Burning health care questions for tonight’s Democratic debate Presented by

With David Lim, Rachel Roubein and Renuka Rayasam

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Quick Fix

— Democrats are debating in New Hampshire tonight, amid pressing health concerns like the coronavirus and rising suicide rates.

— The coronavirus outbreak in China is renewing concerns about the U.S.’s heavy reliance on foreign drug manufacturing.

— House Democrats voted to rebuke the Trump administration’s block grant plan, the latest sign the party is leaning into its political advantage on health care.

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

IT’S FRIDAY PULSE: Where the case for launching a POLITICO pet health vertical just got stronger: The number of dog fertility clinics is rising sharply.

What other great health stories — human or otherwise — are falling by the wayside? Be PULSE’s best friend: Send tips to Dan Diamond at [email protected] and Adam Cancryn at [email protected].

Driving the Day

THE DEBATE NIGHT QUESTIONS DEMOCRATS NEED TO ANSWER — Seven Democratic presidential candidates take the stage at 8 p.m. ET, ahead of a New Hampshire primary that’s grown even more important after the debacle in Iowa.

It’s a debate likely to be heavy once again on health care. Sen. Bernie Sanders (D-Vt.) and Pete Buttigieg — and their dueling health care visions — are both surging. And Joe Biden faces fresh questions about whether his more incremental policy platform can sustain his candidacy.

These are the health care questions we’d ask the candidates tonight:

— The suicide rate is climbing, with increases occurring across all age groups. What would you do to combat, and ultimately reverse, this persistent trend?

— The U.S. took aggressive measures to fight the Wuhan coronavirus, including quarantines and travel bans. To what extent should the government compel Americans to be tested for the virus, and as president, how would you have handled the response differently?

— Sen. Sanders, you contend that Senate Majority Leader Mitch McConnell will help pass Medicare for All if voters put enough pressure on him. But the Senate didn't hear from witnesses before acquitting President Donald Trump of impeachment charges, and McConnell refuses to consider any drug bill permitting direct Medicare negotiation, despite overwhelming public support for both. Why would Medicare for All be different?

— Mayor Buttigieg, hospitals account for one-third of U.S. health spending — far more than drug companies. But you suggested your health care plan would likely increase payments to providers. If so, how do you plan to keep federal health spending under control?

— Each of you has a plan for greatly expanding health coverage, and voters consistently rank the issue among their top priorities. But as president, which of you would make passing a major health care bill one of the top two agenda items of your first term?

Coronavirus

CORONAVIRUS SPARKS DRUG SHORTAGE FEARS — The coronavirus outbreak in China is renewing concerns about the U.S.’s heavy reliance on foreign drug manufacturing, POLITICO’s Sarah Karlin-Smith reports.

Roughly 60 percent of factories manufacturing drug ingredients and finished medicines for U.S. patients are located overseas in places like China and India — a supply chain that lawmakers say could be threatened by public health crises.

The FDA has not yet seen any issues that could create critical shortages of medical products. But the agency is pulling inspectors out of China as travel to the country is cut off, hampering the government’s ability to monitor the state of crucial drug manufacturing factories.

WHITE HOUSE ASKS SCIENTISTS TO PROBE CORONAVIRUS ORIGINS — Kelvin Droegemeier, Trump's top science adviser, on Thursday asked the National Academies of Sciences, Engineering and Medicine to convene "a meeting of experts, particularly world class geneticists, coronavirus experts, and evolutionary biologists … to understand the evolutionary origins" of the outbreak, in a letter shared with POLITICO.

The academies are an independent body that provides recommendations to Congress and the federal government.

— Why the White House request: The outbreak has sparked legitimate questions about China's transparency as well as conspiracy theories that scientists have worked to debunk. Droegemeier's letter references a now-withdrawn paper that suggested the virus may have been man-made as an example of why more information on the virus is necessary.

— The scientists say they're game to help: "The National Academies stand ready to assemble a committee of experts to examine these issues in more detail and provide evidence-based advice to you in an expedited manner if requested," the academy responded to the White House later on Thursday.

Medicaid

HOUSE HITS TRUMP ON BLOCK GRANTS — House Democrats voted to condemn a Trump administration plan letting states cap some federal Medicaid payments, arguing that the week-old guidance aims to hurt those who rely on the safety net program.

—The vote was only symbolic, and no Republicans supported it. But it highlights Democrats’ focus on exploiting what they see as a major advantage on health care issues ahead of November, POLITICO’s Rachel Roubein reports.

The administration’s block grant plan will face more formidable challenges in the coming months — namely, trying to find states that are open to it. Just two — Oklahoma and Alaska — have expressed interest so far, and any attempt is likely to face immediate legal challenges.

INDUSTRY TO GOVS: PRESS CMS ON MEDICAID RULE THIS WEEKEND — Hospitals, nursing homes and other providers are urging state leaders to lobby CMS against a proposed Medicaid rule during this weekend's National Governors Association meeting, POLITICO's Renuka Rayasam and Rachel Roubein report.

They argue the rule — which would overhaul how states use certain Medicaid payments to draw down more federal dollars — threatens to roil hospitals' finances and should be halted.

— NGA has sent a letter to CMS calling on the agency to back off its proposal, dubbed the Medicaid Fiscal Accountability Regulation. Governors of Michigan, New Jersey, Arizona and other states also raised concerns in comment letters.

CMS Administrator Seema Verma disputed the notion the rule would cut Medicaid payments, telling POLITICO the agency is "increasing transparency, integrity and clarity, to ensure Medicaid resources serve the best interests of patients."

On the Hill

ALL ABOARD THE ‘SURPRISE’ BILLING TRAIN — Add the House Education and Labor Committee to the list of panels trying to eliminate “surprise” medical bills, after Chairman Bobby Scott (D-Va.) told POLITICO’s Susannah Luthi that the committee’s got its own proposal on the way.

The new legislation — which is due to be marked up Feb. 11 — would join a forthcoming plan from the Ways and Means Committee, and an existing proposal backed by the Energy and Commerce and Senate HELP Committees.

—That’s not ideal for Democratic leadership, which wants surprise billing to be the centerpiece of a bipartisan May health care package and just weeks ago warned the committee heads they’d need to unite behind a single proposal. The three bills are likely to differ on the key question of how pay disputes are resolved — an issue that stalled progress last year amid a lobbying blitz from providers on one side and insurers on the other.

— More factions are likely to weigh in. The House’s Progressive Caucus met Thursday to consider becoming more involved on the issue, over concerns about private equity’s growing investments in physician staffing firms.

FIRST IN PULSE: DEMOCRATS PRESS HHS OVER LABOR NEGOTIATIONS — House Democrats are stepping into negotiations between HHS and its union, sending a letter to Secretary Alex Azar urging him to resume labor talks. The move comes after an arbiter ruled last year that HHS had bargained in bad faith and should restart discussions on a collective bargaining contract.

Names in the News

NOAH WEILAND will be the New York Times' new Washington health policy reporter.

Former FDA Commissioner SCOTT GOTTLIEB is joining Illumina's board of directors. He also sits on the boards of Pfizer, Aetion and Tempus.

A message from PhRMA: America’s biopharmaceutical companies are making great progress against a common enemy – COVID-19. They’re learning from successful vaccines for other diseases, developing new treatments and collaborating like never before. Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. America’s biopharmaceutical companies are working day and night until they defeat COVID-19. Because science is how we get back to normal.

What We're Reading

With Darius Tahir

Kaiser Health News’ Lauren Weber reports on why insurers can change their mind after the fact about covering pricey procedures.

In a blog for Health Affairs, Emily Eckert argues for continuous Medicaid coverage for one year postpartum.

STAT‘s Helen Branswell interviews the head of a coalition funding efforts to develop a coronavirus vaccine.

Americans evacuated from China are doing anything they can to stay busy during their 14-day quarantine, the Washington Post’s William Wan, Lena Sun and Neena Satija report.

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