Republicans and Democrats have a narrow opening to cut big deals on drug pricing and surprise medical bills and address two key concerns of voters — just in time for 2020 electoral politics to drive them apart.
Congressional leaders are feeling renewed urgency to do something about the high-profile issues, but they fear impeachment and escalating tensions with Iran could swamp the legislative agenda. And on drug pricing, both sides are reluctant to let the other claim victory on a pocketbook issue that recent polling shows ranks high among voter concerns.
The efforts to deliver on these priorities are also colliding with the broader partisan battle over health care that could hold the key to the presidency.
The first test is likely to come within weeks, when a bipartisan group of House members will meet to try to break a lengthy impasse and finalize plans for protecting patients from being charged thousands of dollars if they get out-of-network care. The effort enjoys widespread support but stalled last year amid fierce battles between insurers, employers and well-funded providers over who would pay for a fix.
“The agreement is that something should be done about each of those issues, but there is great debate about what it is,” said Rep. Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health Subcommittee. “[2020] is probably more campaign speeches than serious bipartisan policymaking.”
That would be fine with some well-financed interest groups still eager to influence the debate. Doctor Patient Unity — a dark money group largely funded by two private equity-backed physician staffing companies — was the most prominent of the outside groups to spend heavily to influence the surprise billing debate, dropping more than $53 million on ads over the last half of 2019 to attack a leading surprise billing fix, according to Advertising Analytics.
Congressional leaders blocked an effort to revive the legislation as part of a year-end spending package, instead setting a May deadline for lawmakers to work out an agreement.
“A lot of concerns were expressed” by health care interests since the Senate HELP Committee approved a surprise billing fix in June, said Sen. Tim Kaine (D-Va.). “You hold the patient harmless, but then you allocate the responsibility to providers and insurers. And maybe the allocation was a little more okay with the insurers than the providers. Now we’re back to work to see if we can calibrate it to hit the right balance in the allocation of responsibility.”
The new May deadline — tied to the expiration of funding for several health programs — should give House and Senate negotiators time to iron out the details of legislation that can speed through Congress and retain White House support, lawmakers involved said.
Yet it will also invite a fresh round of high-pressure lobbying that could test vulnerable lawmakers in the House, and give skeptics nearly five months to build a case against a compromise.
Speaker Nancy Pelosi in her end-of-year open letter to the House Democratic Caucus said a top 2020 priority is “ending the financial unfairness of surprise billing.” A senior House Democratic aide told POLITICO the letter was a message to the Energy and Commerce and the Ways and Means committees — whose jurisdictional battle over the issue helped derail any potential action in 2019 — to “figure it out and get this done.”
Senate Majority Leader Mitch McConnell, meanwhile, has not yet said whether he’d bring surprise billing legislation up for a vote, even if House and Senate negotiators reach a deal. Senate Democratic Leader Chuck Schumer of New York remains hesitant as well, amid intense pressure from his powerful home state hospital lobby.
“I’m going to do everything I can to keep surprise medical billing on the front burner between now and May,” said Senate HELP Chairman Lamar Alexander (R-Tenn.), who has made resolving the issue a top goal before he retires this year. “It’s a bill almost everyone wants passed, except a handful of people and the private equity firms that benefit from it.”
Congress faces an even bigger partisan gulf on drug pricing as Democrats and Republicans feature the issue prominently in their 2020 health care agendas. A bipartisan proposal negotiated between Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), the chairman and ranking member of the Finance Committee, has gained little traction despite backing from Trump administration officials, with party leaders more intent on accusing each other of inaction as they fight for control of the Senate in 2021.
Senate Republicans led by McConnell balk at a provision in Grassley and Wyden’s bill that would finedrugmakers that hike prices beyond the rate of inflation, deriding it as a path to price controls.
Leadership’s opposition to holding a vote has turned up the acrimony, with Grassley frequently taking to Twitter to try to enlist President Donald Trump’s help and Wyden repeatedly accusing McConnell of shielding the pharmaceutical industry.
Pelosi and top House Democrats, meanwhile, are insisting that any major drug price deal authorize the government to directly negotiate drug prices — a longtime liberal priority that’s a nonstarter with Republicans.
“My view is that if we don’t have negotiated prices, we’re not accomplishing much,” said House Energy and Commerce Chairman Frank Pallone (D-N.J.).
Though some centrist lawmakers have sought to pass narrower bipartisan measures addressing drug pricing that could boost their own congressional campaigns, House Democratic leaders are signaling they’ll spend much of the year touting their ambitious drug pricing overhaul passed last year — and pressuring Senate Republicans to get on board.
Aside from action on those issues, lawmakers say a pile of unfinished health care business and a slew of investigations several committees launched last year will fill out the health care agenda.
Democratic aides expect the results of an inquiry into whether companies are deceptively marketing short-term health insurance policies promoted by the Trump administration — which critics deride as “junk plans” because of the skimpy coverage — to be released within weeks, including data from the open enrollment period that recently ended. Lawmakers also plan to keep investigating CMS Administrator Seema Verma’s use of private contractors, how states are spending the billions of dollars of funding Congress gave them to address the opioid epidemic, and the Trump administration’s treatment of thousands of separated migrant children.
“We want to know what HHS knew and when they knew it,” a senior Democratic staffer told POLITICO.
Trump’s health department has maintained that all of its decisions were proper and in line with long-standing practices.
House committees are also waiting on responses from pharmaceutical companies about why they raised their prices so much over the last few years, from e-cigarette manufacturers about their marketing practices and internal research on the public health impact of vaping, and from private equity firms about their involvement in the campaign to squash surprise billing reforms.
The Trump administration’s recent walkback of past promises to ban all favored e-cigarettes also has Democratic lawmakers in both chambers seeking further legislative action.
But there’s little confidence much will make it through the GOP-controlled Senate, especially as the presidential campaign heats up.
Trump has already made health care a key element of his rallies, boasting about gutting parts of Obamacare while deriding the “socialist” push for a single-payer system. At the same time, Democrats are confident that a combination of touting their policies to expand coverage and lower drug prices with sustained attacks on Republicans’ moves in court and Congress to roll back the Affordable Care Act will yield the kind of results that flipped control of the House in 2018.
“It’s so polarizing,” said Sen. Rick Scott (R-Fla.). “I think people, because it’s so polarizing, are scared to do anything. And they don’t have to right now. There’s no pressure up here.”