The work Congress does on healthcare next year — and even the year after — will be mostly for show without a lot of concrete results, experts said.
“Probably nothing is going to happen legislatively in the next 2 years around healthcare” in terms of legislation that is actually passed by both the House and Senate and signed by the president, said Chris Sloan, a director at Avalere, a healthcare consulting firm, in a phone interview. “I think the Democrats in the House are going to use this as an opportunity to showcase their policy priorities for 2020 — things like ‘Medicare for All’ or a Medicare buy-in, taking votes on those and nailing down some specifics.”
“You will also see Democrats in the House use their oversight power over [the Department of] Health and Human Services (HHS) — to hold hearings, and give pushback around things the administration is doing around the Affordable Care Act (ACA) like the expansion of association health plans and cuts in funding for marketing and outreach in the [health insurance] exchanges,” he said.
Sloan also expects a lot of activity to occur around drug pricing. “I’m not expecting a major piece of legislation around drug pricing coming out, but it’s a huge issue with a lot of traction on the right and the left… so I’d expect in the House and the Senate [to see] hearings on drug pricing,” he said. “There’s always a chance that the Democratic House and the Republican president will come together on some piece of drug pricing — like transparency reporting — but I think it’s unlikely. So the next 2 years won’t be stagnant for healthcare; there will be a lot of policy development but no major bills.”
Julius Hobson, Jr., JD, senior policy advisor at Polsinelli, a consulting firm here, was a little more optimistic — but only a little. “The first thing on my list is prescription drug pricing,” he said in a phone interview. “If there is an opportunity for Republicans and Democrats to work out something together — provided neither side tries to overreach — that will be the one thing that has the possibility of being enacted.” Possibilities for drug pricing legislation include bills supporting reimportation, pegging U.S. drug prices to those in Europe, or giving HHS the authority to negotiate drug prices under Medicare and Medicaid.
“After that, I can’t find a health issue at the moment that I think the two sides could work on,” Hobson said. “But I think we’ll see more hearings on the oversight of the ACA, especially in the House, as administration officials get dragged in to see what they’re doing.” A House floor vote on a ‘Medicare for All’ bill is also a possibility — although it won’t pass — along with more oversight on veterans’ healthcare, he added.
One area that gets little attention is healthcare costs at the Department of Defense, which is the fastest-growing portion of the budget, said Hobson. “Having been in wars for 17 years, our healthcare costs are going through the roof.” Both President George W. Bush and President Obama pushed for having military members pay more of their costs under the Tricare health insurance program for military families, “but Congress refused to do that.”
Instead of action in Congress, most of the activity on the healthcare front will probably be within the Trump administration, he continued. “There will be more attempts to get things done — things [the administration] can do that Congress is unable to do.” Expect more efforts to come from the Office of Regulatory Reform at the Centers for Medicare & Medicaid Services, “which is consistent with an executive order from last year to come up with lists of regulations they could do away with to make the system less burdensome,” Hobson predicted.
Rodney Whitlock, vice president for health policy at ML Strategies, a consulting firm here, said in a phone interview that he expected some effort to pass a bill related to Texas vs. the United States of America — the court case questioning the constitutionality of the ACA — “and I think there’s something that looks a little more like ACA stabilization in the works… [The question is] what is the difference between the things where they’re trying to make a point versus what might be actually statutorily possible.”
Bob Laszewski, president of Health Policy and Strategy Associates, a consulting firm in Alexandria, Va., agreed with the idea that both parties will be focused on the drug pricing issue. “This seems to be about the only bipartisan interest and it will be interesting to see if there is any real agreement between them,” he said in an email. “Trump’s reference pricing proposal could be an interesting spot — will he find more Democratic allies than Republicans?”
Healthcare-related taxes imposed by the ACA but not yet implemented — including taxes on “Cadillac” health insurance plans and medical devices — are another possible area of cooperation, he said. “These have only been postponed and will have to be dealt with. There does seem to be broad agreement they should not be restarted.” And the pharmaceutical industry will be pushing back against a proposal to have it pay a larger share of drug costs in the Medicare Part D “donut hole,” he added.
Finally, “Democrats will have as their top priority rubbing salt into the Republican wounds on pre-existing conditions and the recent Texas court case,” Laszewski said. “I don’t see any opportunity for bipartisan fixes. With the Supreme Court more than a year away in terms of any final decision, this will be a very dark cloud in 2019.”
