Democrats brawl on health care, with more to come tonight – Politico

Presented by PhRMA

With help from Renuka Rayasam, Rachel Roubein and Alice Miranda Ollstein

Editor’s Note: This edition of Pulse is published weekdays at 10 a.m. POLITICO Pro Health Care subscribers hold exclusive early access to the newsletter each morning at 6 a.m. Learn more about POLITICO Pro’s comprehensive policy intelligence coverage, policy tools and services at www.politicopro.com.

Quick Fix

Health care dominated last night’s Democratic debate and will play a major role tonight too, as centrists and progressives argue over how far to go on coverage expansion.

Washington state will stop drawing federal funds in the Title X family planning program and will instead use state money.

Seema Verma will bash Medicare expansion at the Heritage Foundation today, the latest stop on the CMS administrator’s messaging tour.

WELCOME TO WEDNESDAY PULSE — Where PULSE is wondering, like WaPo’s Erik Wemple, why CNN banned hand-raising questions to the Democrats last night and tonight. Yes, they can unfairly reduce complex topics to a simple yes or no, but your author missed the visual clarity they provided.

Meanwhile, two candidates still threw up their hands — and they didn’t even need to be asked to do it. Feel free to raise your own, especially if you’re flagging ddiamond@politico.com with tips.

Driving the Day

HEALTH CARE MUDDLE AT SECOND DEMOCRATIC DEBATE — And while Democrats agreed it was their party’s top issue, there was no clarity — or unity — on how to expand coverage and lower costs during a lengthy exchange to open the debate.

The big picture: Sens. Bernie Sanders and Elizabeth Warren were frequently pitted against several centrist candidates who criticized their progressive proposals with labels like “wish-list economics” that would cost Democrats the 2020 election.

“You’re wrong” for criticizing “Medicare for All,” Sanders told former Rep. John Delaney in the first answer of the night — setting the evening’s argumentative tone.

— How to get to universal coverage? Candidates debated whether to grow a program like Medicare, on the 54th anniversary of its enactment, or opt for scaled-down public options that supplement it.

“Folks, we have a choice,” Delaney said. “We can go down the road that Sen. Sanders and Sen. Warren wanna take us with … impossible promises that’ll turn off independent voters and get Trump reelected … or we can nominate someone with new ideas to create universal health care for every American, with choice.”

Are Democrats eating their own on health care? Moderate Democrats, who are struggling to register in the polls, argued that Medicare for All plans would force people off private health insurance they like. Rep. Tim Ryan of Ohio, for instance, argued the proposals would take away union-negotiated benefits, echoing an argument frontrunner Joe Biden has made against Medicare for All. (Sanders immediately disputed this.)

Warren, in one of the more memorable exchanges of the night, chided Democratic candidates for their health care rhetoric.

“We are the Democrats. We are not about trying to take health care from anyone,” Warren said. “That’s what the Republicans are trying to do. And we should stop using Republican talking points.” See video.

Mayor Pete Buttigieg, who supports a Medicare buy-in, said Democrats shouldn’t be wary of going big.

“It’s time to stop worrying about what the Republicans will say,” Buttigieg argued. “They will say we’re crazy socialists” no matter the agenda.

Should undocumented immigrants be covered? Democrats have generally embraced the idea — which has reportedly thrilled President Donald Trump, who thinks it will help build his base. But least one candidate walked away from the idea last night.

“Everyone else in America is paying for their health care,” said Ryan, who criticized Sanders’ Medicare-for-All proposal for encouraging illegal immigration. “I don’t think it’s a stretch for us to ask undocumented people in the country to also pay for health care.”

“I happen to believe that when I talk about health care as a human right, that applies to all people in this country,” Sanders countered. “Under a Medicare-for-All single-payer system, we could afford to do that.”

— Health care also crept into other parts of the evening, from the ads aired during commercial breaks to debates over gun violence and the environment.

Marianne Williamson was also there.

‘PULSE CHECK’ podcast: Breaking down that Sanders, Warren and Delaney exchange on Medicare for All, which kicked off the evening. Listen to the bonus episode that crosses over with POLITICO’s Nerdcast.

MEANWHILE: DEMOCRATIC DEBATE, ROUND 2 TONIGHT — And PULSE is sure that health care will again play a major role, with Biden and Sen. Kamala Harris expected to face off over the competing health plans they unveiled this month. POLITICO’s Rachana Pradhan and Adam Cancryn have more on how Tuesday’s Medicare for All brawl foreshadowed tonight’s likely fight.

The fight to define Medicare for All. It’s something to watch, as Sanders insisted that only his single-payer plan meets the true definition of the program — even as candidates like Harris fight to seize the branding.

But Harris may have a better claim, analyst Charles Gaba argues in the Washington Post, pointing to the current structure of the program and other rationale. (Gaba, who made his name tracking ACA sign-ups, is also a part-time contractor with the Center for American Progress.)

HEALTH QUESTIONS FOR EACH CANDIDATE TONIGHT — Here’s what PULSE would ask, if given the opportunity.

Biden: Why does your new health care proposal still leave millions of people uninsured, at a time when most Democratic candidates are proposing universal coverage?

Harris: Why should voters trust that your 10-year health plan will be fully implemented, given that you’d be out of office before it’s complete — and the next president could pause or roll it back?

Sen. Michael Bennet: Do you think your criticism that Democrats aren’t being “honest” about Medicare for All will help Republicans attack?

Sen. Kirsten Gillibrand: You’ve made reproductive health rights a focus of your campaign, but nearly every candidate has made similar pledges about abortion access and codifying Roe v. Wade. What’s special about your platform?

Gov. Jay Inslee: You told POLITICO that health care is “relatively moot if the entire ecosystem collapses,” which is one reason you’re focused on climate change. Does that mean that, if elected president, you’d wait to address health care until after getting a climate change bill?

Rep. Tulsi Gabbard, Julian Castro and Andrew Yang: None of you has played a major role in congressional health care legislation; unlike some other candidates on stage, you haven’t led a city or state. Why should Democrats believe that you have the answers on health care?

Mayor Bill de Blasio: Why have you claimed that you brought universal coverage to your city when hundreds of thousands of New York City residents are still uninsured?

WASHINGTON STATE WON’T USE FEDERAL FAMILY PLANNING MONEY UNDER NEW TRUMP RULE — Inslee notified HHS late Tuesday that his state will not comply with the Title X rule the Trump administration put into effect two weeks ago. Inslee’s administration instead will use state funds at clinics for low-income women around the state while fighting the rules in court.

MEANWHILE: SEEMA VERMA TO BASH MEDICARE EXPANSION AT HERITAGE — The CMS administrator will speak Wednesday morning on “the dangers of Medicare for All,” where she’ll be joined by Sen. Mike Braun (R-Ind.), Grace Marie Turner of the Galen Institute, Sally Pipes of the Pacific Research Institute and others. The 10 a.m. livestream.

— What PULSE is wondering: Whether Verma, who’s bashed Sanders’ Medicare for All proposal and Biden’s public option, will extend her criticism to Harris’ new plan that would build on Medicare Advantage — which Verma has repeatedly praised.

… Heritage Action, the conservative foundation’s sister organization, is also out with a new survey that found Democrats were generally split on doing away with private health insurance in favor of a government-run health system but Republicans were strongly opposed.

In the Courts

Planned Parenthood, ACLU sue to stop Missouri’s eight-week abortion ban. The organizations argue that the ban, which was signed into law in May and slated to take effect next month, violates patients’ constitutionally protected right to a pre-viability abortion. More from St. Louis Public Radio.

Missouri’s already battled with Planned Parenthood over efforts to shutter the state’s lone abortion clinic.

Appeals court schedules oral arguments on Medicaid work requirements. The U.S. Court of Appeals for the District of Columbia on Oct. 11 will consider whether Arkansas and Kentucky can impose work requirements on certain Medicaid enrollees

The Trump administration is hoping to revive the states’ programs after U.S. District Court Judge James Boasberg, an Obama appointee, blocked them in March. Boasberg also struck down Medicaid work rules in New Hampshire on Monday.

In Congress

Texas Democrats target Cornyn’s health care record. The Texas Democratic party on Tuesday launched new digital ads criticizing Sen. John Cornyn’s votes on health legislation and donations from pharmaceutical companies, POLITICO’s Renuka Rayasam reports.

The ads — part of the party’s bid to unseat the senior Republican next year — argue Cornyn voted to gut protections for patients with pre-existing conditions, seeking to debunk Cornyn’s repeated claim that his party has actually led on the issue. The ads also claim that Cornyn hasn’t cracked down on drug companies raising prices.

Inside the Humphrey Building

Two more Medicare payment rules are here. CMS on Tuesday finalized fiscal 2020 payments for skilled nursing facilities and inpatient psychiatric facilities.

The agency is raising Medicare payments for skilled nursing facilities by 2.4 percent, about $851 million. A new payment model is also set to take effect Oct. 1, in which Medicare will determine payment by focusing on the patient’s condition and the level of care needed, rather than the amount of services provided. CMS also finalized a 1.5 percent bump, worth about $65 million, to inpatient psychiatric facilities. Both payments were slightly lower than what CMS proposed in April.

What We’re Reading

With Victoria Colliver

The FDA needs to act on the “CBD craze,” former FDA commissioner Scott Gottlieb argues in the Washington Post.

Memphis’ Methodist Le Bonheur Healthcare announced major policy changes in response to a MLK50-ProPublica investigation into the nonprofit hospital system’s aggressive collections tactics – which involved suing thousands of low-income patients, including its own employees.

Joni Hess writes for Vox about something no one seems to know or wants to address: why the cost of stillbirths appear to be significantly higher than livebirth deliveries.

Wired’s Megan Molteni takes a look at the World Health Organization’s call for a stop to experiments that would lead to the births of gene-edited humans.

CORRECTION: A previous version of Morning Pulse misstated the status of the Title X program in Washington state. The state will now fund family planning clinics directly while it challenges new Trump rules in court.