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The Year Ahead: Drug pricing efforts to test bipartisanship

A new Democratic majority is taking over in the House next year with a number of health issues taking center stage.

Democrats will use their new power to try to shore up the Affordable Care Act and rein in high health-care and prescription drug costs. But the party will also face its own internal debate, while insurgents on the left keep up their push to implement "Medicare for all."

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The Republican majority in the Senate could get in the way of Democrats hoping to accomplish any of their major policy proposals, but there could be room for bipartisanship on smaller bills.

Here are the issues to watch in the next Congress:

 

Drug prices 

House Democrats have said tackling high drug prices will be a top priority after assuming the majority in January. 

That could come in the form of a vote on a bill from Rep. Lloyd DoggettLloyd Alton DoggettDemocrats see political winner in tax fight Progressives up pressure on Biden to back COVID vaccine patent waiver House passes bills providing citizenship path for Dreamers, farmworkers MORE (D-Texas), which would allow Medicare to negotiate drug prices, and has 100 Democratic co-sponsors. 

While it’s unlikely to pass the Senate, it could set the scene early as Democrats warn pharmaceutical companies that the party won’t go easy on them while they’re in the majority. 

Democrats are also looking to pass bills that would bring transparency to drug price increases.

“We definitely want some clarity and justification, if they want to raise their prices, on why they deserve it,” Rep. Jan SchakowskyJanice (Jan) Danoff SchakowskyNIH reverses Trump administration's ban on fetal tissue research Omar: 'Shameful' Biden reneging on refugee promise Biden rebuffs Democrats, keeps refugee admissions at 15,000 MORE (D-Ill.), a member of the House Democrats’ Affordable Prescription Drug Task Force, told The Hill last month.

There might be room for bipartisanship on drug prices, both with the Senate and the Trump administration, which has made the issue a top priority. 

But Democrats have to decide early on how much they want to work with President TrumpDonald TrumpDC goes to the dogs — Major and Champ, that is Biden on refugee cap: 'We couldn't do two things at once' Taylor Greene defends 'America First' effort, pushes back on critics MORE

“So much of 2019 is going to be defined by if and how long the Democrats are willing to play ball,” said a former GOP aide. 

“The Democrats have a bit of an interest in not agreeing with the administration too much. They’ve got to decide how to play that.” 

One area where there could be movement is on two bipartisan drug pricing bills: one that would crack down on the tactics drug companies use to delay the introduction of cheaper generics, and another that would force drug companies to display their list prices in direct to consumer advertisements. 

Schakowsky introduced the House version of the advertising bill this year and said it could see movement next year. It passed the Senate last year but was later blocked by House Republicans. 

The Senate’s versions of those bills have a powerful backer in Sen. Chuck GrassleyChuck GrassleyGrassley: Iowa can't afford to be 'babysitting' unaccompanied minors Anti-Asian hate crimes bill overcomes first Senate hurdle On The Money: Senate confirms Gensler to lead SEC | Senate GOP to face off over earmarks next week | Top Republican on House tax panel to retire MORE (R-Iowa), who will chair the Finance Committee next year and has an adversarial relationship with the pharmaceutical lobby. 

 

ObamaCare

Democrats want to make another run next year at a bipartisan effort to shore up ObamaCare’s markets. 

A Senate bill proposed by Sens. Lamar AlexanderLamar AlexanderSenate GOP faces retirement brain drain The Hill's Morning Report - Presented by the National Shooting Sports Foundation - CDC news on gatherings a step toward normality Blunt's retirement deals blow to McConnell inner circle MORE (R-Tenn.) and Patty MurrayPatricia (Patty) Lynn MurrayHouse passes bill to combat gender pay gap Schumer kicks into reelection mode Democrats target Trump methane rule with Congressional Review Act MORE (D-Wash.) last year came closer than expected, but was held up at the last minute by anti-abortion groups and lawmakers that wanted more restrictions. 

“I'm really hopeful that we can revive discussions in the new Congress and find a way past the ideological standoffs of the past,” Murray said to Alexander last month during a Senate Health Committee hearing. 

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Alexander replied that he “regretted” it didn’t work out and “maybe we can find a way to make it work in the new session.”

Still, Senate Republicans will have an even stronger majority in the next Congress than they did this year, likely making it even harder for a bipartisan deal to get through the upper chamber. 

And in the House, Democrats have said they will vote on a bill that would go even further than the Senate bill did. The bill would increase the size of and eliminate the eligibility cap for tax credits that help people buy insurance. It would also prevent the administration’s expansion of non-ObamaCare plans.

House Democrats also plan an early vote next year on a bill they say would protect health coverage for people with pre-existing conditions, an issue that Democrats honed in on in their campaigns. Still, it’s unlikely to be taken up in the Senate. 

 

Medicare for All 

The chorus of Democrats on the left pushing for a vote on Medicare for all legislation is likely to get louder, despite the call from leadership to focus on protecting the Affordable Care Act. 

Rep. Pramila Jayapal (D-Wash.), co-chair of the new Medicare for All Caucus, has called for hearings and a vote on a Medicare for all bill next year, likely setting up tensions between Democratic leadership and progressives.

The movement is likely to be bolstered by rising Democratic stars like Rep.-elect Alexandria Ocasio-CortezAlexandria Ocasio-CortezBiden on refugee cap: 'We couldn't do two things at once' A proposal to tackle congressional inside trading: Invest in the US Biden angers Democrats by keeping Trump-era refugee cap MORE (N.Y.), who supports Medicare for all and has significant reach with grass-roots groups. 

But House Democratic chairmen have downplayed the likelihood of a vote on single-payer focused legislation in the next Congress. 

"I’ve always been an advocate for a single-payer system, but, you know, the votes aren't there," likely incoming Energy and Commerce Chairman Frank Pallone Jr.Frank Joseph PalloneIntercept bureau chief: Democrats dropping support of Medicare for All could threaten bill's momentum House Democrats reintroduce road map to carbon neutrality by 2050 House Democrats criticize Texas's 'shortcomings in preparations' on winter storms MORE (D-N.J.) told the Asbury Park Press last month.

"So I think we really have to concentrate on trying to stabilize the Affordable Care Act, or ObamaCare, particularly since the Trump administration is consistently trying to sabotage it."

 

Surprise medical bills

Another potential area of bipartisanship could come in the form of addressing surprise billing — when patients get unexpected and often expensive bills for services they thought were covered by their insurance but were not. 

A bipartisan bill sponsored by Sen. Bill CassidyBill CassidyCalls grow for national paid family leave amid pandemic Senators urge Energy chief to prioritize cybersecurity amid growing threats Vivek Murthy confirmed as surgeon general MORE (R-La.) would crack down on the practice and could be one of the few health-care victories for both parties next year. 

“Talking to Democratic leadership, they see this as a potential win for everyone. Everyone hates surprise bills,” said Shawn Gremminger, a lobbyist for Families USA, which works on the issue. 

“There’s really strong bipartisan interest. I don’t think it becomes a partisan fight.”