Where Democrats Head Next On Health Care

With a Democratic majority in the House, Nancy Pelosi touts drug pricing as a legislative priority in the next Congress.

AP Photo/Jacquelyn Martin
Erin Durkin
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Erin Durkin
Nov. 7, 2018, 8 p.m.

Health care played a starring role Tuesday night as Democrats swept back into the majority in the House. But with Senate Republicans strengthening their hold, legislative accomplishments in this area will be hard to come by.

Democrats are looking to one health policy priority where they may find willing help from President Trump: lowering high drug prices.

Minority Leader Nancy Pelosi, speaking to a crowd at the Democratic Congressional Campaign Committee election watch party Tuesday night, described what the Democratic majority will focus on. “Democrats pledge a Congress that works for the people,” she said. “Lower the cost of health care by lowering the cost of prescription drugs. ... We will take real, very, very strong legislative action to legislate to negotiate down the price control of prescription drugs that is burdening seniors and families across America.”

Trump said Wednesday he hopes he can work with Democrats on lowering prescription-drug costs, as Senate Majority Leader Mitch McConnell also noted Republicans are likely to work with Democrats on the issue. “I can’t imagine that won’t be on the agenda,” McConnell said.

Pelosi believes that a House majority will be able to bring the pressure to achieve legislative goals in this area, according to her office. She has said that unless there is a Democratic Congress to back the real, tough legislative authority needed to lower prescription-drug prices, the president’s newfound interest will disappear just like the rest of his broken promises.”

Democrats, unlike congressional Republicans, will likely bring policies to Trump in the effort to tackle drug costs, said Paul Ginsburg, the Leonard D. Schaeffer chair in health policy studies at the Brookings Institution.

“I think that the Democrats taking control of the House makes it more likely that initiative will be taken on the issue,” he said, “because the Republicans seem to be waiting for the president to do things. He so far has opted for using Medicare regulations rather than legislation in this area. I think with Democrats taking some initiative, it’s quite possible they could find some areas of agreement with the administration which would help bring Republicans along.”

A new policy released less than two weeks before the midterms may have opened a door with Democrats and shifted the conversation around lowering drug prices. The Health and Human Services Department announced a new model that would more closely align Medicare payments for physician-administered drugs with prices in other countries, which tend to be lower. The model would be phased in over five years and would apply to 50 percent of the country.

While Democrats have expressed disappointment that Trump has not done more on drug prices overall, this policy action signals he may be able to work with Democrats in a constructive, bipartisan way, Pelosi's office said.

Ginsburg added that the recent administrative action may have expanded the conversation beyond just promoting competition, to applying more regulations to lower prices.

“There are many more opportunities in areas where the Congress could continue to lead or the administration can go to the Congress and potentially get bipartisan support in this drug area,” Ginsburg said. “So you could say that the recent proposal in Part B has perhaps expanded the range of possible situations where the administration and congressional Democrats could agree.”

The top Democrat on the House Energy and Commerce Committee, Rep. Frank Pallone, plans to discuss the issue with members soon after the election. “The Energy and Commerce Committee will follow through on Democrats’ commitment to lower health care and prescription drug costs for consumers while also reversing the harmful Republican sabotage of our nation’s health care system,” Pallone said. “Democrats have put forward a variety of good policy proposals in these areas.”

But while Trump and the Democrats may share the goal of lowering drug prices, politics may make legislative achievements unlikely, said Dan Mendelson, founder of Avalere Health. “I do think that there would be a lot of reasons why the Democrats wouldn’t want to do that in a world of split government because they wouldn’t want to give the president a major legislative victory coming into the election,” he said.

Mendelson said he expects there will be more emphasis on administrative actions to make progress in the area of drug pricing, and Democrats can have influence over this process.

“The administration certainly has an opportunity to work collaboratively with a Democratic House majority,” he said.

“So they could come in and say, ‘Hey, we’re designing this, and we’d love to get your input.’ We will know whether they will go down this collaborative path and whether the Democrats are willing to work with them in the coming weeks,” he added.

Lauren Blair, communications director of the Campaign for Sustainable Rx Pricing, said lawmakers on both sides of the aisle are concerned about this issue and her organization expects progress on the matter. The group has promoted competition-based ideas such as speeding up Food and Drug Administration approvals of generic drugs and encouraging the uptake of biosimilars, drugs that are highly similar to biologic drugs.

She added that Congress needs to act to address the problem. “What I’ve been saying to people is that the administration can’t do this alone,” Blair said.

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