Republicans, Democrats, and President Trump have a chance to pass legislation to lower healthcare costs, but risk squandering the opportunity because of the tight timeline this fall and organized opposition.
A bipartisan group of senators returning to Capitol Hill this week will resume work on bills they advanced at the committee level before the summer recess that would address the high cost of prescription drugs for seniors and curb massive unexpected medical bills patients get after they leave the hospital.
If the bills pass, they would provide members of Congress with evidence to present to voters ahead of the 2020 election that they were able to log bipartisan victories. Alternatively, it could be perilous for Democrats to appear to hand Trump a victory on issues he has promised to address — the White House has said that lowering healthcare costs is a priority.
"The time is certainly now for action — this is the window," a senior GOP congressional aide said in an email.
But Congress is likely to struggle to find time to pass the legislation in the fall, with just three weeks of work in September before another break.
House leaders want to vote on temporary spending bills in September, and Democrats are pressuring Republicans to pass gun-control measures after a string of mass shooting this summer. Senate Minority Leader Chuck Schumer did not list high healthcare costs in a letter he sent to senators about the priorities for the chamber. He instead cited gun control and election security, among other issues.
On healthcare specifically, Democrats want to put pressure on Republicans for their efforts to overhaul Obamacare. The Trump administration has sided with state GOP officials in a lawsuit that threatens to invalidate the healthcare law, a stance that a senior House Democratic aide confirmed would be a "major focus" of criticism for the caucus.
Democrats also want to bring attention to actions the Trump administration has taken to allow states to provide plans that wouldn't cover all of the same rules as Obamacare, including requirements to cover pre-existing conditions.
Senate Majority Leader Mitch McConnell has not pledged to bring the committee-passed bills lowering healthcare costs to the floor. And the long recess provided lengthy time for outside industry groups to lobby members of Congress to oppose the legislation. While the bills are intended to help patients, they do so through having medical groups take the financial hit instead.
One of the bills, the Lower Health Care Costs Act advanced by the Senate Health, Education, Labor, and Pensions Committee, would curb the problem of surprise medical bills — which affect 1 in 6 patients who go to the hospital — by setting a benchmark payment on what hospitals are allowed to charge.
Several lawmakers on both sides of the aisle want to add a provision to that rule that would give hospitals or insurers the option to appeal the amount to an independent arbiter as a backstop in case there's an issue with the pricing. The arbitration idea was crafted by Republican Bill Cassidy of Louisiana and Democrat Maggie Hassan of New Hampshire, whose bill had 25 other supporters. It's not clear whether the bill would have enough support from the full Senate without the arbitration piece.
Outside conservative groups sent a letter pleading with McConnell in August to ditch the HELP legislation, as well as encouraging him to oppose the arbitration idea, saying they would result in "government rate-setting" and "price controls." Doctor and hospital groups oppose the bill as it is now.
The House Energy and Commerce Committee passed the No Surprises Act in July, which is similar to the HELP bill but adds the arbitration piece. If it passes the full House and senators don't make changes to their bill, then members will have to negotiate differences in conference.
Greg Walden of Oregon, the top Republican on the committee, said lawmakers must move ahead.
"We will not allow misleading attacks to distract us from our bipartisan, bicameral efforts in Congress to end surprise billing and protect patients,” he said in a statement, referring to work by outside groups to torpedo the efforts.
The legislation is already behind schedule from what HELP leaders had hoped. Several months ago, they said they wanted a bill to head to Trump's desk ahead of the August recess. The bill could still be combined with must-pass government funding bills in September to expedite passage.
The issue of drug prices is even more controversial. While a bill advanced out of the Senate Finance Committee in July, called the Prescription Drug Pricing Reduction Act, it almost didn't pass because of Republican opposition.
The bill would cap what people on Medicare pay for drugs at $3,100 a year beginning in 2022 and would cap drug costs by forcing drug companies to give rebates to Medicare if they increase their prices above inflation, among more than two dozen other provisions.
It's not yet clear what its path would be in the House, where Democrats control the chamber and would like the government to impose more controls over prices and the extent to which drug companies are allowed to keep exclusivities on medicines.
House Democratic leaders are expected to unveil a drug pricing bill this month. They potentially will face a split among their ranks, however, as members of the Congressional Progressive Caucus seek to ensure that the legislation will adequately go after the pharmaceutical industry.
“We continue to engage members across the caucus as the committees of jurisdiction work to develop the boldest, toughest possible bill to lower prescription drug prices for all Americans," said Henry Connelly, a spokesman for House Speaker Nancy Pelosi.
(Note: This article originally appeared in the September 9, 2019 edition of The Washington Examiner.)