THE PROGNOSIS

Democrats celebrating their new-but-narrow House majority are confronting a hard decision: Whether to work with the Trump administration – and the GOP-led Senate – to lower drug costs.

House Republicans grappled with  exactly this kind of question for six years under then-President Obama, as the president and Democrats urged them to help improve the Affordable Care Act. Republicans refused to cooperate on bills that might have bettered its marketplaces and its other benefits, all because the law’s shortcomings were too good a political weapon with which to keep bludgeoning Democrats.

Democrats, who gained at least 26 seats in the House with a handful of races yet to be declared, could very well make a similar political calculation when it comes to drug prices under President Trump. The issue is a top concern to voters, and it’s likely to come up in 2020 when Democrats are seeking to defeat Trump to win the White House.

“They’ve got to make a decision, which is: How far are they willing to go to show they’re willing to work with Republicans and the Donald Trump administration?" Rodney Whitlock, a former health-policy staffer to Sen. Chuck Grassley (R-Iowa) and now a vice president at ML Strategies, told me.

Minority Leader Nancy Pelosi (D-Calif.), who is expected to reclaim the House speakership, has said going after the high cost of prescription drugs is a task Democrats plan to take on right away. In July, Pelosi personally visited the Pharmaceutical Research and Manufacturers of America to threaten some specific legislative actions, according to Stat News. Last night she told PBS’s Judy Woodruff it’s “hopefully something we can do in a bipartisan way.”

“I think that we could find common ground on reducing the of prescription drugs if the president is serious about his saying that he wants to do that,” Pelosi said, referring to the administration’s surprisingly bold proposal last month to lower the government’s spending on certain Medicare drugs administered in doctors offices.

But Pelosi, who has given little credit to the administration for the proposal, added a jab to Trump: “He has pulled his punch on it so far,” she said.

Pelosi was referring to a campaign promise by Trump to buck conservative norms and push for allowing Medicare to directly negotiate lower prices with pharmaceutical companies -- a policy with huge potential to move the needle on drug prices that would give the government much more influence over the industry. The president has since backed off that pledge as it’s an idea that alienates many in his own party.

Democrats are certainly poised for one type of action: Launching multiple investigations of Trump and scrutinizing his policies on immigration, education, Russia -- and health care, as my colleague Karoun Demirjian writes.

But if anything is to get done legislatively in the next two years on drug prices -- which are much higher in the U.S. than in other developed countries -- it would take House Democrats and Senate Republicans working in tandem with the administration, which has spent the last six months pushing drug costs as a top priority.

Any feasible, bipartisan legislation would likely take the shape of tweaks to Medicare or changes to the laws surrounding the rebates drugmakers give to pharmacy benefit managers, who are widely blamed for putting upwards pressure on list prices.

Some House Democrats have introduced more aggressive bills aimed at the drug industry. Reps. Peter Welch (D-Vt.) and Lloyd Doggett (D-Tex.) have been especially active on the issue. So has Rep. Elijah Cummings (D-Md.), who is poised to become chairman of the House Oversight Committee. Cummings has proposed legislation allowing Americans to import drugs from Canada and permitting direct Medicare negotiations.

Health and Human Services Secretary Alex Azar didn’t back either of those ideas in the drug pricing blueprint HHS and the White House released last spring. But the administration did propose an unusually aggressive idea last month, announcing it would experiment with pegging Medicare drugs dispensed by doctors to an index based on drug prices in other countries.

It’s an idea you’d expect Democrats to support since the Obama administration attempted something similar. But as we’ve noted, Pelosi and other leading Democrats expressed only tepid support, appearing unwilling to give any ground to the administration just weeks before the election. Now, on the other side of the midterms and with the House majority firmly in hand, Democrats will be seriously considering how to engage  onthe issue over the next two years.

Nonetheless, lobbyists are skeptical there will be much bipartisan action on drug prices. “Unlikely,” one GOP lobbyist wrote to me.

Other lobbyists pointed to Grassley – the most likely senator to assume chairmanship of the powerful Senate Finance Committee from retiring Sen. Orrin Hatch (R-Utah_ – and his longtime, bipartisan work on prescription drugs. A key architect of Medicare’s Part D prescription drug program, Grassley teamed up with Sen. Ron Wyden (D-Ore.) three years ago to investigate steep prices for the hepatitis C drug Solvadi.

One could imagine Grassley teaming up with Democratic colleagues on pharmaceutical legislation – assuming, that is, that either party is willing to take actions that would raise the powerful industry’s ire.

AHH, OOF and OUCH

AHH: A Washington Post-Schar School survey of battleground districts on Election Day found health care and the president were the two top issues voters pointed to in House contests.

In the survey, 43 percent of voters overall said health care was the most or second most important issue to them. Broken down by party, 77 percent of Democrats and 22 percent of Republicans said it was the most or second most important issue. Trump was the most or second most important issue for 42 percent of voters overall. The survey included voters in 69 competitive battleground districts. 

Other polls had similar findings. In an NBC News exit poll, 41 percent of voters said health care was the most important issue, replacing the economy, which NBC News noted had been the “top issue going back at least a decade.”

And an Associated Press survey of more than 115,000 voters found 26 percent named health care as the most important issue facing the country. “Nearly 4 in 10 of those who voted for a Democratic House candidate named health care as the most important issue facing the nation, while about as many Republican voters considered immigration to be the top issue," per the report.

OOF: At least one of the Republican lawmakers who played a critical role in passing the GOP’s unpopular Obamacare repeal-and-replace bill will soon be out of a job.

Rep. Dave Brat (R-Va.), , was defeated by Democrat and first-time candidate Abigail Spanberger, who said she decided to run for Brat’s seat the day that he and other Republican lawmakers voted to repeal the ACA. Brat is a member of the House Freedom Caucus, which as Paige wrote this week was were more worried about eliminating Obamacare requirements that maintaining its consumer protections during last year's repeal and replace debate. 

Meanwhile, Rep. Tom MacArthur (R), who helped House Republicans compromise on a repeal bill by inserting language to weaken protections in the ACA for preexisting conditions, was up very slightly in his New Jersey race. It hasn't been called yet.

OUCH: Two critical Senate races and a governor's race where preexisting conditions protections were a signature issue fell different ways on Tuesday. In Missouri, Democratic Sen. Claire McCaskill was defeated by Republican challenger Josh Hawley. But in Wisconsin, Democratic Sen. Tammy Baldwin beat back a challenge from Leah Vukmir, winning a second term, even as the state's Gov. Scott Walker (R) fell in his bid for a third term.

McCaskill had repeatedly hammered Hawley for being one of the plaintiffs in a lawsuit brought by Republican attorneys general that seeks to overturn the ACA. She argued the lawsuit could eliminate the law's provisions that provide protections for people with preexisting illnesses. For his part, Hawley dismissed those attacks and has insisted that such protections can be maintained with an alternative to Obamacare.

And in Wisconsin, Walker was forced to answer for his state's participation in the Obamacare lawsuit, calling the claim by his opponent Tony Evers that he wanted to eliminate preexisting condition protections the “biggest lie of the campaign.” “No matter what happens in the courts or in the Congress, in Wisconsin we’ll codify that, the exact same language that’s in the [ACA],” Walker had said. “We’ll make sure everyone living with a preexisting condition is covered here in the state.” As our Post colleague James Hohmann reported, Gov.-elect Evers made health care a big issue on the campaign trail, campaigning last month with former HHS secretary Kathleen Sebelius.

HEALTH ON THE HILL

— Here are other results from the midterms the health-care policy world is watching:

  • The Arizona Senate race between Republican Rep. Martha McSally and Democrat Rep. Kyrsten Sinema is still too close to call. Sinema repeatedly hammered McSally over her votes to repeal the ACA, as we detailed in this Health 202.
  • Democrat Donna Shalala, the former health and human services secretary under President Clinton, defeated Republican incumbent Rep. Maria Elvira Salazar (R-Fla). Our colleague Colby Itkowitz wrote in the Health 202 back in June about Shalala’s support for a universal health program.
  • Republican and former Celgene CEO Bob Hugin failed to unseat Democratic Sen. Robert Menendez (N.J.).
  • Illinois Republican incumbent Rep. Peter Roskam was ousted by Democrat Sean Casten. Democrats had criticized Roskam, chairman of the House Ways and Means subcommittee Health, for voting to repeal the ACA.
  • As of this morning, the race between New York Republican Rep. Chris Collins and Democrat Nate McMurray was too close to call, according to the Associated Press. Collins was indicted on a charge of insider trading and accused of scheming with his son to avoid losses on an investment in a biotechnology company, Innate Immunotherapeutics.
STATE SCAN

— Here’s where many of the health-care related ballot measures stand:

  • Voters in Alabama and West Virginia approved separate measures to significantly limit access to abortions. Alabama’s voters approved 59-to-41 an initiative declaring that abortion rights are not protected and amending the state constitution to say that state policy protects “the rights of unborn children” and will “support the sanctity of unborn life.” West Virginia voters narrowly passed 52-to-48 an amendment that says nothing in the state constitution “secures or protects a right to abortion or requires the funding of abortion.”   
  • Meanwhile, Oregon voters soundly rejected a measure that would have prevented state funds from covering abortions for public employees and Medicaid beneficiaries. The measure was defeated 64-to 36 percent as of early Wednesday morning.
  • Michigan became the 10th state to approve marijuana for recreational use and the first state in the Midwest to do so. “Western and northeastern states have led the way on legalizing marijuana, but the victory in Michigan powerfully demonstrates the national reach of this movement,” Maria McFarland Sánchez-Moreno, executive director of the Drug Policy Alliance said in a statement.
  • Meanwhile, voters in deep-red North Dakota rejected a measure to legalize the drug, though our Post colleague Christopher Ingraham reports the measure did not including any possession limits or regulatory structure.
  • In Missouri, one of the three medical marijuana measures was approved allowing doctors to recommend pot for certain conditions. As of this morning, the medical marijuana proposal in Utah had not yet officially been approved, though it was leading 53-47 with 76 percent of precincts reporting, according to the Associated Press.
  • Medicaid expansion fared well on Election Day as well. Voters in Idaho and Nebraska approved measures in the state to expand the program. The Utah measure had not yet been called, though approval was leading 53- to- 47, with 75 percent of precincts reporting, according to the Associated Press.
  • In Maine, Democrat Janet Mills won the open gubernatorial race over Republican Shawn Moody. Mills has said she plans to implement Medicaid expansion soon after taking office, criticizing the current Republican Gov. Paul LePage for slow-walking implementation after voters overwhelmingly approved a ballot measure last year.
  • And in Kansas, Democrat Laura Kelly, who defeated Secretary of State Kris Kobach (R), vowed during her campaign to expand the program, and is poised to do so in the state where an expansion bill was previously vetoed by Republican Gov. Sam Brownback.

— And here are a few more good reads From The Post and beyond: 

Massachusetts voted Tuesday to uphold a state law that forbids discrimination based on gender identity in public places.
CNN
Proposition 8, which would have imposed a cap on the profits earned by large dialysis companies such as DaVita, was defeated by voters on Tuesday.
Los Angeles Times
TRUMP TEMPERATURE
The Fix
Democrats are on track to take the House, and Republicans will keep the Senate. And there was, and will be, plenty of shouting.
Aaron Blake
Politics
Women ran for office in unprecedented numbers, mostly as Democrats, and many were first-time candidates.
Mary Jordan
MEDICAL MISSIVES
The heritability of life span, long a hot research topic, is considerably less than widely thought, according to an analysis of millions of family trees.
Stat News
Courts & Law
The Supreme Court spent a gruesome hour on constitutional ways to execute a Missouri inmate.
Robert Barnes
INDUSTRY RX
Bob Hugin, who lost his bid for New Jersey Senate on Tuesday, is the former CEO of Celgene, which has taken flak for hiking the prices of cancer drugs.
Stat News
Democrats' trek out of the health care wilderness was a long one, marked by a series of painful electoral losses.
Politico
REPRODUCTIVE WARS
The new president of Planned Parenthood on patient advocacy, conspiracy theories and why it’s insulting when anti-choicers call themselves “pro-life.”
The New York Times
DAYBOOK

Today

  • Brookings Institution holds an event on girls’ education research and policy.

Coming Up

  • Brookings Institution holds an event on the results and implications of the midterm elections on Thursday.
  • American Enterprise Institute holds an event on postelection analysis on Thursday.
  • The Food and Drug Administration holds its “Vaccines and Related Biological Products Advisory Committee Meeting” on Thursday.
  • The American Medical Association holds its research symposium on Friday.
SUGAR RUSH

2018 midterm election: A night of firsts:

‘Colorado is a state that values diversity’: Rep. Jared Polis to be first openly gay governor

Watch Nancy Pelosi's full speech after Democrats regained control of the House