When it comes to understanding what could happen in health care over the next two years, the guiding principle is maybe. Maybe the two sides will come together on a modest package of changes to federal law, primarily within the Medicare and Medicaid programs, that will begin the process of lowering drug prices and thus costs, or maybe they won’t.
Generally, whenever significant health care legislation has been adopted, a key factor was in place – both parties saw political opportunity in achieving the same result. In 1997, when the Children’s Health Insurance Program was passed, both sides saw the political opportunity in helping kids get healthcare, in 2003, when the Bush Administration passed the Medicare Modernization Act with Democrat’s help, both sides saw the political opportunity presented by providing a drug benefit to seniors. The anomaly was in 2009 and the passage of the ACA. Then, it was simply an issue of Democrats controlling both chambers and the White House and ultimately pushing the plan through. And that history looms over the situation today.
The basic dynamic of both sides seeing a political opportunity is relevant today – in taking control of the House, many Democrats ran on a pledge to fix our health care system while the Trump Administration and HHS have set an aggressive agenda to lower drug prices. This is the opportunity both share. However, the politics, which could prevent cooperation, are complicated with the memory of the ACA adoption and subsequent battle driving the day.
In 2010, right before the mid-term election and after the ACA had been made law, about President Obama, Senate Majority Leader Mitch McConnell said in an interview, “The single most important thing we want to achieve is for President Obama to be a one-term president.” This attitude drove the next six years (even when McConnell failed to make this come true) during which Republicans refused to cooperate with Democrats to make any technical corrections to the ACA (something that often happens when new law is made), attempted to “repeal and replace” the law over 50 times and refused to help make any adjustments to the law that would improve it.
With this memory fresh in the minds of all, Congress finds itself in a place where the Trump Administration, Democrats in the House and a key Republican in the Senate, Finance Committee Chairman Chuck Grassley (R-IA) all want to take steps to help lower drug prices. The public wants to see it happen and importantly, it is supported by the base of each party. And while the details of how each wants to achieve this objective differs, the opportunity to take even modest steps is real. It all comes down to whether, despite a clear shared political opportunity, they are willing to give one another a “victory.”
Democrats have a much more expansive agenda that includes giving CMS the ability to negotiate drug prices directly with drug companies, a position strongly opposed by Republicans, though President Trump, in 2016 on the campaign trail, said Medicare could save $300 billion if it negotiated drug prices directly. However, on other issues there seems to be some general agreement on remaking the current system of using rebates in Medicare to lower drug prices and while not quit agreement, HHS’ plan to index Part B drug prices to similar drugs in Europe where prices are less expensive, is moving forward.
So, the question remains, is each side willing to give the other a “victory,” or will they insist on a 100% victory of their side, which will mean nothing gets done.
The answer is maybe.