Clinton resurrects public option Presented by

With help from Sarah Karlin, Brett Norman, Rachana Pradhan and Darius Tahir

CLINTON RESURRECTS 'PUBLIC OPTION' — Hillary Clinton is bringing back the "public option," a liberal health reform that so far has gotten little attention this campaign cycle as Bernie Sanders has pushed an even more progressive single-payer plan.

The public option — initially conceived as a government-run alternative to private insurance — was backed by Clinton in her 2008 campaign and was the subject of intense debate during the drafting of the Affordable Care Act. However, Democrats abandoned the measure after Senate moderates said they wouldn't vote for it because it expanded the government's role in health care too far.

Clinton is again making clear she supports a version of the public option. This time, though, she wants to allow states to opt in, according to a newly updated policy position on her campaign website. Our story here.

How would it work — and why now? Clinton appears to be suggesting that states could use the ACA's 1332 waivers to "empower states to establish a public option choice" in 2017. It's plausible that liberal governors and legislatures would opt in, while keeping the fight over this progressive idea largely out of Washington.

It's unclear exactly what Clinton's thinking is on this, however. The campaign didn't respond to repeated requests from POLITICO to clarify its new policy language.

Just last month: Clinton said 'we couldn’t get the votes' for public option. While Clinton's spokesperson told PULSE that she has consistently backed the public option since the 2008 campaign, Clinton pointed out just last month that Congress wasn't able to get it through during the ACA. "There was an opportunity to vote for what was called the public option," Clinton said during a debate in South Carolina, after she rebuked Sanders' plan as impractical. "But even when the Democrats were in charge of Congress, we couldn't get the votes for that."

What else is new: Clinton’s health care policy update also contains a handful of new proposals.

· Investing $500 million per year to improve outreach and enrollment for the ACA

· Creating a limit so ACA exchange shoppers would spend no more than 8.5 percent of their income on premiums

· Formally endorsing President Barack Obama's proposal to allow any state that signs up for the ACA's Medicaid expansion to receive full federal funding for the first three years

TODAY IS TUESDAY PULSE — Where your author is fascinated to learn how candidates are A/B testing their campaign websites. Partly because it raises a tantalizing possibility: Who knows what policy positions will appear next? Send guesses, news, and notes to [email protected] or @ ddiamond on Twitter.

SENATE MOVES FORWARD ON CALIFF NOMINATION — The Senate voted 80-6 on Monday evening to clear the way for a final vote on the White House nominee for FDA commissioner over the objections of several Democrats.

The procedural vote clears the way for final confirmation of Robert Califf Tuesday or Wednesday.

… Pro's Brett Norman flagged a tortured but notable line from Sen. Ed Markey on the floor today: If the agency doesn’t change soon, “FDA is not going to stand for Food and Drug Administration, it’s going to stand for Fostering Drug Addiction.”

One of Markey's chief complaints is that FDA would not commit to consulting outside experts before approving so-called abuse-deterrent opioids that are harder for abusers to crush or dissolve. He says the drugs are just as addictive, despite those protections. “Abuse-deterrent opioid is a contradiction in terms, like a jumbo shrimp.”

INSURERS SURGE ON MEDICARE ADVANTAGE NEWS — Investors were bullish on CMS's proposed rate hike for 2017 Medicare Advantage plans, buoying the health insurance sector on Monday. As Pro's Paul Demko reports, that's because after years of battling the Obama administration on proposed cuts, insurers found that this year's batch of proposals raised little alarm. Paul's story for Pros.

Three big risers on Monday:

· WellCare: 9.4 percent

· Molina: 5.2 percent

· Humana: 3.9 percent

How the election could shape the market. — A recent S&P report suggested that a Clinton victory in November would be the "best scenario for health care investors," the Intercept's Zaid Jilani reports. The financial services company cites Clinton's unique commitment to the ACA, but also notes that Republicans are expected to retain control of Congress and block major reforms to the drug industry and other health care sectors.

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.

HUTCHINSON SETS SPECIAL SESSION ON MEDICAID EXPANSION — A special session will begin April 6 for Arkansas lawmakers to consider continuing Medicaid expansion beyond this year, a spokesperson for Gov. Asa Hutchinson tells Pro's Rachana Pradhan. That special session is expected to last for three days.

Hutchinson wants to continue Medicaid expansion in Arkansas but is negotiating with the Obama administration to add a few more conservative policies to his model, including premiums and copays, work referrals and keeping people in employer-sponsored insurance when it is available.

SENATE HELP's MARKUP OF MENTAL HEALTH BILL HAS A DATE: MARCH 16 — The Senate HELP Committee is expected to mark up its broad bipartisan mental health and substance abuse bill on March 16, an aide for Chairman Lamar Alexander confirmed to Pro’s Brianna Ehley.

The measure, crafted by Alexander, ranking member Sen. Patty Murray and other committee members, has not yet been introduced. Sources say it will likely address the mental health workforce shortage, opioid abuse, and how Medicaid pays for behavioral health, among other things.

DIRECTORS TO FDA: ADOPT BLACK-BOX WARNINGS TO HELP STEM OPIOID EPIDEMIC — A nationwide coalition of public health directors petitioned the FDA on Monday to adopt labels that explicitly warn about the concurrent use of opioids and anxiety drugs known asbenzodiazepines, which increases the risk of fatal overdose. Among the petitioners: New York City health commissioner Mary Bassett and San Francisco health commissioner Tomas Aragon.

— Roughly 23,000 people per year die from prescription drug overdoses. About 1 in 3 unintentional overdose deaths from prescription opioids also involve benzodiazepines.

PHYSICIANS, PATIENTS REACT POSITIVELY TO CANCER TREATMENT PRICE TOOL — A pilot study to provide physicians with information about the costs of drugs, tests and other related services through an electronic health record system was well-received by both patients and doctors at four oncology clinics in Washington state, Pro's Sarah Karlin reports.

Results to be presented at the American Society of Clinical Oncology’s quality care symposium later this month showed that 70 percent of providers said the tool had no effect on their workload, and they said the tool provided very high value both to patients and to their own practice. The main drawbacks: The data could not specify patients' out-of-pocket costs and some treatment protocols were not included. http://bit.ly/1Or8PZh

FINANCE COMMITTEE MEETS TODAY ON OPIOIDS — It’s the latest Senate committee to hold a hearing on the opioid epidemic and will spotlight legislation sponsored by some of its members to let Medicare plans include “lock-in pharmacy” provisions — a doctor-shopping prevention tool to limit the number of pharmacies that can dispense certain drugs to patients.

Committee Democrats were already grumbling that the focus of the hearing will be too narrow. “Committee members should hear the full range of options on how Congress can stem the opioid crisis,” a Democratic aide tells PULSE. “Unfortunately, while a number of important perspectives will be presented, we are concerned this hearing will fall far short. The lack of attention to improving access to behavioral health treatment for the millions of people struggling with addiction is disappointing.”

ALSO ON TAP TODAY: The National Association of Attorneys General hosts its annual winter meeting, and HHS Inspector General Daniel Levinson will deliver remarks this morning on the importance of fighting Medicaid fraud.

The Senate Armed Services Committee Personnel Subcommittee at 2:30 p.m. will host a hearing on reforming military health care.

ON TAP TONIGHT: CLINTON FUNDRAISER — For anywhere between $500 and $2,700 per head, you can join Ann O'Leary, Clinton's senior policy adviser, for a conversation on health care. Special guests include former Surgeon General Regina Benjamin, former White House health reform adviser Chris Jennings, and former CMS official Will Shrank. Clinton campaign aide Jake Sullivan will deliver remarks, too. (H/t David Eldridge of Inside Sources.)

WHITE HOUSE GATHERING PRECISION MEDICINE FORCES THURSDAY — The administration is hosting a gathering Thursday morning to talk precision medicine. It’ll be part celebration (of the initiative’s one-year birthday), and part demonstration of new commitments. Apparently, Obama will be participating in a panel discussion as well.

CLAIRE McCASKILL: I HAVE BREAST CANCER — The Missouri senator says her "prognosis is good," but she'll be in St. Louis for the next three weeks receiving treatment.

HERITAGE PUSHES CONSERVATIVE BUDGET — The right's flagship think tank is set to unveil a detailed budget blueprint that goes far, far beyond anything House Speaker Paul Ryan is proposing when it comes to slashing government spending, Pro's Ben Weyl and Matthew Nussbaum report. For instance, Heritage is proposing that Medicaid for able-bodied adults "should be converted to a direct contribution to facilitate participation in the private marketplace" — a major restriction compared to the program's current model. The aggressive conservative wish list is likely to increase unrest in the Republican conference and boost hardliners' resistance to Ryan's pitch of sticking to a spending deal made with President Barack Obama. The story for Pros.

WHITE HOUSE DETAILS $200M INVESTMENT IN MALARIA FIGHT — According to United Nations ambassador Susan Rice, the funds would go toward expanding the president’s Malaria Initiative’s work in six countries. About $129 million of the $200 million budgeted would come from unspent Ebola emergency-response funds.

NEW CENSUS DATA ON INSURANCE, VACCINATION RATES, AND MORE — The latest estimates from the National Health Interview Survey are out today, and they show that the nation's uninsured rate continues to fall. (Among other key findings.) http://1.usa.gov/1oyE7YY

THE THREE ISSUES THAT MOST CONCERN DOCTORS — A new QuantiaMD poll asked 600 physicians to name the most pressing problem facing the industry. According to their responses:

· 65 percent said rising health care costs

· 55 percent said bureaucratic red tape

· 47 percent said caring for an aging population

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WHAT WE'RE READING by Jennifer Haberkorn

New York hospitals and doctors are scrambling to meet the state's e-prescribing requirements, the Wall Street Journal reports. http://on.wsj.com/1XJDeJd

Whooping cough is making a comeback, The New York Times reports. http://nyti.ms/1QX00bh

Mental health providers are getting into the app business, according to New York Magazine. http://nym.ag/1Qd34nw

A former Insys Therapeutics sales representative has pleaded guilty to violating federal kickback laws related to a scheme to boost opioid painkiller sales, according to STAT News. http://bit.ly/1oykuAe

North Carolina’s Medicaid program is being changed to allow managed care companies and regional network to compete, but the state still shouldn’t expand Medicaid under Obamacare, according to an analyst at a free-market think tank writing in Forbes. http://onforb.es/1Qd3Dh9

The CDC is conducting a case control study in Brazil to determine whether Zika is actually what's causing microcephaly, according to NPR, which is in Brazil with the CDC. http://n.pr/1oEfyun

Barbra Streisand and Surgeon General Vivek Murthy are working together to try to fight cardiovascular disease, according to Time. http://ti.me/1Q7wsIf

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