Five health care fights to watch in 2020

Five health care fights to watch in 2020
© Greg Nash

Advocates hope lawmakers can beat the odds and move major health care legislation in the new year.

2019 opened with bipartisan talk of cracking down on drug prices and surprise medical bills. But it ended without major legislation signed into law on either front, and a host of other health care battles, including a lawsuit threatening the entire Affordable Care Act, looming over the coming election year. 

Here are five health care fights to watch in 2020. 

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Drug pricing

Lowering drug prices was supposed to be an area for potential bipartisan action in 2019, but the effort ran into a brick wall of industry lobbying and partisan divisions. 

There is a push to finally get legislation over the finish line in 2020, though. 

Speaker Nancy PelosiNancy PelosiBiden to meet House Dems before Europe trip: report On The Money — Will the billionaire tax survive Joe Manchin? Overnight Energy & Environment — Presented by American Clean Power — Democrats prepare to grill oil execs MORE (D-Calif.) is calling for attaching drug pricing legislation to a package of expiring health care programs, like community health center funding, that must be renewed by May 22. She hopes the pressure from that deadline helps carry a larger package, but that is far from certain, especially as the election gets closer. 

Democrats point to President TrumpDonald TrumpOvernight Defense & National Security — Presented by Boeing — Milley warns of 'Sputnik moment' for China WSJ publishes letter from Trump continuing to allege voter fraud in PA Oath Keeper who was at Capitol on Jan. 6 runs for New Jersey State Assembly MORE’s vow to support allowing the government to negotiate drug prices during his 2016 campaign. While Trump backed off that pledge this year, they hold out hope he might come back around. Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellMcConnell backs Herschel Walker in Georgia Senate race The Hill's Morning Report - Presented by Facebook - Democrats insist budget consensus close as talks drag on Manchin backs raising debt ceiling with reconciliation if GOP balks MORE (R-Ky.) is also strongly opposed to the idea, and has concerns about a more modest bill from Sens. Chuck GrassleyChuck GrassleyBipartisan lawmakers target judges' stock trading with new bill Another voice of reason retires Overnight Health Care — Presented by Carequest — FDA moves to sell hearing aids over-the-counter MORE (R-Iowa) and Ron WydenRonald (Ron) Lee WydenOn The Money — Will the billionaire tax survive Joe Manchin? Patience wears thin as Democrats miss deadlines Crucial talks on Biden agenda enter homestretch MORE (D-Ore.) that could provide a more realistic bipartisan path. 

“The president said when he ran and until relatively recently that he would support negotiated prices and I expect at some point he will go back to that, and we're just going to keep pushing the Senate to try to achieve that,” said House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.). 

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Surprise billing

The other major health care initiative that Pelosi says she wants in the May package is protecting patients from surprise medical bills. 

That effort has also fallen prey to intense industry lobbying and congressional infighting. 

Backers of a bipartisan bill from the House Energy and Commerce Committee and Senate Health Committee on the issue pushed for including the measure in a year-end spending and were deeply frustrated when it was left out. 

A key factor was House Ways and Means Committee Chairman Richard NealRichard Edmund NealTrump lawyers ask judge to block IRS from giving his tax returns to congressional panel Manchin dampens progressive hopes for billionaires tax 535 'presidents' with veto power: Why budget deal remains elusive MORE (D-Mass.) putting forward the outline of a rival plan days before this month’s funding deadline, showing a split on the way forward. 

“It’s certainly going to be harder [next year],” said Shawn Gremminger, senior director of federal relations at Families USA, a liberal health care advocacy group.

“You are now under six months out from the general election,” he said about moving legislation in May 2020.

Backers have a tough road ahead. They will have to bridge the divide between the competing plans and overcome lobbying from powerful doctor and hospital groups, who worry the legislation could lead to damaging cuts to their payments. 

 

ObamaCare

Outside of Capitol Hill negotiating rooms, the GOP lawsuit to overturn the Affordable Care Act is looming large. 

A federal appeals court last week issued a long-awaited ruling on the fate of the law, though it did little to settle the issue. The 5th U.S. Circuit Court of Appeals ruled that the law’s mandate to have health insurance is unconstitutional, but punted on the question of whether any of the rest of the law should also be struck down, instead sending it back to the lower court.

The most tangible effect of the move could be to push a final Supreme Court decision on the fate of the law past the 2020 elections, though it’s possible the justices could still choose to take the case sooner.  

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Democrats intend to hammer Republicans over the lawsuit during next year’s campaign, though, a strategy that paid off for the party during the 2018 midterms when they focused on health care. 

The Democratic group Protect Our Care launched a national TV ad on Friday, saying “President Trump and Republicans just won a major decision in their lawsuit to repeal health care from millions of American families,” and warning of the loss of pre-existing condition protections. 

 

Medicare for All 

In the Democratic presidential race, "Medicare for All" is a central dividing line.

How the issue plays out in 2020 will depend in large part on who wins the Democratic nomination. If progressives like Sens. Bernie SandersBernie SandersDemocrats hope to hold Big Oil 'accountable' On The Money — Will the billionaire tax survive Joe Manchin? Democrats cutting paid leave from spending deal amid Manchin opposition MORE (I-Vt.) or Elizabeth WarrenElizabeth WarrenOvernight Energy & Environment — Presented by American Clean Power — Democrats prepare to grill oil execs Manchin dampens progressive hopes for billionaires tax Merkley, Warren and Markey sound alarm over 'dirty' hydrogen provision in climate deal MORE (D-Mass.) win the nomination, Republicans will be able to go full bore on their attacks that private health insurance would be eliminated under the proposal.

Even more moderate candidates like former Vice President Joe BidenJoe BidenBiden to meet House Dems before Europe trip: report 21 House Democrats call for removing IRS bank reporting proposal from spending bill Overnight Health Care — Presented by Altria — Vulnerable House Dems push drug pricing plan MORE and South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegThe Hill's Morning Report - Presented by Facebook - Biden, Democrats inch closer to legislative deal Republican spin on Biden is off the mark Unanswered questions remain for Buttigieg, Biden on supply chain catastrophe MORE would face attacks that their public option plans are a step down the road toward eventually implementing full-scale single payer. 

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The internal debate on the issue has faded somewhat from its peak. Health care has not featured as prominently in the last two debates, and some of the fighting has shifted to other areas, like candidates' fundraising practices. 

But the issue is still simmering and could burst back to open warfare among Democrats at any point. 

 

Vaping

The battle over e-cigarette flavors will likely resume in 2020 as the Trump administration and Congress try to cut rising youth vaping rates. 

Public health advocates are pushing the administration to clear the market of flavors like mint and fruit that they argue are fueling a youth vaping epidemic. 

Trump said he would eliminate those flavors in September, but has appeared to back down after backlash from vaping advocates and the e-cigarette industry.

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Now he says he would like to find a compromise that preserves such flavors for adults while keeping them away from kids. 

Advocates like the Campaign for Tobacco-Free Kids plan to pressure Trump to follow through on his word, though it’s looking unlikely. 

However, the e-cigarette market could also look vastly different after May 2020, when companies must apply to the Food and Drug Administration to stay on the market

The industry must prove its products benefit public health, a big ask for companies like Juul, whose products are favored by kids who vape. 

House Democrats also plan to vote on a bill that would ban flavored e-cigarette and tobacco products, but it’s not clear if it will get a vote in the Senate.