Analysis | The Health 202: Mike Bloomberg is pounding voters with a single ad. It’s about health insurance. – The Washington Post

THE PROGNOSIS

Mike Bloomberg has pitched his tent in the improve-on-Obamacare camp as he tries to forge his own pathway to the White House among a still-crowded Democratic field.

The former New York mayor, who didn’t enter the race until late November, hasn’t participated in the heated debates over expanding insurance coverage that have exposed deep fissures between his moderate and liberal presidential opponents. Many of his Democratic rivals have thrown their weight behind Medicare-for-all, which would dramatically expand coverage at a high cost.

But Bloomberg, who is pumping millions of dollars into his entirely self-funded campaign, is running a single ad in 26 states that details where he stands in the health-care debate that has become a central issue in the Democratic primary. The ad, the only TV message Bloomberg is currently airing, is all about — you guessed it — health insurance.

Bloomberg’s ad, which your Virginia-dwelling Health 202 author spotted at least three times during the Golden Globe Awards, touts improvements in insurance coverage, life expectancy and infant mortality during his tenure as mayor. It also contrasts his support for the Affordable Care Act with President Trump’s attempts to dismantle it.

“When you hear Mike Bloomberg on health care … you should know he did it as mayor, he’ll get it done as president,” the ad says.

Bloomberg is much better known for his work on smoking and obesity (where he has a mixed record) than on health insurance. Though it’s true that the number of uninsured New Yorkers dropped from 1.8 million to 927,000 while he was mayor, that’s chiefly because of provisions in President Obama’s health-care law — a law Bloomberg cheered at the time but obviously had no direct hand in passing.

But the billionaire is making a calculated effort to cast himself as a health-care reformer in a race that has been characterized by vigorous debate over how to bring universal coverage to Americans.

“It’s a top voter concern, but also I think Mike is trying to remind people that he’s always had public health, health care at the top of his agenda,” Bloomberg campaign spokesman Michael Frazier told me. “He did that while mayor of New York City — he does that in his philanthropy. So it’s reminding people he’s done this and he’ll do more as president.”

In the past month, Bloomberg has released a proposal to add a government-sponsored plan to compete with private plans on the Obamacare marketplaces, much like what former vice president Joe Biden wants. The plan also calls for expanded subsidies to help people afford their plans and additional Medicare coverage for dental, hearing and vision care.

In comments throughout this past year, Bloomberg has made clear he’s no fan of Medicare-for-all. During a trip to New Hampshire last January, he said it would “bankrupt us for a very long time.”

“I think you could never afford that. You’re talking about trillions of dollars,” Bloomberg said at the time.

Bloomberg has also proposed ways to improve maternal health, particularly for African American women — an issue that has increasingly garnered interest from policymakers because of clear racial disparities and a troubling increase in mortality rates overall.

If Bloomberg has any hope of competing seriously for 2020 nomination, he’ll need to create a large groundswell of support — and soon. He’s skipping the first four state primaries, instead hinging his campaign on the 25 states that will award nearly two-thirds of all delegates between March 3 and March 18.

Toward that end, he’s been launching field offices and flooding the airwaves and the Internet with ads entirely funded by his own vast wealth. His campaign told NBC News yesterday that it now has organizers and staff in more than 30 states, including all 14 of the crucial states with primaries on Super Tuesday.

The campaign employs more than 800 staffers and has spent more than $ 100 million on advertising in the past six weeks. To put that in perspective, the four top-polling Democrats in the race — Biden, former South Bend, Ind., mayor Pete Buttigieg, and Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) — have spent about $ 28 million on ads all year.

Bloomberg is investing heavily in online advertising, my colleagues Isaac Stanley-Becker and Michael Scherer reported last month. He has bought $ 4.6 million of Google ads, while on Facebook, his spending over a single week ran at more than $ 170,000 per day, 2 ½ times the level of Trump’s reelection campaign.

It’s too early to tell for sure whether the strategy is working, although a Hill poll released this week gave Bloomberg a 6-point bump, from 5 percent support nationally to 11 percent support. He’s fifth in The Washington Post’s national poll average.

“Although far outside the box, the effort is not easily dismissed,” Isaac and Michael wrote. “Rival campaigns worry about the creeping possibility that he finds a way to catch fire if the early states deliver no clear front-runner, or that he wins enough delegates to deny anyone a majority, granting him a brokering role in choosing the nominee before the convention.”

AHH, OOF and OUCH

AHH: The Supreme Court has ordered the Trump administration and a group of red states to respond by the end of the week to an appeal from California and 19 other Democrat-led states to quickly hear a case challenging the ACA’s constitutionality. The states asked the high court last week to consider the case during its current term.

The Friday deadline “gives the court the option to take up the case during its current term, which would mean a ruling on a contentious issue this spring, just as the presidential campaign heats up,” NBC News’s Pete Williams reports.

The states defending the ACA are appealing a December ruling by a federal appeals court that the law’s individual mandate is unconstitutional. The appeals court kicked the case back to a lower federal court, but the states are eager for a final ruling from SCOTUS.

OOF: Months after Trump said he ordered the Veterans Affairs Department to purchase a drug called esketamine, a novel antidepressant meant to treat those with the hardest cases of depression, the department had treated just over a dozen veterans nationwide with the drug, Stat’s Megan Thielking reports.

The Food and Drug Administration approved the drug in March. VA treated its first patient with the nasal spray, named Spravato, in June. By mid-December, it had treated just 15 veterans.

“Experts disagree on whether the VA’s rollout has been slower than is reasonable. Some have raised safety and efficacy concerns about the treatment, and the effort to get it covered and administered in the private health care system has been rocky,” Megan writes. “But there is little doubt that the VA’s moves to make Spravato accessible stand in sharp contrast with Trump’s claims that the drug could deliver widespread relief for veterans struggling with depression.”

OUCH: States have been slow to enforce the new law raising the cigarette and e-cigarette purchasing age to 21, Bloomberg Government’s Alex Ruoff reports.

Trump signed a measure on Dec. 20 that raised the federal minimum age to buy tobacco products. The effort was spearheaded by Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Tim Kaine (D-Va.), in part to curb a spike in youth vaping.

“Nineteen states had already increased to 21 the age requirement to buy tobacco products when the federal law passed. Raising the federal age limit was intended to force the remaining 31 states to follow suit,” Alex writes. “However, public health advocates say the Food and Drug Administration hasn’t made clear how state and local authorities that enforce tobacco-age laws are supposed to react. One advocate said many were caught off guard when the FDA simply announced with a notice on its website that the new law is in effect.”

—California lawmakers have proposed a measure to ban all flavored tobacco sales in stores across the state. The bill, introduced by a bipartisan group, goes much further than the federal plan the Trump administration announced last week to ban most flavored e-cigarette pods.

“Senate Bill 793 would prohibit flavored products not covered by the federal ban, including menthol-flavored cartridges and refillable, tank-based vaping systems that can be filled with flavored chemicals. It would also outlaw flavors for traditional combustible cigarettes and cigars, as well as for chewing tobacco and hookah pipes,” the Los Angeles Times’s Patrick McGreevy reports.

The measure is supported by health and youth advocacy groups but is likely to face opposition by tobacco and vaping industry groups, he adds. It could also face hurdles in a state where the tobacco industry has had a lot of influence.

AGENCY ALERT

— The Trump administration has tapped Brad Smith to be the new director of the Centers for Medicare and Medicaid Services’s innovation center.

Smith is a former executive of insurance giant Anthem’s Diversified Business Group and was also the chief executive of the palliative care services company Aspire Health, Fierce Healthcare’s Robert King reports.

INDUSTRY RX

— A new survey from Gallup found Americans rank nurses highest among a list of professions for honesty and ethics. Eighty-five percent of Americans say nurses have high or very high levels of these attributes.

It’s the 18th year in a row that nurses have come out on top of Gallup’s annual survey. Among a list of nearly two dozen professions, five medical professions rank among the top 10. The survey found 65 percent of Americans say medical doctors have high or very high levels of honesty and ethics, while 64 percent of Americans say the same about pharmacists and 61 percent about dentists. The survey also found 43 percent and 41 percent of Americans rate the level of honesty and ethical standards as high and very high for psychiatrists and chiropractors, respectively.

— A new analysis from the Kaiser Family Foundation finds the ACA market remained stable through the third quarter of 2019 despite the individual mandate being essentially gutted.

The ACA’s penalty for lacking health coverage was repealed with the 2017 tax overhaul, prompting concerns from Democrats that it would lead to upheaval for consumers who get their insurance through the marketplace.

“Results from the first nine months of 2019 suggest that the individual market remains profitable and stable despite the effective repeal of the individual mandate,” the KFF analysis reads. “Continued modest growth in claims costs and a decrease in hospitalizations through the third quarter of 2019 indicate that the repeal of the individual mandate penalty and expansion of short-term insurance plans did not leave the individual market significantly less healthy.”

— And here are a few more good reads:

MEDICAL MISSIVES

TRUMP TEMPERATURE

STATE SCAN

OPIOID OPTICS

DAYBOOK

Coming Up

The House Energy and Commerce subcommittee on health holds a hearing on legislation to “improve Americans’ health care coverage and outcomes” on Wednesday.
The Bipartisan Policy Center hosts “20/20 Health Care Series: A Snapshot of Early Primary Voters” on Wednesday.
The House Veterans’ Affairs subcommittee on economic opportunity holds a hearing on “resources to address veteran hunger” on Thursday.

SUGAR RUSH

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