with Meryl Kornfield


Former vice president Joe Biden was supposed to be the favorite among Democrats who think Medicare-for-all is too extreme.

But in Iowa, Pete Buttigieg seized those voters.

The former South Bend, Ind., mayor is at the front of the Democratic pack after his surprisingly robust finish in the Iowa caucuses. While the results still aren’t complete, Buttigieg essentially tied with Sen. Bernie Sanders (I-Vt.), showing he’s a viable candidate who could pick up more momentum in next Tuesday's New Hampshire primary.

Buttigieg didn’t do it as the Medicare-for-all candidate. He did it as the Medicare-for-all-who-want-it candidate.

Sanders was the clear favorite among Iowa caucuses-goers who prefer a single-payer health-care system. But Buttigieg nabbed the largest share of voters who are leery of replacing all private plans with government coverage.

That addition of three key words to the description of Buttigieg's health plan “who-want-it” represented a strategic pivot for Buttigieg when he started using the phrase early last year. It was almost as though the Democrat anticipated the tricky questions Sanders and other Medicare-for-all candidates would face about paying for such a sweeping overhaul of the U.S. health-care system and whether people would lose their workplace coverage.

Buttigieg staffers insist they were focused solely on policy while writing the proposal — regardless of any positive side effects of saving Buttigieg from the political potholes into which Sanders and Sen. Elizabeth Warren (D-Mass.) have stumbled on the issue.

“When we were writing his plan, we didn’t read any polls,” the campaign’s policy director, Sonal Shah, told me yesterday. “We were focused on how do we get to quality coverage. ”

But Buttigieg has qualified his position since then. He entered the presidential primary race in January 2019 saying he favored the Medicare-for-all-style system originally envisioned by Sanders. Eleven months prior, he  tweeted that he “most affirmatively and indubitably” supports Medicare-for-all.

Buttigieg soon started speaking about health care in a more nuanced way, stressing he didn’t want to eliminate private plans Americans might like and want to keep. Polls show that while a majority of voters like the idea of a national health plan, support declines if they’re told it would end private coverage options.

— In February, Buttigieg told ABC News’s George Stephanopoulos the country should start with “Medicare-for-all-who-want-it” by making a government plan available in the individual marketplaces.

“You can try before you buy, so to speak, as a country,” Buttigieg said.

— By the first presidential debate in June, Buttigieg was regularly contrasting his “Medicare-for-all-who-want-it” approach with the single-payer system espoused by his opponents.

“You take something like Medicare, a flavor of that, you make it available on the exchanges, people can buy in,” Buttigieg said. “And then if people like us are right, that that will be not only a more inclusive plan, but a more efficient plan than any of the corporate answers out there, then it will be a very natural glide path to the single-payer environment.”

By staking out this position so early in the campaign season, Buttigieg didn’t fall prey to some of the accusations of flip-flopping that have plagued Warren. Warren, who says she wants Medicare-for-all, qualified her position last fall by saying she wouldn’t push for it until the third year of her presidency.

“I think it was so early people didn’t know who he was and he wasn’t defined as doing any kind of flip-flopping,” said Chris Jennings, a longtime Democratic adviser and health-policy expert. “He was able to tell people what his policy was before people could frame it differently.”

Under Buttigieg’s plan, which he detailed in September, anyone would be allowed to buy a government-backed “public option” plan on the individual marketplaces with benefits at least as generous as the private plans sold there. This public option would probably be cheaper than private plans because the government would have more leverage to pay doctors and hospitals lower rates.

A campaign video describing Medicare-for-all-who-want-it:

Buttigieg also wants to make private marketplace plans more affordable. He has proposed providing more generous federal subsidies by pegging them to the cost of more generous “gold” plans instead of less-generous “silver” plans under the Affordable Care Act. He would also cap premiums at 8.5 percent of income, regardless of how much an enrollee earns.

The proposal is similar to Biden's own — so similar, in fact, that he has accused Buttigieg of stealing his idea.

Biden appeared agitated yesterday, acknowledging his presidential campaign received a “gut punch” in the caucuses. 

“I am not going to sugarcoat it,” he told a crowd at a VFW hall in New Hampshire, my Washington Post colleague Cleve R. Wootson Jr. reports. “We took a gut punch in Iowa. The whole process took a gut punch. But look, this isn’t the first time in my life I’ve been knocked down.”

Buttigieg appears to have been the second-choice candidate of Iowans whose first choice in the caucuses failed to meet the threshold qualifying them during the first round of those contests.

Warren supporters forced to make a second choice were as likely to move to Buttigieg as to Sanders, according to this analysis by my Post colleague Philip Bump. Supporters of Sen. Amy Klobuchar (D-Minn.) went mostly to Biden and Buttigieg. Biden supporters went mostly to Buttigieg.

“Over and over, Buttigieg was the second choice of choice, so to speak,” Philip rites. “Tallying losses and gains across the field, Buttigieg gained the most support as a second pick, followed by Klobuchar. Yang saw the biggest erosion of support — and didn’t gain much support as a second pick.”


AHH: The Supreme Court will discuss whether to take up the legality of Obamacare at its Feb. 21 private conference, after turning down a chance in January to fast-track a case challenging the ACA.

A coalition of Democratic-led states asked the court last month to consider tackling the case during its current term, our Post colleagues Amy Goldstein and Robert Barnes report. California Attorney General Xavier Becerra, who was among the those who asked the case be heard, said that for the sake of ending uncertainty in our healthcare system and saving lives, we're hopeful the Supreme Court will decide to swiftly resolve this repeal lawsuit.

Several conservative states, including Texas, wrote the court on Monday, asking for it to hold off deciding, the Hill reports

In December, the U.S. Court of Appeals for the 5th Circuit ruled the federal government couldn’t constitutionally mandate states provide health insurance coverage, Goldstein reported previously. But the three-judge panel punted on how much of the rest of the law to send back to a lower court. Democrats are hoping for a Supreme Court ruling before the November election.

A legal reporter for Bloomberg Law:

OOF: With a partial ban on flavored e-cigarettes taking effect today, the heads of major e-cigarette makers weren’t excited about facing lawmakers’ scrutiny in yesterday's hearing on youth vaping.

Instead, the corporate executives pointed fingers at one another as they testified before the House Energy and Commerce Committee’s Oversight and Investigations subcommittee.

Jay Loftin, president of Logic Technology Development, said the business practices of some manufacturers “have caused tremendous damage to the reputation of this important category” but did not mention names. I do not wish to be painted with the same brush as others.

Hill reporter Nathaniel Weixel:

The executives from Juul, Logic, NJOY, Fontem (Blu) and Reynolds American (Vuse) played defense, saying their companies were trying to do better and contending their products could help adult smokers quit. The executives argued they had no motive to target youth. 

Guy Bentley, director of Consumer Freedom, a libertarian think tank:

Lawmakers didn't agree. “The industry caused this mess and the industry needs to be responsible for cleaning it up,” said Rep. Diana DeGette (D-Colo.), the subcommittee's chairwoman.

The morning of the hearing, the House Oversight Economic and Consumer Policy subcommittee released a 46-page memo detailing how Juul marketed itself to Native Americans, BuzzFeed News reports. Juul visited reservations and pitched its products.

Sarah Owermohle, Politico's drug and tobacco reporter:

Democrats blasted the Trump administration’s partial vape ban, saying it’s riddled with loopholes and won’t be effective in curbing underage vaping. 

The policy bars sales of fruit-, dessert- and mint-flavored pods but not sales of tobacco- and menthol-flavored cartridges, our Post colleague Laurie McGinley reports. It also exempts disposable flavored e-cigarettes which come in an array of teen-appealing flavors and often have high nicotine concentrations as well as thousands of flavored e-liquids and open-tank systems that are used more often by adults. 

Some Republican lawmakers focused on a different issue — the possibility that flavor bans can spur the rise of a black market that might raise safety risks for consumers.

OUCH: The 12th case of coronavirus in the U.S. was confirmed in Wisconsin on Wednesday. China has reported more than 560 coronavirus deaths and 28,000 confirmed cases.

In a heated closed-door briefing yesterday, members of Congress confronted Health and Human Services Secretary Alex Azar and other Trump administration officials about their response to the outbreak, our Post colleagues Erica Werner and Yasmeen Abutaleb report. Senators from Hawaii complained health officials from their state didn’t know in advance that their airport would need to be ready to quarantine U.S. citizens returning from China.

Yet the administration has drastically stepped up its response to the growing coronavirus outbreak.

"Last week, the administration declared the virus a public health emergency; began on Sunday barring non-U.S. citizens who recently visited China from entering the United States, subject to a few exemptions; said it would quarantine any Americans who had visited China’s Hubei province, the epicenter of the outbreak, within the last 14 days; and would require screening and self quarantines for Americans who had recently visited other parts of China," Erica and Yasmeen write.

Azar is leading an administration task force overseeing the coronavirus response that is composed of top officials from the White House and other agencies. And federal health officials have worked closely with states, even shipping coronavirus test kits to more than 100 state labs on Wednesday, the Post's Lena H. Sun reports

American returning have faced paperwork, delays and other challenges to get home, Siobhán O'Grady, Lenny Bernstein, Anna Fifield and William Wan report. Once they get here, they're being quarantined for 14 days in hotels on military bases, as authorities wait to see whether anyone has the virus.

"One flight delivered 178 people to Travis Air Force Base outside Sacramento. The other landed there, then went on to Marine Corps Air Station Miramar in San Diego, where about 170 people exited. Two more flights are leaving Wuhan and arriving in the United States on Thursday. An additional 195 people who arrived Jan. 28 are quarantined at March Air Reserve Base in Riverside, Calif," our colleagues write.

— The House Foreign Affairs subcommittee on Asia, the Pacific and Nonproliferation held a hearing Wednesday regarding the outbreak and response, asking experts to weigh in. Jennifer Nuzzo, an epidemiologist and senior scholar at Johns Hopkins University’s Center for Health Security, argued the travel restrictions the U.S. government has implemented would do little to stop the spread of the virus given its speed. 

“I am concerned by our singling out China for travel bans we are effectively penalizing it for reporting cases,” Nuzzo told lawmakers. “This may diminish its willingness to further share data and chill other nations' willingness to be transparent about their own outbreaks.”


After trace amounts of asbestos were found in Johnson & Johnson’s baby powder, the Food and Drug Administration is considering testing for the carcinogen in talc products, Reuters reports. Johnson & Johnson maintains its products are asbestos-free. 

The agency held a hearing Tuesday on testing for asbestos in talc, which is the first time the issue has been considered since 1971. The meeting was focused on recommended testing standards.

Despite denials from Johnson & Johnson, plaintiffs in multiple lawsuits against the company allege it knew its products could cause cancer, The Post previously reported.


— Executives of large health-care systems are asking the Trump administration to modify proposed new rules making it easier for patients to access their own health-care data. Azar has said the rules, which are currently being reviewed by the White House, are intended to enable patients to view their electronic health records at no cost.

But the CEOs of more than 60 health systems are arguing the new rules would be overly burdensome for providers and could endanger patient privacy, according to a letter provided to Health 202. They want Azar to narrow the regulations and give them more time to comply.

“Specifically, the scope of regulated data, the timeline for compliance, and the significant costs and penalties will make it extraordinarily difficult for us to comply, and there is potential for misuse of patient and family member information,” the executives wrote. 


— Makers of car seats for children have marketed their products as safe despite their own testing that showed children could be in grave danger if they were in a crash, ProPublica reports.

ProPublica’s investigation focused on Evenflo, a company labeled their booster seats as “SIDE IMPACT TESTED” without revealing that there was no regulation it needed to follow to indicate that. In the company's own tests, child dummies were tossed from the seats with the side impact feature, according to video of the tests obtained by ProPublica.

Nearly two decades ago, Congress told the National Highway Traffic Safety Administration to develop rules for car seats that minimize children’s head injuries in side-impact collisions. But regulators never created standards for the tests run on these products, allowing companies to devise tests that they knew they could pass, ProPublica writes. 


It is difficult to get opioid treatment medication buprenorphine in some of the areas of the country most impacted by addiction, a report HHS's Office of Inspector General found, NPR reports.

Doctors specializing in addiction are often not in the rural areas that were hardest hit during the opioid crisis. NPR writes 40% of counties across the country don't have a single provider who is approved to prescribe buprenorphine.

Along with counseling and behavioral therapy, taking a drug like buprenorphine can greatly increase the likelihood people remain drug-free.


Coming up:

  • The New Hampshire Democratic debate will be held Friday.
  • The Supreme Court will considering hearing a case that could settle the face of the Affordable Care Act at its conference on Feb. 21.


Robin, a resident of Wuhan, posts videos of what life is like in a quarantined city. (Bloomberg)