Tagged 2018 Elections

As Mass Gun Violence Rises, Debate Intensifies Over Strategy On How To Proceed In Active Shooter Situations

The recent shooting at a bar in California highlights how difficult it is to decide on how emergency responders should handle highly dangerous situations. Meanwhile, The Associated Press looks at California’s gun laws, which are some of the strictest in the country. And a community grieves.

Montana’s Legislature Could Decide Medicaid Expansion’s Fate

A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset.

“We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure.

The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster.

Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish.

The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana.

Part of the expected $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana.

Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act.

In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.”

Republican State Rep. Nancy Ballance, who opposed I-185, disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.”

Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products.

“No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.”

Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won’t qualify.

In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge.

North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax hike someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.”

This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story.

Podcast: KHN’s ‘What The Health?’ Split Decision On Health Care

Voters on Election Day gave control of the U.S. House to the Democrats but kept the U.S. Senate Republican. That will mean Republicans will no longer be able to pursue partisan changes to the Affordable Care Act or Medicare. But it also may mean that not much else will get done that does not have broad bipartisan support.

Then the day after the election, the Trump administration issued rules aimed at pleasing its anti-abortion backers. One would make it easier for employers to exclude birth control as a benefit in their insurance plans. The other would require health plans on the ACA exchanges that offer abortion as a covered service to bill consumers separately for that coverage.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • The Trump administration’s new contraception coverage rule comes after an earlier, stricter regulation was blocked by federal courts.
  • The insurance bills that the Trump administration is now requiring marketplace plans to send to customers for abortion coverage will be for such a small amount of money that they could become a nuisance and may persuade insurers to give up on the benefit.
  • House Democrats, when they take control in January, say they want to move legislation that will allow Medicare to negotiate drug prices. But fiscal experts say that may not have a big impact on costs unless federal officials are willing to limit the number of drugs that Medicare covers.
  • It appears that both Democrats and Republicans in Congress are interested in doing something to protect consumers from surprise medical bills. The issue, however, may fall to the back of the line given all the more pressing issues that Congress will face.
  • One of the big winners Tuesday was Medicaid. Three states approved expanding their programs, and in several other states new governors are interested in advancing legislation that would expand Medicaid.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: Kaiser Health News’ “Hello? It’s I, Robot, And Have I Got An Insurance Plan For You!” by Barbara Feder Ostrov

Margot Sanger-Katz: Stat News’ “Life Span Has Little to Do With Genes, Analysis of Large Ancestry Database Shows,” by Sharon Begley

Joanne Kenen: The Washington Post’s “How Science Fared in the Midterm Elections,” by Ben Guarino and Sarah Kaplan

Rebecca Adams: The New Yorker’s “Why Doctors Hate Their Computers,” by Atul Gawande

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Measure To Cap Dialysis Profits Pummeled After Record Spending By Industry

Record-breaking spending by the dialysis industry helped doom a controversial California ballot measure to cap its profits.

The industry, led by DaVita and Fresenius Medical Care, spent nearly $111 million to defeat Proposition 8, which voters trounced, 62 to 38 percent, and appeared to approve in just two of 58 counties. The measure also faced strong opposition from medical organizations, including doctor and hospital associations, which argued it would limit access to dialysis treatment and thus endanger patients.

The opposition presented a powerful message that “if you can’t get dialysis, you will die,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “If you didn’t know that, the commercials made it clear.”

Despite arguments about the outsize profits of dialysis companies, Kominski said the “Yes on 8” case wasn’t as clear. The measure, sponsored by the Service Employees International Union-United Healthcare Workers West, sought to cap dialysis clinic profits at 115 percent of the costs of patient care. Revenues above that amount would have been rebated primarily to insurance companies. Medicare and other government programs, which pay significantly lower prices for dialysis, wouldn’t have received rebates.

The union raised nearly $18 million — a large sum for most initiatives but about 16 percent of what the opposition mustered.

The proposition also was poorly written and difficult for voters to understand, said Erin Trish, associate director of health policy at the USC Schaeffer Center for Health Policy and Economics. Trish said she wasn’t surprised by the landslide defeat given the widespread ads against the initiative about the potential harms to patients. “The message came through loud and clear,”  she said.

Trish said health care industry groups genuinely viewed Proposition 8 as a poor initiative — but they also didn’t want to see rate regulation. “This is not what most of these associations want to open the door to,” Trish said.

Generally speaking, said Jessica Levinson, a professor at Loyola Law School, voters’ default on initiatives is “no.” In addition, money spent against an initiative is usually more effective than money spent for it. Levinson said people weren’t 100 percent sure what they were voting on with Proposition 8. All of those factors made passage “an uphill battle,” she said.

Kathy Fairbanks, a spokeswoman for the opposition, credited the electorate for properly sorting out the facts. “Voters did their homework and saw who lined up on both sides,” Fairbanks said. “All the leaders of the medical community were against Proposition 8 because of the negative impact it would have had on patients and access to dialysis.”

Proponents of the measure argued that highly profitable dialysis companies don’t invest enough in patient care and that they need to hire more staff and improve clinic safety. Opponents said passage would have forced clinics to cut their hours or close altogether, resulting in more emergency room visits by dialysis patients.

SEIU-UHW said the opponents tried to “scare and mislead” voters. It vowed to continue targeting profitable dialysis companies with another measure on the 2020 ballot, as well as through legislation.

“We exposed problems within the dialysis industry and we put a spotlight on a sector that has operated in the shadow for far too long,” said Sean Wherley, spokesman for the “Yes” campaign. “But we are not finished yet. … The need is still there to hold this industry accountable.

He added that the union is proud to have put a spotlight on “the inflated charges that drive up health care costs for all California.”

Critics say that SEIU-UHW, which represents more than 95,000 workers in California, uses state and local ballot initiatives as a way to pressure legislators and gain bargaining power. They’ve sponsored measures on such topics as hospital and clinic funding, access to affordable insurance and training for in-home caregivers.

The union maintains its goal is simply to improve health care.

Two other Bay Area initiatives sponsored by SEIU, aiming to limit hospital pricing, also were defeated Tuesday, indicating that the ballot box may not be the best place to address concerns about costs in the health care industry.

“This is too complicated to do by ballot proposition,” Trish said.

Dialysis patients participated heavily in both the pro and con sides of the initiative, appearing in dramatic television ads and presenting their personal stories on social media.

Lili Hernandez, 27, who began treatment four years ago, showed up to her appointments at a DaVita clinic in Hollywood with “Yes on Prop. 8” placards even as  the clinic posted “No” signage, she said.

Hernandez supported the initiative because she believes the corporations should be held accountable, she said. “They take advantage of how much money they can charge, but don’t give the best service,” she said. “Too many people are at risk of infection and neglect.”

She woke up Wednesday feeling defeated. “I was awake last night, checked results online, had my cry and went to sleep,” she said, adding that she thinks people were confused about the initiative and believed the “false ads.”

Meanwhile, DeWayne Cox, a dialysis patient from Los Angeles, expressed relief. “This means that voters got the message, they understood,” he said.

Cox, 56, said he comes from a union family and believes in unions, but this was a “terrible” move by SEIU because it could lead to cutbacks in services. “Not only was this scary for me, but they made me angry,” he said, noting concerns about potential cutbacks in services. “If their motive was truly to help patients, they would have written a better, more precise measure.”

The measure became the most expensive race in California this year. Industry giants DaVita and Fresenius Medical Care, which operate nearly three-quarters of the chronic dialysis clinics in California, were responsible for more than 90 percent of the contributions in opposition to the measure

The California Medical Association, the California Hospital Association and the California chapter of the American College of Emergency Physicians all opposed Proposition 8. “Our concern was the impact on patient care,” said hospital association spokeswoman Jan Emerson-Shea. “If dialysis clinics were forced to close and patients needed care, we are the only place within the health care system that is open 24/7.”

Municipal ballot initiatives sponsored by SEIU-UHW targeted Stanford Health Care in Livermore and Palo Alto by attempting to cap prices at 115 percent of the “reasonable” cost of care. Under the initiatives, hospitals and other medical providers would have been required to pay back any charges above the cap each year to private commercial insurers. The initiatives failed dramatically, losing 77 to 23 percent in Palo Alto and in Livermore, 82 to 17 percent.

Voters did approve three statewide health care initiatives Tuesday, however:

  • Proposition 2 won 61 to 39 percent, allowing the state to issue $2 billion in bonds for housing for homeless people in need of mental health services. Bond money will be distributed to counties and repaid with proceeds from the Mental Health Services Act, which levies a 1 percent tax on personal incomes of $1 million and above.
  • Proposition 4, which won by the same margin, allows the state to distribute $1.5 billion in bonds to help the state’s 13 children’s hospitals’ pay for construction and equipment. It was the third time in 14 years that voters had agreed to subsidize the hospitals.
  • Proposition 11, passing with  59 percent of the vote, requires private ambulance employees to remain on call during their breaks — just as firefighters, policemen and other public emergency workers do.

Samantha Young and Harriet Rowan contributed to this report.


KHN’s coverage of these topics is supported by
California Health Care Foundation
and
Blue Shield of California Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

California’s Top Lawyer Sees Election Win As Mandate To Sustain Trump Resistance

California Attorney General Xavier Becerra has cemented his role as one of the nation’s top defenders of the Affordable Care Act, filing multiple lawsuits in the past two years to uphold key protections of the law and often clashing with the Trump administration.

Voters this week gave Becerra a clear mandate to continue that work, he said.

“Californians had a chance to register their opinion on the work that I’ve done,” Becerra told California Healthline on Wednesday, the day after voters overwhelmingly elected him to the state’s top law enforcement job — 61 percent to 39 percent over Republican Steven Bailey.

“My sense is there’s a pretty clear signal.”

Becerra has filed 44 legal challenges against the Trump administration in less than two years on cases involving immigration, birth control, health care, transgender rights, net neutrality, climate change and other issues.

Four of the lawsuits involve former President Barack Obama’s signature achievement, the 2010 federal health care law, which Trump and fellow Republicans have sought to dismantle. In one key case, Becerra is leading more than a dozen other Democratic attorneys general against a Texas-led GOP lawsuit challenging the law’s constitutionality.

“We’re defending health care protections and rights not just for the 40 million Californians, but for the 320 million Americans in the country, because the Trump administration elected to back out of their role in defending a federal statute,” Becerra said. “We stepped in and are now the lead state defending the Affordable Care Act. That’s a big undertaking.”

Democratic Gov. Jerry Brown appointed Becerra to the top post at the state Department of Justice in December 2016 after Kamala Harris was elected to the U.S. Senate. So, Tuesday’s election was the first time that the 60-year-old Democrat, who previously served in Congress, won a statewide office.

Bailey had criticized Becerra for fighting Washington instead of focusing on California issues — not an argument that resonated with voters in a state that prides itself as the head of Trump resistance.

Becerra said he has sought to spotlight health care at the state Justice Department, creating a new “strike force” of attorneys who have expertise in health care issues.

Becerra, the son of Mexican immigrants, said he also is ready to defend California should state lawmakers decide to extend health care coverage to unauthorized immigrant adults (children already are eligible). That could spur a legal challenge and would not likely be supported by the Trump administration.

The state’s estimated 1.8 million unauthorized immigrants make up nearly 60 percent of the state’s remaining uninsured residents. Covering them is key to Democratic leaders’ goal of insuring all Californians.

Aside from tangling with Trump, Becerra also has taken on both the hospital and pharmaceutical industries.

This year, he filed a lawsuit against Sutter Health, the largest hospital system in Northern California, for anti-competitive practices, and he is investigating pharmaceutical manufacturers and the three largest opioid distributors over unlawful practices. In 2017, Becerra joined a federal lawsuit that charges six makers of generic drugs with an illegal conspiracy to increase prices for an antibiotic and a diabetes medication. All three cases are pending.

In the Sutter Health lawsuit, Becerra said evidence will show that the hospital chain overcharged for services. While he has made anti-competitiveness a priority, he would not say whether he planned similar lawsuits against other hospitals. But he didn’t rule it out.

“We’re going to be vigilant to make sure that everyone follows the law and does what they’re supposed to,” Becerra said. “If we find that there are people who are acting anti-competitively or overpricing or trying to take advantage of California health care consumers, we’ll be prepared to act.”

All of the investigations and litigation, he said, are slow-moving. He compared the process to a football game in which most of the plays yield small gains, with an endgame in sight.

“We’re looking to score some touchdowns,” he said.


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Health Care Stocks Soar As Threat To Health Law Fades With Democrats’ House Victory

Analysts have called a split Congress the best case scenario for the marketplace. “We expect to see legislative deadlock for the next two years, with an uptick in House hearings and political posturing while President Trump continues to push his agenda through executive action and the judiciary,” Leerink analyst Ana Gupte said.

Midterm Election Boosts Medicaid Expansion, But Challenges Remain

Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election.

Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures.

Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020.

Medicaid proponents also were celebrating the Democrats’ takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people.

“Tuesday was huge for the Medicaid program,” said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. “The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect.”

But health experts caution that GOP opposition won’t fade away.

David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. “I see this as a turning point in ACA politics,” he said. Still, he added‚ “it’s not inevitable.”

Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities.

The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest.

GOP opposition has left about 4.2 million low-income Americans without coverage in various states.

“It’s not over until it’s over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. “But the trend overall has been to increasing implementation and increasing coverage.”

Montana Fails To Endorse Funding

Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program.

In addition, Democrats secured the governor’s offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it.

Current and incoming Republican governors in Utah and Idaho said they wouldn’t block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase.

It wasn’t a clean sweep, however, for Medicaid on Tuesday.

In preliminary results, a ballot issue to fund Montana’s Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products.

The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so.

Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected.

Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements.

“There are some people in the state who may not have disabilities but need some help to access coverage,” she said. “I think we can pass something without people having a gap in coverage. … That will be a priority.”

“It was never our intent to simply sunset the expansion and have it go away,” she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes.

Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along.

But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the state’s sales tax, just over a penny for a $10 purchase.

Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the state’s ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage.

“I think it showed there was a clear need for it,” he said. The legislature likely won’t block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps.

Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom lines because it cuts down on uninsured patients and uncompensated care.

“The broad population does see the value of Medicaid,” she said. “They saw it as a loss by their states not to accept the federal funds,” she said.

Despite the victories, Burke said, advocates should not assume other states such as Florida, Texas and Tennessee will follow suit.

“I don’t see a radical shift, but it moves us closer,” she said.

‘Fertile Ground’ For More Referendums

If advocates press for more referendums, Florida might be a tempting target. More than 700,000 adults there could become eligible, but the campaign would likely also be very costly.

Jonathan Schleifer, executive director of The Fairness Project, which financed the ballot initiatives in Maine in 2017 and the four states this year, refused to say which states would be targeted next.

The group is funded by the Service Employees International Union-United Healthcare Workers West, a California health care workers union.

“The GOP has been bashing the ACA for nearly a decade, and voters in the reddest states in the country just rejected that message,” Schleifer said. “It’s a repudiation and a tectonic shift in health care in this country.”

“There is fertile ground” for more such ballot votes, said Topher Spiro, vice president for health policy at Center for American Progress, a liberal think tank. “It is clear that public opinion is on the side of Medicaid expansion and the election results merely confirm that.”

“This will build momentum for expansion in other states,” he added.

The election results also could have consequences on efforts by states to implement work requirements for Medicaid enrollees.

New Hampshire and Michigan — which expanded the program but recently won federal approval to add controversial work requirements — could revisit that additional mandate as a result of Democrats winning control over both houses of the legislature in New Hampshire and the governor’s office in Michigan.

House Dems In New Seats Of Power Will Steer Health Policy, Attack Drug Prices

For the first time since passing the Affordable Care Act, Democrats will soon control the House of Representatives and its powerful health committees. But Republicans’ tightened grip on the Senate means those hoping for another round of dramatic, progressive reforms may be disappointed.

Empowered by voters outraged over Republican attempts to chip away at the law’s protections for the sick, Democrats owe much of their midterm takeback to health care issues. And Democratic leaders say they are ready to get back to work, this time training their sights on skyrocketing drug prices, among other policy conundrums, with a majority of House votes and a slate of new committee chairmanships in hand.

In a few weeks, House Democrats will meet to elect their leaders, including several committee chairs who will be responsible for the nation’s health care policy and spending in the coming years. Hill denizens expect those currently serving as the top Democrat on most House committees to ascend to the chairmanships, with few if any members mounting serious challenges.

Those basking in a post-“blue wave” glow would do well to temper their expectations, recalling that the Republican-controlled House had already voted 54 times to unravel some or all of the Affordable Care Act by its fourth birthday in 2014. In most cases, Democrats in the Senate and White House stopped those efforts in their tracks.

With the Senate (and the presidency) remaining under Republican control and even fewer moderate Republicans left in the House after this election, Democrats will struggle to move legislation without Republican support. What they can do is hold hearings, launch investigations and generally unnerve the pharmaceutical industry, among other likely adversaries.

And there’s a chance they could strike a deal with President Donald Trump, whose administration is moving to crack down on drug companies.

Who are the members most likely to wield the gavels? And what will they do with that power? Here’s a look at some of the major committees that influence health policy — and the people who may lead them.

The Committee on Energy and Commerce: Rep. Frank Pallone, New Jersey

Pallone, who has served in the House for 30 years, became the top Democrat on this influential committee in 2015. Should he become chairman, he would be responsible for the broadest health portfolio in the House, which includes Medicaid, public health, insurance and drug safety. This is the committee that marked up the Affordable Care Act in 2009 (when Pallone chaired the health subcommittee) and the House Republican repeal effort in 2017.

Under the Trump administration, Pallone has touted his stewardship of bipartisan legislation reauthorizing the fees charged to manufacturers to review the safety of prescription drugs and medical devices. He has also called for hearings on “mega-mergers” like the proposed merger between CVS and Aetna and worked with other Democrats to counter Republican attempts to undermine the Affordable Care Act.

Unsurprisingly, his influence over health care issues has attracted a lot of money from pharmaceutical companies, health professionals, HMOs and other industry players. By mid-October, Pallone had received more than $945,000 in campaign contributions from  the health sector for this election, according to the Center for Responsive Politics. According to a KHN analysis, nearly $170,000 came from political action committees associated with pharmaceutical companies.

The Committee on Oversight and Government Reform: Rep. Elijah Cummings, Maryland 

Cummings could prove the pharmaceutical industry’s biggest headache come next year. Having served as the committee’s ranking member since 2011 — a post that lacks the chairman’s subpoena power — he has been champing at the bit to hold drugmakers accountable.

Shortly after Trump’s inauguration, Cummings approached him about working together to lower the cost of prescription drugs (to no immediate avail), and he has partnered with other lawmakers to demand information from pharmaceutical companies about their drug pricing strategies. Previewing what a Cummings-led committee might look like, he has even launched his own investigations into drug costs, releasing reports with his findings.

Drugmakers have wasted few campaign contributions on Cummings: He has received just $1,000 from their PACs this election, according to data analysis by KHN.

In a statement to Kaiser Health News, Cummings said Democrats would conduct “credible, responsible oversight” of the Trump administration, adding: “For healthcare, that means investigating skyrocketing prescription drug prices, actions that would threaten protections for people with preexisting health conditions, and efforts to undermine the Medicaid program.” 

The Committee on Ways and Means: Rep. Richard Neal, Massachusetts

Ways and Means oversees Medicare and influences health policy through its jurisdiction over taxes. Though Neal became the top Democrat on this committee in 2017, he has been involved in health care much longer, having played a part in the crafting of both the Affordable Care Act and the failed reform effort under the Clinton administration in 1993.

Facing a primary challenger who touted her support for “Medicare-for-all” in his deep-blue district, Neal denied that he opposes the progressive single-payer proposal. But he also said Democrats should focus on shoring up the Affordable Care Act, particularly its protections for those with preexisting conditions and caps on out-of-pocket expenses. (He won handily.)

The health sector was by far one of the top contributors to Neal’s re-election campaign this year, giving more than $765,000, according to the Center for Responsive Politics. Neal’s district includes the headquarters of several health insurers and other medical companies, which makes him a prime target for campaign contributions.

The Committee on Appropriations: Rep. Nita Lowey, New York

If chosen, Lowey would become the first woman to chair the powerful House Committee on Appropriations, holding the nation’s purse strings.

Like Neal and Pallone, Lowey was first elected to Congress in 1988, and she became the committee’s top Democrat in 2013. She has been a dedicated and effective advocate for investing in biomedical research into major diseases like diabetes and Alzheimer’s, as well as public health programs like pandemic preparedness.

She has also long championed women’s health issues, proving a vocal critic of the Trump administration’s proposed gag rule on Title X funding, among other policies. Watch for her to continue to push back on the administration’s efforts to restrict access to abortion rights.

And on the Senate side, the Committee on Finance: Sen. Chuck Grassley, Iowa?

The rumor mill favors Grassley, the Republican who has served most recently as the chairman of the Senate Committee on the Judiciary, to replace retiring Sen. Orrin Hatch (R-Utah).

Senate Republican leaders have signaled that entitlement programs like Medicare and Medicaid could use trimming and, with Republicans emerging from the midterms with a slightly bigger majority, this committee could have its hands full.

Hatch proved a friend to the pharmaceutical industry, and his war chest reflected that, taking in more than $850,000 in campaign contributions from drugmaker PACs in the past decade alone, according to a Kaiser Health News analysis. But Grassley has taken a more adversarial approach to the industry, working with a Democratic colleague last summer to pressure drug companies to list their prices in direct-to-consumer ads, for instance.

Grassley held the chairmanship from 2003 to 2006, leaving him two more years at the top, should he want it. (Senate Republican chairs may serve for only six years.) But he might choose to stay on as head of the Judiciary Committee, in which case the next chairman may be the next-most-senior Republican: Sen. Mike Crapo of Idaho.

Resultados de las urnas: la salud es importante, pero no crucial, para los votantes

La atención médica resultó importante, pero aparentemente no fue crucial, en las elecciones de medio término del martes 6, en las que los votantes les dieron a los demócratas el control de la Cámara de Representantes, dejaron a los republicanos a cargo del Senado y dijeron sí a la expansión de Medicaid en al menos tres estados controlados por largo tiempo por republicanos.

Al hacerse cargo de la Cámara de Representantes, es poco probable que los demócratas puedan impulsar muchas iniciativas sobre políticas de salud, ya que los republicanos siguen controlando el Senado y la Casa Blanca. Pero podrán frenar, vetando de manera efectiva, los esfuerzos republicanos por derogar la Ley de Cuidado de Salud Asequible (ACA), por convertir al sistema de atención médica de Medicaid para personas de bajos ingresos en un programa de subvención en bloque y por realizar cambios importantes en Medicare.

Un desarrollo probable es una expansión de Medicaid en varios de los 18 estados que hasta ahora no lo expandieron. Los votantes en Utah, Idaho y Nebraska dijeron sí a las medidas de la boleta electoral sobre la expansión.

En Montana, los votantes están decidiendo si la expansión existente debe continuar y si los gastos del estado deben cubrirse mediante el aumento de los impuestos al tabaco. En resultados preliminares, los que están en contra superaron en número a los que están a favor.

Medicaid también podría expandirse en Kansas, donde la candidata demócrata a la gobernación, Laura Kelly, derrotó al secretario de estado del Partido Republicano, Kris Kobach. La legislatura de Kansas había aprobado previamente la expansión de Medicaid, pero fue vetada en 2017 por el ex gobernador republicano Sam Brownback. Kobach no había apoyado la expansión propuesta por ACA.

Y en Maine, en donde los votantes aprobaron la expansión de Medicaid en 2017, pero el gobernador republicano Paul LePage se negó a implementarla, la demócrata Janet Mills resultó ganadora. Mills ha prometido seguir los deseos de los votantes. LePage no se presentó de nuevo.

En las encuestas a boca de urnas, como en muchos sondeos anteriores en 2018, los votantes dijeron que la atención médica, en particular la protección de las personas con condiciones preexistentes, era su principal problema. Pero al final del día, este tema siguió siendo más importante para los demócratas que para los republicanos.

Los que este año instaron a los demócratas a enfatizar la atención médica se atribuyeron los éxitos para retomar el poder en el Congreso. “La carrera por la Cámara de Representantes fue un referéndum sobre la guerra republicana a la atención médica. Lo sabes, lo sé, y los republicanos que intentaron vergonzosamente cubrir su historial real sobre atención médica y perdieron sus asientos lo saben”, dijo Brad Woodhouse, del grupo de defensa Protect Our Care.

Pero el problema no fue suficiente para salvar a algunos de los demócratas del Senado en los estados en los que el presidente Donald Trump ganó en 2016. La senadora Claire McCaskill (demócrata de Montana) fue derrotada por el fiscal general del Partido Republicano, Josh Hawley, quien es uno de los demandantes en un caso judicial clave que busca declarar inconstitucional a la Ley de Cuidado de Salud Asequible. La senadora Heidi Heitkamp (demócrata de Dakota del Norte) y el senador Joe Donnelly (demócrata de Indiana), quienes también hicieron de la atención de salud un tema de campaña, fueron derrotados.

No obstante, el senador Joe Manchin (demócrata de West Virginia) venció al republicano Patrick Morrisey, el procurador general del estado que también es un demandante en la causa que busca cambiar ACA.

La representante Nancy Pelosi (demócrata de California), líder de los demócratas en la Cámara de Representantes, quien estaría primera en la lista para asumir como vocera, dijo a un grupo de partidarios reunidos en Washington, DC para celebrar la victoria, que su grupo haría que la asistencia médica fuera un tema legislativo clave.

“Se trata de frenar el asalto de los republicanos y del líder de la mayoría del Senado, Mitch McConnell, al Medicare, al Medicaid, a la Ley de Cuidado de Salud Asequible, y a la atención médica de 130 millones de estadounidenses que viven con condiciones médicas preexistentes”, enfatizó. Pelosi prometió también que los demócratas ejecutarían “una acción legislativa muy, muy fuerte” para reducir el costo de los medicamentos recetados.

Entre las muchas caras nuevas en la Cámara de Representantes hay al menos una con una experiencia significativa en políticas de salud. La ex Secretaria de Salud y Servicios Sociales, Donna Shalala, quien dirigió el departamento durante los ocho años de la administración Clinton, ganó un asiento abierto en Florida.

Voters Reject Calif. Proposition To Cap Dialysis Profits, Approve Limits On Abortion In W.Va. And Alabama

Among the many other ballot measures voters considered across the country: California opted to have ambulance crews stay on duty while eating lunch, approved new funding for California’s children’s hospitals; Massachusetts rejected hospital staffing ratios; and Missouri approved medical marijuana.

Midterm Results Show Health Is Important To Voters But No Magic Bullet

Health care proved important but apparently not pivotal in the 2018 midterm elections on Tuesday as voters gave Democrats control of the U.S. House, left Republicans in charge in the Senate and appeared to order an expansion of Medicaid in at least three states long controlled by Republicans.

In taking over the House, Democrats are unlikely to be able to advance many initiatives when it comes to health policy, given the GOP’s control of the Senate and White House. But they will be able to deliver an effective veto to Republican efforts to repeal the Affordable Care Act, convert the Medicaid health care system for low-income people into a block grant program and make major changes to Medicare.

One likely development is an expansion of Medicaid in several of the 18 states that had so far not offered coverage made available by the Affordable Care Act. Early returns showed voters in Utah, Nebraska and Idaho easily approving ballot measures calling for expansion.

In Montana, voters are deciding if the existing expansion should be continued and the state’s expenses covered by raising tobacco taxes. In preliminary results, opponents outnumbered supporters but key counties were not expected to release their tallies until Wednesday.

Medicaid might also be expanded in Kansas, where Democratic gubernatorial candidate Laura Kelly defeated GOP Secretary of State Kris Kobach. The Kansas legislature had previously passed Medicaid expansion, but it was vetoed in 2017 by former GOP Gov. Sam Brownback. Kobach had not supported the ACA expansion.

And in Maine, where voters approved Medicaid expansion in 2017 but GOP Gov. Paul LePage refused to implement it, Democrat Janet Mills was victorious. She has promised to follow the voters’ wishes. LePage was not running.

In exit polling, as in many earlier surveys in 2018, voters said that health care, particularly preserving protections for people with preexisting conditions, was their top issue. But health care remained more important to Democrats than to Republicans.

Those who urged Democrats to emphasize health care this year took credit for the congressional successes. “The race for the House was a referendum on the Republican war on health care. You know it, I know it, and the Republican incumbents who shamefully tried to cover up their real record on health care and lost their seats know it,” said Brad Woodhouse of the advocacy group Protect Our Care.

But the issue was not enough to save some of the Senate Democrats in states won by President Donald Trump in 2016. Sen. Claire McCaskill (D-Mo.) was defeated by GOP Attorney General Josh Hawley, who is a plaintiff in a key lawsuit seeking to declare the Affordable Care Act unconstitutional. Sens. Heidi Heitkamp (D-N.D.) and Joe Donnelly (D-Ind.), who also campaigned hard on health care, were defeated.

Nonetheless, Sen. Joe Manchin (D-W.Va.) beat Republican Patrick Morrisey, the state’s attorney general who is also a plaintiff in the lawsuit seeking to upend the ACA.

Rep. Nancy Pelosi (D-Calif.), the leader of the House Democrats who is poised to take over as speaker, told supporters gathered in Washington for a victory celebration that her caucus would make health care a key legislative issue.

“It’s about stopping the GOP and [Senate Majority Leader] Mitch McConnell’s assault on Medicare, Medicaid and the Affordable Care Act and the health care of 130 million Americans living with preexisting medical conditions,” she said. She pledged that Democrats would take “very, very strong legislative action” to lower the cost of prescription drugs.

Among the many new faces in the House is at least one with some significant experience in health policy. Former Health and Human Services Secretary Donna Shalala, who ran the department for all eight years of the Clinton administration, won an open seat in Florida.

California Dreamin’? With Newsom’s Win, Single-Payer Unlikely To Follow Anytime Soon

Californians on Tuesday elected a governor who campaigned for a complete overhaul of how people get their health coverage — but they shouldn’t hold their breath.

Rather, as Gov.-elect Gavin Newsom and the Democratic-controlled legislature take steps to provide more people with health insurance, they’ll likely approach it piecemeal over several years.

Newsom himself is already tempering expectations about California’s move to a single-payer system, saying it will take more than the will of one person to realize.

“I’m not going to hesitate to be bold on this issue, and I also want to set expectations,” Newsom told reporters last week at a campaign stop in Sacramento. “It’s a multiyear process.”

The Democratic lieutenant governor easily routed Republican John Cox in the governor’s race Tuesday, with Newsom vowing to stand up to President Donald Trump and restore the “California Dream” by addressing affordable housing, health care and income inequality in the nation’s most populous state.

Newsom’s views are in stark contrast to Cox’s, who maintained that government should largely stay out of health care. The free-market businessman said single-payer would send health care costs soaring while diminishing quality, and warned that it “is a sure way to destroy the California economy.”

Like many Democrats, Newsom has described health care as a right and vowed to defend the Affordable Care Act as governor. He also criticized the legislature last year when it held up a single-payer bill that would have created one government-run public insurance program for all Californians.

He won the endorsement from the politically powerful California Nurses Association for vigorously advocating single-payer. Going slow on single-payer could test his relationship with the union, which launched a brutal attack against the Democratic state Assembly speaker when he shelved the measure last year.

It could also upset progressive Democrats and donors who are counting on action.

“This is the governor who has the best shot to get this done,” said Stephanie Roberson, the union’s director of government relations. “It takes political will and courage, and I’m going to cash in on what he said to my association.”

Now Newsom’s attitude is cautious — many say realistic — even in a state that aims to set national trends and relishes its role at the forefront of the resistance to the Trump administration.

Last week, Newsom called single-payer the most “effective and efficient” strategy to achieve universal coverage, but he questioned whether it could be achieved at the state level, given the Trump administration’s opposition to the concept.

Trump’s top Medicare and Medicaid official, Seema Verma, last summer firmly rejected the idea that the federal government would grant the essential exemptions from federal rules to try single-payer, which she called “unaffordable” and “something that’s not going to work.” The exemptions, or waivers, are necessary because the state relies heavily on federal health care dollars that would be needed to pay single-payer costs.

Undaunted, the California Nurses Association said it intends to bring another single-payer bill before the legislature next year and has launched a national campaign to pass single-payer in other states and convince Congress of its merits.

But it’s unlikely that a single-payer bill will make it to Newsom’s desk next year, in part due to the price tag: A single-payer system could cost an estimated $400 billion annually. Lawmakers earlier this year directed a council to study the feasibility of a publicly funded health insurance plan, and its findings aren’t due until 2021 — giving the new governor and lawmakers time to punt on the issue.

Still, Democrats who head the key legislative health committees see Newsom as a partner who will be more engaged on health care than fellow Democrat Gov. Jerry Brown has been these past eight years.

“Health care has not been one of the issues that he’s been particularly focused on,” Assemblyman Jim Wood, chairman of the Assembly Health Committee, said of Brown. “I think we’ve missed some opportunities to really move forward on some policies that would be good for all Californians.”

Brown this year blocked measures that would have expanded health care coverage to some low-income unauthorized immigrants — not because he philosophically opposed the idea, lawmakers say, but because it would have required new state spending.

He also raised cost concerns about bills that would have provided state-funded tax credits and subsidies to people who buy coverage through Covered California, the state’s insurance exchange.

With a new governor, those proposals are back on the table. Newsom was, after all, the San Francisco mayor who signed off on the nation’s first universal health care program for city residents without insurance, including undocumented immigrants. And, as he has reminded reporters, he did it during a recession.

“It’s a question of what do you value, what you prioritize,” he said last week when asked how the state could afford both universal health care and his call for universal preschool.

Newsom’s campaign did not respond to questions about how he would expand coverage absent single-payer. But, earlier this year, his spokesman told California Healthline that proposals to give coverage to undocumented immigrants and earmarking state dollars to help consumers buy insurance coverage were “two major parts” of his plan to deliver health coverage to all state residents. The state’s estimated 1.8 million unauthorized immigrants, for example, make up roughly 59 percent of the state’s remaining uninsured residents, according to Covered California.

The Democratic-dominated legislature would have to approve these moves.

“We’re going to be looking at a variety of ways that we might be able to get everyone covered,” Wood said. But, he added, “it will be significantly expensive to do that.”

Wood and state Sen. Richard Pan, chair of the Senate Health Committee, said lawmakers should look at the structural issues in health care — how prices for services and pharmaceuticals are regulated and how efficiencies, improved access and curbs on costly care of chronic diseases might be achieved.

“I think it’s clear the health care landscape is a focal point for the California legislature,” said Erin Trish, associate director of health policy at University of Southern California’s Schaeffer Center. “They don’t have to push for a single-payer system to push for expanded coverage.”

Expanding health care coverage would require more state spending, but that wouldn’t necessarily mean a hit to the state economy, experts said.

After California implemented the Affordable Care Act (albeit with significant federal assistance), the state’s economy continued to grow and the number of uninsured residents fell to 7.2 percent in 2017, according to the U.S. Census Bureau.

“We’ve expanded coverage and our economy has continued to flourish,” said Dr. Andrew Bindman, a primary care physician who is also a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco, who helped draft the federal health care law. “These things are achievable, and I think California is a model of that.”

Pan, the chair of the Senate Health Committee, said he looks forward to engaging Newsom, someone who proved he could move beyond rhetoric by signing the San Francisco measure that offered more city residents health coverage.

“Hopefully, we have an opportunity to get something done,” Pan said.


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Drugmakers Switch Gears This Year With Big Bankroll For Democrats

Pharmaceutical companies have contributed heavily to candidates, with 63 percent of their donations going to Democrats, Stat reports. And in other election-related news, KHN explains the “Medicare-for-all” buzz. Plus, how anti-vaccine supporters are backing candidates and a look at where the Georgia gubernatorial candidates stand on health issues.

Soda Industry Steals Page From Tobacco To Combat Taxes On Sugary Drinks

In the run-up to the midterm elections, the soda industry has poured millions of dollars into fighting taxes on sugary drinks, an increasingly popular approach to combating obesity, which affects 40 percent of American adults.

Soda makers have campaigned against sugary drink taxes in dozens of cities in recent years, mostly successfully. But after a string of recent defeats, the industry is now pushing statewide measures that strip cities and towns of their ability to tax soda. Two of these state initiatives are on the ballot Tuesday in Washington and Oregon.

Arizona and Michigan already ban localities from enacting soda taxes. In California, where four cities have soda taxes, the beverage industry pressured lawmakers this summer into accepting a 12-year moratorium on local taxes on sugar-sweetened drinks. Some California lawmakers said they felt they were “held hostage” by the soda industry, which spent $7 million on a ballot initiative that would have made it much harder for cities to raise taxes of any kind. The beverage industry dropped the initiative after lawmakers agreed to the moratorium.

Soda makers also have cultivated close relationships with doctors, scientists and professional societies, including the Obesity Society and the Academy of Nutrition and Dietetics. Both groups say there’s not enough evidence to know if sugar taxes are effective.

Public health advocates say Big Soda is following a script perfected by the tobacco companies, which denied that their products were harmful and funded research that cast doubt on scientific studies while forcefully resisting taxes and regulations. Tobacco companies used their lobbying clout to persuade state lawmakers to prevent cities and counties from passing smoke-free ordinances. In 2006, 21 states pre-empted local smoke-free laws, according to Americans for Nonsmokers’ Rights. Even today, 13 states have some sort of ban on local smoke-free laws.

“There are definitely parallels with the tobacco industry,” said Betsy Janes, an activist with the American Cancer Society Cancer Action Network. Soda makers “are happy to take a page from their playbook.”

Following recommendations from the World Health Organization, more than 30 countries and seven U.S. cities — including Seattle, San Francisco and Boulder, Colo. — now tax sugary drinks. These laws usually exempt diet soda, pure fruit juice and bottled water.

Most public health advocates describe soda taxes as a proven way to reduce Americans’ consumption of added sugars, which have been linked to 40,000 deaths from heart disease every year. A study published last year in PLOS One projects that Mexico’s soda tax will prevent up to 134,000 cases of diabetes by 2030. In Philadelphia, sales of sweetened beverages fell 57% after a city tax of 1.5 cents per ounce took effect, according to a 2017 study.

Soda companies used their war chests to fund the Washington and Oregon ballot measures. Coca-Cola has contributed nearly half the $20 million raised in support of the Washington initiative, while the American Beverage Association has contributed about half the $5.6 million behind the Oregon measure.

PepsiCo, one of the largest soda companies, did not respond to calls or emails. Coca-Cola declined to comment on the issue, referring all questions to the American Beverage Association, which represents the soda industry. William Dermody, a spokesman for the beverage association, declined to comment on the comparison with Big Tobacco. But Dermody said the soda industry supports “keeping food and beverages affordable” and is “standing up for small business and working families” by supporting the ballot measures. Taxes on soda and other groceries “are harmful; they raise prices and they cost jobs,” he said.

Health advocates say the ballot measures aren’t really about groceries. The beverage industry’s strong support suggests the measures are really about protecting soda profits, said Hillary Caron, senior policy associate at the Center for Science in the Public Interest.

In Washington, basic groceries are exempt from sales taxes, said state Sen. Reuven Carlyle, a Seattle Democrat opposed to the initiative. “In 41 years, there hasn’t been one bill to tax groceries,” Carlyle said. The beverage industry “is retaliating against our state” because of Seattle’s soda tax.

Matthew Myers, of the Campaign for Tobacco-Free Kids, said the tobacco industry has long allied itself with anti-tax and pro-business groups, which have helped it fend off cigarette taxes. The tobacco industry fought smoke-free laws by warning that they would drive customers away from restaurants and bars. In fact, the Centers for Disease Control and Prevention reports that smoking bans increase business at bars and restaurants because customers enjoy clean air. Similarly, research shows that Philadelphia’s sugary drink tax hasn’t hurt business, Myers said. Although sales of sugary drinks have fallen, overall business at chain stores hasn’t suffered, according to a 2017 study. A study of a soda tax in Berkeley, Calif., found similar results, with residents buying less soda but more bottled water.

Public health groups said they aren’t giving up on soda taxes. In California, the state dental and medical associations have filed a ballot measure for 2020 to create a statewide tax on sugary drinks.

A Show Of Force

Soda makers have plenty of money for a fight. The food and beverage industry spends $22.3 million a year on lobbying, including $5.4 million by Coca-Cola. That’s more than the tobacco industry, which spends $16.7 million on lobbying, according to OpenSecrets.org.

The tobacco industry spent decades funneling money into research that made cigarettes look less harmful than they really were, Myers said. Beverage companies also have tried to win over scientists and medical societies by funding research, said Marion Nestle, an emeritus professor of nutrition, food studies and public health at New York University and author of “Unsavory Truth: How Food Companies Skew the Science of What We Eat.”

Soda industry funding of medical meetings, journals and researchers is ubiquitous. Coca-Cola acknowledges spending $146 million on “well-being related scientific research, partnership and health professional activities” from 2010 through 2017. A 2016 study found that Coca-Cola and PepsiCo funded 95 national medical organizations from 2011 to 2015, while lobbying against 29 public health bills that aimed to reduce soda consumption or improve diet. Coca-Cola funded the publication of 389 articles in 169 journals from 2008 to 2016, according to a study published this year in Public Health Nutrition.

Nestle said no one should be surprised that industry-funded research tends to absolve soda from any role in causing obesity. Beverage industry research typically shifts the blame for obesity onto inactivity and “energy balance,” suggesting that exercise is far more important to weight loss than cutting back on sugar and calories, she said.

Yet independent researchers have found “quite compelling” evidence linking sugary drinks to obesity, heart disease and diabetes, said Dr. Frank Hu, chair of the nutrition department at the Harvard T.H. Chan School of Public Health. The CDC notes that sodas are among the largest sources of added sugar in the American diet. A 12-ounce can of Coke contains 9 1/3 teaspoons of sugar; the American Heart Association recommends that women consume no more than six teaspoons of sugar a day, and that men limit themselves to nine.

Dermody questioned the link between sugary drinks and obesity. Obesity has increased steadily over the past three decades. Yet in 2015, sales of carbonated soft drinks fell to their lowest level in 30 years, suggesting the obesity epidemic is being driven by something other than soda, Dermody said. He noted that half the soft drinks sold today have no calories. That shows that voluntary industry efforts to reduce sugar and calories in soft drinks are working, and that taxes aren’t needed.

A number of medical groups and universities stopped accepting soda industry funding in 2015, after extensive publicity of Coca-Cola’s attempts to influence science. Most health groups — including the American Heart Association, American Cancer Society and American Diabetes Association — now support soda taxes.

Two medical groups have defied this trend.

In July, just after California lawmakers approved the moratorium on soda taxes, the Obesity Society, which represents doctors who treat overweight patients, issued a statement saying there’s no proof that such measures will save lives. The Academy of Nutrition and Dietetics, which includes dietitians, has taken a “neutral” stand on soda taxes, noting that “scientific evidence is insufficiently clear.” In a statement similar to positions taken by the beverage industry, the nutrition academy said, “No single food or beverage leads to overweight or obesity when consumed in moderate amounts and within the context of the total diet.”

Both the obesity and nutrition groups have had close relationships with the soda industry. Coca-Cola and PepsiCo were “premier sponsors” of the nutrition academy in 2016, according to the group’s annual report. PepsiCo and Ocean Spray paid for “premium” exhibit booths at the nutrition academy’s national conference in October. Booths that size were priced at nearly $40,000 to $50,000 each.

In October, PepsiCo underwrote a special issue of the Obesity Society’s journal, which was devoted entirely to the science of artificial sweeteners, at a cost of $26,880. Although PepsiCo paid the journal’s publisher for the special issue, part of the money also went to the Obesity Society, said Dr. Steven Heymsfield, the group’s president-elect. The Obesity Society also has nurtured close ties with soda makers through a “food industry engagement council.” Past meetings were chaired by executives of PepsiCo and attended by employees of the Dr Pepper Snapple Group, now known as Keurig Dr Pepper.

Anthony Comuzzie, the Obesity Society’s executive director, said the society has disbanded the food industry council. In an email, Comuzzie denied that the society’s ties to industry have influenced its position on soda taxes. “To imply that the group or society collectively is biased by food companies has no basis in reality,” he said in an email.

The nutrition academy notes that sponsorships make up less than 5 percent of its budget. “Revenue generated from sponsorships has no impact on the Academy’s policymaking or any stance on issues,” the group said in a statement.

Nestle said that the soda industry appears to have bought the nutrition academy’s silence.

“It is shameful that the academy is not strongly supporting public health measures to prevent obesity,” Nestle said. “The academy’s position puts it squarely on the side of the food industry and against public health.”

It’s Almost Time To Vote … Experts Opine About How It’s All Played Out, What Could Happen Next

Polls will open for the midterm elections in less than 24 hours. Already there’s an effort to look at how the health care debate has unfolded — fact-checking statements, measuring what people understand about catch phrases such as Medicare-for-all, handicapping what might happen to Obamacare if the GOP retains control of the House and Senate, and predicting how the health care sector might come out in the end.

It’s Almost Time To Vote … Experts Opine About How It’s All Played Out, What Could Happen Next

Polls will open for the midterm elections in less than 24 hours. Already there’s an effort to look at how the health care debate has unfolded — fact-checking statements, measuring what people understand about catch phrases such as Medicare-for-all, handicapping what might happen to Obamacare if the GOP retains control of the House and Senate, and predicting how the health care sector might come out in the end.

Tobacco Tax Battle Could Torch Montana Medicaid Expansion

Montana legislators expanded Medicaid by a very close vote in 2015. They passed the measure with an expiration date: It would sunset in 2019, and all who went onto the rolls would lose coverage unless lawmakers voted to reapprove it.

Fearing legislators might not renew funding for Medicaid’s expanded rolls, Montana’s hospitals and health advocacy groups came up with a ballot measure to keep it going — and to pay for it with a tobacco tax hike.

If ballot initiative I-185 passes Tuesday, it will mean an additional $2-per-pack tax on cigarettes and levy a tax on e-cigarettes, which are currently not taxed in Montana.

The tobacco tax initiative has become the most expensive ballot measure race in Montana history — drawing more than $17 million in opposition funding from tobacco companies alone — in a state with fewer than 200,000 smokers.

Amanda Cahill works for the American Heart Association and is a spokeswoman for Healthy Montana, the coalition backing the measure. She said coalition members knew big tobacco would fight back.

“We poked the bear, that’s for sure,” Cahill said. “And it’s not because we were all around the table saying, ‘Hey, we want to have a huge fight and go through trauma the next several months.’ It’s because it’s the right thing to do.”

Most of the $17 million has come from cigarette maker Altria. According to records from the National Institute on Money in Politics, that’s more money than Altria has spent on any state proposition nationwide since the center started keeping track in 2004.

Meanwhile, backers of I-185 have spent close to $8 million on the initiative, with most of the money coming from the Montana Hospital Association.

“What we want to do is — No. 1 — stop Big Tobacco’s hold on Montana,” Cahill said. Also, she continued, it’s imperative that the nearly 100,000 people in Montana who have gotten Medicaid under the expansion will be able to keep their health care.

Cahill said I-185 will allocate plenty of money to cover the expansion, though some lawmakers say the state can’t afford the expansion even with higher taxes.

Nancy Ballance, a Republican representative in the Montana state Legislature, opposes the measure.

“In general I am not in favor of what we like to refer to as ‘sin taxes,’ ” Ballance said. “Those are taxes that someone determines should be [levied] so that you change people’s behavior.”

Ballance also isn’t in favor of ballot initiatives that, she said, try to go around what she sees as core functions of the Legislature: deciding how much revenue the state needs, for example, or where it should come from, or how it should be spent.

“An initiative like this for a very large policy with a very large price tag — the Legislature is responsible for studying that,” Ballance said. “And they do so over a long period of time, to understand what all the consequences are — intended and otherwise.”

Most citizens, she said, don’t have the time or expertise to develop that sort of in-depth understanding of a complicated issue.

Montana’s initiative to keep Medicaid’s expansion going would be a “double whammy” for tobacco companies, said Ben Miller, the chief strategy officer for the nonprofit Well Being Trust.

“People who are covered are more likely to not smoke than people who are uninsured,” said Miller, who has studied tobacco tax policies for years. He notes research showing that people with lower incomes are more likely than those with higher incomes to smoke; and if they’re uninsured, they’re less likely to quit.

Federal law requires Medicaid to offer beneficiaries access to medical help to quit smoking.

Plus, Miller added, every time cigarette taxes go up — thereby increasing the price per pack — that typically leads to a decrease in the number of people smoking.

And that, he said, works against a tobacco company’s business model, “which is, ‘you need to smoke so we can make money.’ ”

Ballance agrees that tobacco companies likely see ballot initiatives like I-185 as threats to their core business. But, she said, “for anybody who wants to continue smoking, or is significantly addicted, the cost is not going to prohibit them from smoking.”

The U.S. Centers for Disease Control and Prevention says tobacco use is the leading cause of preventable disease and death in the U.S.

Montana’s health department says that each year more than 1,600 people in the state die from tobacco-related illnesses.

This story is part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News.

Quick: What’s The Difference Between Medicare-For-All and Single-Payer?

MODESTO, Calif. — Betsy Foster and Doug Dillon are devotees of Josh Harder. The Democratic upstart is attempting to topple Republican incumbent Jeff Denham in this conflicted, semi-rural district that is home to conservative agricultural interests, a growing Latino population and liberal San Francisco Bay Area refugees.

To Foster’s and Dillon’s delight, Harder supports a “Medicare-for-all” health care system that would cover all Americans.

Foster, a 54-year-old campaign volunteer from Berkeley, believes Medicare-for-all is similar to what’s offered in Canada, where the government provides health insurance to everybody.

Dillon, a 57-year-old almond farmer from Modesto, says Foster’s description sounds like a single-payer system.

“It all means many different things to many different people,” Foster said from behind a volunteer table inside the warehouse Harder uses as his campaign headquarters. “It’s all so complicated.”

Across the country, catchphrases such as “Medicare-for-all,” “single-payer,” “public option” and “universal health care” are sweeping state and federal political races as Democrats tap into voter anger about GOP efforts to kill the Affordable Care Act and erode protections for people with preexisting conditions.

Republicans, including President Donald Trump, describe such proposals as “socialist” schemes that will cost taxpayers too much. They say their party is committed to providing affordable and accessible health insurance, which includes coverage for preexisting conditions, but with less government involvement.

Voters have become casualties as candidates toss around these catchphrases — sometimes vaguely and inaccurately. The sound bites often come across as “quick answers without a lot of detail,” said Gerard Anderson, a professor of public health at the Johns Hopkins University Bloomberg School Public Health.

“It’s quite understandable people don’t understand the terms,” Anderson added.

For example, U.S. Sen. Bernie Sanders (I-Vt.) advocates a single-payer national health care program that he calls Medicare-for-all, an idea that caught fire during his 2016 presidential bid.

But Sanders’ labels are misleading, health experts agree, because Medicare isn’t actually a single-payer system. Medicare allows private insurance companies to manage care in the program, which means the government is not the only payer of claims.

What Sanders wants is a federally run program charged with providing health coverage to everyone. Private insurance companies wouldn’t participate.

In other words: single-payer, with the federal government at the helm.

Absent federal action, Democratic gubernatorial candidates Gavin Newsom in California, Jay Gonzales in Massachusetts and Andrew Gillum in Florida are pushing for state-run single-payer.

To complicate matters, some Democrats are simply calling for universal coverage, a vague philosophical idea subject to interpretation. Universal health care could mean a single-payer system, Medicare-for-all or building upon what exists today — a combination of public and private programs in which everyone has access to health care.

Others call for a “public option,” a government plan open to everyone, including Democratic House candidates Antonio Delgado in New York and Cindy Axne in Iowa. Delgado wants the public option to be Medicare, but Axne proposes Medicare or Medicaid.

Are you confused yet?

Sacramento-area voter Sarah Grace, who describes herself as politically independent, said the dialogue is over her head.

“I was a health care professional for so long, and I don’t even know,” said Grace, 42, who worked as a paramedic for 16 years and now owns a holistic healing business. “That’s telling.”

In fact, most voters approached for this article declined to be interviewed, saying they didn’t understand the issue. “I just don’t know enough,” Paul Her of Sacramento said candidly.

“You get all this conflicting information,” said Her, 32, a medical instrument technician who was touring the state Capitol with two uncles visiting from Thailand. “Half the time, I’m just confused.”

Paul Her, 32, a medical instrument technician from Sacramento, says he’s “just confused” by the conflicting health care pitches he hears from politicians. (Samantha Young/KHN)

The confusion is all the more striking in a state where the expansion of coverage has dominated the political debate on and off for more than a decade. Although the issue clearly resonates with voters, the details of what might be done about it remain fuzzy.

A late-October poll by the Public Policy Institute of California shows the majority of Californians, nearly 60 percent, believe it is the responsibility of the federal government to make sure all Americans have health coverage. Other state and national surveys reveal that health care is one of the top concerns on voters’ minds this midterm election.

Democrats have seized on the issue, pounding GOP incumbents for voting last year to repeal the Affordable Care Act and attempting to water down protections for people with preexisting medical conditions in the process. A Texas lawsuit brought by 18 Republican state attorneys general and two GOP governors could decimate protections for preexisting conditions under the ACA — or kill the law itself.

Republicans say the current health care system is broken, and they have criticized the rising premiums that have hit many Americans under the ACA.

Whether the Democratic focus on health care translates into votes remains to be seen in the party’s drive to flip 23 seats to gain control of the House.

The Denham-Harder race is one of the most watched in the country, rated too close to call by most political analysts. Harder has aired blistering ads against Denham for his vote last year against the ACA, and he sought to distinguish himself from the incumbent by calling for Medicare-for-all — an issue he hopes will play well in a district where an estimated 146,000 people would lose coverage if the 2010 health law is overturned.

Yet Harder is not clinging to the Medicare-for-all label and said Democrats may need to talk more broadly about getting everyone health care coverage.

“I think there’s a spectrum of options that we can talk about,” Harder said. “I think the reality is we’ve got to keep all options open as we’re thinking towards what the next 50 years of American health care should look like.”

To some voters, what politicians call their plans is irrelevant. They just want reasonably priced coverage for everyone.

John Byron, a 73-year-old retired grandfather from Modesto, wants a government-run health care system that doesn’t include private insurance companies. What politicians call the program is irrelevant to him, he says. (Samantha Young/KHN)

Sitting with his newspaper on the porch of a local coffee shop in Modesto, John Byron said he wants private health insurance companies out of the picture.

The 73-year-old retired grandfather said he has seen too many families struggle with their medical bills and believes a government-run system is the only way.

“I think it’s the most effective and affordable,” he said.

Linda Wahler of Santa Cruz, who drove to this Central Valley city to knock on doors for the Harder campaign, also thinks the government should play a larger role in providing coverage.

But unlike Byron, Wahler, 68, wants politicians to minimize confusion by better defining their health care pitches.

“I think we could use some more education in what it all means,” she said.


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.