Democrats Have A Health Care Platform, But Not Much Appetite To Fight For It

Democrats want to legislate on health care, but it may be time for other issues to take center stage in a Democratic administration.

Hillary Clinton delivers remarks at Family Health Centers in Louisville, Ky. on May 10.
AP Photo/Patrick Semansky
July 26, 2016, 8 p.m.

As im­port­ant as health care was to the Demo­crat­ic primary, don’t ex­pect to hear much about it if Hil­lary Clin­ton wins the White House.

Sure, Demo­crats have a long list of health care policies that they sup­port, from minor tweaks to the Af­ford­able Care Act to large-scale re­forms such as a pub­lic-in­sur­ance op­tion and let­ting Medi­care ne­go­ti­ate drug prices. But that doesn’t mean—even with a Demo­crat­ic pres­id­ent and a Demo­crat­ic Sen­ate—that the party would wade back in­to the treach­er­ous polit­ics of health care.

“Health care hasn’t been a pure polit­ic­al pos­it­ive for the Demo­crats in re­cent years,” said Larry Levitt, a Kais­er Fam­ily Found­a­tion seni­or vice pres­id­ent. “The ACA has taken up a lot of time and polit­ic­al cap­it­al for the White House and Demo­crats on the Hill. Get­ting the law passed was tough, and then the melt­down of Health­ and all the af­ter­math of that, so I think there’s likely a de­sire among Demo­crats to move onto oth­er is­sues.”

Demo­crats had their big shot on health re­form at the be­gin­ning of the Obama ad­min­is­tra­tion, and they won. But it sapped the party’s polit­ic­al cap­it­al. The year­long le­gis­lat­ive battle ul­ti­mately put every Sen­ate Demo­crat on the line, fol­low­ing a pro­trac­ted in­tra-party fight over a pub­lic op­tion and help­ing to ush­er in the GOP wave of 2010. And if Demo­crats are for­tu­nate enough to see the be­gin­ning of an­oth­er Demo­crat­ic ad­min­is­tra­tion, with a Demo­crat­ic ma­jor­ity in the Sen­ate, they may be keep­ing lar­ger health re­forms at arm’s length this time.

Chris Jen­nings, a former seni­or health care ad­viser for the Obama and Clin­ton ad­min­is­tra­tions, said he sees ad­vant­ages of oth­er is­sues com­ing in­to the polit­ic­al spot­light—and tak­ing some of the heat off of health care. The hope is that could lead to more fo­cus on ac­tu­al health policy and less on its con­ten­tious polit­ics. (Clin­ton has already prom­ised that, if elec­ted, she would send Con­gress com­pre­hens­ive plans to re­form the coun­try’s im­mig­ra­tion sys­tem and fix its crum­bling in­fra­struc­ture with­in the first 100 days of tak­ing of­fice.)

Health-policy ex­perts say a Clin­ton ad­min­is­tra­tion would likely fo­cus in­stead on ad­min­is­trat­ive changes in­clud­ing de­liv­ery-sys­tem re­forms, ways to bet­ter care for the chron­ic­ally ill, and cer­tain tweaks to the Af­ford­able Care Act.

If Con­gress and the White House do take a ser­i­ous stab at health care le­gis­la­tion, they said, the cost of pre­scrip­tion drugs would be the most likely tar­get. It’s an is­sue that hits con­sumers dir­ectly, and that both Re­pub­lic­an and Demo­crat­ic pres­id­en­tial hope­fuls dis­cussed on the cam­paign trail.

Must-pass reau­thor­iz­a­tions will en­sure that health care has some time on the House and Sen­ate floor. The Chil­dren’s Health In­sur­ance Pro­gram—which Clin­ton helped cre­ate—needs to be reau­thor­ized next year. So do the user fees that the Food and Drug Ad­min­is­tra­tion col­lects from phar­ma­ceut­ic­al com­pan­ies to help ex­ped­ite the drug-ap­prov­al pro­cess.

The lat­ter “presents the op­por­tun­ity for Demo­crats, and a source of lever­age, to de­mand con­ces­sions from the drug in­dustry on policies to ad­dress drug costs,” Toph­er Spiro, Cen­ter for Amer­ic­an Pro­gress vice pres­id­ent for health policy, wrote in an email.

Demo­crats could pack­age this with the 21st Cen­tury Cures bill—a stalled but largely bi­par­tis­an meas­ure to stream­line the drug-ap­prov­al pro­cess—“as an en­tice­ment,” he wrote. (The House passed its bio­med­ic­al in­nov­a­tion bill 344-77 and is eager for the Sen­ate to do the same, yet the up­per cham­ber’s ver­sion has been stuck over a fund­ing dis­pute.)

Health care was one of the de­fin­ing de­bates of the Demo­crat­ic primary. Sen. Bernie Sanders ran on a plat­form to fun­da­ment­ally change health care, mov­ing the U.S. to a fed­er­ally ad­min­istered, single-pay­er sys­tem provid­ing cov­er­age to every Amer­ic­an. And Clin­ton has re­it­er­ated her sup­port for a pub­lic op­tion, com­pet­ing along­side private in­surers, as part of her ef­fort to win over Sanders’s sup­port­ers.

But Clin­ton’s up­com­ing coron­a­tion as the party’s nom­in­ee gives a sense of where Demo­crats could head on health care. She prefers build­ing in­cre­ment­ally on Obama’s sig­na­ture health care law.

Her wish list in­cludes: cap­ping out-of-pock­et pre­scrip­tion-drug costs at $250 per month, let­ting Medi­care ne­go­ti­ate drug prices, mak­ing more ser­vices avail­able without any cost-shar­ing for pa­tients, and more steps to re­ward­ing qual­ity of care over quant­ity.

The non­bind­ing Demo­crat­ic plat­form notes that the party “will tackle the prob­lems that re­main in our health care sys­tem.” It high­lighted com­batting pre­scrip­tion-drug prices, re­form­ing the men­tal-health sys­tem, and let­ting those over 55 opt in­to Medi­care as sev­er­al im­port­ant meas­ures. But it also in­cluded at least two that could garner bi­par­tis­an sup­port: re­peal­ing the tax levied on pricey em­ploy­er-sponsored health cov­er­age and re­cog­niz­ing the im­port­ance of an ad­equately fun­ded Na­tion­al In­sti­tutes of Health.

But if Re­pub­lic­ans con­trol both the White House and Con­gress, this will all be a dif­fer­ent story. A House Re­pub­lic­an task force com­prised of four high-rank­ing chair­men has already re­leased a 37-page broad out­line of what their ver­sion of a health care sys­tem would look like, and they plan to put it in­to le­gis­lat­ive text next year. House Speak­er Paul Ry­an also sup­ports a dra­mat­ic over­haul of Medi­care and Medi­caid; Don­ald Trump has said he does not want to cut en­ti­tle­ment pro­grams.

No mat­ter how much at­ten­tion health care gets next year, it’s an is­sue that’s nev­er en­tirely go­ing away. Re­pub­lic­ans are likely al­ways go­ing to bash Obama­care, and health tends to seep in­to de­bates on oth­er agenda items, such as the budget or tax re­forms or even im­mig­ra­tion.

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