Chances Congress will bolster price transparency in health care, crack down on pharmaceutical middlemen, or support those struggling with addiction are dwindling as lawmakers race to fund federal health agencies.
Skepticism is mounting that lawmakers will make good on their health policy agenda, particularly after last year’s historically unproductive congressional session packed with House Republican infighting.
“I don’t think the political machine is working right now in terms of trying to pass legislation, and that’s more of a commentary about what’s happening in the House of Representatives than Congress as a whole,” said Bobby Clark, a principal at Pyxis Partners who worked almost a decade as a health policy adviser for the House Energy and Commerce Committee and for Rep.
The House was able to pass a slate of health bills late last year: a reauthorization of key federal addiction programs (
However, the Senate appears to have its own plans for these issues: the chamber has its own health package more focused on expanding access to primary care and key Democrats have opposed the Republican-lead push to lean on law enforcement to deal with the drug overdose crisis.
Failing to get these bills to the president’s desk would mean another year without Congress addressing the rising health care costs burdening Americans, and the ongoing addiction and overdose crisis would remain unmitigated.
But first, Congress must extend funding for the Food and Drug Administration and the Department of Health and Human Services before Jan. 19 and Feb. 2, respectively.
Even if both chambers beat these deadlines, that will leave only about a two-month window to get any other policies or packages to President Joe Biden’s desk before the distraction of election-year politics, according to Duane Wright, a senior government analyst for Bloomberg Intelligence.
“You’ll see these members retreat to their political and ideological corners and focus on retaining not only their own seats, but either retaining or trying to take over the majority,” Wright said.
More Spending Fights
The Senate, where the Democratic majority can’t pass legislation without votes from Republicans, has advanced appropriations bills, including their Agriculture-FDA bill in November, a largely bipartisan fashion.
House Republicans, however, have been unable to pass either of their health-care spending bills due to steep budget cuts and contentious “poison pill” provisions that drew staunch opposition from Democrats and moderate Republicans.
The Ag-FDA bill includes a provision to block the sale of the abortion pill mifepristone in pharmacies and by mail with a prescription. As for the Labor-HHS bill, controversy arose over the deep cuts to health agencies and contentious provisions targeting abortion and health care discrimination protections for LGBTQ individuals.
There’s been no indication that House Republicans will change course and the same concerns are likely to resurface if the bills are reconsidered for a vote, according to Rachel Stauffer, a government relations and legislative affairs strategist at health policy firm McDermott+Consulting.
“Republicans can’t coalesce around a strategy there either,” said Stauffer, a previous lead health policy aide for several members of Congress.
Biggest Priorities
If lawmakers can push past the dysfunction and divisiveness of the last session, there are a few things that they’re most likely to address.
There’s been interest and movement in both chambers to prevent the 3.4% Medicare payment cuts that went into effect on Jan. 1. Physicians and hospital groups have repeatedly warned that allowing these cuts would add more strain to a health care system already struggling with staffing shortages.
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“That remains a high priority for a number of members, and obviously a number of stakeholders,” Stauffer said.
Pharmacy benefit managers were caught in congressional crosshairs last session. The pharmaceutical industry has thrown the blame for soaring drug costs on them and their practices. If lawmakers are to get a year-long funding bill passed, legislation regulating PBMs likely gets tacked on to that, according to Wright.
“What we’ll see is an attempt to include some of the provisions in the House-passed health care bill relating to spread pricing and more transparency on the PBM fronts,” Wright said.
The Senate Finance Committee advanced a package of bills last session that would rein in some pharmacy benefit managers’ practices, too. If not tacked onto a spending bill, the growing bipartisan interest in both chambers to regulate these middlemen is shaping the outline of a potential PBM package, Stauffer said.
Lawmakers in the House have made it a priority to get their legislation reauthorizing federal addiction programs signed into law this year. The Senate’s version, however, has key amendments that aren’t in the version the House passed.
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Finding consensus on the legislation itself is easy, as everyone wants to do something about the mental health crisis and opioid epidemic, but these amendments could pose hurdles, according to Clark.
“Part of the problem is that they become opportunities for people to offer amendments and other issues. And then that’s where things potentially become more controversial,” Clark said.
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