Course | Overview | Healthcare Reform

This course addresses the broad provisions of the Affordable Care Act (ACA) of 2010, CMS's proposed alternative delivery and payment models, and Standard Quality Measures.


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Course | Overview | Healthcare Reform

Next to national defense, the healthcare industry in the United States is one of the largest sectors of the economy. Currently making up almost 20 percent of the nation's gross domestic product, health care in the U.S. will be a significant...

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Trend | Healthcare Reform

What’s the outlook for prescription drug price legislation given the bipartisan efforts underway

Trend | Healthcare Reform

What’s the outlook for prescription drug price legislation given the bipartisan efforts underway


In the wake of three mass shootings in a single month — El Paso, Texas, Dayton, Ohio and Odessa, Texas — many advocates for U.S. gun law reform have expressed their frustration with legislative inaction by shouting a simple command to their public servants: “Do something!” That same blunt command to legislators could also apply to the issue of high prescription drug prices, which is sure to occupy center stage in discussions about healthcare in the 2020 presidential primaries as well as the general election.

According to a February 2019 Kaiser Family Foundation poll, 79% say the cost of prescription drugs is unreasonable, and 63% — including majorities of Democrats, independents and Republicans — think there is not as much regulation as there should be to limit the price of prescription drugs.[1]

Given such widespread public concern, what else is required to pass legislation to rein in prescription drug prices? In a word, it’s bipartisanship, within Congress and between the executive and legislative branches, given the current divided government.

On July 27, 2017, the late Sen. John McCain (R-Ariz.) dramatically cast the deciding vote against the “skinny” repeal of the Affordable Care Act. After McCain voted, he called for a return to “regular order” in the Senate, urging his colleagues to move toward compromise and an open legislative process.

“Our responsibilities are important, vitally important, to the continued success of our republic,” he said. “And our arcane rules and customs are deliberately intended to require broad cooperation to function well at all. The most revered members of this institution accepted the necessity of compromise in order to make incremental progress on solving America’s problems.” 

In his last speech before the Senate, McCain implored his colleagues, “Let the Health, Education, Labor, and Pensions Committee under Chairman Alexander and Ranking Member Murray hold hearings, try to report a bill out of committee with contributions from both sides. Then bring it to the floor for amendment and debate, and see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.”[2]

McCain’s plea may not have fallen on completely deaf, partisan ears. Ironically, there appears to be a green shoot of bipartisanship in a healthcare-related area. On July 23, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) introduced the Prescription Drug Pricing Reduction Act (PDPRA) of 2019, to lower the price of prescription drugs for Americans.

Senate Finance Committee Chairman Chuck Grassley, (R-Iowa) Senate Finance Committee Chairman Chuck Grassley, (R-Iowa)
Senate Ranking Member Ron Wyden, (D-Ore.) Senate Ranking Member Ron Wyden, (D-Ore.)

A lion of the Senate, Grassley has a long history of working with Democrats on prescription drug pricing issues, having introduced bills in collaboration with Sens. Dick Durbin (D-Ill.), Patrick Leahy (D-Vt.), Amy Klobuchar (D-Minn.) and Wyden, respectively.

The PDPRA was produced after months of bipartisan negotiations, and it addresses challenges in Medicare Parts B and D as well as Medicaid. Notably, the bill caps out-of-pocket drug costs for Medicare Part D participants and requires pharmaceutical companies to justify drug price increases to the Department of Health and Human Services (HHS).

In an opinion piece touting the PDPRA’s bipartisan basis, Grassley cites a Congressional Budget Office review estimating that the bill would lower government spending by $85 billion over 10 years and save Medicare beneficiaries $27 billion in out-of-pocket costs and $5 billion in premium spending over the same period.[3]

On July 25, the Senate Finance Committee voted the PDPRA out of committee favorably by a vote of 19-9, in a bipartisan manner, with all 13 of the committee’s Democrats and six Republicans voting for it.

Grassley and Wyden struck a realistic, somewhat modest tone about the bill, with the former calling it “a good start,” and the latter describing it as “the beginning of the debate,” according to an article by Politico.[4]

Politico also reports the optimism was tempered somewhat by Sen. Ben Cardin (D-Md.), who said of the bill, “It doesn’t solve the problem by any stretch of the imagination.” Cardin added that Democrats will seek to amend it, but he acknowledged that “it does some good things.”

The Trump administration, which greatly desires a political win on prescription drug prices, has also worked closely behind the scenes with the Senate Finance Committee on the PDPRA. Correspondingly, before the committee’s vote, HHS Secretary Alex Azar called Republican senators to encourage them to vote for the bill.[5]

So far, the PDPRA is following McCain’s playbook, with bipartisan sponsorship, a recognition that the bill is a work in progress, consideration of amendments, early collaboration with the executive branch and, above all, a spirit of compromise adopted by some in the Senate.

Even if the PDPRA ultimately does not make it through the gauntlet of both houses of Congress and presidential review, the way it has been drafted, introduced and debated serves as a refreshing reminder that bipartisanship is key to the functioning of the nation’s political system. 

[1] Kaiser Family Foundation, “Public opinion on prescription drugs and their prices,” July 15, 2019.

[2] Farrington, D., “Watch: Sen. McCain calls for compromise in return to senate floor,” NPR, July 25, 2017.

[3] Grassley, C., “Sen. Chuck Grassley: We can find areas of consensus when it comes to health care. Here’s proof,” Fox News,  July 26, 2019.

[4] Cancryn, A., and Owermohle, S., “Senate Finance pushes ahead on plan to address high drug prices,” Politico, July 23, 2019.

[5] Sullivan, P., “Azar calling GOP senators to back Grassley drug price plan,” The Hill, July 24, 2019.

 

About the Authors

Ken Perez

is vice president of healthcare policy, Omnicell, Inc., Mountain View, Calif., and a member of HFMA’s Northern California Chapter.

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