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 PelosiOn The Money: Pelosi, Mnuchin talk but make no progress on ending stalemate | Trump grabs 'third rail' of politics with payroll tax pause | Trump uses racist tropes to pitch fair housing repeal to 'suburban housewife' Bass on filling Harris's Senate spot: 'I'll keep all my options open' Win by QAnon believer creates new headaches for House GOP 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 John TrumpNew Bob Woodward book will include details of 25 personal letters between Trump and Kim Jong Un On The Money: Pelosi, Mnuchin talk but make no progress on ending stalemate | Trump grabs 'third rail' of politics with payroll tax pause | Trump uses racist tropes to pitch fair housing repeal to 'suburban housewife' Biden commemorates anniversary of Charlottesville 'Unite the Right' rally: 'We are in a battle for the soul of our nation' 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 McConnellOn The Money: Pelosi, Mnuchin talk but make no progress on ending stalemate | Trump grabs 'third rail' of politics with payroll tax pause | Trump uses racist tropes to pitch fair housing repeal to 'suburban housewife' Pelosi, Mnuchin talk but make no progress on ending stalemate Democrats say White House isn't budging in coronavirus relief stalemate MORE (R-Ky.) is also strongly opposed to the idea, and has concerns about a more modest bill from Sens. Chuck GrassleyCharles (Chuck) Ernest GrassleyThe Hill's Morning Report - Presented by Facebook - The choice: Biden-Harris vs. Trump-Pence Trump grabs 'third rail' of politics with payroll tax pause On The Money: McConnell says it's time to restart coronavirus talks | New report finds majority of Americans support merger moratorium | Corporate bankruptcies on pace for 10-year high MORE (R-Iowa) and Ron WydenRonald (Ron) Lee WydenElection security advocates see strong ally in Harris OVERNIGHT ENERGY: Watchdog report raises new questions for top Interior lawyer | Senate Democrats ask Trump to withdraw controversial public lands nominee | Border wall water use threatens endangered species, environmentalists say Watchdog report raises new questions for top Interior lawyer 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 NealAllegations roil progressive insurgent's House bid The Hill's Campaign Report: Biden picks Harris as running mate New Florida Biden ad accuses Trump of raiding Social Security for coronavirus relief 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 SandersOcasio-Cortez's 2nd grade teacher tells her 'you've got this' ahead of DNC speech Trump and allies grapple with how to target Harris Chris Wallace: Kamala Harris 'not far to the left despite what Republicans are gonna try to say' MORE (I-Vt.) or Elizabeth WarrenElizabeth WarrenNew poll shows Markey with wide lead over Kennedy in Massachusetts Trump and allies grapple with how to target Harris Chris Wallace: Kamala Harris 'not far to the left despite what Republicans are gonna try to say' 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 BidenRon Johnson signals some GOP senators concerned about his Obama-era probes On The Money: Pelosi, Mnuchin talk but make no progress on ending stalemate | Trump grabs 'third rail' of politics with payroll tax pause | Trump uses racist tropes to pitch fair housing repeal to 'suburban housewife' Biden commemorates anniversary of Charlottesville 'Unite the Right' rally: 'We are in a battle for the soul of our nation' MORE and South Bend, Ind., Mayor Pete ButtigiegPete ButtigiegThe Hill's Morning Report - Presented by Facebook - The choice: Biden-Harris vs. Trump-Pence California Democrats back Yang after he expresses disappointment over initial DNC lineup Obamas, Clintons to headline Biden's nominating convention 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.