The bruising battle looming over single-payer Presented by

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It's the last day to submit comments on the Trump administration's controversial "public charge" proposal, and a coalition is pledging to protect patients from surprise medical bills.

But first: A bruising battle over Medicare for All could be looming.

THE (POTENTIALLY) BRUTAL FIGHT LOOMING OVER SINGLE-PAYER — Progressives will soon mount their push for universal government health care, but deep-pocketed health industry lobbies are already plotting to crush the movement next year, POLITICO's Adam Cancryn reports.

— One result: The coalition that helped the ACA is fragmenting: The private-sector interests, supported in some cases by key Obama administration and Hillary Clinton campaign alumni, are now focused on beating back another prospective health care overhaul.

— What advocacy groups are planning: The recently formed Partnership for America's Health Care Future — backed by AHIP, PhRMA, the Federation of American Hospitals and others — is preparing to launch a campaign featuring ads, polling and white papers playing up the private sector's role and warning against further disruptions to the health system.

— How it could look in Congress: There's a potentially fierce battle between establishment Democrats who want to preserve Obamacare — and not risk another divisive health care fight that could advantage Republicans — and a new wave of progressive House Democrats who ran on single-payer health care.

Keep reading: More for Pros. | Listen to last week's "Pulse Check" with Rep. Pramila Jayapal, leader of the House Medicare for All caucus

— Another name entering the fray: Wendell Potter. The ex-Cigna executive-turned-industry whistleblower on Friday was named president of the Business Initiative for Health Policy, a group trying to rally companies to support Medicare for All.

MEET THE DEMS, WITH DIFFERENT PHILOSOPHIES, WHO WILL HELP GUIDE DRUG STRATEGY — In one corner, there's Rep. Anna Eshoo, the likely chair of the Energy and Commerce health subcommittee. Eshoo, a biotech champion from Silicon Valley, is the second biggest recipient of drug and health product industry contributions in Congress.

In the other corner, there's Rep. Lloyd Doggett of Texas, the probable next chair of the Ways and Means health subcommittee, who's zinged the drug industry and previously urged President Donald Trump to curb drugmakers' patent rights.

— Eshoo and Doggett haven't always seen eye to eye on drugs, POLITICO's Sarah Karlin-Smith writes, and there's concern among pharma critics that the two will clash on policy.

Patient advocates have been especially frustrated with Eshoo and worry she could use her subcommittee chairmanship to slow walk bills that directly take aim at the cost of drugs. “We are all paying higher drug prices because of Anna Eshoo,” said David Mitchell, president and founder of Patients for Affordable Drugs.

For her part, Eshoo said she's not going to discuss specific plans before House leadership elections but promised to be committed to lowering drug prices. "Watch and see," she told Sarah.

WELCOME TO MONDAY PULSE — Where your author knew Harold Baines. (Well, as much as an adolescent Baltimore Orioles fan knew any baseball player.) Harold Baines was a hero of mine. Harold Baines is no Hall of Famer, regardless of what the official record now says.

Baseball leaders are quailing as election outrage grows. Does the league need a special counsel? Tips to [email protected].

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.

The American Bar Association kicks off its Washington Health Law Summit. Your author and POLITICO's Alice Miranda Ollstein will be on the lunchtime docket.

The Atlantic looks at loneliness and health. Former surgeon general Vivek Murthy will be in conversation. More.

IT'S THE LAST DAY TO COMMENT ON 'PUBLIC CHARGE' — Advocacy groups have sounded alarms over the Trump administration’s proposal to penalize immigrants for using Medicaid and other government benefits when applying for green cards.

— Why health groups are worried: They say the proposal could roll back recent health coverage gains and force immigrant patients to choose between necessary treatment and citizenship.

"The proposed rule would threaten access to Medicaid coverage for immigrants and their families, worsen existing disparities in sexual and reproductive health care and coverage for immigrants, undermine the fundamental goals of Medicaid, and harm the ability of immigrants to support themselves and their families," Rachel Benson Gold of the Guttmacher Institute wrote last week.

— Health care providers say they'd suffer major funding hits as a result, jeopardizing their ability to provide care. NYC Health + Hospitals, the nation's largest municipal hospital system that serves a largely immigrant population, warned last week that the hospital system could take a financial hit of as much as $362 million per year if the Trump proposal takes effect.

— Expect activities today. Planned Parenthood president Leana Wen will join immigration leaders at the National Immigration Integration Conference in Arlington, Virginia, at noon to speak out against the proposed rule.

— More than 150,000 comments have been filed on the rule so far, making it among the most provocative proposals issued by the Trump administration this year. See comments.

GROUPS PLEDGE TO PROTECT PATIENTS FROM SURPRISE BILLS — A coalition representing patients, providers and businesses this morning says that more policies are necessary to protect patients from the rising problem of surprise health bills.

— Why it's a problem: The coalition points to Kaiser Family Foundation polling that most Americans are worried about surprise bills and that nearly 40 percent of Americans have received a surprise bill in the past year.

— Who's in the coalition: AHIP, American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, The ERISA Industry Committee, Families USA, National Association of Health Underwriters, National Business Group on Health, and the National Retail Federation.

— What the groups vow to support: Federal legislation to end surprise billing as well as efforts to inform patients about out-of-network care. They also want the feds to standardize payments to out-of-network physicians. Read their statement.

Looking at Juul's growing Washington muscle. The San Francisco company that's become synonymous with vaping — "juuling" is now a verb — has hired political hands in Washington and started a political action committee that has donated to members of Congress and state attorney-general candidates, POLITICO's Lorraine Woellert and Sarah Owermohle report. More.

Advocacy groups urge Pompeo not to censor diplomats on 'sexual health.' More than 70 organizations, including AIDS United and Physicians for Reproductive Health, are calling on the State Department to not curb language related to reproductive health care and sexuality, following a POLITICO report that the department is considering a ban on those terms.

"This unprecedented proposal erases critical aspects of people’s health and lives," the groups warned Secretary of State Mike Pompeo in a letter last week, shared with PULSE. Read letter.

Medicaid's importance to rural Kentucky is 'eye-popping.' That's according to Joan Alker of Georgetown's Center for Children and Families, who found that in nine rural counties in the state, at least 45 percent of adults were on Medicaid. More.

Manatt looks at Medicaid buy-in plans in New Mexico. The consulting firm examined four different options to allow residents to buy into the Medicaid program, a plan that state leaders are considering. More.

Andrew O'Connor joins Association for Accessible Medicines. O'Connor, who will be manager of state government affairs for the generic drug lobbyists, previously worked at Stateside Associates and for Connecticut House Republicans.

The CDC has picked Austin, Texas, for a first-of-its-kind study of dockless scooter injuries. More. (h/t Renuka Rayasam)

Doctors aren't disclosing their industry ties in medical journals, which are doing little to enforce the rules, ProPublica's Charlie Ornstein and the NYT's Katie Thomas report. More.

The latest on the fetal tissue front: NIH scientists have been effectively barred from acquiring new fetal tissue for experiments, Science's Meredith Wadman reports. More.

The Trump administration could use innovation waivers to try and unwind state certificate of need laws, Modern Healthcare's Susannah Luthi reports. More.

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