This story previously appeared in The Hill Extra.
The future of the Affordable Care Act will be the legislative battle looming over all work in the new session.
That’s raising some worry from interest groups and lawmakers that the highly partisan atmosphere will spill over into other “must pass” healthcare bills — like pharmaceutical and medical device user fees and the Children’s Health Insurance Program (CHIP) — which usually enjoy bipartisan support. Both sides agree ObamaCare repeal will make other health priorities more complicated.
“In the first few months, the ACA battle will suck the air out of everything, and then we’ll look and see what we can do” for some of the must-pass bills, Rep. Gene Green (D-Texas) told The Hill Extra. Green is ranking member of the Energy and Commerce health subcommittee.
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“I hope in our committee, we do try to work bipartisan, but I know [Republicans’] goal is to abolish the Affordable Care Act,” he said.
Still, members will have to put aside ObamaCare, which might not be so easy. Feelings are still raw from 2010, when the ACA was passed without Republican votes.
Rep. Bill Flores (R-Texas), chairman of the Republican Study Committee, said he wants to give Democrats more input in an ACA replacement than Republicans got in the original.
“They basically flipped Republicans the finger throughout the entire ObamaCare process and it didn’t work out well for them, so we’ll give them a chance to have input,” Flores said. “If they take it, it can be constructive, and hopefully it will help the process. If they want to be obstructive they’ll have to deal with what the American people tell them in 2018.”
Aside from CHIP and FDA user fees, drug pricing will continue to be a headline issue in Congress in 2017, but Republican divisions suggest meaningful changes will be hard to come by.
Senate Republicans, especially Sens. Susan Collins (R-Maine) and Chuck Grassley (R-Iowa), seem eager to try to find a way to stem the rising cost of prescription drugs.
“Initially all the oxygen will be sucked up by overhaul of ACA, but ultimately we have to do something about the spiraling cost of healthcare,” Collins told The Hill Extra.
Collins is the chairwoman of the Senate’s Special Committee on Aging, which recently released a bipartisan report reviewing millions of pages of documents obtained from four drugmakers: Turing Pharmaceuticals, Retrophin Inc., Rodelis Therapeutics and Valeant Pharmaceuticals.
She said she’ll try to bring up drug pricing bills during ObamaCare replacement discussions.
Still, she acknowledged it will be difficult enough to craft a replacement “that has a sufficient transition time to ensure individuals who have been reliant on subsidies, who are getting insurance for the first time in their lives, don’t end up falling through the cracks.”
House Republicans, though, don’t seem to have the same priorities as their Senate colleagues.
“We’re not really into that fight,” John Shimkus (R-Ill.) told The Hill Extra. “We want to do it through innovation, through competition, make sure generics get a quick pathway, make sure biosimilars get to the market quicker and fight that competitive prices that way. We’re not going to do any price controls.”
Rep. Fred Upton (R-Mich.), former chairman of the Energy and Commerce Committee, said he thinks the recently passed 21st Century Cures Act is all the legislation needed to bring down drug costs. The law is intended to make it easier for innovative drugs to get on the market.
“By being able to streamline the [approval] process, and yet maintain the safety, we think the costs to research will be less, which ultimately will bring the prices down, bring downward pressure on the price of both drugs and devices, so that’s a good thing,” Upton said.
House Democrats are limited in what issues they can bring up, but lawmakers said they will try.
“We need to do something about drug pricing, and there’s a growing chorus of experts and citizens who want it, but I think it’s going to be difficult to do with a Republican House and Senate,” Rep. Diana DeGette (D-Colo.) said.
“We will talk about drug pricing, but the majority will set the tone,” Green said. “You’ll hear us [Democrats] talk about the high prices of pharmaceuticals.”
The current legislative authority for user fees that fund the Food and Drug Administration’s review of drugs and medical devices expires at the end of the fiscal year, as does the funding for CHIP.
Without new user fee legislation, the FDA won’t be able to collect industry-paid user fees for future fiscal years to fund the drug and medical device review processes.
The legislation is considered must-pass because lawmakers don’t want to force the FDA to lay off employees. It’s also an opportunity for the industry to lobby for policy changes.
Talks over the bill, though, won’t answer all of the big questions. Those include how Medicare negotiates its drug prices or how manufacturers calculate cost. But the bill could affect how the FDA operates and how quickly generics come to market.
For CHIP, the must-pass nature of the program is a potential roadblock to a clean reauthorization. Congressional Republicans aiming to change Medicaid or Medicare could attach measures to a CHIP reauthorization package.
But Democrats are likely to fight back, accusing Republicans of playing politics with children’s health. The potential for political backlash could make GOP lawmakers wary of using CHIP legislation to push Medicaid and Medicare changes.
“I just don’t think anybody will successfully be able to hold CHIP hostage,” Jennifer Walsh, a public affairs director with Foley & Lardner LLP, said. “Generally members will want to get [CHIP] taken care of pretty quickly. So, anyone who tries to hold CHIP hostage for sake of ACA-related changes, that’s a political problem, and I don’t think Republicans would want to see that happen.”
According to a 2015 Medicaid and CHIP Payment and Advisory Commission report to Congress, if federal CHIP funding is not renewed and states exhaust their federal balances, approximately a third of all children in the program — 1.1 million — would become uninsured.
The remaining two-thirds of the children covered in CHIP could move to exchange coverage or their parents’ job-based insurance. However, if Congress successfully dismantles the federal exchanges, the only other option for those children is CHIP.
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