Democrats Won a Mandate on Health Care. How Will They Use It?

After House Democrats’ election triumph, Nancy Pelosi’s appraisal was clear: “Health care was on the ballot, and health care won.”

But how do Democrats intend to use the power they won?

The top priorities for Ms. Pelosi, the House Democratic leader, and her party’s new House majority include stabilizing the Affordable Care Act marketplace, controlling prescription drug prices and investigating Trump administration actions that undermine the health care law.

Administration officials who have tried to undo the Affordable Care Act — first by legislation, then by regulation — will find themselves on the defensive, spending far more time answering questions and demands from Congress.

House Democrats plan to hold early votes on proposals to protect people with pre-existing medical conditions, an issue they continually emphasized in midterm races. The votes will test campaign promises by Republicans who declared their support for such protections.

Democrats will push for the House to intervene in a lawsuit in which 20 states, with support from the Trump administration, are challenging provisions of the Affordable Care Act, including the protections for people with pre-existing conditions.

If the states’ lawsuit succeeds, legislation to shore up the health care law and coverage for people with pre-existing conditions could become a priority for Congress.

While Democratic leaders push legislation and investigations on Capitol Hill, several of the party’s potential presidential candidates will be urging support for a public health insurance option or even “Medicare for all.” Republicans, who retained their Senate majority in the election, are eager to attack Democrats over those proposals, which they portray as a threat to private health plans covering more than half of all Americans.

Some lawmakers want to try again next year to stabilize the marketplaces where more than 10 million Americans obtain insurance under the Affordable Care Act. Several ideas were set forth in a bill drafted by Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington.

One idea is to provide money to resume the payments to insurers that President Trump terminated in October last year. The payments offset the cost of discounts that insurers are required to give low-income people.

Another idea is for the federal government to provide money to states to help pay the largest medical claims. Such assistance, which provides insurance for insurance carriers, has proved effective in reducing premiums in Alaska and Minnesota, and several other states will try it next year.

In addition, many Democrats say they want to provide more money to help consumers enroll in health insurance under the Affordable Care Act. Over the last two years, Mr. Trump has cut the funds for insurance counselors and enrollment assistance by 84 percent, to $10 million.

Mr. Trump said he believed he could work with Democrats in Congress on “lowering the cost of prescription drugs,” and the Senate majority leader, Mitch McConnell of Kentucky, said the issue was sure to be on the agenda.

Democrats have praised two of the proposals Mr. Trump has advanced in recent weeks. One would require drug manufacturers to include the list prices of drugs in television advertising. The other would reduce Medicare payments for certain high-cost drugs by using the average of prices in other advanced industrial countries as a benchmark in deciding what Medicare should pay.

Drug companies oppose both ideas. They say the price disclosures would confuse consumers, who often pay less than the full list price. And drug lobbyists say Mr. Trump’s proposal for an “international price index” would just import price controls from other countries.

Lawmakers from both parties could also find common ground with the administration on a bill that requires manufacturers of brand-name drugs to make samples available to generic drug companies trying to develop inexpensive copies of those medicines.

Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, says some drug makers have tried to stifle competition by blocking access to samples.

An agreement to lower drug prices is far from certain. Democrats would be reluctant to give Mr. Trump a victory for which he could take credit in the next presidential election.

The pharmaceutical lobby remains powerful and knows how to exploit differences between the Republican-controlled Senate and the Democratic-led House.

“The best outcome for drug makers is divided government,” because it means there will probably be legislative gridlock for the next two years, said Rick Weissenstein, an analyst at Cowen Washington Research Group, which tracks federal policy.

Trump administration officials and drug company executives can expect a steady stream of requests for documents and testimony from the Democrats in line to lead House committees.

The Democrats are eager to investigate the many ways in which they say the administration has sabotaged the Affordable Care Act. They also plan to investigate the work requirements that have been imposed on Medicaid beneficiaries in several states with encouragement from the Trump administration.

On the issue of drug prices, Representative Elijah E. Cummings of Maryland, who is poised to become the chairman of the Committee on Oversight and Government Reform, has already asked numerous drug makers to explain how they set them.

With other Democrats, he intends to seek detailed information to show how much drug companies spend on research, marketing, advertising and lobbying.

For their part, Trump administration officials said they did not expect any fundamental changes in health policy as a result of the elections.

Much of the president’s policy has been shaped and carried out by Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.

She tried to persuade governors and members of Congress to support legislation repealing the Affordable Care Act, including its expansion of Medicaid. She has also pushed for federal rules that allow the sale of more short-term health insurance plans, which do not have to cover pre-existing conditions or provide all the benefits required by the health law.

Aides said that Ms. Verma intended to stay on the job, but that the administration’s health policies would remain intact even if she left. Her top deputy, Paul Mango, an unsuccessful candidate for governor of Pennsylvania, wrote last year that “Obamacare has been a disaster.”

The official recruited last month to run the national Medicaid program, Mary Mayhew, strenuously opposed the expansion of Medicaid when she was the commissioner of health and human services in Maine.

Trump administration officials say they still see the expansion of Medicaid to cover able-bodied adults — approved this past week by voters in Idaho, Nebraska and Utah — as a costly departure from the original purpose of the program.


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