| Welcome to Tuesday's Overnight Health Care. In today's news, a Trump health official said he warned the administration about the consequences of separating children from their families. Also, liberal House Democrats are laying the groundwork to push "Medicare for all," even as a study about the costs ignited the debate over the plan. We'll start with some revelations from a Senate hearing today: Trump official warned of potential trauma because of family separations A Trump administration official told lawmakers Tuesday that he warned for months against "any policy" separating children from their parents, before the administration enacted a policy that would do precisely that. Jonathan White of the Department of Health and Human Services oversees reunification efforts of parents separated from their children after crossing the southern border illegally. He told a Senate panel: "There is no question that separation of children from parents entails significant potential for traumatic psychological injury to the child." Significance: This is one of the only times an official has acknowledged the administration was told that its policy of separating migrant families could result in harm that could result in harm to the children. White said he was in the dark about the end result of the policy. He had private conversations with administration officials while he served as deputy director of the Office of Refugee Resettlement, but he left that post a few weeks before the "zero tolerance" policy was implemented. "I was advised that there was no policy which would result in separation of children from family units," White said. More criticism: At the same hearing, Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) said the administration is "failing miserably" at treating some of the migrant children humanely. However, he couched his criticism by saying the policy was "well intentioned" and the policy was an unintended consequence. Backstory: A federal judge set a July 26 deadline to force the administration to reunite more than 2,000 children it has in custody. As of the deadline, the administration said it had reunited more than 1,400 children with their parents, while an additional 700 children remained in government custody. Get the full story on today's hearing here. Liberal Dems lay groundwork to push 'Medicare for all' It's not too early to start thinking about next year if you are a liberal Democrat and support Medicare for all. House Democrats are starting to plan for actions on the issue if they win back the House. Some examples: - A new Medicare for All caucus, with over 60 Democratic lawmakers, is holding briefings with experts.
- Lawmakers plan to update a Medicare for All bill first introduced by former Rep. John Conyers (D-Mich.).
- Rep. John Yarmuth (D-Ky.), the top Democrat on the Budget Committee, plans hearings on the cost of Medicare for All next year if he is chairman.
Some Democrats even want a vote on a Medicare for All bill next year. When asked if she wanted the House to vote on a "Medicare for all" bill next year if Democrats control the chamber, Rep. Debbie Dingell (D-Mich.) said, "Yes, we're going to travel the country talking about why it makes a difference." Notes of caution: Even if Democrats win back the House, a Medicare for All bill might not be able to pass, given that many Democrats do not support the idea. And it certainly couldn't become law with President Trump in office. Still, the activity shows how Medicare for All is gaining ground as an idea among Democrats, and that it is sure to be on the table when Democrats have united control of Washington again. Read more on Dems' efforts here. Meanwhile, a new study has ignited a debate over the cost of "Medicare for all." The analysis, from the libertarian-leaning Mercatus Center at George Mason University, focuses on legislation introduced by Sen. Bernie Sanders (I-Vt.) and estimates that his proposal to create a national health insurance system would lead to a $32.6 trillion increase in federal spending over a 10-year period. But proponents of Medicare for all, also known as a single-payer system, are quick to note this isn't quite the full picture. So how much does it really cost? The study also estimates national expenditures on health care would decrease by about $2 trillion by 2031 if the Sanders bill were signed into law. That means overall health-care spending would decline, but the government's share of that figure would go up, something small-government Republicans find unsettling. Foreshadowing: Larry Levitt of the Kaiser Family Foundation said the Mercatus study is a good indicator of both the "promise and peril" of Medicare for all. "You can save money and cover everyone, but it would be a big shift from private payers to the public, and a $32 trillion increase in taxes is going to be scary." Read more on the debate here. Today's the day the comment period for the administration's proposed changes to Title X family planning program closes at midnight. If you need a refresher: Title X funds organizations that provide family planning services to low-income women and men. The administration's proposal would ban these organizations from referring women for abortions and would lift the requirement that organizations receiving funds tell women that abortion is an option. The proposal would also require Title X grantees have a physical and financial separation from abortion providers, which some argue is targeted at Planned Parenthood. The rule has been cheered by Republicans as a way to defund Planned Parenthood, which serves 40 percent of Title X patients. Some reproductive health advocates say the proposal favors projects that provide limited contraception options. Some responses: - American Medical Association CEO and Executive Vice President James Madara: "We are very concerned that the proposed changes, if implemented, would undermine patients' access to high-quality medical care and information, dangerously interfere with the patient-physician relationship and conflict with physicians' ethical obligations, exclude qualified providers, and jeopardize public health."
- New York Attorney General Barbara Underwood and Washington Gov. Jay Inslee threatened to sue if the rule is finalized: "Title X is a tremendously successful family planning program – providing affordable, confidential, and desperately-needed care to low-income patients across New York," Underwood said. " This gag rule will drive health care providers out of the program and harm the very patients that Title X is intended to serve. The Proposed Rule must be withdrawn in its entirety – and if it becomes law, we will sue." "The Trump Administration has given our state no choice but to explore all possible avenues, including legal options, to block this policy from harming the women of Washington," Inslee said. "I believe the rule as written will not withstand legal challenge, and I'll do all I can to prevent it."
- National anti-abortion group the Susan B. Anthony List supports it (and has lobbied for it): "We wholly support the Protect Life Rule, which draws a bright line between abortion and family planning in the Title X program. Abortion is not health care and it is not 'family planning.' The American people have repeatedly and clearly voiced their opposition to taxpayer funding of abortion, but for years, their will – expressed in the statute itself – has been ignored."
- 44 Senate Democrats urged the administration to reverse course: The proposed rule would allow politicians with extreme ideological views to interfere with women's personal health care decisions, undermine the provider-patient relationship, and leave women's access to health care increasingly dependent on how much money they have and where they live.
On the lookout: The final rule on expanding short-term plans is expected soon. The move would open plans that are cheaper for healthy people. But those plans can also charge people with pre-existing conditions higher premiums. Democrats deride the plans as "junk" insurance. A new analysis from the Kaiser Family Foundation shows that rising premiums are forcing unsubsidized enrollees off the market: - 17.4 million people enrolled in the individual market in 2015, compared to 15.2 million in 2017 and 14.4 million in the first quarter of 2018.
- Most of the decline is in the off-exchange market, signaling that unsubsidized consumers are being priced out.
Why it matters: The Trump administration last year canceled key ObamaCare subsidies for insurers, leading insurers to increase premiums substantially. While ObamaCare enrollees who receive subsidies are mostly shielded from these increases, those who don't are left to pay the full price. As the administration continues to push cheaper policies outside of ObamaCare (like short term health plans,) more people are likely to leave the individual market -- especially those who don't get subsidies. Read more here. What we're reading Poll: Majority backs ObamaCare, disapprove of Trump on health care (The Hill) Sanders thanks Koch brothers for accidentally making argument for 'Medicare for all' (The Hill) Pfizer CEO expects Trump to eliminate drug rebates (Reuters) States defend family planning program against Trump administration's threats (The Washington Post) Trump spurns Medicaid proposal after furious White House debate (The New York Times) State by state North Carolina's Blue Cross cutting 'ObamaCare' prices despite changes (Associated Press) These Republican governors are bolstering ObamaCare in their states (CNN.com) From The Hill's op-ed page The Trump administration stands up for health-care workers and Medicaid recipients | 
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