THE PROGNOSIS

It’s up to House and Senate leaders to act on bipartisan proposals addressing high drug costs and surprise medical bills. But they don’t appear interested.

Over the past few days, lawmakers have introduced or updated legislation that may, if it were brought to the floor, stand a chance of passing the Democratic-led House, the Republican-led Senate and be signed by President Trump. That’s a rare thing in this divided Washington, especially amid the turbulence of impeachment and year-end spending negotiations.

The leaders of the Senate Finance Committee have updated their bipartisan drug pricing bill. House Republicans insist they’ve assembled a similar bill Democrats should have no reason to oppose. And committee leaders in the House and Senate have agreed on legislation to protect consumers from surprise medical bills they can get when obtaining care from an out-of-network provider at no fault of their own. The White House is supportive of all these efforts.

Sen. Lamar Alexander (R-Tenn.), a key author of the surprise billing legislation, noting support from Health and Human Services Secretary Alex Azar:

Azar: 

Via CNN’s Phil Mattingly: 

These bipartisan bills include hundreds of provisions addressing pressing voter concerns around steep health-care costs. But theyre sitting in the wings and may very well stay there, despite insistence by both parties and President Trump that the problem is one they want to take a stab at. Consider this:

  • House Speaker Nancy Pelosi (D-Calif.) is holding a Thursday vote on a drug pricing bill supported only by Democrats. The move ensures lawmakers will spend the week criticizing each other’s ideas about lowering drug prices instead of working on the issue together.
  • Senate Majority Leader Mitch McConnell (R-Ky.) has privately criticized the bipartisan drug pricing bill in his chamber and has made no commitments to bring it to the floor. Lobbyists say the bill’s chances of getting passed are slim to none.
  • Sen. Patty Murray (D-Wash.) hasn’t joined a House and Senate agreement on surprise billing legislation due to skepticism by Minority Leader Charles E. Schumer (D-N.Y.). Schumer is reportedly wary of legislation that hospitals in his home state of New York have said would shortchange them. Hospitals continue to oppose the measure — including the bipartisan agreement lawmakers announced over the weekend.

Vox’s Dylan Scott: 

The congressional leaders also have a ton on their plates over the nine legislative days left this year. 

Today, Democrats are expected to unveil two articles of impeachment against Trump that will focus on abuse of power and obstructing Congress, and would be voted on by the full House next week, my colleagues Rachael Bade, Mike DeBonis, Elise Viebeck and Toluse Olorunnipa report.

"Democrats laid the groundwork for the charges Monday, lambasting Trump as a danger to the country during a contentious Judiciary panel hearing that foreshadowed a likely party-line vote on the articles," they write.

While all this goes on, House and Seate aides have been working behind closed doors on a spending deal to avert a potential government shutdown on Dec. 20.

"The partisan rancor at Monday’s hearing belied the growing closed-door cooperation between the two parties on other issues as they negotiate with the White House to complete several major legislative agreements before the end of the year," my colleagues write. "With pending deals on budget measures, a North American trade agreement and a new paid family leave initiative, Congress faced the prospect of ending 2019 with a rush of bipartisan legislation to go along with a party-line impeachment vote in the House that would be followed by a Senate trial early next year."

It's easy to see how provisions on drug pricing and surprise billing legislation fall by the wayside amid all this hubub. That's not stopping the authors of the legislation from calling on leaders to prioritize it.

“Our bill ... is the only significant, bipartisan legislation to address the skyrocketing cost of prescription drugs in Congress,” Senate Finance Committee Chairman Chuck Grassley, co-author of that chamber’s bipartisan drug pricing legislation, said on the Senate floor yesterday. “The Senate must demonstrate courage and finally act. It should get a vote soon.”

There’s the negotiations and the lobbying going on behind the scenes. And then there’s the public posturing. Expect to see a lot of that on Thursday, as House Democrats take up their bill, H.R. 3, to allow the federal government to directly negotiate lower drug prices with drugmakers.

Pelosi has been working all fall to tamp down progressive demands for revisions to the measure, which would allow negotiations for a maximum of 250 drugs. But now there are rumblings among progressive leaders of trying to tank a procedural vote on the bill, Politico reports. Such a move would be publicly embarrassing to the speaker.

As for House Republicans, they hate that measure. Instead, they’ve introduced legislation similar to that written by Grassley and Sen. Ron Wyden (D-Ore.). They plan to ask Pelosi to hold a vote on that legislation, which they say contains only measures that have received previous bipartisan supportt. Democrats are unlikely to heed their calls, but it helps Republicans look tougher on the drug industry than they usually appear and allows them to argue they're taking a higher, bipartisan ground.

“This will be an ongoing matter that the Amerian people expect us to come together to solve,” House Energy and Commerce ranking member Greg Walden (R-Ore.) told reporters yesterday. “Unfortunately … we were making good, bipartisan progress at the beginning of the year in the committee. Then we ended up with H.R. 3 and that stopped all the discussions.”

Walden was also part of the bipartisan group that agreed on surprise billing legislation.

AHH, OOF and OUCH

AHH: The Supreme Court announced it won’t hear a challenge to a Kentucky law requiring doctors who perform abortions to show the woman an ultrasound image and describe the development of the fetus, even if the woman objects. 

The refusal to hear the appeal leaves the law in place. Doctors at Kentucky’s only abortion clinic who challenged the law said the state’s requirements violate their First Amendment rights, our Washington Post colleague Robert Barnes reports

The clinic used dramatic language to describe the scene the law requires. “While the patient is half-naked on the exam table with her feet in stirrups, usually with an ultrasound probe inside her vagina, the physician has to keep talking to her, showing her images and describing them, even as she tries to close her eyes and cover her ears to avoid the speech,” the brief from EMW Women’s Surgical Center said.

But the state of Kentucky argued that without the requirement, there is no reason to believe that abortion providers “do anything to dispel the mistaken beliefs of women who . . . are under the impression that their fetuses are simply masses of inanimate tissue rather than living beings that are assuming the human form."

The court’s refusal to review the challenge came without comment or noted dissent from the liberal members, Robert writes. “The Supreme Court already has one high-profile abortion case on its docket this term,” he adds. “Next month, it will consider a Louisiana law that requires physicians to have admitting privileges at a nearby hospital. It is almost identical to a Texas law the court struck down in 2016 as medically unnecessary and meant to limit a woman’s access to the procedure. But the court’s membership has changed since then and now has a conservative majority thought to be more receptive to laws that restrict abortion.” 

OOF: Rep. Joe Kennedy (D-Mass.) wants Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, to resign amid reports that she directed taxpayer funds toward contracts for communication consultants and also sought to have taxpayers cover the costs of stolen jewelry, Politico’s Dan Diamond reports.

“We have now seen a systemic effort by the administrator to use public funds to elevate her own position,” Kennedy told Dan, also calling it a “gross misuse of public funds.” 

He’s the first lawmaker to call for her resignation. 

Politico reported earlier this year that Verma directed millions in contracts to private communications consultants to bolster her public profile. Over the weekend, the publication also reported that Verma filed a $47,000 claim for property stolen during a work-related trip that included $43,065 worth of jewelry, including a $5,900 Ivanka Trump-brand pendant. 

“The irony is not lost on me that an administrator of health care services for tens of millions of people had decided to forgo insurance and was looking for a government bailout,” Kennedy added. “That’s the entire point of insurance.”

Kennedy also said CMS has ignored questions about Verma’s contractors. 

— In the latest development in the ongoing feud between Azar and Verma, the Wall Street Journal’s Stephanie Armour reports that officials at CMS’s parent agency may have been the sources for recent news stories on Verma, according to an interval review by the agency. 

“At least one email from one of the communications consultants was in the possession of the HHS Office of the General Counsel before it was provided to reporters at Politico and the Washington Post last month, according to the Nov. 23 internal review by CMS staff,” Stephanie writes. “… The review notes specific conversations between CMS press representatives and reporters — conversations that came after HHS’s legal office was reportedly in possession of the consultant’s email — as well as documents provided to various entities such as the inspector general.” 

The HHS inspector general is also separately looking into whether Verma violated ethics requirements when she directed public funds toward communication consultant contracts. 

Stephanie adds: “Amid the conflict between Mr. Azar and Ms. Verma, some CMS staffers say they are working in a tense environment where they fear retaliation by the HHS for backing Ms. Verma, according to interviews with about a dozen current and former employees.”

OUCH: A record rate of Americans say they are putting off treating serious medical conditions because of costs. 

A new poll from Gallup found that 25 percent of Americans say they or a member of their family have delayed treatment for a serious medical condition in the past year, up from 19 percent a year ago. It also found 8 percent said they or a family member are putting off treatment for a less-serious condition.

The survey found 36 percent of adults in households earning less than $40,000 a year said they put off treatment for a serious condition a 13 percentage-point increase for that income group in the last year. 

“Since 2001, Gallup has tracked a near 50% increase in the percentage of Americans saying that they or a family member chose not to get medical care because of the costs they would have to pay,” Gallup writes. “Such delays in medical treatment, whether for injuries, illnesses or chronic conditions, can have significant implications for the economy and healthcare system, but also the political climate.”

HEALTH ON THE HILL

— There’s a widening partisan gap in how satisfied Democrats and Republicans are in what they pay for health care. 

New Gallup polling finds 73 percent of Republicans say they are satisfied with what they pay for health care, compared with 52 percent of Democrats who say the same. That’s a change from the 60 percent of Republicans who said they were satisfied with such costs a year ago and 61 percent of Democrats. The satisfaction level among Democrats is at its lowest in 19 years of Gallup data. 

Notably, the polling finds 69 percent of Democrats say their health coverage is either “excellent” or “good,” down just slightly from 71 last year. And 81 percent of Republicans say the same about their coverage, up from 76 percent a year ago. 

The polling implies Americans are largely satisfied with their health coverage, and Republicans increasingly so. That’s notable as health care continues to be a critical debate leading up to 2020 and as Democratic presidential candidates have sparred over how exactly to get health coverage to more people. 

— Former Navy officer and White House physician Ronny L. Jackson has filed to run for Congress in Texas. 

Jackson was once considered to lead the Veterans Affairs Department but withdrew his name from consideration after Sen. Jon Tester (D-Mont.) released a report that accused Jackson of improperly dispensing medication to staff earning him the nickname “Candyman” and contributing to a hostile work environment during his tenure as White House physician, as our Post colleague Michael Brice-Saddler writes

The Texas GOP confirmed to The Post that Jackson is running for a congressional seat. The Texas Tribune’s Patrick Svitek first reported that Jackson arrived at the Texas GOP headquarters hours ahead of the filing deadline to submit paperwork for the bid to replace retiring Republican Rep. Mac Thornberry. He’s at least the 13th Republican to get into the race for that seat. 

OPIOID OPTICS

— A new report found the number of opioid-related deaths in the state of New York, excluding New York City, has decreased for the first time in a decade. 

There was a 15.9 drop in opioid overdose deaths among New York residents, excluding New York City residents, in 2018 compared with the previous year. The drop from 2,170 deaths in 2017 to 1,824 deaths in 2018 was the first decrease since 2009. That’s based on preliminary state health department data that covers counties outside of New York City. 

“New York’s first reduction in opioid overdose deaths in over ten years is an important milestone and demonstrates our work to combat this deadly scourge is working,” New York Gov. Andrew M. Cuomo (D) said in a statement. “And while New York has taken the most aggressive actions to combat the opioid crisis of any other state in the country, the opioid epidemic continues to devastate too many families and we will not rest until we put an end to it once and for all.”

The report also found a decrease in the number of hospitalizations for opioid-related overdoses. There were 3,029 hospitalizations in 2018, down 7.1 percent from 3,260 the year before. 

— And here are a few more good reads:

More than $12 billion is at stake for the nation’s health insurers Tuesday when the Supreme Court hears another Affordable Care Act case.
Fierce Healthcare

TRUMP TEMPERATURE

Tiny prison uniforms were replaced with T-shirts. Health care and schooling improved. Experts say there is still no safe way to incarcerate families.
New York Times

INDUSTRY RX

Merck and Sanofi, two of the world’s biggest drugmakers, struck multibillion-dollar deals aimed at bolstering their lineups in the fiercely competitive cancer-drugs market.
Wall Street Journal
Private equity firm Tiger Global Management has cut its valuation of e-cigaratte...
Reuters

REPRODUCTIVE WARS

National
Three people were killed in the shooting rampage and standoff in Colorado Springs
Mark Berman

MEDICAL MISSIVES

Sports
The viral challenge raised more than $200 million to help find a cure for Lou Gehrig's disease. “Pete was an inspiration to so many people around the world who drew strength from his courage and resiliency,” Frates’s family said.
Derek Hawkins
Health officials in the U.S. territory of American Samoa say they will begin mass measles vaccinations later this week.At a meeting Sunday, officials said the vaccinations would be given for seven days starting Friday. There are nine confirmed cases of measles in the island territory.
Associated Press

DAYBOOK

Today

  • The House Energy and Commerce subcommittee on health holds a hearing on universal health care coverage proposals.
  • The House Energy and Commerce subcommittee on oversight and investigations holds a hearing on the FDA’s foreign inspection program.

 

SUGAR RUSH