Even before House Speaker Nancy Pelosi, D-CA, announced last week that she was formally launching an impeachment inquiry, the outlook this fall was uncertain for a number of bipartisan health care priorities like ending surprise medical bills, reining in drug costs, and rolling back the Affordable Care Act’s “Cadillac” tax.
The common wisdom in Washington is that any deals on these issues needs to come together in the weeks ahead in order to hitch a ride on a year-end spending bill. But as much of Congress’ focus turns to investigating President Trump's behavior and the legislative calendar winds down, the headwinds are now much stronger.
To be sure, health care and how to control costs will continue to be a dominant issue on Capitol Hill this fall, and as key lawmakers in both parties continue their drive to pass legislation, some proposals could cross the finish line. A number of proposals have already advanced out of committees, though many details are still subject to negotiation.
Balancing act on surprise bills
House and Senate members are still struggling, for example, to find consensus on how to stop surprise medical bills from out-of-network providers amid a fierce lobbying fight between providers and insurers/employers. The Energy and Commerce Committee advanced a bill (HR 3630) to the full House that would require insurers to pay out-of-network providers the median in-network rate for a given geographic area. But it would allow providers to appeal through an arbitration process in cases where the claim is for more than $1,250.
Two other House committees with jurisdiction over health may also markup similar bills, one of which – the Ways and Means Committee – is considering the idea of punting the issue to regulators.
The Senate, the Health, Education, Labor and Pensions (HELP) Committee approved a bill (S 1895) backed by the employer community that would set the same benchmark rate as the House measure but it does not include language allowing for arbitration. However, HELP Committee Chairman Lamar Alexander, R-TN, and Sen. Bill Cassidy, R-LA, are discussing adding some form of arbitration to the bill before a floor vote.
While there is concern in Congress that the impeachment investigation could hinder progress on surprise billing legislation this year, some lawmakers remain optimistic, noting that disagreements on the issue don’t follow partisan lines and that any deal stands a decent chance of getting the president’s support.
Waning chances for big drug pricing reforms
Odds were never high for a bipartisan deal on sweeping drug pricing reform, but the impeachment inquiry seems likely to all but kill any chances for a breakthrough in this Congress.
Major legislation recently passed by the Senate Finance Committee, while bipartisan, has drawn fire from both parties. Many Republican senators object to its attempt to prevent Medicare drug prices from rising faster than inflation as government price control, while Democrats criticize it for not giving Medicare authority to negotiate prices.
Giving Medicare that authority is a non-starter for Republicans, but it’s at the heart of the new drug pricing bill (HR 3) unveiled last week from Speaker Pelosi. That puts Pelosi’s measure and the Senate Finance bill on a collision course, and although President Trump campaigned in 2016 on letting Medicare negotiate drug prices, the White House has supported the Finance Committee bill.
Whether the new partisan tensions over impeachment will stop the White House from continuing to work with Democrats on drug pricing remains to be seen, but the policy rift between the parties over big changes was already deep. The impeachment proceedings make it more likely that the president moves forward with a long-discussed proposal, fiercely opposed by the drug industry, that would peg drug prices paid by Medicare to the prices paid for the same drugs overseas.
Still, some less ambitious bipartisan proposals already cleared by Senate and House committees stand a decent chance of enactment as revenue offsets to pay for other health legislation. These include provisions in the HELP Committee bill and other legislation to crack down on brand-name drug makers’ efforts to delay cheaper generic competition and to help speed development of biologic and biosimilar products.
Hopes remain high for ‘Cadillac’ tax repeal
Meanwhile, the Senate could take up House-passed legislation (HR 748) this fall to repeal the “Cadillac” tax on “high-cost” employer-sponsored health coverage set to take effect in 2022. Majority Leader Mitch McConnell, R-KY, has not said whether he will put the bill on the floor, but more than 60 senators are co-sponsoring repeal legislation and a broad coalition (including Mercer) continues to urge senators to send the bill to the president.
Some lawmakers also hope that other ACA taxes will be rolled back before the end of the year. A tax on medical device sales and another on health insurance companies are set to come into effect again next year, and interest groups are pushing Congress to act.