The Health 202: Labor unions aren’t sure about Medicare-for-all. That’s bad for Sanders and good for Buttigieg.

THE PROGNOSIS

There is lots of head-butting between Sen. Bernie Sanders (I-Vt.) and former South Bend, Ind., mayor Pete Buttigieg over Medicare-for-all, as they vie for an edge in the Democratic presidential primary.

And labor unions — one of the party’s core constituencies — are at the center of the brawl.

It all started when the Nevada union representing 60,000 housekeepers, cooks and other workers who staff the state’s casinos distributed a flier this week warning members that Sanders would “end” their health care if elected president.

After Sanders supporters lashed out at the Culinary Union’s fliers, the union issued a statement defending its description of Sanders’s approach to health care.

“It’s disappointing that Senator Sanders’ supporters have viciously attacked the Culinary Union and working families in Nevada simply because our union has provided facts on what certain healthcare proposals might do,” wrote the union’s secretary-treasurer, Geoconda Argüello-Kline.

Nevada Independent reporter Megan Messerly:

The influential labor union announced yesterday it would not endorse a candidate ahead of the state’s Feb. 22 Democratic caucuses, the Post’s Holly Baily and Felicia Sonmez report.

“The decision came after months of aggressive courting from candidates eager to win the support of the politically powerful group, whose endorsement has long been viewed as a major advantage in mobilizing Latinos and women, who make up most of its membership and have been a decisive political force in the state,” they write.

The whole dust-up kicked off a vigorous debate on Twitter and beyond over how Medicare-for-all would affect the health coverage labor unions negotiate for about 18 million Americans.

Workers typically pay lower premiums for these plans than for employer-sponsored coverage, because union members have a seat at the table when it comes to deciding on their health benefits. So many unions view Sanders’s Medicare-for-all approach with skepticism, fearing it could eliminate with health benefits for which they’ve fought hard.

“While we would like to see universal health care, we want to make sure that there is a role for employer-bargained plans in that plan,” AFL-CIO President Richard Trumka told reporters after the second Democratic debate.

Buttigieg sought to capitalize on those concerns by arguing his Medicare-for-all-who-want-it approach would allow unionized workers to keep their collectively bargained coverage instead of being forced into a single government plan.

Sanders and his team fired back, noting that he has won the support of more unions than any of his opponents.

Sanders senior adviser Warren Gunnels:

Nina Turner, a national co-chair of Sanders’s campaign:

It’s true that Sanders has quite a bit of union support. More than 15 unions have endorsed him compared to at least seven who back former vice president Joe Biden and at least three who support Sen. Elizabeth Warren (D-Mass.). National Nurses United has been active in promoting Sanders’s candidacy and Medicare-for-all.

But the largest unions still aren’t backing anyone yet, a notable departure from years past. “The major national and international unions have refrained from endorsing anyone so far, treating the political scrum with more circumspection than in previous years,” The Washington Post’s Eli Rosenberg reports.

Back in 2015, many of the largest unions picked sides well before the primary season began, Eli notes.

The Service Employees International Union (about 2 million members), the American Federation of Teachers (about 1.7 million members), and American Federation of State, County and Municipal Employees (1.4 million members) had all endorsed Hillary Clinton by fall 2015, a full year before the election. The United Food and Commercial Workers endorsed Clinton in January of the election year. But this year, none of those big unions have endorsed a candidate yet.

“Unions are keeping their powder dry,” said Dane Strother, a Democratic political consultant, told Eli. “We’ve never had a primary like this….I think everyone is trying to see how this shakes out.”

Sanders is certainly trying to lure more backing from the workers he says he’s fighting for, as he reaches for more first-place finishes in the upcoming primary contests around the country. Nevada, the next primary election, is a week from tomorrow, following by the South Carolina primary on Feb. 29.

Sanders responded to union concerns last August by tweaking his Medicare-for-all proposal so that employers would have to pay out any money they save to union members in the form of other benefits.

“Unions will still be able to negotiate for and provide wrap-around services and other coverage not duplicative of the benefits established under Medicare-for-all,” the plan now says.

AHH, OOF and OUCH

AHH: Sanders pledged after a heart attack on the campaign trail that he would release his medical records before votes were cast. But he hasn’t yet. And he appears confident there won’t be much of a penalty if he doesn’t, despite repeated questioning by the press, Politico’s John Harris writes.

John argues that Sanders’s reversal — in the fall he said he would “certainly” release “comprehensive” information on his health before voting began — shows how the mainstream media’s institutional power has been diluted and how political culture has shifted away from transparency in the Trump era.

“The narrow question is whether the public needs to see full health records of a 78-year-old man who recently suffered a heart attack and now hopes to be commander in chief or whether his physicians’ letters of reassurance (not accompanied by a news conference or interviews) that he is in satisfactory health are sufficient,” John writes.

“A much larger question is raised by Sanders’ willingness to tell Todd—and the rest of us—to pound sand, seemingly confident in his belief that there is not much price to be paid for doing so,” he adds.

OOF: Health and Human Services Secretary Alex Azar testified before the Senate Finance Committee over the White House 2021 budget request. He faced the fury of Democratic senators who disagree with the Trump administration’s health-care policies. 

Sen. Bob Menendez (D-N.J.) shouted at Azar and held up a photo of a young boy saying he was saved by the Affordable Care Act, which Republicans have tried to repeal. 

“If you have a better idea, show us, Menendez said. “But I have yet to see one plan that the administration has put forward over the health care of millions of Americans. What are you waiting for?”

Azar responded the administration was waiting for a ruling from the Supreme Court, which is expected to consider next week whether it should hear the high-profile case challenging the ACA.

Sen. Ron Wyden (D-Ore.) challenged the administration’s assertion that the budgets for Medicare and Medicaid wouldn’t be cut under Trump’s proposal. 

Republicans on the committee, including Sen. Rob Portman (R-Ohio), applauded the parts of the budget that dealt with prescription drug pricing and states’ opioid recovery programs.

Azar said funding for HHS would partially be invested in research on infectious diseases, adding there was a 15th confirmed case of coronavirus in the United States.

OUCH: The 14th and 15th cases of coronavirus in the United States have been found in people who had traveled from China and are in quarantine, our colleagues Gerry Shih, Miriam Berger and Adam Taylor report.

And China again reported a big jump in coronavirus cases on Friday after changing its methodology for diagnosing and counting infections. With another 5,000 cases reported Friday, the number of cases in mainland China has now surged past 63,000. There are about 1,380 deaths. Yet the World Health Organization said that the uptick “does not represent a significant change in the trajectory of the outbreak.”

And the economic fallout is mounting. The latest casualties are flower sellers in the country, some of which have seen their sales fall up to 95 percent on Valentine’s Day.

“More places in Hubei province, the epicenter of the outbreak, are enacting ‘wartime’ measures, such as sealing off residential complexes and allowing only essential vehicles on the roads,” our colleagues write. “Authorities in Yunmeng county, where the new steps kicked in Friday morning, said that anyone attempting to breach the lockdown “at compounds, buildings or road connections” would be detained.”

Four in 5 people surveyed in eight countries, including the United States, Japan, Canada, United Kingdom and Australia, support mandatory screening for those traveling from infected countries, according to a report published Wednesday by Ipsos, a global market research and a consulting firm. 

President Trump praised China yesterday for how it has handled the coronavirus outbreak, contradicting his director of the National Economic Council, Larry Kudlow, who said China should be more transparent, Miriam reports.

And Trump has also said this: “By the way, the virus,” he told supporters at a political rally this week. “Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

HEALTH ON THE HILL

Senate Majority Leader Mitch McConnell (R-Ky.) set up two votes on antiabortion bills in the Senate once the chamber returns from a week-long recess. 

Both bills, which previously have failed to pass the Senate, are the “Pain-Capable Unborn Child Protection Act,” which bans abortions after 20 weeks of pregnancy, and the Born-Alive Abortion Survivors Protection Act,” which would require medical care for fetuses surviving an abortion.

Both bills would need to meet a 60-vote threshold required of the Senate, a tall order considering Republicans control 53 seats.

— Rep. Alexandria Ocasio-Cortez (D-N.Y.) conceded that Sanders’s health-care platform may not be fulfilled if the candidate makes it into the White House, HuffPost’s Matt Fuller reports.

“A president can’t wave a magic wand and pass any legislation they want,” she said.

AOC even said it wouldn’t be a “nightmare” if a public option happens instead of Medicare-for-all, which she has signed onto.

“The worst-case scenario? We compromise deeply and we end up getting a public option. Is that a nightmare? I don’t think so,” she said. 

MALPRACTICE

— Washington is full of health policy fights. Sometimes they even ruin dates.

Like for Sery, a 41-year-old lawyer who shared this story with Washingtonian: “We were six or seven dates into it, and we met up for drinks at the Ritz-Carlton in the West End. He shows up and proceeds to pick a fight about politics. We are of opposite parties—he did health-care policy, I did health-care policy. He couldn’t stand the fact that I was going toe to toe with him. He was telling me how Medicare should work this way, and I was like, no, Medicare should work this way. We were, like, deep in the weeds of payment policy, right? Five minutes later, he’s like, ‘I don’t even like you.’ So he just got up and left.”

— And here are a few more good reads:

SECOND OPINION

DAYBOOK

Coming up:

  • The Supreme Court will consider hearing a case that could settle the face of the Affordable Care Act at its conference on Feb. 21.
  • The Washington Post will host a live talk on Feb. 26 on the plight of working families and low-income workers in the United States. Discussions will include topics such as the rising cost of health care.
  • The House Transportation Subcommittee on Water Resources and Environment will hold a hearing on proposals for a Water Resources Development Act of 2020 on Feb. 27.

SUGAR RUSH

After Trump falsely claimed that warmer weather will slow the spread of coronavirus, Stephen Colbert spoofed his comments as CBS’s newest hospital drama:

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