As the two candidates shook hands on stage, Biden could be heard telling Harris “go easy on me, kid.” She didn’t exactly listen.

Harris charged that Biden’s plan would leave millions of Americans still without coverage. Biden called Harris’s plan “malarkey.”

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“The senator has had several plans so far,” Biden said. “If you noticed, there is no talk about the fact that…you will lose your employer-based insurance…to be very blunt and to be very straightforward, you can’t beat President Trump with double-talk on this plan.”

Discussions over how to reach universal coverage in the United States consumed the first half hour of both nights of CNN’s presidential primary debate this week – solidifying the issue as a top one in the 2020 election. The first night, Medicare-for-all as envisioned by Sen. Bernie Sanders (I-Vt.) was on trial. Last night, it was the public option and a modified version of Medicare-for-all being touted by Harris under scrutiny.

Under the proposal Biden released last month, people could buy a government-sponsored plan if they lack coverage through their workplace or just don’t like it or can’t afford it. It would also cap every American’s health-care premiums at 8.5 percent of their income and effectively lower deductibles and copayments.

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“It would take place immediately, it would move quickly,” Biden argued. “And it would insure the vast, vast, vast majority of Americans.”

But Biden’s plan wouldn’t result in every single American having coverage – his campaign has admitted that much – and Harris pounced on that vein.

“Under our plan, we will ensure that everyone has access to health care,” Harris told Biden. “Your plan, by contrast, leaves out almost 10 million Americans. Understand that the people of America want access to health care and do not want cost to be their barrier to getting it.”

Harris's campaign tweeted this:

Yet Harris was up against her own siege. She only recently clarified exactly where she stands on the issue, after previously waffling on whether she backs eliminating the employer-sponsored coverage that 160 million Americans have.

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The proposal her campaign released this week took an unexpected twist. It would do away with employer-sponsored coverage, like Sanders’s plan. It would also be very expensive. But it’s a slightly different flavor of Medicare-for-all, allowing for the preservation of privately-run Medicare plans, which are currently provided to seniors through the Medicare Advantage program. It would also provide for a 10-year transition, much longer than Sanders’ four-year transition.

Biden’s campaign has called Harris’ plan a “have-it-every-which-way approach.” Moderator Dana Bash asked the senator to respond to that characterization.

“I listened to American families who said I want an option that will be under your Medicare system that allows a private plan,” Harris said. “So I designed a plan where, yes, responsive to the needs of American families, there will be a public plan, under my plan for Medicare, and a private plan, under my plan for Medicare.”

The Post's Dave Weigel noted that Biden on several occasions dramatically understated the estimated cost of Medicare-for-all:

The 20 Democrats onstage this week got into plenty of policy weeds as they debated how to close the persistently wide uninsured gap, which hit a low of 10.7 percent in 2016 but has recently inched back up to 13.7 percent, per Gallup.

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But that just means the party is grappling with where to move next on the country’s health-care ills. The candidates are tackling weighty questions of how much the government should be involved in providing Americans with health care, how much money it should spend on the whole endeavor – and the consequences if the current system doesn’t change.

Sen. Cory Booker (D-N.J.) offered a big-picture look at the problem. “We are on our way in just a handful of years of literally spending 20 percent of our economy – one out of every five dollars spent – on health care,” Booker said. “And we spend more than every other nation.”

Booker was correct, my fact-checking colleague Glenn Kessler noted. The latest figures show health spending is 17.9 percent of gross domestic product, and the Centers for Medicare and Medicaid Services projects it will be 19.4 percent in 2027. Nearly $10,000 is spent annually per capita in the U.S., 20 percent more than second-place Switzerland’s nearly $8,000.

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This week’s clashes over health care are only the beginning in the primary battle. Of the top-polling four candidates, Sen. Elizabeth Warren (D-Mass.) is now the only one not to release her own health-care proposal. Instead, she has closely aligned herself with Sanders’ Medicare-for-all.

That plan, along with Harris’s version of Medicare-for-all and Biden’s public option plan, will form the basis for the debate in the coming months as the candidates seek to gain the upper hand on the top voting issue for Democratic primary-goers.

Biden, who has aggressively trying to distinguish himself from Sanders and Harris on the issue, published an op-ed on CNN yesterday entitled “After my family’s car accident, health care became personal for me,” which refers to the decades-ago death of his first wife and baby daughter and injuries suffered by his sons.

“Time is precious, and families experiencing health care problems and rising medical bills right now can’t wait for us to start over with a complete overhaul of our health care system, including the elimination of Obamacare and after a transition period, the elimination of your private insurance,” Biden wrote.

Here are a few of the other key health care-related moments from the first round of the second Democratic debate:

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HYDE AMENDMENT: Harris also went after Biden for his shifting stance on the Hyde Amendment, which prohibits the use of federal funds for abortion except in the case of rape, incest or if a mother's life is at risk. Last month, Biden reversed his long-held support for the Hyde amendment.

"You made the decision for years to withhold resources to poor women to have access to reproductive healthcare, including women who were the victims of rape and incest. Do you now say that you have evolved and you regret that?" Harris asked.

Biden noted that Harris and other members of Congress on stage have all voted for bills at some point that have included the amendment. He said the measure had been "available" previously because there was access to private funding for abortion services. "Once I wrote the legislation making sure that every single woman would in fact have an opportunity to have health care paid for by the federal government -- everyone -- that could no longer stand," Biden said. "I support a woman's right to choose. It's a constitutional right... I will continue to support it and I will in fact movea as president to see to it that the Congress legislates that that is the law as well."

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Asked by Harris again why it took "so long to change your position on the Hyde Amendment," Biden responded: "Because there was not full federal funding for all reproductive services prior to this point." The exchange was also the only one that referred to abortion rights across the two debate nights. Abortion rights groups NARAL Pro-Choice America and Planned Parenthood Action Fund praised Harris for bringing up the issue.

Here are some other health care issues debate last night:

MENTAL HEALTH: Washington Gov. Jay Inslee was one of two candidates to talk about mental health. “We are having -- we've had some success in integrating mental health with physical health. There's no reason we should distinguish between your physiological and your mental health,” he said.

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In response to a question about how he would beat President Trump, businessman Andrew Yang said it was critical to address concerns from people who “feel like the economy has left them behind.” He cited increases in rates of suicide, drug overdoses, depression and anxiety. “The way we win this election is we redefine economic progress to include all the things that matter to the people in Michigan and all of us like our own heath, our wellbeing, our mental health, our clean air and clean water, how our kids are doing,” he said.

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MARIJUANA LEGALIZATION: Booker called for legalizing marijuana at the federal level during a response about how he would address criminal justice. “We have got to have far more bold action on criminal justice reform, like having true marijuana justice, which means that we legalize it on a federal level… and reinvest the profits in communities that have been disproportionately targeted by marijuana enforcement.” Earlier this year, Booker reintroduced a new version of his Marijuana Justice Act that would legalize marijuana and expunge convictions for possessing the drug. As our Post colleague Dave Weigel reported, the bill is also cosponsored by fellow 2020 contenders Harris, Warren, Sanders, Sen. Kirsten Gillibrand and Sen. Michael Bennet.

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AHH, OOF and OUCH

AHH: The Trump administration is moving toward plans that could eventually allow for some lower-cost prescription drugs to be imported to the United States from Canada. It’s a controversial idea that Trump has expressed support for, but that Republicans have long opposed, and experts warn it could still take years for such rules to be finalized.

On a call with reporters, HHS Secretary Alex Azar said the administration is “open to importation." "What we’re saying today is we’re open. There is a pathway. We can be convinced,” he said. The administration outlined plans that would allow states, pharmacies and pharmaceutical manufacturers to come up with proposals that would require federal approval for the safe importation of drugs.

“Top officials at Health and Human Services and the Food and Drug Administration outlined two measures the administration could take to allow Americans to purchase lower-cost, Canadian versions of some medicines,” our Post colleagues Yasmeen Abutaleb and Laurie McGinley report. “That could potentially include insulin — whose price rose about 300 percent from 2002 to 2013 — as well as drugs for rheumatoid arthritis, cancer and cardiovascular disorders, HHS said.”

The government is still months from formally proposing such rules, and any final rule could take two or three years, according to experts on the FDA’s regulatory process.

The pharmaceutical industry quickly pounced to criticize the plan. Stephen Ubl, president and chief executive of the Pharmaceutical Researchers and Manufacturers of America, referred to Azar's own remarks previously calling drug importation a "gimmick." "There is no way to guarantee the safety of drugs that come into the country from outside the United States’ gold-standard supply chain," Ubl said in a statement. "...Rather than surrender the safety of Americans by importing failed polices from single-payer countries, we should work on solutions here at home that would lower patient out-of-pocket costs at the pharmacy counter."

— The incremental step toward drug importation from the administration is part of a scramble among the president’s advisers to establish health-care wins Trump can tout on the campaign trail. They’re meeting every day “with the aim of rolling out a measure every two to three weeks until the 2020 election,” our colleagues Yasmeen and Josh Dawsey report.

The push to rack up health-care victories signals a sense of vulnerability from the Trump administration after Democrats were able to successfully use healthcare as the key issue that propelled the party to a majority in the House after the midterm elections.

“White House officials are eager to inoculate the president against a repeat of that strategy in 2020 — and reduce the GOP disadvantage on an issue that pollsters say plays to Democratic strengths,” Yasmeen and Josh write. “…Some, however, are doubtful a flurry of executive orders and new regulations would have an immediate effect on consumers’ pocketbooks. What is clear is that the approach, which includes White House support for a bipartisan Senate bill to cap Medicare drug price increases to the rate of inflation, is putting congressional Republicans in a tough spot: Embrace Trump’s agenda and abandon conservative precepts about interference in the marketplace, or buck the president on one of his top priorities.”

Benedic Ippolito, a health economist at the American Enterprise Institute, also expressed skepticism that the administration could accomplish anything via executive order that voters will take notice of ahead of next November. “It’s an incredibly ambitious timeline,” he said.

OOF: The state of Arizona has filed a lawsuit in the Supreme Court calling on the justices to compel the Sackler family, which controls Purdue Pharma, to return billions of dollars that the suit argues was “looted” from the company.

“What distinguishes the new suit is that it was filed directly in the Supreme Court, which almost never hears cases until after lower courts have considered them,” the New York Times’s Adam Liptak reports.

Arizona Attorney General Mark Brnovich acknowledged it’s a “long shot” and a “little unorthodox” but a move that’s justified by the high stakes of the ongoing opioid crisis.

“We want the Supreme Court to make sure that we hold accountable those individuals who are responsible for this epidemic,” he said. “We allege that the Sacklers have siphoned billions of dollars from Purdue in recent years. They did this while knowing the company was facing massive financial liabilities.”

“Between 2008 and 2016, Purdue transferred more than $4 billion to the Sacklers, according to the new lawsuit. It is commonplace and lawful, of course, for a company’s owners to withdraw profits,” Adam reports. “But the suit contends that the transfers were intended to frustrate efforts by victims of the opioid crisis to obtain compensation.”

OUCH: Democrats are itching for another opportunity to force Republicans to make their health-care positions known. Senate Democrats introduced a resolution to force a vote on the Trump administration’s plan to allow states flexibility to change its insurance marketplaces.

“While it’s unlikely to pass the Republican-controlled Senate, it gives Democrats another opportunity to hit the GOP on health care and protections for pre-existing conditions ahead of the 2020 elections,” the Hill’s Jessie Hellman reports.

The administration's guidance would allow waivers for some states from ACA requirements, which could “lead to states offering ObamaCare subsidies for plans that don’t meet ObamaCare’s requirements and that don’t cover people with pre-existing conditions.”

“Many of my Republican colleagues always say they’re for protecting folks with preexisting conditions. Well, with this CRA vote, there’s a chance for them to prove whether they actually support continuing this protection,” Sen. Mark Warner (D-Va.) said during a news conference.

— And here are a few more good reads:

HEALTH ON THE HILL

MEDICAL MISSIVES

INDUSTRY RX

STATE SCAN

REPRODUCTIVE WARS

DAYBOOK

Coming Up

The Bipartisan Policy Center hosts an event with Sen. Chuck Grassley (R-Iowa) about rural health care challenges on Aug. 13.

SUGAR RUSH