It wasn’t so long ago that Bernie Sanders (I-VT) comfortably occupied the left flank of health care policy. His Medicare For All bill was sufficiently costly, coercive and utopian to set him apart from the pack.

Times have changed. When it comes to drug pricing, Bernie faces unexpected intruders on his left:  Republicans.

In recent months, Bernie has yielded socialist turf to two Republicans of impeccable capitalist pedigree. First, it was President Trump, who last fall announced a plan to incorporate drug prices set by foreign governments into Medicare. Then Sen. Rick Scott (R-FL) last week introduced a bill pegging U.S. retail prices for prescription drugs to those set by five foreign governments.

Expanding Medicaid in the remaining non-expansion states would crowd millions of able-bodied adults out of private insurance coverage and shift them into taxpayer-funded Medicaid. In fact, nearly two-thirds of these adults either have private coverage already or have access to very low-cost coverage through the ObamaCare exchange. Even worse, this expansion could also shift more than one million kids who currently have private insurance into Medicaid.

Ultimately, ObamaCare’s Medicaid expansion means taking resources away from those who truly need Medicaid in order to fund a welfare expansion for those who already have private coverage.

The Trump administration has been pushing for lower drug prices, and some drug manufacturers have responded by lowering prices and providing greater access to life-saving treatments. However, there is a growing concern among health care providers that the middlemen who negotiate drug prices on behalf of insurers—known as pharmacy benefit managers (PBMs)—are actively working to keep prices high for consumers, presumably in an effort to increase their own profits. I run a free cardiovascular risk reduction service at a local clinic where we see many patients either suffering from, or at high risk for, heart disease. In collaboration with providers, I work to apply evidence-based medicine in the clinical setting and ensure any new treatment is financially sustainable for a patient—a task that can be made difficult by profit-driven insurance companies denying medication access and PBMs that keep treatment costs high.
Republican Idaho Gov. Brad Little has signed a bill that adds work requirements and other sideboards to Idaho’s Medicaid expansion. Voters approved the expansion—giving Medicaid health insurance to all low-income adults in Idaho—with a 61% vote in November. Instead of funding the expansion or repealing it, the Idaho Legislature took up bills to change it. Lawmakers passed the latest version of their sideboards legislation on Friday, after weeks of intense deliberation. The governor received it Monday.

Alaska Gov. Mike Dunleavy told President Donald Trump that the state is open to the idea of receiving Medicaid funding through fixed amounts annually. The block grant approach could allow the state more flexibility in how it spends Medicaid funding, Dunleavy spokesman Matt Shuckerow told Alaska Public Media. The Republican governor wrote to the president last month that Seema Verma, the administrator of the Centers for Medicare and Medicaid, had urged the state to become the first receive the federal funding this way. He noted that Alaska is eager to do it.

The Justice Department has appealed a federal judge’s decision to strike down work requirements in Kentucky and Arkansas pertaining to certain Medicaid beneficiaries. The case will go before the U.S. Court of Appeals for the District of Columbia after being struck down March 27 by Judge James Boasberg of the U.S. District Court for the District of Columbia, an appointee of former President Obama. At issue are rules the Trump administration approved in the states obligating some people who are able to work, volunteer, or take classes for 80 hours a month to be allowed to remain on Medicaid. The rules don’t apply to caregivers, parents, and people undergoing treatment for serious illness.

Sen. Sanders calls his new bill “Medicare for All” because polls tell him that voters don’t want to abolish traditional Medicare. Voters also don’t want him to destroy the U.S. system of private medical insurance, but his plan would do that, too. The bill reads, “Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.” In other words, you are free to choose any doctor the federal government allows you to choose. But good luck finding one when payments to doctors and hospitals will be slashed to the point that many will have difficulty keeping their doors open.  On at least one point, Mr. Sanders is being honest. He’s not even trying to sell the Obama whopper that patients will get to keep the plans and the doctors they like.

Sen. Bernie Sanders (I-VT) on Wednesday unveiled his revamped Medicare for all bill with the support of four Senate Democrats also running for president. Sanders, who is again seeking the Democratic nomination for president in 2020, rolled out the bill that would largely eliminate private insurance and institute a single-payer system managed by the government. Sens. Elizabeth Warren (MA), Kirsten Gillibrand (NY), Cory Booker (NJ) and Kamala Harris (CA)—all 2020 Democratic presidential candidates—again signed on to the bill after also supporting it in 2017. The updated version will also include coverage for long-term care, such as nursing homes, which is currently not covered by the Medicare program. No cost estimate was provided.

Seeking to show Republicans’ commitment to protecting those with pre-existing conditions, a group of GOP senators led by Sen. Thom Tillis of North Carolina is reviving and expanding a bill that would retain at least some of the protections built into Obamacare. The move is an attempt to address concerns that the popular and ironclad provisions secured by the ACA may disappear amid President Trump’s renewed drive to overturn the landmark health reform law. It comes as Democrats offer up an array of new proposals for universal, government-backed health coverage. The bill’s introduction comes less than two weeks after the Trump administration said in a federal appeals filing that the entire ACA should be struck down.

The Trump Administration may be slowing down its push to replace the ACA, but several conservative groups are still pushing the Health Care Choices proposal. “We keep hearing that Republicans don’t have any ideas and it makes us a little crazy, because [we] worked for a year and a half to come up with a new generation of health reform,” said Grace-Marie Turner, president of the Galen Institute. “One thing we have learned is that the federal government is out of its element overseeing and regulating something as regional and personal as health care,” said Turner. “States have a much better understanding of their markets and their constituencies. . . . and can really influence how their state moves forward. Also, people are smarter and understand more than they did before that more regulations mean higher costs.”