with Paulina Firozi

THE PROGNOSIS

The door has officially closed for Congress to pass major legislation in 2019 lowering drug and health-care costs. But it might open again in five months. 

Call it the drug pricing fiscal cliff. 

In a $1.3 trillion spending deal to keep the government open past Friday, Congress will fund community health centers and other ongoing health-care programs only until May. 

The idea is effectively set another deadline for lawmakers to act to keep essential health services going. This could help them muster enough support to tack on the tricky and controversial drug pricing and surprise billing legislation that has eluded them thus far.

There are some reasons the strategy might work. And there are plenty of reasons it might not.

Many of Congress’s proposals to lower drug prices would save the government money, including Senate Finance Committee legislation requiring rebates from drugmakers who hike prices faster than inflation. These savings could help pay for extending these health programs when their funding is now due to expire on May 22.

But by then, we'll be five months before Election Day and well into a heated campaign season in which Democrats will be loath to give President Trump any achievements to tout on the campaign trail. House Speaker Nancy Pelosi (D-Calif.) could use the deadline as a political opportunity to tout Democrats’ passage last week of their own drug pricing bill while characterizing Republicans as inactive on the topic.

The punt on an issue voters say they want tackled is disappointing for patient advocacy groups. 

“Because Congress kicked the can, a patient tonight will skip their dose, a patient will leave their prescription at the pharmacy counter because of the price,” Ben Wakana, executive director of the advocacy group Patients for Affordable Drugs, told me. “Congress had a chance to fix it and they didn’t.”

The spending deal — which Congress is racing to pass this week — does contain some major advances on the health policy front. Perhaps most notably, it would ban sales of tobacco products to anyone under 21, including both e-cigarettes and traditional cigarettes. 

Senate Majority Leader Mitch McConnell (R-Ky.) first introduced the measure last spring, and Trump also supports it — although some advocates fear the administration will use it as an excuse to abandon its promised crackdown on vaping.

Known as “Tobacco 21,” the effort “is partly designed to reduce teens’ ability to get e-cigarettes from older friends or acquaintances,” my colleagues Laurie McGinley and Yasmeen Abutaleb report. “Federal regulators have said that ‘social access’ is the most common way for kids to get vaping products.”

The Washington Post’s Paul Kane: 

The deal also fully repeals three taxes created to pay for the Affordable Care Act that industry has been fighting tooth and nail for years. They include an unpopular tax on medical devices, a tax on health insurance plans and the “Cadillac tax on high-cost plans. Congress has previously delayed or suspended the taxes multiple times.

And the spending deal would allow federal research on gun violence for the first time in more than 20 years, as The Post’s William Wan reports

The deal would send $25 million to the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence. Under a 1996 rule known as the Dickey Amendment, the CDC was prohibited from funding research that could be used to advocate for gun control — which had a chilling effect on gathering data on gun violence.

The deal does include a single provision aimed at lowering the cost of drugs, a piece that is part of the Senate Finance package. It’s based off the Creates Act, a bill that would prevent branded drugmakers from guarding their medications so other companies can’t develop alternatives. 

There’s broad support for this provision, as it could speed the development of cheaper generic medications. But its effects would take years to play out, far from the speedy response patient advocates want to see from Congress.

And what Congress excluded from the funding deal is just as interesting as what it included. There’s a big, glaring hole where lawmakers had hoped to put significant legislation lowering drug prices and protecting consumers from surprise medical bills when they receive care outside their health plan’s network through no fault of their own. 

Surprise billing reforms have been a top goal for House and Senate committees, which have rolled out multiple bipartisan proposals for how insurers and hospitals should settle out-of-network bills. But the whole issue has been caught up in an intense lobbying and advertising effort by doctors and hospitals, who are angling for a solution that will help their bottom line.

The New York Times’s Sarah Kliff: 

Sen. Lamar Alexander (R-Tenn.) has been the Senate’s point person on surprise billing legislation, while Sen. Charles E. Grassley (R-Iowa) is the cheerleader for drug pricing. Their measures are likely to rise or fall together. For now, they’re both stuck with a big question mark for 2020.

“I will continue to do everything I can to keep surprise medical bills at the top of the congressional priority list until it’s done,” Alexander said on the Senate floor yesterday.

AHH, OOF and OUCH

AHH: The Trump administration is extending the deadline by two days for enrolling on HealthCare.gov. It had been pressured to do so by advocates, Democratic lawmakers and presidential candidates after some shoppers experienced technical issues with the website over the weekend. The deadline to enroll will now be Dec. 18. 

The Centers for Medicare and Medicaid Services said the move was out of an “an abundance of caution, to accommodate consumers who attempted to enroll in coverage during the final hours of Open Enrollment but who may have experienced issues.” 

“Consumers on Sunday reported technical glitches signing up on the federal site, healthcare.gov, and an inability to reach a representative to help by phone,” the Wall Street Journal’s Stephanie Armour writes. “Sign-up deadlines are later in many of the states that don’t use the federal platform, so final enrollment tallies won’t be available for some time. The pace of sign-ups tends to be more robust in these states, which also direct more funding to outreach and marketing.” 

CMS said some consumers were asked to leave their names at a call center while shopping on Sunday, as more than half a million consumers enrolled throughout the day. “Those consumers who have already left their contact information at the call center do not need to come back and apply during this extension because a call center representative will follow up with them later this week,” the agency said in a statement.

Ahead of the deadline extension, former president Barack Obama urged people to sign up for plans: 

— Meanwhile, Rep. Alexandria Ocasio-Cortez (D-N.Y.) complained about the dozens of insurance options she has as a member of Congress. Lawmakers have access to generous coverage plans that are heavily subsidized by the federal government.

OOF: Kentucky’s new Democratic Gov. Andy Beshear announced he will drop the state’s Medicaid work requirement, nixing the controversial plan from the former Republican governor to require low-income residents to work to maintain coverage.

“In one of his first major moves as the 63rd governor of Kentucky, Beshear signed an executive order Monday rescinding Bevin’s Kentucky HEALTH plan, which sought to impose strict work requirements for able-bodied, working-age adults. It would have ended health coverage for an estimated 95,000 Kentuckians,” the Lexington Herald Leader’s Alex Acquisto reports.

During his Monday announcement, Beshear said: “Rescinding this waiver is not only the right thing to do, it is the moral, faith-driven thing to do.” He also praised those who had brought a legal challenge against the work requirements. “You did the right thing, and we appreciate you for doing that,” he said, according to the Herald Leader. 

OUCH: A new audit found Purdue Pharma’s payments to its owners, members of the Sackler family, spiked as the opioid crisis intensified.

In the past dozen years, the family directed more than $10 billion from the company to the family’s trusts and overseas holding companies, the New York Times’s Jan Hoffman and Danny Hakim report.

The new findings — part of a 350-page report commissioned by the company and prepared by consulting firm Alix Partners — are “likely to renew questions about how much the Sacklers should pay to resolve more than 2,800 lawsuits that seek to hold Purdue accountable for the opioid crisis,” they write. 

“Overseas transfers have been a source of inquiry by the New York state attorney general and other states seeking information about where the billionaire Sackler family moved Purdue profits over the past decade,” our Post colleague Christopher Rowland reports. “... One set of overseas cash transfers of $312 million came in 2017, the same year states and counties began filing lawsuits against the company, accusing it of stoking America’s opioid epidemic with misleading marketing, according to the report. But the money was subsequently characterized as a loan and paid back to Purdue, the report said.”

Daniel Connolly, an attorney for part of the family, including former Purdue Pharma board chairman and president Raymond Sackler, said the distribution amounts “have been public for months, and this filing reflects the fact that more than half was paid in taxes and reinvested in businesses that will be sold as part of the proposed settlement.’’

In a statement, New York attorney general Letitia James said the audit’s findings highlight why it’s critical to understand details of the family’s worth.

“The fact that the Sackler family removed more than $10 billion when Purdue’s OxyContin was directly causing countless addictions, hundreds of thousands of deaths, and tearing apart millions of families is further reason that we must see detailed financial records showing how much the Sacklers profited from the nation’s deadly opioid epidemic,” James said. “We need full transparency into their total assets and must know whether they sheltered them in an effort to protect against creditors and victims.”

HEALTH ON THE HILL

— Sen. Elizabeth Warren (D-Mass.) has been using the term “choice” during recent campaign stops to describe her plan for transitioning into Medicare-for-all, which CNN’s Daniella Diaz and Maeve Reston write is a “notable rhetorical shift on Warren’s part after her moderate Democratic rivals — namely South Bend, Indiana, Mayor Pete Buttigieg — have criticized her plan that would eventually eliminate private health insurance.” 

Warren told reporters, when asked about the shift, that she was “just talking about the plan.” She has been describing her transition phase into Medicare-for-all as “choice” that allows Americans to try the system, they add. 

“Let’s let people try it,” Warren said during a stop in Iowa, according to CNN. “Find out what it feels like to be making healthcare decisions just between you and your medical professional to get the prescription drugs you need without having to worry about how big the copay is going to be, and whether or not you’re going to be able to get the prescription filled and still have enough money left over to buy groceries this week. ... When tens of millions of people have had a chance to try that, I believe, at that point, we’re going to be ready to vote for Medicare for everyone.”

— Andrew Yang has released a public-option health-care plan that seemingly moves away from his initial support for Medicare-for-all, NBC News’s Julia Jester reports.

The Democratic presidential candidate’s campaign website has listed Medicare-for-all as one of his “3 Big Policies.” But his newly released plan looks at “ways to reduce the burden of healthcare on employers, including by giving employees the option to enroll in Medicare for All instead of an employer-provided healthcare plan.”

The new plan looks similar to what’s been proposed by former vice president Joe Biden and by Buttigieg. 

The single-payer proposals from “candidates like Sens. Bernie Sanders, I-Vt., and [Warren] envision a landscape where private insurance is rendered obsolete. Yang has changed his stance on Medicare for All over recent months, but has maintained support for keeping private insurers if they can compete in the market,” Julia writes. 

“To be clear, I support the spirit of Medicare for All, and have since the first day of this campaign. I do believe that swiftly reformatting 18% of our economy and eliminating private insurance for millions of Americans is not a realistic strategy, so we need to provide a new way forward on healthcare for all Americans,” Yang writes on his website. 

— And here are a few more good reads: 

AGENCY ALERT

INDUSTRY RX

STATE SCAN

DAYBOOK

Today

  • The Senate Judiciary Committee holds a hearing on the opioid crisis. 

 

SUGAR RUSH

Rep. Jeff Van Drew (D-N.J.), an anti-impeachment Democrat, is expected to switch parties following a private meeting with President Trump on Dec. 13. (The Washington Post)