The Health 202: Single-payer health care gets a second Captiol Hill hearing today.

Published in Politics
3 weeks ago   by Paige Winfield Cunningham

THE PROGNOSIS

Medicare-for-all is poised for another big day on Capitol Hill, as the House Budget Committee convenes this morning to examine the intricacies and challenges of any U.S. transition to a unified health-care system run by the government.

As in a similar House Rules Committee hearing last month, there will be plenty of back-and-forth between Democrats and Republicans over whether a single-payer system would be a good idea at all. The GOP members, who have been chomping at the bit to put Democrats on the spot over Medicare-for-all, will charge that such a system would hurt access to care, worsen the care itself and cost the government way too much money to administer.

House Budget Committee ranking Republican Steve Womack (Ark.):

But today’s hearing is also the perfect opportunity for Democrats to dive deep into the nitty-gritty logistics of setting up such a system, given that they’ll be hearing from three Congressional Budget Office analysts who recently completed a report on the highly complicated subject — one that raised more questions than it gave answers.

The Democrat running the hearing, House Budget Committee Chairman John Yarmuth (D-Ky.), isn’t exactly a Medicare-for-all crusader. He has voiced some skepticism of the sweeping Medicare-for-all bill from Rep. Pramila Jayapal (D-Wash.) and last week told my Washington Post colleague Dave Weigel there’s no “sense of urgency” to move on the legislation “because it’s not going anywhere.”

So Yarmuth is likely to raise some serious questions around single-payer systems — such as how to pay for the whole thing and what benefits it should cover — while stressing that Democrats share an overarching goal of closing the gap of uninsured people and making coverage more affordable for everyone else, even if they don’t agree on Medicare-for-all.

“Too many American families still must make the impossible choice between going to the doctor or putting food on their table; filling their gas tank or refilling a prescription,” Yarmuth plans to say in his opening statement, shared in advance with The Health 202.

“We cannot accept this tragic reality as the status quo. Progress must produce more progress, and we must begin to pursue the next wave of health care reforms.”

As we’ve written, the CBO report on single-payer systems laid out many pros and cons of moving everyone to a government-run health plan, but it didn’t offer many specifics. It reads more like a list of the questions Congress would need to answer in passing a Medicare-for-all system.

But there is a relatively extensive analysis of Medicare-for-all, completed by the University of Massachusetts at Amherst at the end of last year. This 200-page report focuses on the very first Medicare-for-all bill introduced in 2017 by Sen. Bernie Sanders (I-Vt.) and is much more extensive than oft-cited analysis from the Urban Institute and the Mercatus Center (we’ve written about those reports here).

The University of Massachusetts analysts reached mostly positive conclusions about the effects of Medicare-for-all once implemented -- although it's important to remember they had to make lots of assumptions that might not necessarily bear out in real life. Here’s a brief synopsis of their conclusions:

1. It would lower costs for people at lower and middle incomes and increase costs for those at higher incomes.

Middle-income families would see their net costs for health care fall by 2.6 percent to 14 percent of their income. Net costs would rise an average of 3.7 percent of income for the top 20 percent of income-earners and 4.7 percent of income for the top 5 percent of earners, the researchers found.

2. Businesses could also save on health-care costs. Sanders has proposed increasing payroll taxes or enacting a gross receipts tax to help pay for the plan, but the higher taxes would be offset by savings from employers not having to pay premiums. The researchers estimate their health-care costs could fall between 8 and 13 percent.

3. Americans would consume more health-care services. People would presumably use more services if they aren’t charged a co-pay, as Sanders has suggested. The researchers estimate that would increase demand by 12 percent.

4. But costs overall would fall by 19 percent relative to the current system because a government plan could achieve savings that private insurers can’t. The researchers estimate a Sanders-style system would reduce administrative costs by 9 percent, pharmaceutical prices by 5.9 percent, and payments to hospitals, physicians and clinics by 2.8 percent.

Overall, the researchers emerged with a favorable analysis of Medicare-for-all. “The most fundamental goals of Medicare for All are to significantly improve health care outcomes for U.S. residents while also establishing effective cost controls throughout the health care system,” they wrote. “We conclude that these two purposes are both achievable.”

AHH, OOF and OUCH

AHH: A coalition of two dozen states and cities, led by New York Attorney General Letitia James, has sued the Trump administration over a federal rule giving health-care providers, insurers and employers the protections  to refuse to provide or pay for medical services, such as abortion, they say violate their religious or moral beliefs.

The lawsuit alleges the “conscience protections” favor health-care workers’ views over patient needs, our Post colleague Amy Goldstein reports. In a separate lawsuit, California Attorney General Xavier Becerra (D) alleges the rule “impedes access to basic care” and “encourages discrimination against vulnerable patients,” such as women and LGBTQ individuals. The rule is scheduled to take effect in late July.

“The suits, plus one brought earlier this month by the city of San Francisco, seek to block the rule, announced by President Trump early this month and published Tuesday in the Federal Register. It allows individuals and entities to refrain from delivering or paying for services such as abortion, sterilization or assisted suicide if they have a religious or moral objection to them,” Amy writes. The rule is part of a series of actions by the administration has taken to “appeal to Christian conservatives, a constituency that is part of Trump’s political base.”

OOF: A new poll from NPR found many people living in rural areas across the country are struggling with finances and with access to medical care.

The survey, conducted with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, found 49 percent of rural Americans acknowledge they could not afford to pay an unexpected $1,000 expense of any type. The poll also found 40 percent struggle with routine bills related to food, housing and medical expenses.

Just over a quarter of those surveyed said they have at some point in recent years not been able to get health care when they needed it, even as 87 percent said they had some sort of health insurance. Of the 26 percent who said they couldn’t get health care when they needed it, the poll found 45 percent couldn’t afford the care, while 23 percent said the location of health services was too far away or difficult to get to and 22 percent had trouble getting an appointment.

“At a time when we thought we had made major progress in reducing barriers to needed health care, the fact that 1 in 4 still face these barriers is an issue of national concern,” Robert J. Blendon, co-director of the survey and professor of health policy and political analysis at the Harvard T.H. Chan School of Public Health, told NPR.

OUCH: A Mississippi federal judge expressed frustration toward a recent state law prohibiting abortions once a fetal heartbeat is detected, or as early as six weeks of pregnancy.

During a hearing about the law, set to take effect July 1, U.S. District Judge Carlton Reeves pointed out that he had struck down a 15-week abortion ban just six months ago, suggesting the new law's passage “smacks of defiance” to the court, our Post colleague Reis Thebault reports.

“And defiance may be the point,” Reis writes. “Mississippi’s law… is part of a nationwide barrage of restrictions, pushed for by the religious right and meant to challenge the Constitution and force the Supreme Court to reconsider its ruling in Roe v. Wade. In most cases, the goal is not a law’s enaction, but the legal challenges and appeals that could pave a path to the high court and its conservative majority.”

Reeves said he would issue a ruling on the law soon.

REPRODUCTIVE WARS

— Hundreds gathered outside the Supreme Court yesterday, including abortion rights supporters and candidates for the 2020 Democratic presidential nomination, to demonstrate against the wave of recent abortion bans that have passed in the states.

“We are not going to allow them to move our country backward,” Sen. Amy Klobuchar (D-Minn.), a presidential contender, told a gathered crowd, Reuters’s Amanda Becker and Jonathan Allen report.

Sen. Kirsten Gillibrand (D-N.Y.), another 2020 contender called the “outrageous bans” the “beginning of President Trump’s war on women.” “If he wants his war, he will have his war, and he will lose.”

Others vying for the 2020 nomination including Sen. Bernie Sanders (I-Vt.), Sen. Cory Booker (D-N.J.) and South Bend, Ind. Mayor Pete Buttigieg also gathered outside the Supreme Court.

The rally was one of many scheduled yesterday across the country, planned as #StopTheBans rallies and organized by abortion rights groups including NARAL Pro-Choice America, Planned Parenthood Action Fund and American Civil Liberties Union

From Planned Parenthood president Leana Wen

— The research arm of the antiabortion group Susan B. Anthony List says it has found evidence that medication abortions are on the rise, causing overall abortions in the United States to decrease at a slower rate than in years past. According to the Charlotte Lozier Institute, 2017 abortion data reported to the Centers for Disease Control and Prevention by 32 states indicates medication abortions constituted 39 percent of abortions in that year, compared to 27 percent in the CDC's most recent 2015 report. Charlotte Lozier also says it found abortions declined by just over a quarter of 1 percent between 2016 and 2017, compared to a 3 percent drop the previous year.

But the group acknowledge the data is incomplete, given that many states don't specify abortion methods in their reporting to the CDC. “The lack of accurate chemical abortion data at the national level means that adverse events caused by chemically induced abortions may be much more common than researchers realize,” Charlotte Lozier President Chuck Donovan said in a statement.

HEALTH ON THE HILL

— Coming Thursday: A bipartisan discussion draft to lower health-care costs. The top Democrat and the top Republican on the Senate Health, Education, Labor and Pensions Committee couldn't manage to reach a deal last year to shore up the Affordable Care Act marketplaces — but that's not stopping them from working together on trying to reduce the cost of care. HELP Chair Lamar Alexander (R-Tenn.) and ranking Democrat Patty Murray (Wash.) plan to release a discussion draft tomorrow laying out some bipartisan ideas for lowering the high cost of care for American consumers. Surprise medical billing, drug pricing transparency and electronic health records are among the issues the draft will address, according to aides.

TRUMP TEMPERATURE

— Long-timeTrump adviser Johnny DeStefano, who has served as a bridge between Trump officials and Republican lawmakers, is set to leave the White House and will go on to advise, among other companies, e-cigarette maker Juul, our Post colleague Josh Dawsey reports.

“Juul has significant business in front of the Food and Drug Administration, and former Trump spokesman Josh Raffel also works for the company,” he writes.

Josh adds: “DeStefano — one of the last remaining aides from the start of the administration — was a key contributor to the administration’s political strategy during the 2018 midterms and ran the Office of Presidential Personnel in the early days of the administration, where he was responsible for staffing a large portion of the government during the turbulent early days of the Trump presidency.”

AGENCY ALERT

— A decades-old State Department policy has left children of same-sex couples born abroad unable to qualify for citizenship at birth, the New York Times’s Sarah Mervosh reports.

The policy, which is based on immigration law, says children who are born abroad must have a biological connection to an American parent to qualify for citizenship at birth. That leaves an added obstacle for some families who use resources such as surrogacy or in vitro fertilization to have children.

“For years the techniques have set off provocative legal and ethical debates about what defines parenthood. Immigration and citizenship are the latest frontier in those debates,” Sarah writes. “The policy has come under intense scrutiny in recent months amid lawsuits arguing that the State Department discriminates against same-sex couples and their children by failing to recognize their marriages. Under the policy, the department classifies certain children born through assisted reproductive technology as ‘out of wedlock,’ which triggers a higher bar for citizenship, even if the parents are legally married.”

Sarah adds that it’s not clear how many people, or how many same-sex couples specifically, are impacted by the policy.

— And here are a few more good reads from The Post and beyond: 

STATE SCAN

MEDICAL MISSIVES

INDUSTRY RX

Coming Up

SUGAR RUSH

On "Take Your Child To Work Day," Washington Post kids tried to explain what their parents do:


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