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The Health 202: House GOP is preparing for a drug pricing fight

with Alexandra Ellerbeck

House Republicans are gearing up for a fight over a drug pricing proposal expected soon from the White House.

Their argument is this: It’s hardly the time to crack down on the pharmaceutical industry just as Americans are relying on coronavirus vaccines made by it.

This morning, three GOP committee leaders will go on the offensive with a bipartisan drug plan.

“Lower Costs, More Cures,” provided first to The Health 202, contains dozens of provisions with bipartisan support aimed at lowering the price of prescription pharmaceuticals. Most of the provisions are relatively minor, involving things such as expanding transparency or tweaking incentives, but the bill would cap what seniors pay out of pocket for Medicare drugs for the first time ever.

With the legislation, Republicans aim to show they’re willing to take incremental steps toward bringing down the cost of drugs — something that polls well with Americans — even as they and the pharmaceutical industry recoil at the ambitious moves expected in President Biden’s next big spending bill.

In that bill, Biden is expected to propose a top wish-list item for Democrats: Allowing the federal government to directly negotiate with drug companies for lower prices for certain drugs in the Medicare program. He’s likely to draw from H.R. 3, the drug pricing bill House Democrats passed at the end of 2019.

Republicans already hate the bill, but now they’ve got a new, pandemic-derived zinger.

H.R. 3 would have gotten in the way of drug companies developing treatments and vaccines for the coronavirus, Reps. Kevin Brady (Tex.), Cathy McMorris Rodgers (Wash.) and Virginia Foxx (N.C.) wrote in a letter they’re sending today to colleagues.

“If H.R. 3 were the law of the land before the pandemic, it would have hindered America’s private sector medical innovators from stepping up to help us beat the virus,” the trio wrote.

“It was bad policy then, and it’s even worse policy today for the hardworking people of this country who are seeking normalcy and an improved quality of life,” the letter says. “The pandemic has further proven we can’t let the Speaker’s government price control scheme stop the development of lifesaving cures and treatments.”

That argument seems dubious, considering the federal government has paid pharmaceutical companies billions of dollars for developing, manufacturing and distributing six different coronavirus vaccines.

However, H.R. 3 could lead to a modest reduction in the number of drugs coming to market in the future.

The Congressional Budget Office estimates around 38 fewer new drugs over the next two decades, due to reduced revenue for drug makers. The bill sets upper and lower limits for the price of certain drugs based on an index of prices in six other countries. The Health and Human Services secretary would negotiate prices with drug maker in between those limits.

To Republicans, that approach amounts to government price fixing. They warn it could hurt research and development incentives for U.S. drug makers, who lead the world in developing new products. But Democrats often note that other countries pay far less for drugs, benefitting from U.S. R&D while using government price controls to keep costs low within their borders (this is an argument former HHS secretary Alex Azar also made). 

This is a replay of the drug pricing debate 18 months ago.

Republicans previously introduced their “Lower Costs, More Cures” bill at the end of 2019, as a counter when Democrats were passing H.R. 3. 

Since then, former president Donald Trump signed 15 of the bill's bipartisan provisions into law. The measures largely make modest tweaks to how drugs are approved, regulated and paid for. One provision closed a loophole in which brand-name companies would block generic companies from getting the drug samples they need to make a lower cost version of the same drug.

Expect to hear Republicans talk about their bill a lot, but it won't go anywhere.

Of course, it's not certain Democrats will be able to pass parts of H.R. 3, either. Even if they use budget reconciliation, requiring just 50 votes in the Senate, they're operating on extremely narrow margins. And while allowing direct negotiations with HHS is likely to pass muster within budget reconciliation rules, other parts of the bill, including the international pricing index, might not.

Ahh, oof and ouch

AHH: Chuck Schumer celebrated marijuana yesterday.

The Senate majority leader called the day “an unofficial holiday” and used the occasion to make a case for federal legalization of marijuana, The Post’s Mike DeBonis and Colby Itkowitz report. Some marijuana enthusiasts celebrate April 20 as a folk holiday.

“It’s as appropriate a time as any to take a hard look at our laws that have overcriminalized the use of marijuana and put it on a par with heroin, LSD and other narcotics that bear little or no resemblance in their effects either on individuals or on society more broadly,” Schumer said.

White House press secretary Jen Psaki dodged a question on April 20 about whether President Biden would support congressional efforts to legalize marijuana. (Video: The Washington Post)

Schumer said criminal penalties for marijuana have disproportionately hurt people of color and that he is working on legislation with Sens. Cory Booker (D-N.J.) and Ron Wyden (D-Ore.) to legalize marijuana. While the bill could change federal laws on marijuana use, it is unlikely to undo state laws that restrict use.

But it's not clear the Biden administration will support congressional efforts to legalize recreational marijuana. White House press secretary Jen Psaki said the president supports decriminalizing marijuana and legalizing medical marijuana, but would leave decisions about recreational use up to the states.

OOF: Unaccompanied minors are spending weeks in government custody, even if they have U.S.-based parents.

Federal officials are struggling to respond to an unprecedented number of children and teenagers crossing the border without their parents. Many children are detained for weeks as their cases wind through an overwhelmed bureaucracy.

“The U.S. government has never had so many migrant teens and children in its care, with more than 20,000 held in Health and Human Services shelters and another 2,200 in border facilities waiting for shelter beds to open up,” The Post’s Maria Sacchetti and Nick Miroff report

More than 40 percent of the minors released by the government have at least one parent already living in the United States, but HHS has been taking 25 days on average to approve release and grant custody to the mother or father. 

HHS has acknowledged in court records that it is straining to add case workers, and many shelters are struggling to hire and retain staff members. The shortages have been so acute that HHS is asking federal workers, including those at NASA, the Federal Trade Commission and the Environmental Protection Agency, to deploy to the border and help perform case management duties.

OUCH: Vaccine-opposing Republicans are only becoming more skeptical.

While more than half of American adults have now received at least one dose of a coronavirus vaccine, more than 40 percent of Republicans have consistently told pollsters that they don’t plan to be vaccinated. A recent focus group of 17 Trump voters suggests that these vaccine holdouts may be becoming even more entrenched in their decision not to get a shot, The Post's Dan Diamond reports.

After a similar focus group convened five weeks ago, most participants were persuaded by pro-vaccine pitches from doctors, including Republican politicians, and former Centers for Disease Control and Prevention director Tom Frieden. This time, participants said that doctors’ urging had little impact on their decision.

A focus group of vaccine-hesitant Trump voters spoke about why they've avoided getting immunized against the coronavirus. (Video: Courtesy of Frank Luntz and de Beaumont Foundation)

“The further we go into the vaccination process, the more passionate the hesitancy is,” said Frank Luntz, a longtime GOP communications expert who convened Sunday’s focus group over Zoom. “If you’ve refused to take the vaccine this long, it’s going to be hard to switch you.”

Participants didn't seem influenced by regulators’ decision to suspend use of the Johnson & Johnson vaccine. Instead, they were worried about news that people may need additional booster shots; tired of hearing from Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; and did not want to feel bullied into getting a vaccine. 

More in coronavirus news

  • Public health experts say the United States still lacks a comprehensive national testing strategy and that basic questions about what kinds of tests to use and in what settings remain unanswered, Roll Call's Lauren Clason reports. A month-long study announced by the National Institutes of Health could help provide answers. Residents in two counties in North Carolina and Tennessee will get three free at-home coronavirus tests a week to gauge their effectiveness in reducing transmission.
  • Most Americans who haven’t received a shot say that they don’t plan to, according to an Axios-Ipsos poll. Of the unvaccinated adults, 2 in 3 told pollsters they were either “not likely at all” or “not very likely” to get the vaccine. Just 14 percent of unvaccinated Americans said they were likely to get the shot, The Post’s Derek Hawkins and Erin Cunningham report.
  • European regulators said the Johnson & Johnson vaccine may be linked to rare blood clots but that its benefits outweigh its risks. They placed no restriction on use of the vaccine within the European Union, The Post’s Michael Birnbaum reports.
  • A tidal wave of coronavirus cases is devastating India, which now accounts for a third of all global new cases. Experts say that changes in behavior and new variants are driving the spread of the virus, The Post’s Joanna Slater reports.

Biden's CMS nominee

Cornyn is placing a hold on Biden’s nominee to oversee Medicaid and Medicare.

Sen. John Cornyn (R-Tex.) indicated that the move was in response to the Biden administration’s decision to withdraw Texas’s Medicaid waiver last week, Stat News’s Rachel Cohrs and Lev Facher report.

The procedural roadblock is unlikely to stop the nomination of Chiquita Brooks-LaSure, Biden’s pick for administrator of the Center for Medicare and Medicaid services, although it could slow it down. In practice, Senate Majority Leader Chuck Schumer (D-N.Y.) can decide how long to honor Cornyn’s hold.

The Biden administration on April 15 told Texas that it was rejecting the state's $100 billion Medicaid extension request, which was approved in the final weeks of the Trump administration. Officials said that the request had not gone through the proper rulemaking process. The decision was seen as an effort to pressure Texas to expand Medicaid, The Post’s Dan Diamond reported last week.

“I’m going to hold her nomination until we can sort something out,” Cornyn said. “This is our basic safety net for health care in Texas, and for the administration to pull the rug out from under us like that is just unacceptable.”

Hospital bills

The University of Virginia Health System will cancel a backlog of liens over unpaid medical bills.

“UVA had been suing patients for decades, many with unpaid bills in the tens or hundreds of thousands of dollars, KHN (Kaiser Health News) reported in 2019. Once the health system won cases in court, it could seize wages and the value of patient homes when they were sold,” Kaiser Health News’s Jay Hancock reports.

The health system will release all judgments and liens against households making less than 400 percent of the federal poverty level, about $106,000 for a family of four. The liens can drain home equity years after a hospital visit, and the move is likely to benefit tens of thousands of families. The hospital will still use courts to recover money from wealthier patients, and those who have already surrendered money as the result of a judgment or lien will not get it back.

Sugar rush