By Fred Schulte
CBS News via KFF Health News, August 28, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an “uproar” from the industry, newly released court filings show.

The Centers for Medicare & Medicaid Services published the draft regulation in January 2014. The rule would have required health plans, when examining patient’s medical records, to identify overpayments by CMS and refund them to the government.

But in May 2014, CMS dropped the idea without any public explanation. Newly released court depositions show that agency officials repeatedly cited concern about pressure from the industry.

The 2014 decision by CMS, and events related to it, are at the center of a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group pending in federal court in Los Angeles.

The Justice Department alleges the giant health insurer cheated Medicare out of more than $2 billion by reviewing patients’ records to find additional diagnoses, adding revenue while ignoring overcharges that might reduce bills. The company “buried its head in the sand and did nothing but keep the money,” DOJ said in a court filing.

Medicare pays health plans higher rates for sicker patients but requires that the plans bill only for conditions that are properly documented in a patient’s medical records.

In a court filing, UnitedHealth Group denies wrongdoing and argues it shouldn’t be penalized for “failing to follow a rule that CMS considered a decade ago but declined to adopt.”

This month, the parties in the court case made public thousands of pages of depositions and other records that offer a rare glimpse inside the Medicare agency’s long-running struggle to keep the private health plans from taking taxpayers for a multibillion-dollar ride.

“It’s easy to dump on Medicare Advantage plans, but CMS made a complete boondoggle out of this,” said Richard Lieberman, a Colorado health data analytics expert.

Spokespeople for the Justice Department and CMS declined to comment for this article. In an email, UnitedHealth Group spokesperson Heather Soule said the company’s “business practices have always been transparent, lawful and compliant with CMS regulations.”

Missed diagnoses

Medicare Advantage insurance plans have grown explosively in recent years and now enroll about 33 million members, more than half of people eligible for Medicare. Along the way, the industry has been the target of dozens of whistleblower lawsuits, government audits, and other investigations alleging the health plans often exaggerate how sick patients are to rake in undeserved Medicare payments — including by doing what are called chart reviews, intended to find allegedly missed diagnosis codes.

By 2013, CMS officials knew some Medicare health plans were hiring medical coding and analytics consultants to aggressively mine patient files — but they doubted the agency’s authority to demand that health plans also look for and delete unsupported diagnoses.

The proposed January 2014 regulation mandated that chart reviews “cannot be designed only to identify diagnoses that would trigger additional payments” to health plans.

CMS officials backed down in May 2014 because of “stakeholder concern and pushback,” Cheri Rice, then director of the CMS Medicare plan payment group, testified in a 2022 deposition made public this month. A second CMS official, Anne Hornsby, described the industry’s reaction as an “uproar.”

Exactly who made the call to withdraw the chart review proposal isn’t clear from court filings so far.

“The direction that we received was that the rule, the final rule, needed to include only those provisions that had wide, you know, widespread stakeholder support,” Rice testified.

“So we did not move forward then,” she said. “Not because we didn’t think it was the right thing to do or the right policy, but because it had mixed reactions from stakeholders.”

The CMS press office declined to make Rice available for an interview. Hornsby, who has since left the agency, declined to comment.

But Erin Fuse Brown, a professor at the Brown University School of Public Health, said the decision reflects a pattern of timid CMS oversight of the popular health plans for seniors.

“CMS saving money for taxpayers isn’t enough of a reason to face the wrath of very powerful health plans,” Fuse Brown said.

“That is extremely alarming.”

Invalid codes

The fraud case against UnitedHealth Group, which runs the nation’s largest Medicare Advantage plan, was filed in 2011 by a former company employee. The DOJ took over the whistleblower suit in 2017.

DOJ alleges Medicare paid the insurer more than $7.2 billion from 2009 through 2016 solely based on chart reviews; the company would have received $2.1 billion less if it had deleted unsupported billing codes, the government says.

The government argues that UnitedHealth Group knew that many conditions it had billed for were not supported by medical records but chose to pocket the overpayments. For instance, the insurer billed Medicare nearly $28,000 in 2011 to treat a patient for cancer, congestive heart failure, and other serious health problems that weren’t recorded in the person’s medical record, DOJ alleged in a 2017 filing.

In all, DOJ contends that UnitedHealth Group should have deleted more than 2 million invalid codes.

Instead, company executives signed annual statements attesting that the billing data submitted to CMS was “accurate, complete, and truthful.” Those actions violated the False Claims Act, a federal law that makes it illegal to submit bogus bills to the government, DOJ alleges.

The complex case has featured years of legal jockeying, even pitting the recollections of key CMS staff members — including several who have since departed government for jobs in the industry — against those of UnitedHealthcare executives.

Red herring

Court filings describe a 45-minute video conference arranged by then-CMS administrator Marilyn Tavenner on April 29, 2014. Tavenner testified she set up the meeting between UnitedHealth and CMS staff at the request of Larry Renfro, a senior UnitedHealth Group executive, to discuss implications of the draft rule. Neither Tavenner nor Renfro attended.

Two UnitedHealth Group executives on the call said in depositions that CMS staffers told them the company had no obligation at the time to uncover erroneous codes. One of the executives, Steve Nelson, called it a “very clear answer” to the question. Nelson has since left the company.

For their part, four of the five CMS staffers on the call said in depositions that they didn’t remember what was said. Unlike the company’s team, none of the government officials took detailed notes.

“All I can tell you is I remember feeling very uncomfortable in the meeting,” Rice said in her 2022 deposition.

Yet Rice and one other CMS staffer said they did recall reminding the executives that even without the chart review rule, the company was obligated to make a good-faith effort to bill only for verified codes — or face possible penalties under the False Claims Act. And CMS officials reinforced that view in follow-up emails, according to court filings.

DOJ called the flap over the ill-fated regulation a “red herring” in a court filing and alleges that when UnitedHealth asked for the April 2014 meeting, it knew its chart reviews had been under investigation for two years. In addition, the company was “grappling with a projected $500 million budget deficit,” according to DOJ.

Data miners

Medicare Advantage plans defend chart reviews against criticism that they do little but artificially inflate the government’s costs.

“Chart reviews are one of many tools Medicare Advantage plans use to support patients, identify chronic conditions, and prevent those conditions from becoming more serious,” said Chris Bond, a spokesperson for AHIP, a health insurance trade group.

Whistleblowers have argued that the cottage industry of analytics firms and coders that sprang up to conduct these reviews pitched their services as a huge moneymaking exercise for health plans — and little else.

“It was never legitimate,” said William Hanagami, a California attorney who represented whistleblower James Swoben in a 2009 case that alleged chart reviews improperly inflated Medicare payments. In a 2016 decision, the 9th Circuit Court of Appeals wrote that health plans must exercise “due diligence” to ensure they submit accurate data.

Since then, other insurers have settled DOJ allegations that they billed Medicare for unconfirmed diagnoses stemming from chart reviews. In July 2023, Martin’s Point Health Plan, a Portland, Maine, insurer, paid $22,485,000 to settle whistleblower allegations that it improperly billed for conditions ranging from diabetes with complications to morbid obesity. The plan denied any liability.

A December 2019 report by the Health and Human Services Inspector General found that 99% of chart reviews added new medical diagnoses at a cost to Medicare of an estimated $6.7 billion for 2017 alone.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

https://cbsnews.com…

August 15, 2024

Podcast host Joe Sparks highlights the story of U.S. Olympian Ariana Ramsey, who availed herself of free health care services in Paris and shared her experience on social media.

“America needs to do better with their health care system” she said on TikTok. “There’s no reason why me—an American girl—should be so amazed by free health care.”

Additional episodes will be uploaded monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Building Bridges, WBAI Pacifica Radio, August 5, 2024

PNHP national board secretary Dr. Ed Weisbart discusses his recent piece in Common Dreams, “To Win ‘Medicare for All,’ First Reclaim Medicare From Profiteers.”

Dr. Weisbart cites the corporate insurance industry’s indefensible overcharging of taxpayers—to the tune of up to $140 billion per year.

“If we could get that money back from them,” he says, “then we could use that money to help us pay for hearing, and vision, and dentistry for everybody in Medicare” along with other important health care priorities.

https://wbai.org…

By Amos Barshad
The Lever, August 2, 2024

On a chilly Monday night in January 2019, Kamala Harris was in Des Moines, Iowa for a CNN town hall. At the time, Harris was the junior senator from California and one of nearly 30 candidates vying to be the Democrats’ 2020 presidential nominee. A few minutes into the event, a self-employed local resident named Renee Welk asked a pertinent, inevitable question: “What is your solution to ensure that people have access to quality health care at an affordable price?”

Without hesitation, Harris answered, “We need to have Medicare For All.” Then, as the applause rang out, she riffed beautifully. “To live in a civil society, to be true to the ideals and the spirit of who we say we are as a country,” Harris said, “we have to appreciate and understand that access to health care” is not a “privilege” but a “right.”

“It is inhumane,” she continued, “to make people go through a system where they cannot literally receive the benefit of what medical science can offer because some insurance company has decided it doesn’t meet their bottom line in terms of their profit motivation. That is inhumane.”

This wasn’t Harris’s first time publicly backing universal government-sponsored health care: In 2017, she was one of the first co-sponsors of Sen. Bernie Sanders’ (I-Vt.) sweeping Medicare For All bill. But never before Des Moines had Harris spoken about the issue so forcefully, so passionately, and under such a bright spotlight.

When CNN’s moderator Jake Tapper pushed her on whether that meant she would “eliminate private insurance,” Harris seemingly stayed resolute. She described the painful process of filing an insurance claim, of dealing with all of the required paperwork, of facing delays in coverage, and then said: “Let’s eliminate all of that. Let’s move on.”

For supporters of universal health care, it was a stirring moment, a rousing defense from a senator whose state was then in the early stages of its ongoing fight for a single-payer system. For Harris, fighting to make herself known nationally, it was potentially definitive. On an issue of grave importance, she had spoken with a ringing moral clarity.

But within days, as opponents across the political spectrum launched attacks on her position, Harris and her campaign began walking it all back.

In confused, mealy-mouthed statements, campaign reps told the media that while Harris’s “preference” was Medicare For All, she was open to more than one “path” to providing universal coverage. By the summer of 2019, Harris had proposed a widely panned proposal that critics said would continue to enrich the private insurers who have fueled the country’s health care crisis.

Now that Harris is the Democratic Party’s presumptive 2024 presidential nominee, questions about her back-pedaling on Medicare For All have a new urgency. What does her retreat under pressure from powerful monied interests tell us about a potential Harris presidency’s agenda on issues that conflict with donors’ demands?

Medicare Privatization For All?

Throughout 2019, Harris stumbled repeatedly when prompted to express her views on Medicare For All. In May 2019, in another interview with CNN’s Tapper, Harris said that back in Iowa, when he’d asked her if she wanted to get rid of insurance companies and she said yes, that was actually “not what I meant.”

During a debate in June of that year, when the candidates were asked who would be in favor of eliminating all private health care insurance, Harris raised her hand. Days later, she again backed off the position. The next month, in a Medium post headlined “My Plan For Medicare For All,” Harris finally released the specifics of her health care plan.

“She called it Medicare For All,” said Adam Gaffney, an ICU doctor and the former president of the advocacy group, Physicians for a National Health Program. “But it really wasn’t. She did envision covering everyone and that is laudable and that is critical. But the plan maintained a central role for private insurers, and we’ve seen year after year is that private insurers are driving up the cost of care. They are a key problem in our crisis.”

Medicare For All is also known as single-payer health insurance because it would create one federal government entity that would oversee all health care spending. Its advocates believe the best way to provide health insurance to all Americans is by improving and expanding Medicare, a system that has successfully provided health care for millions of people for decades. Advocates also estimate a single-payer system would net $500 billion in savings by mimicking the efficiency of Medicare, which spends just two percent of costs on administrative tasks like billing.

Harris’s plan wasn’t a single-payer system. Instead, it aimed to give all Americans the choice of enrolling in Medicare while also likely expanding Medicare Advantage, the controversial for-profit insurance program subsidized by the federal government.

People choose Medicare Advantage because it’s cheap: The upfront premiums average less than $20 a month. What they don’t know is that actually receiving treatment with their Medicare Advantage plan is costly in other ways: Critics say that Medicare Advantage insurers profit by denying patients care.

The Journal of Clinical Oncology has found that, in part due to inferior care options, cancer patients in Medicare Advantage have higher mortality rates immediately after surgeries than traditional Medicare enrollees. Researchers studying one large insurer’s data found a 15 year increase in denials over a five year period. One in three Medicare Advantage enrollees are denied at least one claim annually. The programs are being investigated by the Department of Justice for fraud.

This privatized version of Medicare has existed in previous versions since at least the nineties. In 2003, it was renamed Medicare Advantage. Under Trump, it ballooned. In 2018, his administration’s Department of Health and Human Services sent physical letters to millions of Americans saying things like “See if you can save money with Medicare Advantage.” Under the Biden and Harris administration, its growth continued. Last year, around half of all eligible patients were in Medicare Advantage plans rather than traditional Medicare.

As The American Prospect wrote in 2019, “what’s so insidious about Harris’ approach” is that it “would expand the commercial part of the system, falsely branded as a variant of Medicare, and take us further away from true seamless and universal coverage.” While that’s not good for patients, it’s also not good for the federal budget. As The Lever recently reported, “The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans.”

As far as the GOP is concerned, Medicare Advantage should get even bigger. Project 2025, a broad package of policy proposals being pushed by the Heritage Foundation as the blueprint for a second Trump administration, wants to set Medicare Advantage as “the default enrollment option” for Medicare.

It’s been fourteen years since the Obama administration passed the Affordable Care Act and in many ways America’s health care crisis is worse than ever, as health insurance companies have taken advantage of its many loopholes. This year, the prices of health insurance premiums are estimated to reach record highs. By 2026, the number of uninsured Americans is predicted to spike to over 30 million.

By the end of 2019, in the wake of her flailing around Medicare For All, and as her support waned, Harris quit the Democratic primaries.

In the summer of 2020, Joe Biden — who, during his own successful campaign for the Democratic nomination, explicitly said he’d veto any Medicare For All bill as president — named Harris his vice president.

How Harris “Abandoned” Medicare For All

When Harris first began talking about her support for Medicare For All, she often told the story of her own mother who died in 2009 at 70 years old, due to complications from colon cancer. In a 2018 New York Times op-ed, Harris wrote touchingly of cooking “elaborate meals for her, filling the house with the smells of childhood,” and of finding time outside of her then-job as San Francisco district attorney to hold her mother’s hand “through the misery of chemotherapy.” She wrote, “I am so grateful my mother had Medicare, and I will fight for it to be guaranteed to all.”

In the fall of 2019, Harris sat down for an interview with Ady Barkan, the Medicare For All advocate who died last year, at the age of 39, from complications of ALS. At that point, Harris had already released her Medicare Advantage-boosting health care plan.

At first, the two speak in generalities about the importance of health care over the kind of crescendoing instrumentals that would sound right on a motivational YouTube sports highlights compilation. Barkan asks Harris about her late mother; Harris breaks down in tears. Then, to his credit, Barkan doesn’t let the opportunity slip to push back on the specifics of Harris’s plan.

“You philosophically believe the insurance companies play a useful role and should continue existing?” he asks her, using the augmentative technological intervention he needed to communicate toward the end of his battle with serious degenerative disease.

“I believe that those who abuse the system should be held accountable, but I am not trying to get rid of all private insurance,” she answers. “The problem is they have been writing the rules and they have been taking advantage of consumers.”

Michael Lighty, a longtime Medicare For All advocate, worked as the health care constituency director for Sen. Sanders’ 2020 presidential campaign. He was also the longtime single-payer expert for the California Nurses Association/National Nurses Union organization, which represents over 150,000 nurses nationwide.

He recalls being initially impressed with Harris’s thoughts on Medicare For All, both during the Des Moines event and on previous occasions, “It was very passionate, very sincere. Her framing was ‘we’re not getting a good ROI on health care,’ which was certainly unique, but she definitely seemed committed to the issue.”

The context for Harris’s eventual retreat, Lighty said, was that support for Medicare For All was making the Sanders campaign a target for huge attack ad spending. “Bernie was getting hit with about a million-and-a-half dollars in Iowa” ahead of the 2020 caucus, Lighty says. Meanwhile Pete Buttgieg, then best known as the former Mayor of South Bend, Indiana, “was claiming he had a better plan, some kind of public/private combination.” Sen. Ellizabeth Warren (D-Mass.) “felt compelled to prove how we pay for it in order to distinguish herself, which was not a smart move politically,” Lighty said. “You don’t wanna talk about what it’s gonna cost you, you wanna talk about what it’s gonna save.”

Harris, he explained, was trying to find something to make herself stick out while avoiding the ad spending being directed against Sanders for his support of Medicare For All.

“A majority of voters want the option to keep their plans,” Lighty said. “Primarily that’s because the situation is so bad, they’re desperate to keep what they have.” Political consultants “will tell candidates, ‘you don’t want to be out there telling people you’re taking away their plans.”’

When Harris finally did release her so-called version of Medicare For All, Lighty explained, she “backed off the fundamental principle — a single, publicly-administered plan that would eliminate the power of the commercial insurance companies.” For the Sanders campaign, Lighty says, Harris’s plan felt like an opportunity. “So, fine. Not ‘fine’ from a policy perspective, because she’s wrong.” But it distinguished Sanders as the sole champion for a true Medicare For All proposal.

“She had abandoned support for Medicare For All,” Lighty concluded. “We saw it as exactly that.”

In the long fight for universal healthcare, 2019 was “a very exciting time,” said Gaffney, the ICU doctor. “Single-payer activism had been going on for decades, but for many years had really been on the sidelines” of the political discourse.

Sanders’ 2016 presidential run energized the issue; with the ongoing efforts of progressive activists, and the broader pushback to the Trump administration, Medicare For All suddenly had real momentum. And Harris in Des Moines was a significant moment in the groundswell.

But despite bipartisan support, the movement faltered. “I think many politicians responded to the energy of their progressive constituencies,” Gaffney said. “But it’s one thing to sign on. It’s another thing to stay on.”

“I’ve Never Encountered Kamala”

Alex Lawson is the executive director of the advocacy organization Social Security Works, which aims to expand Social Security and Medicare. He’s an advocate for Medicare For All and has helped draft single-payer legislation introduced in the House of Representatives.

Of the plan Harris proposed in 2019, he said, “I totally reject the idea that the policy is terrible.” He understands why people might be alarmed at the plan’s potential to expand Medicare Advantage. But he said, “Harris’s goal is really clear. It’s to not allow corporate insurers to delay and deny care.”

He doesn’t agree with the people criticizing her approach as an expansion of Medicare Advantage, saying that was not her intention: ”I can tell you, I was right there.” As an activist in close communication with both the Sanders and the Harris teams, he saw that “Harris and her staff were looking to guarantee health care for Americans.’”

In her 2019 proposal, Harris writes, “Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services. If they want to play by our rules, they can be in the system. If not, they have to get out.”

Lawson points to the Biden-Harris administration’s health care track record, which includes, he says, “the largest expansion of Medicare since the creation of Medicare,” and the creation of price caps on a select handful of drugs for Medicare patients. Harris should be judged on what her administration has done, Lawson argued: “They beat pharma! The unbeatable pharma!”

For Lawson, Harris’s walkback on Medicare For All in 2019 is not as telling as its critics believe it to be. “That episode is not nearly as clarifying as the totality of what she did before, during, and up to now,” he said.

As President, Biden was very cozy with the insurance industry: He welcomed its lobbyists to his very first fundraisers, and he took its cues when crafting emergency relief policies during the pandemic.

What kind of relationship Harris will look to build with insurers is not yet known. According to Open Secrets, Harris now has over $800,000 in donations from the health services sector, which includes insurance giants like UnitedHealth and Blue Cross Blue Shield. (Donations to Biden’s campaign before he dropped out will now be transferred to Harris’s campaign, and so are included in that number.)

The Harris campaign recently told The New York Times that Harris “no longer supported a single-payer health insurance program.”  In a statement to NBC News on July 31, a campaign official said, “The VP will not push single payer as president.” When reached for comment, a Harris campaign official confirmed that to The Lever, adding, “The VP won’t push her 2019 health care plan. She will continue to build on the successes of the Biden-Harris Administration — lowering prescription drug costs and making health care more affordable and accessible.” The campaign official declined to elucidate Harris’s vision any further than that.

On July 30 of this year, Harris commemorated the anniversary of the creation of Medicare, signed into law by Lyndon B. Johnson 59 years ago, with a post on X, formerly Twitter: “Trump’s Project 2025 plans to cut Medicare and roll back our progress on Medicaid. As Vice President, I have worked to expand these programs—and we are not going back.” Once, she was clear and bold on the issue; these days, she is a cipher.

RoseAnn DeMoro, the former executive director of National Nurses United, is widely known as one of the most effective union leaders in recent American history. Before retiring in 2018, she helped create real and ongoing momentum for single-payer health care in California and remains an activist for Medicare For All in the state and nationwide. When asked about Harris’s shifting positions on Medicare For All, she first offers a preamble: “I really want her to win, and I hope you say that. She has to win.”

Then she said of her former neighbor in the Golden State, “I’ve been in the political world forever. And I cannot tell you what she advocates. In all my years doing political work in California, in terms of our issues, I’ve never encountered Kamala.”

https://www.levernews.com…

The Attitude with Arnie Arnesen, August 1, 2024

PNHP national board secretary Dr. Ed Weisbart discusses his recent piece in Common Dreams, “To Win ‘Medicare for All,’ First Reclaim Medicare From Profiteers.”

Despite the need for improvements such as additional benefits and lower out-of-pocket costs, Dr. Weisbart reminds us that “Medicare is a spectacular public health program, [but] Medicare Advantage is completely different from that.”

After all, the corporate insurers that sell Medicare Advantage plans have financial priorities that are incompatible with public health. “Every time they spend money on our health care,” he says, “that’s a loss.”

https://www.podomatic.com…

By Adam Gaffney, M.D., M.P.H.
The Nation, July 31, 2024

President Biden’s exit from the Democratic ticket and Vice President Kamala Harris’s emergence as the presumptive nominee has, perhaps, escalated the stakes of the November election for healthcare. Trump’s schemes are, of course, unchanged: A unified Republican government could shred the nation’s healthcare safety net, accelerate the (ongoing) privatization of Medicare, and further restrict or even ban abortion nationwide. In contrast, like a second Biden administration would have, a Harris administration might mostly mean continuity—allowing her to consolidate some real gains (like Biden’s landmark Medicare drug negotiation reform) without confronting the broader injustices and galloping corporatization of US healthcare. But in some quarters, hopes are rising that a Harris administration could go a step beyond Biden—and even open the door to a progressive shift on health policy.

Harris has been to Biden’s left on abortion, supporting a measure in 2019 that would have gone beyond Roe by curtailing state-level abortion restrictions; she is also the first vice president to visit an abortion provider. As a California senator, she endorsed Senator Bernie Sanders’s landmark 2017 Medicare for All bill, a far more expansive reform than anything Biden has put his name on. Yet Harris backtracked on Medicare for All, and the political pressure her administration would face in any major reform effort from both right and center would be daunting, particularly without a powerful grassroots movement pushing the cause, once again, to center stage. Such a mobilization is precisely what we need regardless of the election’s outcome—to advance progressive reform if possible and to fight calamitous policies if necessary.

Forecasting the impact of a second Trump administration requires distinguishing his rhetoric from the reality of his rule. Recall that in the 2016 presidential primary, Trump ran on vaguely popularist promises to protect public health insurance programs, while maligning Obamacare and promising to replace it with something better. “They’re gonna cut Social Security, they’re gonna cut Medicare, they’re gonna cut Medicaid,” Trump said of his Republican primary competitors in 2015. “I’m the one saying that’s saying I’m not gonna do that!” He also famously accused pharmaceutical companies of “getting away with murder” in how they priced their products, causing pharma stocks to briefly tumble.

Given the popularity of Medicare and Social Security even among Republican voters, such claims may well have helped pave the road to the White House for Trump. But as we know, once in office, he governed as a hardened healthcare right-winger, joining congressional Republicans’ nearly successful campaign to dismember Medicaid and dismantle preexisting conditions protections. Even after the Obamacare repeal effort failed, Trump’s budgets continued to call for devastating Medicaid cuts.

A second Trump administration could well give us something of a rerun. As in the past, Trump continues to deride Obamacare, but his platform’s healthcare provisions are reminiscent of his prior popularist claims. “FIGHT FOR AND PROTECT SOCIAL SECURITY AND MEDICARE WITH NO CUTS,” it promises, along with nebulous words about competition and transparency and some virulent threats to “protect” Medicare from immigrants. But if history is any guide, once in office, Trump will again serve as a right-wing standard-bearer on healthcare. Indeed, though he has distanced himself from the Heritage Foundation’s Project 2025 blueprint, his administration’s actions seem more likely to be guided by this conservative wish list—whose contributors include numerous members of his last administration, including six cabinet secretaries—than by his hazy populism. The document calls for sweeping conservative change, including gutting cuts to Medicaid via block grants and lifetime caps on benefits (i.e., kicking people out of the program even if they remain poor) “to disincentivize permanent dependence.” The Center for American Progress estimated that as many as 18.6 million enrollees could be at risk of losing coverage if the latter provision were to become reality. Project 2025 also proposes making privatized Medicare Advantage the “default enrollment option” for seniors, which would no doubt be the death knell for public Medicare.

Yet if Trump’s designs seem plain as day, the meaning of a Harris administration for healthcare seems underdetermined. “We believe in a future…where every person has affordable health care,” Harris said at a recent speech, without further details. The party’s platform has yet to be released, and Harris’s prior stances on healthcare issues have varied significantly. Her aforementioned cosponsorship of Sanders’s 2017 Medicare for All bill was no small thing; the senator’s last single-payer bill prior to the 2017 bill was launched with precisely zero cosponsors. But the progressive energies unleashed by his campaign, years of single-payer activism, and the galvanizing effect of Trump’s ascent to the White House (along with his attack on Obamacare) brought not just Harris but a historic 16 senators on board for the 2017 bill. (Similarly, Representative Pramila Jayapal’s 2019 Medicare for All bill, reintroduced last year, was ultimately cosponsored by two-thirds of House Democrats.) Yet, after endorsing Sanders’s bill, Harris backtracked, putting out her own plan that would give insurance companies a major role in providing universal coverage—an approach many of us criticized at the time for its accommodation of corporate interests. On Wednesday, a Harris spokesperson told NBC News that “The VP will not push single payer as President.”

Those years were something of a high watermark for M4A: The arrival of the Covid pandemic and the end of the Democratic primaries saw the issue’s prominence fade. But as we look ahead to the November election, it’s critical to realize that the dynamics that drove it to the forefront of the national political discussion are no less pressing today. A Trump administration would cruelly degrade healthcare coverage for the sick and working class, while accelerating the corporate corruption of care. Yet, even without such a regressive shift, US healthcare remains deeply inequitable and under siege from corporate power: The number of uninsured fell during the pandemic but is predicted to rise 32.8 million by 2032; one in four adults go without needed medical care, and one in five without a prescription drug, because they cannot afford it; private equity firms are strip-mining the nation’s hospitals; private insurance companies are gobbling up Medicare; and vertically integrated insurer-pharmacy-provider behemoths like UnitedHealth are increasingly subordinating the healing mission of medicine to their corporate bottom lines.

Harris is no doubt aware of these issues: As attorney general of California, she helped block a merger between two massive insurance giants, and, though she backtracked, her endorsement of Medicare for All demonstrated that she was responsive to the progressive constituencies that mobilized behind it. A Trump victory, make no mistake, would be a deadly disaster for our nation’s health—and something we must be prepared to fight. But it is important to be clear-eyed about a Harris victory: It will be an opening if and only if a progressive grassroots movement is able, once again, to put real universal healthcare back on center stage.

Dr. Adam Gaffney is a critical care physician and an assistant professor at Harvard Medical School, and past president of Physicians for a National Health Program.

https://thenation.com…