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 DoggettPelosi woos progressives on prescription drug pricing plan House Democratic Caucus chairman announces support for 'Medicare for All' Here are the 95 Democrats who voted to support impeachment 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 SchakowskyLawmakers jump-start talks on privacy bill The Hill's Morning Report — Mueller testimony gives Trump a boost as Dems ponder next steps On The Money: House to vote on budget deal Thursday | US, China resuming trade talks next week | Mnuchin backs DOJ tech antitrust probe 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 John TrumpHarris bashes Kavanaugh's 'sham' nomination process, calls for his impeachment after sexual misconduct allegation Celebrating 'Hispanic Heritage Month' in the Age of Trump Let's not play Charlie Brown to Iran's Lucy 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 GrassleyCharles (Chuck) Ernest Grassley'Mike Pounce' trends on Twitter after Trump slip at GOP retreat Cruz warns GOP support for expanded background checks could help elect Warren president Lawmakers applaud Trump's ban on flavored e-cigarettes 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 AlexanderAndrew (Lamar) Lamar Alexander The 13 Republicans needed to pass gun-control legislation Liberal group urges Senate panel to vote against Scalia as Labor secretary Suburban anxiety drives GOP on guns MORE (R-Tenn.) and Patty MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: Juul's lobbying efforts fall short as Trump moves to ban flavored e-cigarettes | Facebook removes fact check from anti-abortion video after criticism | Poll: Most Democrats want presidential candidate who would build on ObamaCare Trump's sinking polls embolden Democrats to play hardball Democrats threaten to withhold defense votes over wall 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-CortezBill Maher, Michael Moore spar over Democrats' strategy for 2020 Super PAC head spars with CNN's Cuomo over Ocasio-Cortez ad Young insurgents aren't rushing to Kennedy's side in Markey fight 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 PalloneHotel industry mounts attack on Airbnb with House bill Push on 'surprise' medical bills hits new roadblocks Overnight Health Care: Insurance lobby chief calls Biden, Sanders health plans 'similarly bad' | Trump officials appeal drug price disclosure ruling | Study finds 1 in 7 people ration diabetes medicine due to cost 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 CassidyWilliam (Bill) Morgan CassidyRepublicans grumble over Trump shifting military funds to wall Push on 'surprise' medical bills hits new roadblocks Iowa professor resigns after saying he's affiliated with antifa 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.”