Analysis | The Health 202: Democratic primary voters want health care fixed. But Congress is tangled up in political fights. – The Washington Post

THE PROGNOSIS

The Iowa and New Hampshire primaries confirmed that health care is the No. 1 issue on the minds of Democratic primary voters.

But whether the lawmakers currently controlling Congress will heed their pleas is another question entirely. 

Check out these exit polling results from New Hampshire:

Efforts are afoot on Capitol Hill to pass legislation protecting patients from surprise medical bills — amid strong urging by the White House — and there is still some chatter about a bipartisan deal to lower prescription drug prices.

President Trump tweeted this yesterday:

Yet for any of this to be accomplished, lawmakers must carefully pick their way through a slew of political and policy land mines that only seem to multiply by the day as the November election nears.

House Speaker Nancy Pelosi (D-Calif.) is aiming to hold a vote this spring on legislation to resolve the “surprise” medical bills patients often receive after getting care from an out-of-network hospital or doctor through no fault of their own. The thought is to tee up a measure that can hitch a ride on must-pass legislation in May funding community health centers.

But first lawmakers must merge three different measures proposed by three different House committees, which all reflect varying degrees of lobbying influence by doctors and hospitals, who are pitting themselves against the insurance industry. Both sides have been furiously lobbying Congress and pouring money into advertising over the past nine months.

Discussing surprise medical billing gets wonky quickly because it involves precise details of how payments for these out-of-network bills should be negotiated.

And the stakeholders aren’t going to their partisan corners in the usual ways. The feud is best understood as a battle between health insurers and providers, with both parties fearful of getting the shorter end of the stick when it comes to payments for medical services.

Surprise billing is a serious problem. It’s also good fodder for health-policy Valentines. Per New York Times reporter Sarah Kliff:

— Doctors and hospitals argue this: Surprise bills should be resolved through an arbitration process, in which both the insurer and the provider name a price and a third-party arbiter chooses the one that seems most fair.

They’re enthused about a bill the House Ways and Means Committee unanimously approved yesterday and another measure introduced last year by Sen. Bill Cassidy (R-La.), both of which are viewed as friendlier to health providers.

The American Medical Association has issued a statement of support. So did 18 leaders of major academic medical systems around the country, who called it a “balanced and thoughtful solution” to address surprise medical bills.

— But here’s what insurers say: They want to pay roughly the same set rate for a “surprise” out-of-network item or service as they pay for the same item or service rendered in-network. Under this approach known as “benchmarking,” surprise bills would be pegged to the median in-network rate in a particular geographic area.

Leaders of two health panels — the House Energy and Commerce Committee and the Senate Health, Education, Labor and Pensions Committee — have struck a deal on legislation taking this approach for health claims up to $750 and air ambulance bills up to $25,000. Another bill approved Tuesday by the House Education and Labor Committee is virtually identical. 

The Trump administration also appears partial to the concerns of insurers, echoing their arguments that arbitration could result in insurers paying even more for medical services than before. 

White House spokesman Judd Deere issued a statement this week expressing concern that the Ways and Means legislation would “overuse arbitration” and “raise healthcare costs.”

Consumer advocates are frustrated the policy disagreements have stalled in Congress. Eagan Kemp, a health-care policy lobbyist for Public Citizen:

It’s an issue that oddly divides the Trump administration from traditional conservative groups and some Republicans, who have labeled the benchmarking approach as “price-fixing” by the government and vigorously oppose it.

Nearly 40 House Republicans have asked Pelosi to avoid any legislation to “give the federal government the power to set rates.” The National Taxpayers Union wrote a letter saying benchmarking “would have the federal government setting the rates for certain kinds of care” and would give insurance plans too much leverage over the rates they’re paid.

Heritage Action for America and the Taxpayers Protection Alliance have united with other conservative groups for a new ad effort called the “Coalition Against Rate-Setting.” 

This week, the coalition announced it is running digital and newspaper print ads in several states including Tennessee, where HELP Committee Chair Lamar Alexander (R) is from, and Kentucky, the home state of Senate Majority Leader Mitch McConnell (R).

Dark-money groups funded by doctor staffing companies have also been running ads against benchmarking. One group, called Doctor Patient Unity, has targeted several members of Congress, running ads that say “government rate-setting could mean closed hospitals.”

The Hill’s Peter Sullivan:

A parallel issue — lowering the cost of prescription drugs — is being caught up in the 2020 political fray. And it might just stay there this year, as Democrats seek to leverage it against Trump and Republicans.

An advertising campaign launched last month by Democratic operatives has updated and expanded a website highlighting ties between Trump administration officials and pharmaceutical companies and lobbying groups, according to details provided first to The Health 202.

The website — dubbed Big Pharma’s Best Friends — shows past and present officials in the White House, the Department of Health and Human Services, and other agencies who have worked in or consulted for the pharmaceutical industry.

It lists such major players as White House domestic policy chief Joe Grogan, who lobbied for Gilead Sciences, and Alex Azar, who left a career at Eli Lilly to serve as HHS secretary, but also lower-level staffers.

The aim of Patients Over Pharma is to portray the administration as in bed with the pharmaceutical industry. The group is run by Accountable.US, an umbrella organization of liberal nonprofit groups that go after the Trump administration by focusing on industry ties and conflicts of interest.

“We are going to make sure that people understand that President Trump and his administration are bought, paid for, and influenced by Big Pharma,” spokesman Eli Zupnick said in a statement.

— Your Health 202 author will be chatting about these dynamics — and sharing health policy Valentines — at a live taping of the “What the Health” podcast hosted at 11:30 a.m. today by the Kaiser Family Foundation. Register here.

AHH, OOF and OUCH

AHH: Chinese officials reported an uptick of 14,840 confirmed coronavirus cases Thursday as health officials expanded the type of cases that it includes in its count, our Post colleagues Anna Fifield, Siobhán O’Grady, Miriam Berger and Marisa Iati report.  The Hubai province, the epicenter of the outbreak, also reported 242 new deaths – the fastest rise in daily count since December.

“China’s state-run Xinhua News Agency announced Thursday that national health authorities issued revised guidelines to consider ‘clinically diagnosed’ coronavirus cases in the confirmed total,” our colleagues write. “Chinese officials previously only counted cases confirmed by nucleic acid tests, which critics said were faulty and greatly underestimated the true magnitude of the epidemic.”

The total number of coronavirus cases has now surpassed 60,000, and the virus has killed roughly 1,360 people, nearly all in China.

North Korea announced Wednesday it would expand its quarantine period from 15 days to 30 days in an effort to prevent new coronavirus infections, according to the state-run Korean Central News Agency.

— Airbnb joined other companies suspending their services in China, The Post’s Rick Noack reports. British Airways announced Monday it has canceled all flights to mainland China until the end of March as well. 

Asia & Pacific

For China’s leaders, pop-up hospitals are about politics as much as health

The outbreak of the deadly coronavirus poses the biggest challenge to Communist leaders in at least two decades.

Anna Fifield

OOF: Nevada’s Culinary Union is the latest labor union to sound alarms over Medicare-for-all. 

The union warned its members in a flier that Sen. Bernie Sanders (I-Vt.) would “end” their health care if elected president, The Nevada Independent’s Megan Messerly reports. The flier, which compared six Democratic presidential hopefuls’ positions on health care, jobs and immigration, took aim at Sanders over his Medicare-for-all policy.

“The Culinary Union, which provides health insurance to 130,000 workers and their family members through a special trust fund, strongly opposes Medicare for all on the basis that it would eliminate the health insurance they have negotiated for over several decades,” Megan writes. 

Pete Buttigieg, fresh from a second-place finish to Sanders in New Hampshire, was quick to comment.

“Nevada’s a good example of a place where there are a lot of union workers, who sometimes gave concessions on wages in order to get excellent plans — I’m thinking about culinary workers, for example,” the former South Bend, Ind., mayor told NBC News

“If the choice is between Senator Sanders telling them they’re gonna have to give that up, and me saying we can enhance and increase choice without asking them to sacrifice what they have worked so hard for, I think that is a very good debate for us to have, and I’m looking forward to having that debate.”

Buttigieg tweeted, too:

Association of Flight Attendants President Sara Nelson had a retort:

OUCH: The remains of more than 2,000 fetuses found in the garage and car of the prominent Midwest abortion provider Ulrich Klopfer were buried Wednesday, our colleague Katie Mettler reports. Indiana Attorney General Curtis Hill presided over the mass burial at an Indiana cemetery, which donated a burial plot.

“The remains were placed in the same grave at Southlawn Cemetery in South Bend, a northern Indiana city Klopfer predominantly served alongside Gary and Fort Wayne,” Katie writes.

“Today, we finally memorialize the 2,411 unborn babies whose remains were senselessly hoarded by Dr. Ulrich Klopfer after he performed the abortions from 2000 to 2003,” Indiana Attorney General Curtis Hill said at the gravesite. “These babies deserved better than a cold, dark garage or the trunk of a car.”

Indiana, which has some of the strictest abortion laws, mandates the burial or cremation of fetal remains after the procedure. Vice President Pence signed that law in 2016 when he was governor, and it was ultimately upheld by the U.S. Supreme Court.

An investigation is ongoing into why Klopfer, who died last fall, collected the remains and whether anyone helped him transport them to his home.

U-Haul will stop hiring people this month who use tobacco or nicotine products in the 21 U.S. states where it is legal to discriminate against job applicants who smoke, the Associated Press’s Matthew Perrone reports

While about 70 percent of large employers offer programs to help employees quit smoking as part of their health coverage, the truck rental company is taking an unusual step beyond that. 

The policy shift could save U-Haul money. Smoking-related medical expenses add less than $170 billion a year to employer and government medical expenses, according to the Centers for Disease Control and Prevention. 

MEDICAL MISSIVES

— Mark Pavelich, a former Olympic U.S. hockey team player, may have post-traumatic stress from life trauma and chronic traumatic encephalopathy, a degenerative brain disease found in athletes, John Rosengren reports for The Post. He is charged with beating his neighbor with a metal bar in August, cracking two ribs, bruising a kidney, fracturing a vertebra and more.

Two psychologists said he wasn’t competent to stand trial, but it’s unknown why. Diagnosing CTE requires a brain autopsy.

In 2016, in response to a lawsuit filed by a group of ex-National Hockey League players, NHL Commissioner Gary Bettman said concussions may not be the cause of CTE. The league ultimately settled the claim with 302 players, but Pavelich wasn’t part of the lawsuit.

STATE SCAN

— Since 2015, Indiana has implemented programs that help drug users, such as offering clean needles, HIV testing, naloxone and fentanyl test strips. But five years later, syringe exchanges are operating in only nine of Indiana’s 92 counties, Kaiser Health News’s Giles Bruce reports

Local officials remain reluctant to treat addiction as a health issue, and the state’s law requires syringe exchanges to be authorized and renewed at least every two years by a local governing body.

“We’re handing people equipment we know [is] going to be used for injection or ingestion of narcotics. We’re not getting anywhere,” Lt. John Watson, a police officer in Seymour, Ind., told KHN.

A few more good reads from The Post and beyond:

Real Estate

Can condos create different rules for smokers?

REAL ESTATE MATTERS | The boards may pass rules to limit or ban cigarette smoking over time or could grandfather existing homeowners who smoke.

Ilyce Glink and Samuel J. Tamkin

Juul Bought Ads Appearing on Cartoon Network and Other Youth Sites, Suit Claims

The case, brought by Massachusetts after a lengthy investigation, presents some of the strongest evidence the vaping company was marketing to teenagers.

New York Times

Business

My employer requires a flu shot. My doctors say no.

My primary-care doctor and specialists say I shouldn’t get a flu shot because of a medical condition, and my employer agreed. Until this year, when I am being told I must get the vaccine.

Karla Miller

DAYBOOK

Coming up:

  • The Supreme Court will consider hearing a case that could settle the face of the Affordable Care Act at its conference on Feb. 21.
  • The Washington Post will host a live talk on Feb. 26 on the plight of working families and low-income workers in the United States. Discussions will include topics such as the rising cost of health care.

SUGAR RUSH

The Westminster Dog Show finished Wednesday. Some good boys and girls competed: