Tagged Legislation

Podcast: KHN’s ‘What The Health’: Still More ‘Medicare-For-All’

Vermont Sen. Bernie Sanders, a presidential candidate, unveiled the 2019 version of his “Medicare-for-all” bill this week. But even more than two decades after first proposing a single-payer plan for the U.S., Sanders still has not proposed a way to finance such a major undertaking.

Congress continued to pursue its examination of high prescription drug prices this week by calling to testify both insulin makers and the drug “middlemen” known as pharmacy benefit managers.

And Idaho is following Utah in trying to scale back an expansion of Medicaid under the Affordable Care Act approved by voters last November.

This week’s panelists are Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

Also, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans.

Among the takeaways from this week’s podcast:

  • “Medicare-for-all” was in the spotlight again this week with the release of Sanders’ bill, which is co-sponsored by four of the five other Senate Democrats running for president. Still, neither Sanders nor any other candidates — or their proposals — focus on how to pay for it. Experts differ on how much expanding Medicare would cost. But, whether it’s moving around money already being spent or raising new taxes, expanding Medicare to more people would result in winners and losers, a key political factor going forward.
  • Both parties face internal divisions over health care, revolving around whether to create something new or stick with the status quo. Within the GOP, the split is between Republicans who point to years of unsuccessful efforts to repeal and maybe replace the ACA and want to move on to other things, and others — including some in the White House — who are continuing the push. Democrats’ division is between those who back House Speaker Nancy Pelosi’s call to strengthen and improve the ACA and those who back various efforts to create a Medicare-for-all system.
  • The GOP is playing both offense and defense on the ACA. Leaders say they want to be the party of health care and protect people with preexisting medical conditions, even as the Justice Department is officially backing a court ruling in Texas that would invalidate the entire law, including those protections.
  • There was lots of talk but little action on drug prices at hearings before Congress. Lawmakers heard from drug companies and pharmacy benefit managers, but are no closer to answering the question about what to do about high drug prices. While there may be incremental changes that can be adopted, few expect legislation that would fundamentally change business practices, intellectual property rights or the ability for Medicare to negotiate drug prices.
  • Action in the Utah and Idaho legislatures around Medicaid expansion show that even successful ballot initiatives to expand the program can be changed by lawmakers in ways voters may not have expected. In both state capitols, elected officials reduced the number of people eligible for expansion below what voters approved.

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

Julie Rovner: The New York Times’ “Would ‘Medicare for All’ Save Billions or Cost Billions?” By Josh Katz, Kevin Quealy and Margot Sanger-Katz

Sarah Kliff: Politico’s “Public Option Hits a Wall in Blue States,” by Rachana Pradhan and Dan Goldberg

Margot Sanger-Katz: Politico’s “Obamacare Fight Obscures America’s Real Health Care Crisis: Money,” by Joanne Kenen

Paige Winfield Cunningham: STAT News’ “Amazon Alexa Is Now HIPAA-Compliant. Tech Giant Says Health Data Can Now Be Accessed Securely,” by Casey Ross

To hear all our podcasts, click here.

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

Big Soda Pours Big Bucks Into California’s Capitol

Dinners at an expensive restaurant in Maui — with ocean views. Tickets to professional sports games. A free screening of “Black Panther” at a Sacramento IMAX theater. And a $250,000 donation to a group that funds the governor’s travel.

That’s just a sampling of the $11.8 million that soft drink companies and their lobbyists spent at the state and local levels in the past two years in California to block proposals such as taxing sugary beverages and slapping health warnings on their drinks, a California Healthline analysis found.

“They exercise extraordinary influence in this building,” state Sen. Bill Monning (D-Carmel) said of the industry. “We don’t underestimate the power of the opposition.”

Monning doesn’t accept soda industry money — and has tried repeatedly to tax sugary beverages in California and place warning labels on packaging. He was one of the most vocal critics last year when the industry blocked cities and counties from levying soda taxes — a maneuver some lawmakers described as “extortion.”

Angered by the industry’s tactics, Monning and other lawmakers now are pushing a package of bills to clamp down on drinks they say contribute to rising rates of obesity and diabetes. Several of the measures are scheduled for a committee hearing Tuesday, including one that would tax distributors of sugary drinks at 2 cents an ounce.

Connecticut, Massachusetts, New York, Rhode Island and Vermont also are considering statewide taxes on sugar-sweetened beverages. At least four states, including Arkansas and West Virginia, already impose taxes on sodas, either by the fluid ounce or on gross receipts, according to the National Conference of State Legislatures.

California Sen. Bill Monning (D-Carmel) displays the amount of sugar in a 20-ounce bottle of Coca-Cola. Monning is pushing legislation that would put health warning labels on sugary drinks. He describes the soda industry as a big influencer in California politics. (Samantha Young/KHN)

Although it’s anybody’s guess how much the industry will spend to sway California lawmakers this year, its previous largesse indicates money will flow to nearly every Capitol officeholder.

A California Healthline analysis found that 9 in 10 state senators and members of the Assembly, or a member of their staff, accepted a campaign contribution, gift or charitable donation in 2017 and 2018 from the American Beverage Association (or its political action committee), the Coca-Cola Co. or PepsiCo — the three largest givers in the industry.

The beverage industry, like other interest groups, spends money to influence lawmakers in several ways: It makes financial contributions to their campaigns and lobbies them and their staffs, sometimes plying them with meals, events and travel. It also donates to charities in lawmakers’ names.

“They follow the playbook of the tobacco industry in protecting their products from criticism, casting doubt on the science, lobbying, working behind the scenes, funding front groups, doing all the things that industries that make potential harmful products do,” said Marion Nestle, author of “Soda Politics” and a professor emerita of food nutrition at New York University.

The beverage association and Coca-Coca did not respond to specific questions about their political giving, and PepsiCo didn’t respond at all. William Dermody Jr., an ABA vice president, argued “excessive” taxes on drinks would harm the economy.

“It’s important to inform lawmakers about the contributions that our products make to the local economy, not only the millions in tax revenues we generate for the state but the wages we bolster for hundreds of thousands of California workers,” Dermody said in an email.

Big Soda is not alone in trying to influence lawmakers on the issue of sugary drinks.

The California Medical Association and the California Dental Association, which represent doctors and dentists, are planning a ballot initiative to tax sugary drinks. Together they spent about $10.6 million in lobbying and campaign contributions to influence a broad range of health-related legislation over the past two years.

For the soda industry, 2017-18 was particularly expensive.

Why? As more California cities passed and proposed local taxes on sugary beverages, soda companies last year poured $8.9 million into a statewide ballot measure that would have made it more difficult for cities to levy any new tax, not just those on beverages. The money came from the American Beverage Association PAC, primarily funded by Coca-Cola, Pepsi and Dr Pepper Snapple Group.

Concerned that California voters would approve a higher voting threshold for all local taxes, lawmakers reluctantly banned local soda taxes until Jan. 1, 2031, if the industry dropped its ballot proposal.

“I don’t think they won any friends in the legislature,” said Assemblywoman Lorena Gonzalez (D-San Diego). She received $11,000 in campaign contributions from the industry in the past two years, and has voted on its side against bills to label and tax sugary drinks, citing concerns that a soda tax is regressive and would harm poor, minority communities.

Entertaining Lawmakers And Their Staffs

In 2017 and 2018, the American Beverage Association spent just over $1 million lobbying California policymakers, while PepsiCo spent $371,482 and Coca-Cola spent $352,469, according to forms filed with the California Secretary of State’s office. That’s nearly 70 percent more than they spent in the previous two years.

The bulk of the money went to lobbying firms staffed by former government employees — people with connections at the Capitol who know how to influence legislation.

The ABA spent $379 on food for eight lawmakers in November 2017 as part of an $813 dinner tab at the upscale Humble Market Kitchin Restaurant in Maui — where a steak might go for $65 and a whole fried fish for $57. The legislators were attending a legislative retreat.

The association gave 11 legislative staffers tickets to Sacramento Kings basketball games and paid for their food and drinks, at a cost ranging from $163 to $326 per staffer. It also shelled out at least $3,747 for at least 92 lawmakers, staff members and their guests to attend a showing of “Black Panther” in March 2018.

Asked why Assemblywoman Sabrina Cervantes (D-Riverside) attended the movie, her spokeswoman said she is “supportive of the arts and celebrates diversity in cinema.”

The ABA’s biggest lobbying expense was a $250,000 payment to the California State Protocol Foundation, which funded Jerry Brown’s travel while he was governor.

In The Name Of Charity

While there are limits on how much lawmakers can accept in gifts, companies also seek to gain influence by making unlimited charitable donations on a lawmaker’s behalf. These donations are known as “behested payments,” and the industry made nearly $100,000 of them in 2017 and 2018.

State Assemblywoman Lorena Gonzalez (D-San Diego) is skeptical of soda taxes and their impact on low-income and minority communities. But she says the soda industry didn’t win any friends last year when it maneuvered a vote to ban local soda taxes. (Samantha Young/KHN)

Last year, a Coca-Cola distributor in Gonzalez’s district donated $10,000 to the San Diego Food Bank in her name — a contribution she said she was unaware of until contacted for this article.

Sometimes, lawmakers seek out contributions. When state Assemblyman Adam Gray (D-Merced) asked the beverage association to sponsor the annual meeting of the National Conference of State Legislatures, the association gave $25,000 in his name. Gray, who served as California’s representative to the meeting, said it was his responsibility to secure sponsors, and that he asked several corporations to contribute.

Those contributions, he said, don’t influence his vote. For example, he said Google gave $100,000 but he voted for privacy legislation the company opposed.

“If you want to support my agenda, my voting record and the things I stand for, I’m happy to take that support,” Gray said. “But it has zero role in how I represent my district or how I make decisions on public policy.”

Funding Lawmakers’ Campaigns

The most direct method that interest groups use to influence the political process is by giving money to campaigns, political parties and legislative caucuses.

Along with spending $8.9 million on the statewide ballot measure, the American Beverage Association PAC, PepsiCo and Coca-Cola gave about $1.1 million to other statewide and local political efforts in the past two years.

The majority of legislators received campaign cash from the beverage association, Coke or Pepsi — if not all three.

A spokesman for Coca-Cola said the company selects recipients based on committee assignments, caucus memberships, leadership positions and whether they represent regions with Coca-Cola facilities.

“There is no one-size-fits-all approach,” said company spokesman Max Davis. “At times, the individual views of candidates we support may vary from our own.”

Monning said the soft drink industry is a formidable adversary. Many colleagues tell him they can’t vote for legislation that would cut sales because they have a distributor in their district.

In addition to a statewide soda tax, the bills under consideration this year would require warning labels about sugar and prevent soda companies from offering retailers incentives to sell their drinks. They also would ban retailers from selling supersize sodas and prohibit sales in checkout lanes.

As lawmakers consider these bills, Monning said, his question to his colleagues will be simple:

“Do you represent the soda industry?” he said. “Or do you represent those children in your district showing a steady increase in poor health?”

California Healthline digital reporter Harriet Blair Rowan contributed to this report.

How California Healthline compiled data about soda companies’ political spending

Among the ways soda companies try to exert influence on the political process is by contributing money to campaigns; hiring lobbyists and plying elected officials with drinks, meals and event tickets and making charitable contributions on the behalf of lawmakers.

Using the California secretary of state’s website, California Healthline downloaded the campaign contributions made by the American Beverage Association PAC, Coca-Cola Co., PepsiCo and Dr Pepper Snapple Group in 2017-18. This includes some non-monetary contributions.

To track lobbying, we created a spreadsheet of expenses reported on lobbying disclosure forms, also available on the secretary of state’s website, by the American Beverage Association, Coca-Cola and Pepsi. We found details about how much the industry paid lobbying firms and which lawmakers, or members of their staff, accepted gifts.

To find how much these entities gave in charitable contributions, California Healthline pulled data described as “behested payments” from the California Fair Political Practices Commission website. These are payments special interests can make to a charity or organization on behalf of a lawmaker. Sometimes, a few of these payments also show up on lobbying forms. We compared the behested payments with the lobbying reports to ensure we did not double-count money.


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The question for the day is: If there were a drug that would turbocharge your brain, would you take it? I’ve seen enough sci-fi movies to make me, uh, less than enthused about the idea, but as my second cup of coffee of the day has yet to kick in, I find it interesting to ponder.

Anyway, on to this roller coaster of a news week!

Republicans on the Hill have been quietly pretending they might wake up and this renewed focus on the health law will all have been a fever dream. But Democrats are doing their best to make sure everyone knows exactly where everyone stands on President Donald Trump’s recent legal attacks. On Wednesday, the House Dems officially voted to condemn the president’s decision to tell the courts to nullify the entire health law instead of just parts of it. In practice, this means nothing, but it puts Republicans on record of once again voting against popular health law provisions.

Trump, meanwhile, softly backpedaled on his promises that Republicans were coming up with a “spectacular” replacement plan before 2020. This came after a talk with Senate Majority Leader Mitch McConnell — who essentially channeled his inner Ariana Grande and said thank u, next to the issue that has left the party with political bruises the past two years.

But Trump is remaining steadfast in his message that Republicans need to reclaim health care as a winning topic for 2020. “We can’t run away” from health care, he said. “We’ll lose.”

The bumpy week, for some, was a reminder of the surprises that could be in store for the upcoming election season.

The Wall Street Journal: Democrats, Trump Try to Keep Spotlight on Health Care

The Associated Press: Pivoting on Pledges, Trump Explores Art of the Climb-Down

Bloomberg: Trump Says GOP `Blew It’ on Health Care and Must Run on New Plan

Politico: Killing Obamacare Kills Trump’s Health Agenda, Too


Going on name only, the Violence Against Women Act sounds like one of the least controversial bills out there, but a closer look at its history reveals fault lines. The House this week passed its version of the legislation (which is geared toward protecting women from violence and domestic abuse and has to be renewed every few years), but don’t expect smooth sailing the rest of the way. This time the underlying drama stems from a new provision that expanded law enforcement’s ability to strip domestic abusers of their guns.

The New York Times: A Brief History of the 25-Year Debate Over the Violence Against Women Act


Fill-in-the-blank copycat bills powered by special interests and businesses have infiltrated the legislative process to a shocking extent. USA Today, The Arizona Republic  and the Center for Public Integrity has an amazing two-year investigation that examined nearly 1 million bills in all 50 states and Congress to root out legislation that was nearly identical to others. These measures touched on almost every subject imaginable, from sugary drinks to “right-to-try” legislation to abortion to gun control. The investigation found that these bills are often drafted with deceptive titles, include misleading information on the extent of expert or public support, and push agendas that override the will of voters. Be sure to check out this story — it has examples of the bills, data and charts, and all kinds of fun goodies to delve into.

USA Today: Abortion, Gun Control: How Special Interest Groups Push Legislation


A veritable flurry of movement on drug pricing bills is coming up in the next week or so, with legislation and hearings that will focus on PBMs, the price of insulin, transparency, public accountability for pharma and more. With that as context …

Express Scripts this week announced that it is capping the price of insulin at $25 per month. Under the new plan, employers who cover their workers through Cigna and Express Scripts can opt into the program, and the extra costs will be picked up by the three drugmakers that sell insulin — Eli Lilly, Novo Nordisk and Sanofi. Advocates deemed the decision nothing but a PR move, saying it does little to address the actual problems of high list prices for people who aren’t lucky enough to be on one of the plans.

The New York Times: Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

Stat: House Committee to Weigh Bills Aimed at Shedding Light on High Drug Prices


“One medical emergency, that’s all it would take to wipe me out financially,” is something I’ve heard friends worry about time and again, so a grim new report about the reality of paying for health care in America came as no surprise. Over the past year, Americans have borrowed $88 billion (billion! with a b!) to pay for health care. A survey went on to report that nearly half of Americans are haunted by fears of medical-related bankruptcy, and 1 in 4 people have skipped needed care because of the cost. Not only that, about 70% of respondents across the political spectrum said they had no confidence in their elected officials to bring prices down.

The New York Times: Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds


This technically happened last Friday, but not in time for the Breeze: The Trump administration approved a work-requirements waiver for Utah — just days after similar restrictions were struck down for both Kentucky and Arkansas. The Utah story is even more nuanced, though, because voters in that state approved full expansion of the program. Lawmakers have been scrambling to put rules into place ever since the ballot measure passed.

The New York Times: Trump Administration Approves Medicaid Work Requirements in Utah

Meanwhile, both HHS Secretary Alex Azar and CMS Administrator Seema Verma have been quietly trying to sell states on applying for block grant waivers, with Verma, in particular, pushing Alaska to become the first in the nation to apply. A legal challenge would almost certainly follow any such decision.

The Hill: Trump Administration Urging Alaska to Be First to Apply for Medicaid Block Grant


In the same vein as this happened late last week but you should know about it: The Trump administration announced the recipients of $250 million in Title X federal family planning grants, including a chain of anti-abortion clinics designed to siphon off patients from Planned Parenthood. The group had been turned down last year because it doesn’t provide birth control other than natural family planning and abstinence. Meanwhile, Planned Parenthood and its affiliates saw a steep drop in what it had been previously receiving — going from about $50 million-$60 million to $16 million.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes


In the miscellaneous file this week:

• A look at how a former congressman has become a one-man gate-keeping operation when it comes to lobbying the VA.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes

• A wild investigation into how high-speed chases, while frowned upon in other agencies, are a strategy often used by the Border Patrol, despite the fact that they can often end in gruesome injuries and death.

Los Angeles Times/ProPublica: Border Patrol Agents Are Granted Wide Latitude When Trying to Catch Drivers Seeking to Enter U.S. Illegally

• Torture, rape, murder and other violence in the Alabama prison system is “severe and systematic,” a new Department of Justice report finds. Fair warning, the details are pretty disturbing, but it’s worth a read.

The New York Times: Alabama’s Gruesome Prisons: Report Finds Rape and Murder at All Hours

• Can getting drugs to treat libido issues or thinning hair be as easy as ordering off a restaurant menu? That’s what these new types of websites offer: a way for patients to self-diagnose their problems and then get a sign-off from a doctor whom they don’t even meet with. The sites often don’t include warnings about side effects of the medications, and it’s entirely unclear whether their doctor-screening process follows any kind of standards.

The New York Times: Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’

• The “lede” on this story was a cold reality check about the intersection of public health fears and prejudice when it comes to vulnerable populations. Rockland County, N.Y., where one of the country’s largest measles outbreaks is rippling through the Jewish Orthodox community, is serving as a model of how those tensions can boil over in times of crisis.

The New York Times: An Outbreak Spreads Fear: Of Measles, of Ultra-Orthodox Jews, of Anti-Semitism

• “Healthy Holly” may sound like an innocuous children’s book, but the controversy surrounding it — and its author, Baltimore Mayor Catherine Pugh — will likely bring down several careers.

The Baltimore Sun: As a Maryland Senator, Pugh Pushed Bills to Benefit Hospitals While Getting Book Payments From Medical System


And make sure to check out this fun history on how the concept of personal space is hard-wired into our brains. Have a great weekend!