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Good morning. I’m Elisabeth Rosenthal, senior contributing editor for KFF Health News, a former emergency medicine physician and author of “An American Sickness.” As we ramp up for the <a href="https://www.washingtonpost.com/elections/election-2024/" target="_blank" class="contextual_link">2024 election</a>, I’ve wondered why talk of the public option has disappeared. Write me at <a href="mailto:elisabethr@kff.org">elisabethr@kff.org</a>. Not a subscriber? <a href="https://www.washingtonpost.com/newsletters/the-health-202/">Sign up here.</a>

Today’s edition: Inside the effort to place an <a href="https://www.washingtonpost.com/abortion/" target="_blank" class="contextual_link">abortion</a> rights amendment on the ballot in Arkansas this November. Federal regulators are warning a medical distributor against marketing unapproved syringes manufactured in China. But first …

Biden ran on the public option. Since entering office, he hasn’t mentioned it.

Cornell Watson

In the 2020 elections, then-candidate <a href="https://www.washingtonpost.com/elections/candidates/joe-biden-2024/" target="_blank" class="contextual_link">Joe Biden</a> and many of his congressional colleagues loudly advocated for a federal “public option” health insurance plan. It was framed, at the time, as part of his incoming administration’s response to the pandemic.

“Low-income Americans will be automatically enrolled in the public option at zero cost to them, though they may choose to opt out at any time,” Democrats promised in their party platform.

But since Biden entered office, it’s been crickets. The president hasn’t uttered the phrase “public option” since December 2020, <a href="https://factba.se/biden/search#%22public%2Boption%22">according to factba.se</a>, which tracks his public remarks.

Why the disappearing act? In a word: politics.

“Out of the gate you’d have a huge powerful lobby against the public option — the hospitals — since providers have the most to lose: lots of money,” said Matthew Fiedler, an economist at the Brookings Institution who has studied payment disparities between insurance plans. The health-care industry is the largest lobbying sector in Washington, with more than<a href="https://www.opensecrets.org/federal-lobbying/sectors/summary?cycle=2023&amp;id=H"> $132 million spent</a> annually just by hospitals and nursing homes, according to OpenSecrets.

For those who’ve forgotten, the idea was to create a government-sponsored insurance plan to compete with commercial insurers under the Affordable Care Act. The concept, previously backed by President Barack Obama, <a href="https://www.commonwealthfund.org/publications/newsletter-article/senate-democrats-drop-public-option-woo-lieberman-and-liberals-howl">didn’t make it into the final version of the ACA</a> due to opposition from pretty much everyone in health care.

In theory, a public option structured like Medicare, Medicaid or the military’s Tricare program could save billions in health-care spending by both the federal government and consumers because (like the existing federal plans) it would pay health providers less than commercial insurers. Fiedler said the public option could possibly save money, relative to commercial insurance, even if it paid as much as double Medicare’s rates.

And without having to earn a profit, such a plan could spend more money on patient care.

Unsurprisingly, insurers opposed the public option, but Fiedler said it’s hospital opposition that keeps it shelved.

As an example, Fiedler points to Medicare drug price negotiation, another long shot Democratic priority. Biden got that across the finish line as part of his 2022 Inflation Reduction Act.

“Congress didn’t want to pick a fight with hospitals, but they’re willing to take on drug companies,” Fiedler said.

Biden’s party hasn’t yet put together its official platform for the 2024 election, so perhaps the public option will reappear on his agenda. Spokespeople for his reelection campaign and the White House didn’t respond to emailed questions about it.

The idea still has many fans: Led by Colorado, some states have sought to create their own versions, though their plans rely on commercial insurers to administer the coverage. Insurers were able to tank <a href="https://www.npr.org/sections/health-shots/2020/02/26/809256960/insurers-sank-connecticut-s-public-option-whats-that-mean-for-the-u-s">public option proposals in Connecticut</a>, and they’ve complained that <a href="https://coloradosun.com/2023/06/07/colorado-option-health-insurance-public-hearing/">they would lose money</a> under Colorado’s proposal.

<a href="https://kffhealthnews.org/">KFF Health News</a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at <a href="https://www.kff.org/">KFF</a> — an independent source of health policy research, polling, and journalism.

Inside the long-odds push to undo an abortion ban in Arkansas

Will Newton

New this a.m.: After winning campaigns in both red and blue states, abortion rights activists are facing a test of the limits of their success in what is sometimes ranked as the “most pro-life state in America,” <a href="https://www.washingtonpost.com/politics/2024/04/26/abortion-ban-arkansas-overturn-activists/">The Post’s Hannah Knowles reports</a>.&nbsp;

Key context: Arkansas has a near-total ban on abortion, with exceptions only for life endangerment. It’s also a rural state with high poverty rates, uneven access to medical services and the nation’s highest maternal death rate — making local options for abortion especially important, supporters say.

But the ballot proposal to legalize abortion through the first 18 weeks of pregnancy is facing stiff headwinds. Almost a dozen groups have filed with the state to oppose the ballot measure, seeking to prevent it from meeting the July 5 deadline for roughly 90,000 signatures, according to officials.

Undeterred, Arkansans for Limited Government has pressed forward with a tiny budget and about 500 volunteers. Some individual donors have helped the effort crack six figures in fundraising, according to organizers, who said they are looking into hiring paid canvassers to pick up the pace on signatures.&nbsp;

It’s not clear that the group can make its July deadline — let alone run a statewide ad campaign in the face of fierce resistance. Notably, the effort has so far been overlooked by the main groups funding abortion ballot measures across the country, a testament to the uncertainty of its success as well as divisions over strategy in the ruby-red state.&nbsp;

Planned Parenthood affiliates <a href="https://apnews.com/article/abortion-planned-parenthood-north-carolina-investment-election-786d9103328e51db7f97e998e352201b">are rolling out</a> a $10 million campaign aimed at mobilizing voters concerned about abortion access ahead of the November elections, Makiya Seminera reports for the Associated Press.&nbsp;

Organizations are aiming to break the GOP supermajority in the North Carolina General Assembly, which imposed new abortion restrictions last year, and to defeat Republican gubernatorial candidate Mark Robinson, who wants the law to become stricter.

FDA warns Cardinal Health over marketing unauthorized syringes

Jacquelyn Martin

The Food and Drug Administration is warning Cardinal Health not to market unauthorized devices.&nbsp;

The agency <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/cardinal-health-679404-04242024">sent a letter</a> to the medical distributor following an inspection of its Illinois facility last year, where federal regulators determined that the company was marketing and distributing unapproved plastic syringes manufactured by China-based Jiangsu Shenli Medical Production Co.&nbsp;

“We take FDA’s concerns seriously,” a Cardinal spokesperson said in a statement. “We are working to ensure appropriate actions are taken with Jiangsu Shenli Medical-manufactured plastic syringes.”

Key context: The warning comes after the FDA <a href="https://public4.pagefreezer.com/browse/FDA/25-03-2024T16:14/https:/www.fda.gov/medical-devices/safety-communications/evaluating-plastic-syringes-made-china-potential-device-failures-fda-safety-communication">recommended last year</a> that U.S. health care providers stop using plastic syringes made in China, citing reports of breakages, leaks and other quality problems. The agency’s investigation into the issue <a href="https://www.fda.gov/medical-devices/safety-communications/update-evaluating-plastic-syringes-made-china-potential-device-failures-fda-safety-communication">is ongoing</a>.&nbsp;

The Department of Health and Human Services <a href="https://www.hhs.gov/about/news/2024/04/25/biden-harris-administration-partners-states-and-releases-data-recommendations.html">has selected</a> 20 states for participation in two technical assistance programs aimed at addressing shortages in their direct care workforce.&nbsp;

The programs, managed by the Administration for Community Living's Direct Care Workforce Strategies Center, focus on improving the recruitment, training and retention of workers providing home and community-based services to older adults and people with disabilities.

In a related effort, HHS and the Labor Department released <a href="https://acl.gov/sites/default/files/Direct%20Care%20Workforce/improving-hcbs-workforce-data-issue-brief.pdf">joint recommendations</a> for building a stronger data infrastructure to better inform policies aimed at supporting the industry. They include implementing a nationally representative survey of the direct care workforce and the needs of adults with disabilities, as well as enhancing state data collection and information sharing.

New this a.m.: In 2022, 63.7 percent of Americans aged 65 and older had a dental visit in the past 12 months. Older adults with diabetes, heart disease, or those in fair or poor health were less likely to have had appointments than their counterparts, <a href="https://www.cdc.gov/nchs/products/databriefs/db500.htm">according to the National Health Interview Survey</a>.&nbsp;

Genetic traces of the bird flu virus <a href="https://www.fda.gov/food/alerts-advisories-safety-information/updates-highly-pathogenic-avian-influenza-hpai">have been found</a> in 1 in 5 samples of pasteurized milk, <a href="https://www.washingtonpost.com/health/2024/04/25/bird-flu-cows-government-response/?itid=lk_inline_manual_60">the FDA said yesterday</a>, maintaining its confidence that the national supply remains safe to consume.&nbsp;

GlaxoSmithKline has <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/glaxosmithkline-sues-pfizer-biontech-over-covid-19-vaccine-technology-2024-04-25/">filed a federal lawsuit</a> against Pfizer and BioNTech, alleging patent infringement related to messenger RNA technology used in their coronavirus vaccines, Blake Brittain reports for Reuters.&nbsp;

HHS Secretary Xavier Becerra, in response to industry claims that a new minimum staffing mandate is unworkable. 

“If you’re claiming that you can’t find nurses, then explain to me how you’re <a href="https://www.washingtonpost.com/business/2024/04/22/nursing-home-staff-minimum/?itid=lk_inline_manual_52">running a nursing home</a>.”

<a href="https://www.washingtonpost.com/health/2024/04/25/vampire-facials-hiv-new-mexico/" target="_blank">How ‘vampire facials’ at an unlicensed spa left three women with HIV (By Fenit Nirappil | The Washington Post)</a>

<a href="https://www.cnn.com/2024/04/26/health/emergency-room-wait-times-kff-partner-content-wellness/index.html" target="_blank">Long ER waits plague short-staffed hospitals, affecting older adults (By Judith Graham | KFF Health News via CNN)</a>

<a href="https://www.cnbc.com/2024/04/25/walgreens-launches-cell-gene-therapies-in-service-expansion.html" target="_blank">Walgreens to help bring cell and gene therapies to patients as it expands specialty pharmacy services (By Annika Kim Constantino | CNBC)</a>

See you on Monday everyone, and thanks for reading.

Elisabeth Rosenthal

American University, BA in journalism

McKenzie Beard is a researcher for The Health 202, a morning newsletter and daily guide to Washington's health-care policy debate. She started at the Post as an American University practicum student on the investigative desk in 2021 and has previously reported for Voice of America and Teen Vogue.

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