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Forget Medicare For All: Even Basic Fixes To The Health Care System Can’t Pass Congress

Members of Congress in both parties believe the American health care system is badly broken and needs reforms, but it appears likely nothing will be done any time soon.

Last updated on May 16, 2019, at 8:43 p.m. ET

Posted on May 16, 2019, at 5:38 p.m. ET

Speaker of the House Nancy Pelosi
Win Mcnamee / Getty Images

Speaker of the House Nancy Pelosi

WASHINGTON — You’d be hard pressed to find a single person in Congress who doesn’t say they want health reform. Americans continue to pay sky-high drug prices, insurance premiums are inflated, the number of people without health insurance is rising, surprise billing is rampant, and maternal mortality rates soar above the rest of the developed world.

But it is becoming increasingly probable that this Congress will not pass any significant healthcare legislation and the status quo will remain through the 2020 election.

House Democrats passed an extensive package of legislation Thursday to reduce drug prices and shore up health insurance markets, but they are already mourning the bill’s death.

The bill is hardly a Green New Deal-type suite of ambitious reforms. Parts of the legislation to increase generic drugs competition would, in a vacuum, win a lot bipartisan support. Only five Republicans joined all Democrats in passing the bill, 234-183.

But provisions to strengthen the Obamacare markets clash directly with the Trump administration’s policies. Few Republicans, if any, are expected to vote for it, and Democrats are already lamenting that Republican Senate Majority Leader Mitch McConnell will never put the bill to a vote in the Senate.

“No debate. No legislation. No votes. Leader McConnell has turned the Senate into a legislative graveyard,” said Senate Minority Leader Chuck Schumer.

Legislation passed through the House by Democrats has consistently died in the Senate for lack of ever being brought up. McConnell has promised to be “the grim reaper” for policies like Medicare for All and the Green New Deal, but that approach has extended to almost everything the House has passed. McConnell has repeatedly said he will not waste Senate floor time on bills the president will not sign into law. Meanwhile, bipartisan negotiations on fixing health insurance markets in the Senate remain hung up on abortion rules, as they have now for over a year.

Thursday’s House bill would :

- Prohibit brand name drug companies from paying off generic manufacturers to delay the release of a competing drug.

- Ban brand name drug companies from refusing to hand over to generic competitors drug samples needed for FDA approval.

- Prevent generic drug manufacturers from manipulating rules around periods of exclusivity to prevent competition.

It would also provide $200 million in federal funds to establish state-based health insurance marketplaces. Much of this has Republican co-sponsors. But the bill goes farther by reversing Trump administration’s policies expanding off-market insurance plans, and restoring enrollment funding cut by Trump. These provisions likely cost the Democrats wide bipartisan support, as Republicans have dismissed the bill as the “Obamacare Bailout Act.”

“Individually there’s some things in there I’m supportive of,” said Rep. Tom Reed, a Republican who has sided with Democrats on health care votes earlier this year. “But overall it appears to be more of a partisan exercise in regards to the Affordable Care Act provisions they’re lumping in there.”

The President has said his priority is tackling the high cost of prescription drugs, but this has already hit roadblocks. Democrats are pushing for legislation targeting drug manufacturers, while the White House wants to go after pharmacy benefit managers, who act as a middle man between manufacturers and customers. The two sides remain far apart.

The Senate ostensibly continues to work on a bill that could reduce Obamacare premiums by 20%. But Republicans want a rule that prevent any insurance plans receiving public subsidies from offering abortion coverage. Democrats call this a non-starter, and are pushing for the status quo, where insurers can carve out abortion coverage separately so that it does not receive government subsidies.

The abortion question first derailed a deal over a year ago. In recent days Sen. Lamar Alexander confirmed to BuzzFeed News that it remains the key sticking point.

That leaves surprise billing. Both parties agree that something needs to be done about the problem of people receiving massive bills for health services they thought was covered by their insurance network. This happens in cases such as a person going to an in-network hospital, but unknowingly being treated by a specialist who works at the hospital who is out-of-network.

Both the House and Senate are working on bills to ban surprise billing. The question is how. If you force the patient’s insurance company to cover the costs, how do you decide how much it must pay? There are different proposals, such as setting rates or sending the parties to arbitration. Each proposal causes winners and losers, which causes industry groups lobbying for things to go their way.

So far on the surprise billing problem when it comes to how to solve it, Democrats and the White House, once again, disagree.

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