November 12, 2018

Meet the lawmakers poised to shape health care in the 116th Congress

Daily Briefing

    The midterm elections might be over, but health care is going to remain a key policy issue for leaders of the 116th Congress.

    Advisory Board's take on last week's elections and what they mean for providers

    As a result of last week's midterm elections, Republicans widened their majority in the Senate but lost control of the House. The majority change in the House means Democrats will take over leadership of the House and its committees, positioning Democrats to further their health policy agenda. Below, we round up the top contenders for Democratic House leadership positions and the health policy issues they could pursue.

    House leadership

    House minority leader Nancy Pelosi (D-Calif.) is expected to resume her former post as speaker of the House, as CQ News reports she currently is running for the position unopposed. As speaker, Pelosi would be tasked with setting the party's agenda, controlling the House floor's schedule, and serving as the lead negotiator with the Senate and White House.

    Pelosi already has indicated that health care will be a key focus for Democrats in the 116th Congress. The day after the election, Pelosi said, "Democrats pledge, again, a new majority, our 'For the People' agenda, lower health care costs, lower prescription drugs, bigger paychecks, building infrastructure, clean up corruption to make America work for the American people's interest, not the special interests."

    According to CQ, Rep. Steny Hoyer (D-Md.) is running for House majority leader unopposed, while Rep. Diana DeGette (D-Colo.) will face off with Rep. James Clyburn (D-S.C.) for majority whip.

    House Ways & Means Committee

    At the committee level, Rep. Richard Neal (D-Mass.) is positioned to become the next chair of House Ways and Means Committee, which oversees matters related to health care, Social Security, and taxes. Neal, who currently is the committee's ranking member, is not expected to face challenges for the spot from other Democrats.

    As the committee's chair, Neal is likely to seek to bolster the Affordable Care Act's (ACA) exchange markets and reduce prescription drug costs, CQ Health reports. Neal has introduced bills aimed at expanding subsidies and other financial assistance offered to U.S. residents under the ACA, and reversing regulations implemented under the Trump administration to expand access to health plans that do meet all of the ACA's coverage requirements.

    In addition, Neal and his committee members possibly could team up with the administration to bring down prescription drug prices. House Democrats have introduced a bill that would allow Medicare to negotiate prescription drug prices with pharmaceutical companies, and President Trump in a break with the Republican party has indicated his support for such a move.

    Neal and the committee also could convene hearings on proposals to expand Medicare through a single-payer "Medicare-for-all" model or by allowing retired adults to purchase Medicare coverage. However, such proposals are unlikely to pass in the Republican-controlled Senate.

    According to CQ Health, Neal also is expected to closely examine the recently renegotiated North American Free Trade Agreement (NAFTA), which would offer a 10-year data exclusivity period for biologic drugs. The administration intends to send the agreement to Congress after the end of this month.

    The House Energy and Commerce Committee

    Rep. Frank Pallone (D-N.J.) is poised to become the next chair of the House Energy and Commerce Committee, which oversees matters related to health care legislation.

    Pallone, who has served as the committee's ranking member since 2014, intends to bring members of the committee together to discuss how lawmakers can lower health care and prescription drug costs, the Wall Street Journal reports. Pallone also plans to address the opioid epidemic by increasing support for Medicaid, which covers many people with opioid use disorders, according to the Journal.

    House Budget Committee

    Rep. John Yarmuth (D-Ky.) is expected to become chair of the House Budget Committee. Yarmuth, who currently serves as the committee's ranking member, historically has pushed back against budget blueprints from Republicans that have sought to lower federal spending for Medicare and other safety-net programs. Instead, Yarmuth has said he plans to convene a hearing on "Medicare for All" proposals if he becomes the committee's chair.

    House Veterans Affairs Committee

    According to the Journal, it is unclear which Democrat will take the helm of the House Veterans' Affairs (VA) Committee, which oversees VA's health system. Rep. Tim Walz (D-Minn.)—the committee's current ranking member who will not serve in the House after this year—in October endorsed Rep. Mark Takano (D-Calif.) to be the committee's top Democrat, which makes Takano a frontrunner to lead the committee.

    According the Journal, sources familiar with the matter have said Rep. Julia Brownley (D-Calif.) might challenge Takano for the committee's top seat.

    Senate Health, Education, Labor, and Pensions Committee

    Rep. Patty Murray (D-Wash.) is expected to remain the ranking member of the Senate Health, Education, Labor, and Pensions Committee. According to CQ Health, Murray and Sen. Lamar Alexander (R-Tenn.), the committee's chair, are not expected to prioritize their bipartisan legislation to bolster the individual health insurance market in the upcoming legislative session.

    Instead, Alexander and Murray are expected to focus on lowering prescription drug costs. Alexander and Murray during the 115th Congress convened several hearings on prescription drug costs, and the senators have said prescription drug costs would continue to be a priority for the committee (Rubin et al., Wall Street Journal, 11/7; Florko, STAT Plus, 11/7 [subscription required]; Lerman/McIntire, CQ News, 11/7 [subscription required]; Raman, CQ News, 11/7 [subscription required]; McPherson, CQ News, 11/12 [subscription required]).

    Five ways to control the flow of drug expenditures

    Prescription drug expenditures are the fastest growing component of health care spending. And while reducing unwarranted prescribing variation is the single biggest improvement opportunity, there are several other near-term chances to reduce spending and grow revenues.

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