The Health 202: Democrats are putting a political pothole in the way of bipartisan drug pricing bills

THE PROGNOSIS

House Speaker Nancy Pelosi (D-Calif.). (Win McNamee/Getty Images)

Obamacare battles threaten even the most bipartisan health-care efforts on Capitol Hill. 

The House will vote tomorrow on a package aimed at lowering prescription drug prices — one of the few health-care issues getting across-the-aisle momentum this year, due to overwhelming public support. But in a move that alienates Republicans, Democrats have tacked on measures reversing some of the Trump administration’s controversial actions on the 2010 health-care law.

The package includes three provisions, all recently passed unanimously by the House Energy and Commerce Committee, that would remove barriers to generic drugs entering the market. But there’s little chance Senate Republicans — let alone President Trump, who has vowed to keep fighting for Obamacare repeal — would sign off on the other four. Those measures restore ACA outreach funding cut by the administration, block its expansion of leaner health plans and fund state-run marketplaces.

The tactic, which allows Democrats to again drive home their message that the administration is undermining the Affordable Care Act at every turn, won’t end the bipartisan work on high drug prices being carried out on a number of fronts. But it does introduce tensions into the effort and underscores the persistent interparty tensions over virtually anything related to health care.

In a House Rules Committee hearing yesterday afternoon, Rep. Tom Cole (Okla.), the committee's ranking Republican, said the approach “suggests to me this isn’t a sincere attempt to legislate.”

“You had three good pieces of legislation here,” Cole told House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.). “Why not just package the ones you know are going to get through? And then we can continue to fight out our differences on the other four.”

In response, Pallone pointed to an ACA stabilization package hammered out in 2017 by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), saying that shows some Republicans might be willing to shore up the health-care law (although that package never passed Congress). Democrats are also arguing the savings from the drug pricing bills would pay for the ACA pieces.

"The bill we’ll send to the Senate on Thursday combines bipartisan ideas on both strengthening health care and lowering prescription drug prices that help pay for the whole package," Henry Connelly, a spokesperson for House Speaker Nancy Pelosi, told Health 202. "We’re saving money and reinvesting in Americans’ health care."

Pallone will appear alongside Pelosi and Senate Minority Leader Chuck Schumer (D-N.Y.) at a press event this afternoon, where they’ll try to put Republicans in a tough spot by daring them to oppose legislation to lower drug prices.

The Democrats may peel off a few Republicans on the legislation up for a vote Thursday. Four of them crossed the aisle last week on a bill undoing the administration’s expansion of the use of state waivers to duck parts of the ACA. But the vote will mostly split the House down party lines again.

Republicans even tried to advance their own alternative that would instead use the savings for extending funds for community health centers, the National Health Service Corps and other public health programs. They’re dubbing the Democrats’ bill the “Obamacare Bailout Act of 2019.”

“Many Republicans are incredibly disappointed that Speaker Pelosi has decided to politicize bipartisan prescription drug legislation,” said Jesse Solis, a Republican spokesman for the House Ways and Means Committee. “Other than partisan politics by House Democrats at the expense of seniors and patients, there is no reason we shouldn’t advance the drug prices now so that they can become law.”

But tomorrow’s likely skirmish doesn’t mean the drug pricing provisions are doomed forever.

Sen. Chuck Grassley (R-Iowa), chairman of the Senate Finance Committee, has long championed several of them and could include some iteration of them in a bipartisan package he’s working on with his Democratic counterpart on the committee, Ron Wyden (Ore.). The pair have said they’ll roll out the agreement in June. The GOP-led Senate could also take up the House bill and strip out the ACA-related elements.

We’ve written in The Health 202 about some of the generic drug measures in the House package. It includes a version of the “CREATES Act,” which would prevent branded drugmakers from guarding their medications so other companies can’t develop alternatives. “Pay-for-delay” legislation prohibits deals in which drugmakers pay producers of generic medicines to delay introduction of cheaper versions of them. The House bill would also prevent generic drug companies from extending their exclusivity periods by delaying bringing their medications to market.

FreedomWorks, a conservative and libertarian advocacy group:

From the AARP in Iowa: 

Grassley:

AHH: The Alabama senate voted to effectively ban abortion in the state, passing a bill that makes no exceptions for victims of rape and incest and sending what is the strictest abortion ban in the nation to the desk of Republican Gov. Kay Ivey.

The only exception the bill includes is to allow abortions when the mother’s life is at risk, “an unyielding standard that runs afoul of federal court rulings,” our Post colleagues Emily Wax-Thibodeaux and Chip Brownlee report. The bill, which passed on a 25-6 vote, criminalizes the abortion procedure and would penalize doctors with up to 99 years in prison if they perform the procedure. A Democratic amendment that would have included exceptions for victims of rape and incest failed on an 11-21 vote.

“Those who backed the new law said they don’t expect it to take effect, instead intending its passage to be part of a broader strategy by antiabortion activists to persuade the U.S. Supreme Court to reconsider the landmark 1973 Roe v. Wade ruling, which legalized abortion nationwide,” Emily and Chip write.

“This bill is about challenging Roe v. Wade and protecting the lives of the unborn because an unborn baby is a person who deserves love and protection,” the bill's sponsor Alabama state Rep. Terri Collins (R) said after the vote. “I have prayed my way through this bill. This is the way we get where we want to get eventually.”

Reactions swiftly poured in after the vote, including from activists and Democratic presidential contenders vowing to fight the law:

From the ACLU: 

From Planned Parenthood president Leana Wen:

Sen. Kirsten Gillibrand (D-N.Y.):

Sen. Elizabeth Warren (D-Mass.): 

A Gilead Sciences office is shown in Foster City, Calif. (Stephen Lam/Reuters)

OOF: Gilead Sciences allegedly used anti-competitive schemes that blocked generic competition, even when the leading HIV drugmaker’s patents on certain medications expired, according to a new consumer lawsuit.

The result of Gilead’s practices meant consumers and health plans overpaid for combination drug “cocktails” that are critical for HIV patients, our Post colleague Christopher Rowland reports. Brand-name combination treatments start at $30,000 per year.

“Combination pills are created using medicines from multiple manufacturers,” he reports. “Gilead’s agreements with those partner companies required that Gilead’s brand versions of HIV-fighting medication tenofovir, which prevents the virus from replicating, would remain in the pills, the lawsuit alleged, even when generic ingredients could be used at a fraction of the price. In other words, Gilead got its most likely competitors to promise not to compete, according to the suit.”

The lawsuit alleges Gilead was also involved in “product-hopping,” meaning that instead of adjusting an active ingredient in an older medication to reduce negative side effects, the company introduced a new version in another combination tablet and shifted patients to the new product with an extended patent life. 

(iStock)

OUCH: Rural hospitals are closing their doors across the country. Our Post colleague Eli Saslow wrote last week about one such struggling hospital in Fairfax, Okla., noting more than 100 facilities in remote areas of the country have shuttered in the past decade.

Reporting from Fort Scott, Kan., Kaiser Health News’s Sarah Jane Tribble writes about how residents are grappling with the impending closure of Mercy Hospital, which served patients there for 132 years and is the primary source of well-paying jobs in the community.

“For the 7,800 people of Fort Scott, about 90 miles south of Kansas City, the hospital’s closure was a loss they never imagined possible, sparking anger and fear,” Sarah writes. “Sisters of Mercy nuns first opened Fort Scott’s 10-bed frontier hospital in 1886 — a time when traveling 30 miles to see a doctor was unfathomable and when most medical treatments were so primitive they could be dispensed almost anywhere.”

The health system behind the hospital plans to keep the building open for two years in order to continue an outpatient clinic, an emergency department and physical therapy service, but it is “unknown what will happen to the building or the services in two years.”

Sarah’s story is the first in a series that will examine the hospital’s closure and the impact on the community’s health care, economy and identity.

— Leaders on the House Energy and Commerce Committee have unveiled a draft proposal to tackle surprise medical bills.

The draft bill, released jointly by Pallone and Rep. Greg Walden (R-Ore.), is meant to protect patients from getting unexpected bills after an emergency room visit or after they receive other non-emergency medical care.

According to Vox’s Dylan Scott, the bill would mandate that health insurers treat out-of-network emergency care as in network for the purpose of cost-sharing and out-of-pocket expenses for consumers, prohibit balance billing that occurs when providers charge patients for the difference between the set price and what the insurer covers, and require insurers to make minimum payments to out-of-network providers for consumers’ care.

 He writes it's the “most robust proposal yet as lawmakers from both parties and President Donald Trump say they want to end surprise billing.” The Health 202 wrote last week about the president’s call to protect consumers from such surprise medical bills, laying out “broad areas of agreement regarding the bills incurred by many Americans.”

“We must ensure that patients are not responsible for these outrageous bills, which is why our discussion draft removes patients from the middle,” Pallone and Walden said in a statement to Vox. “We look forward to receiving constructive feedback on ways to build upon our proposal, so we can advance a bipartisan solution that protects patients from costly surprise medical bills.”

— Glenn Kessler, The Post's Fact Checker, explains some of the complicated semantics in the back-and-forth between Sen. Kamala Harris (D-Calif.) and CNN host Jake Tapper in an interview over the weekend.

Harris insisted her support for Medicare-for-all and the plan by Sen. Bernie Sanders (I-Vt.) does not mean she supports the elimination of all private insurance. She said the plan doesn’t get rid of all insurance, even as Tapper countered that the plan simply allowed for private insurance for cosmetic surgery but not for all essential health benefits.

Sanders’s bill proposes to cover almost all medically necessary services, including hospital services, primary and preventive care, prescription drugs, dental care, vision care, emergency services, and long-term care, among other services.

Tapper mentioned cosmetic surgery, or elective surgery typically not covered by health insurance, as something left out of Sanders’s plan. So what does that mean?

Here’s how Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, explained it to our colleague: “As a technical matter, the Medicare-for-all bill would allow private insurers to sell supplemental policies for benefits not covered by the government plan … As a practical matter, the government plan covers such a comprehensive set of benefits that there would be virtually no role for private insurance.”

Part of that technicality is in a certain section of the Sanders bill, Section 107, that “would make it illegal for any private health insurer to sell coverage that duplicated benefits under the law or for any employer to duplicate the benefits, but adds that nothing on the proposed law would prohibit the sale of health insurance for benefits not covered under the bill,” Glenn writes. But he writes that section “looks like a loophole for single-payer supporters to claim that private insurance is not being eliminated, even as the main sponsor says he wants to put health insurance companies out of business.”

The verdict: While Glenn writes he won’t assign Pinocchios because of the back-and-forth between Harris and Tapper, he adds: “She could more forthrightly admit that the health plan she supports envisions virtually no role for the private insurance now used by nearly 220 million Americans.”

— Photos obtained and reported on by CNN reveal a glimpse of the situation at a Border Patrol facility in McAllen, Tex. They show migrants, mostly children, sleeping on the ground with Mylar blankets, as Vanessa Yurkevich and Priscilla Alvarez write.

“A baby bottle filled with milk can be seen in one photo next to a child sleeping outside on dirt, and in another, a woman is seen sitting on rocks leaning against a wall clutching a child,” they write. “The photos came from a source who has access to the facility and was disturbed by the conditions over the weekend. Customs and Border Protection has confirmed the images are of the McAllen border station.”

A Department of Homeland Security official told CNN in response to the photos that “Border Patrol agents are doing everything they can to protect and care for migrants in their temporary custody. Border Patrol stations are simply not equipped to handle the number of families and children arriving along the southwest border, and we need Congress to act to provide immediate relief.”

— Meanwhile, the Associated Press’s Andrew Taylor reports Democrats on Capitol Hill have signaled that they may agree to pay for parts of the president’s call for $4.5 billion in funding for humanitarian and security needs at the border.

Aides said Democratic lawmakers are not considering paying for additional beds for detention facilities for Immigration and Customs Enforcement but are considering additional funding for migrant care.

“There are some good parts to it, there are not some good parts to it, and we’ll have to separate the wheat from the chaff,” Schumer said. “We’re going to have to go over that with a fine-tooth comb.”

The border funding could be part of an unrelated disaster spending bill that has stalled, and Andrew writes it adds a “major, tricky element to the already overdue disaster bill.”

— And here are a few more good reads: 

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Despite Measles Warnings, Anti-Vaccine Rally Draws Hundreds of Ultra-Orthodox Jews

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Today

• The House Veterans Affairs Subcommittee on Health holds a hearing on the Veterans Affairs Fiscal Year 2020 budget request for the Veterans Health Administration.
• The House Ways and Means Committee holds a hearing on the economic and health consequences of climate change.

Coming Up

• The Washington Post Live will host actress and mental health advocate Glenn Close and Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) for an event on mental health and addiction on Thursday.
• The House Oversight Committee holds a hearing on the HIV prevention drug on Thursday.

Here's how Trump attacks his 2020 competition: