medicare-for-all is so last year.

Nearly all the Democratic presidential candidates began 2019 espousing a single-payer health-care system. One by one, they backed away as the year progressed. Now Sen. Bernie Sanders (I-Vt.) is the sole remaining candidate who could be regarded as a Medicare-for-all purist.

“I think the debate on Medicare-for-all has fundamentally shifted,” Ben Ritz, a director at the Progressive Policy Institute, told me. “None of the candidates except Bernie Sanders are comfortable walking themselves into his version of Medicare-for-all.”

The shift among the candidates raises the key question of whether Medicare-for-all is politically untenable in the Democratic Party today. There are signs that Democratic voters may not be as progressive as the candidates had originally guessed. “I think a lot of the presidential candidates misjudged the electorate and thought it was a lot more left than it was,” Ritz said.

Just look at how the candidates are now talking about — or not talking about — Medicare-for-all. 

Former South Bend, Ind., mayor Pete Buttigieg — who in February 2018 tweeted he “most affirmatively and indubitably” supports Medicare-for-all — is running an ad that characterizes Medicare-for-all as limiting choice for people. 

The spot promotes Buttigieg’s softer “Medicare-for-all-who-want-it” approach (which he rolled out in September) as one that would get everyone covered while preserving employer-sponsored coverage for those desiring to keep it.

“Medicare-for-all-who-want-it can work in a way that creates that public alternative, gets everybody covered,” the ad says. “Unlike the Medicare-for-all plan, it doesn’t dictate that to the American people and risk further polarizing them.”

The ad:

The ad has raised the ire of liberal leaders. Reps. Pramila Jayapal (D-Wash.), co-chair of the Congressional Progressive Caucus, called it a “misleading half-measure that will not fully address the enormous health care crisis in America.”

Buttigieg was presumably aiming straight at Sanders and Sen. Elizabeth Warren (D-Mass.) — although Warren has also done her own dance around the issue. 

“As the field continued to stay packed, there was a desire to differentiate themselves because it was no longer good enough to just raise your hand and say,' I’m with Bernie,' ” said Kavita Patel, a seasoned Democratic health wonk who worked for the Obama administration.

Warren had originally presented herself as Sanders’s closest ally on Medicare-for-all. But she wasn’t as forthright about whether it would mean higher taxes until last fall, when she proposed $20.5 trillion in new spending over a decade to pay for it.

Then, in another proposal that surprised many, Warren said she’d first create a government-backed “public option” plan and wouldn’t push for Medicare-for-all legislation until later in her presidency. That plan was viewed as a way to soften her stance on Medicare-for-all while still being able to claim she supports it.

Now, Warren rarely brings up Medicare-for-all on the campaign trail, the New York Times’s Astead Herndon recently reported from Des Moines.

“After months of attacks from other candidates, and questions and some blowback from both liberals and moderates, the most ambitious and expensive of Ms. Warren’s many plans — and the one most likely to transform the lives of voters — is just a passing mention in her standard stump speech, rarely explored in depth unless a questioner brings it up,” Astead writes.

Public support for Medicare-for-all dipped slightly last year, from around 57 percent down to 53 percent. More significantly, larger majorities say they oppose the idea if it means Americans would have to pay more in taxes or private insurance companies are eliminated.

It’s those two prospects — higher taxes and no more private coverage — that have haunted the Democratic candidates on the debate stage and the campaign trail. 

Sen. Kamala Harris (D-Calif.), who is no longer running for president, was another candidate who was forced to think more deeply about what Medicare-for-all could entail. She was advised by Patel, who presented her with some of Medicare-for-all’s hardest tradeoffs.

For example, paying doctors and hospitals less than they earn now would make Medicare-for-all more affordable for the government but also make providers scarcer. And taking away private insurance could undermine the work of unions and the benefits they negotiate.

“What I saw was her realizing ‘look, it’s not as black and white as we might want to paint it,’” Patel said.

Harris ultimately came up with a proposal similar to the current Medicare Advantage program, where people could buy a private insurance plan paid by the federal government to administer benefits. 

The field now consists largely of candidates who never supported Medicare-for-all to begin with – namely, former vice president Joe Biden and Sen. Amy Klobuchar (D-Minn.) – and candidates who stepped away from it. 

AHH, OOF and OUCH

AHH: The Trump administration and the coalition of red states challenging the Affordable Care Act told the Supreme Court it can wait on ruling on the health-care law until after the 2020 election. 

California and other states defending the law had called on the high court to expedite its review of a decision by the panel of U.S. Court of Appeals for the 5th Circuit, after the appeals court found the law's individual mandate unconstitutional and asked a lower court to decide whether the rest of the law can stand without it. They argue a final decision is needed, since the ACA remains in limbo and the health coverage of tens of millions of Americans is threatened.

“But President Trump’s solicitor general, Noel Francisco, replied that the decision simply preserved the status quo until a lower court looked more closely at which parts of the law should survive. It would be premature to intervene now, he said,” our Post colleague Robert Barnes reports

“The Fifth Circuit’s decision itself does not warrant immediate review because it did not definitively resolve any question of practical consequence,” Francisco wrote.

"The Supreme Court this month will select the final cases it will consider in its current term that ends in June," Bob writes. "Unless a majority of the court votes to expedite the request from the House and Democratic states, that would mean a final decision on the ACA would not come before November’s election."

OOF: A study published in JAMA Network Open found the expansion of Medicaid under the ACA may have saved up to 8,132 people from fatal opioid overdoses, mostly involving heroin and fentanyl, our Post colleague Lenny Bernstein reports. 

The research found increased access to drug-abuse treatment was linked to a six percent decline in overdose rate for expansion states compared with non-expansion states. The result was 1,678 to 8,132 fewer deaths in those expansion states between 2015 and 2017. 

“The new study appears to be the first to conduct a county-by-county examination of overdose deaths and Medicaid expansion. It found an 11 percent decline in the death rate from heroin overdoses and a 10 percent drop in deaths from illegal fentanyl and its analogues,” Lenny writes. “…The study found no link between Medicaid expansion and declines in overdose deaths from prescription narcotics.” 

OUCH: This season’s flu vaccine has been a poor match for severe flu infections sickening children, our Post colleague Lena H. Sun reports. The Centers for Disease Control and Prevention reported there were five pediatric deaths in the week ending Jan. 4, for a total of 32 such deaths since the beginning of the season. 

This season, flu activity began earlier than usual, and an influenza B strain has been dominating in most parts of the country, whereas usually an A strain dominates in early months. 

“Flu hit hard in the South with influenza B before spreading to much of the rest of the country. It’s the first time in nearly three decades that an influenza B strain has been the dominant circulating flu virus in the United States,” Lena writes. “Generally, that type of virus isn’t as dangerous to people 65 and older, who make up the majority of flu hospitalizations and deaths. But the B virus is more likely to cause complications in children and younger adults than in the elderly.” 

She adds that while flu viruses constantly change, “health officials must choose the influenza strains that vaccine makers should target for an upcoming season months in advance, when it is hard to know what strains might be circulating … The vaccine should still be useful, however. Although the circulating virus is genetically different from the influenza B virus in the vaccine, CDC officials said the two are similar.”

REPRODUCTIVE WARS

— New research from the University of California at San Francisco examined women’s long-term feelings following an abortion – starting at one week following the procedure and then twice yearly after that. It was part of a look at the physical, social, emotional and economic impacts abortion has on women. 

“What they found was a surprise: Over time, all emotions, good and bad, faded,” our Post colleague Ariana Eunjung Cha reports. “A week after their abortions, about 51 percent of women expressed mostly positive emotions, 17 percent expressed negative emotions and 20 percent said they had none or few. As time went by, the number who felt few or no emotions rose sharply. At the five-year mark, 84 percent reported either primarily positive emotions or none at all, while 6 percent had primarily negative feelings. There was ‘no evidence’ of new negative or positive emotions, the authors said.” 

After five years, 99 percent of women said they made the right decision. That’s compared with 95 percent who said they made the right decision immediately after their abortions. 

TRUMP TEMPERATURE

— The Trump administration is working on a proposal to tighten eligibility requirements for disability benefits, changing the considerations for age, education and work experience as the White House furthers its push to reduce the federal safety net, the Wall Street Journal’s Kate Davidson reports

The plan could be the “first significant overhaul of the way age, education and experience are considered in evaluating disability since the criteria were established in 1978.” 

“Under current rules, workers qualify for disability if they have a severe condition that is on a list of impairments recognized by the agency, such as leukemia and chronic heart failure. If the condition isn’t on the list, the agency then considers age, education and past work experience to determine whether an applicant is able to do another type of job. Workers above the age of 50 are more likely to qualify because they are considered less able to adapt to new jobs,” Kate writes. 

But the new rule would no “longer assume age seriously affects a person’s ability to adapt to simple, entry-level work. It would raise the age at which education and work experience are considered in determining eligibility to 55, from 50. The new rule would also update data on occupational skills that the agency uses to determine eligibility, based on new information from the Bureau of Labor Statistics.” 

— And here are a few more good reads:

HEALTH ON THE HILL

Momentum for aggressive tobacco regulation has grown as teen vaping rates skyrocket.
Politico
Several candidates have embraced presidential candidate and Sen. Cory Booker’s (D-N.J.) Marijuana Justice Act, which would legalize marijuana federally and expunge the records of individuals imprisoned on pot-related charges.
Kevin Uhrmacher

AGENCY ALERT

Two fathers who were separated from their children at the U.S.-Mexico border as a result of the Trump administration’s policies are suing the government for $12 million, claiming the children were subject to abuse a
The Hill

MEDICAL MISSIVES

Health
Warnings about e-cigarettes have taken on new urgency in recent weeks as authorities scramble to understand a rash of mysterious vaping-linked illnesses that have put healthy people in the hospital with serious lung diseases.
Hannah Knowles and Lena Sun
Higher Education
An investigation into the Massachusetts Institute of Technology's ties to disgraced financier Jeffrey Epstein found that three top administrators showed errors in judgment in accepting gifts, but did not violate university policy.
Susan Svrluga and Carolyn Y. Johnson
Helen Obando is the youngest person ever to get a gene therapy that scientists hope will cure the disease, which afflicts 100,000 Americans.
New York Times

STATE SCAN

At issue is an Arkansas law that governs the reimbursements rates that pharmacy benefit managers, or PBMs, must pay to pharmacies.
Stat
Virginia Politics
The policy will be enforced for visitors but less so for sitting lawmakers, a Capitol Police official said.
Laura Vozzella and Gregory S. Schneider
Local
The organization overhauled its leadership, but on the eve of its fourth march, experts say the group might be a victim of its own success — or failures.
Marissa Lang

INDUSTRY RX

Innovations
Women have long felt the pressure of looking the part. Now men are feeling it, too.
Peter Holley

DAYBOOK

Coming Up

  • The House Homeland Security Subcommittee on Border Security, Facilitation, and Operations holds a hearing on “Assessing the Adequacy of DHS Efforts to Prevent Child Deaths in Custody” on Tuesday.
  • The House Financial Services Committee holds a hearing on “How the Affordable Housing Crisis and the Gentrification of America Is Leaving Families Vulnerable” on Tuesday.

SUGAR RUSH