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 DoggettOn The Money: Senate rejects border declaration in rebuke to Trump | Dems press Mnuchin on Trump tax returns | Waters says Wells Fargo should fire its CEO Dems press Mnuchin on Trump tax returns Congress must break its addiction to unjust tax extenders 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 SchakowskyHillicon Valley: EU hits Google with .7 billion antitrust fine | GOP steps up attack over tech bias claims | Dems ask FTC for budget wishlist | Justices punt on Google privacy settlement Dems ask FTC if it needs more money to protect privacy Overnight Health Care: CDC pushes for expanding HIV testing, treatment | Dem group launches ads attacking Trump on Medicare, Medicaid cuts | Hospitals, insurers spar over surprise bills | O'Rourke under pressure from left on Medicare for all 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 TrumpClinton and Ocasio-Cortez joke about Kushner's alleged use of WhatsApp Missouri Gov. declares state of emergency amid severe flooding Swalwell on Hicks testimony: 'She's going to have to tell us who she lied for' in Trump admin 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 GrassleyOvernight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' Drug prices are a matter of life and death Senate panel to hear from pharmacy middlemen on drug prices 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 AlexanderOvernight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' Trump signs executive order on campus free speech Senators ask CBO to review options for preventing surprise medical bills MORE (R-Tenn.) and Patty MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at 'financial risk' Senators ask CBO to review options for preventing surprise medical bills White House proposes limits on student loan borrowing as part of higher education reforms 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-CortezClinton and Ocasio-Cortez joke about Kushner's alleged use of WhatsApp Ocasio-Cortez compliments photographer for getting skin tone right The Hill's 12:30 Report: Trump attacks on McCain rattle GOP senators 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 PalloneHillicon Valley: EU hits Google with .7 billion antitrust fine | GOP steps up attack over tech bias claims | Dems ask FTC for budget wishlist | Justices punt on Google privacy settlement Dems ask FTC if it needs more money to protect privacy Trump officials take bold steps on Medicaid 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 CassidySenators ask CBO to review options for preventing surprise medical bills Five things to watch for in Trump's 2020 budget Overnight Health Care - Presented by Kidney Care Partners - FDA chief Scott Gottlieb resigns | House Dems to take up drug pricing bills next week | Planned Parenthood, doctors group sue over Trump abortion rule 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.”