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Analysis

Healthcare Bills Abuzz in the House, Not So Much in the Senate

By MedPage Today  
   May 21, 2019

A few areas may see action yet, experts say, even as the Senate has become 'a legislative graveyard.'

This article was published May 20, 2019, by MedPage Today.

By Joyce Frieden, News Editor, MedPage Today

WASHINGTON — House members seem to be passing healthcare legislation at a fairly good clip these days, but their counterparts in the Senate don't appear to be in any hurry to take up the bills.

As of mid-May, according to a report from David Bernstein at public radio station WGBH, the Senate has passed only 27 bills so far this session, and only 17 have become law; of those, two received roll call votes while the rest were passed on voice vote or unanimous consent. The House, meanwhile, has passed a total of 227 bills, including 10 on healthcare.

Congressional Democratic leadership has taken note. "The American people want us to protect their healthcare," said Senate Minority Leader Chuck Schumer (D-N.Y.) at a press conference held last week by House and Senate Democrats. "The new Democratic majority in the House has taken action and passed bills to ... further protect Americans with preexisting conditions and help Americans get better drug coverage. The Republican-led Senate: no movement, nothing—no debate, no legislation, no votes."

Senate Majority Leader Mitch McConnell (R-Ky.) "has turned the Senate into a legislative graveyard and buried this bipartisan legislation to improve Americans' health," Schumer continued. "We ask, what is he so afraid of? The issue is too important to too many Americans ... it's time for Leader McConnell to restore the Senate to the legislating body it once was, and there's no better place to start than healthcare."

Rep. Annie Kuster (D-N.H.), co-sponsor of a House-passed bill that would revoke Trump administration guidance encouraging states to allow the sale of less-expensive health insurance plans that don't cover preexisting conditions, said it was "time for Mitch McConnell to bring our legislation to the Senate floor and put the American people ahead of your partisan agenda."

McConnell's office didn't respond to a request for comment on the issue, but several analysts said this level of inaction wasn't of much concern. "Many of the bills coming out of the House are setting a marker for the election or trying to embarrass the opposition and are not intended to be enacted," said Gail Wilensky, PhD, senior fellow at Project HOPE, in Bethesda, Maryland, in an email.

Joe Antos, PhD, scholar in healthcare and retirement policy at the American Enterprise Institute, a right-leaning think tank here, agreed. "Let's not forget that the House is run by the Democrats, so they aren't sending bills to the Senate in the spirit of bipartisanship. They want to be able to claim that Republicans and McConnell in particular stopped really great policies—denoted by nice titles for legislation regardless of the actual content," he said in an email. In addition, "McConnell doesn't want to send anything to Trump that he won't sign. So there's no point in going through the committee process for most bills."

Elizabeth Carpenter, leader of the policy practice at Avalere, a healthcare consulting firm here, said in a phone interview that the congressional session "is unfolding as people would expect ... globally, major activity on Capitol Hill over the past several years has really happened [during] spending discussions or budget debates, and I think we're going to see the same thing this year."

There are some bright spots in the picture, the experts said. "The primary healthcare bill that has the best likelihood of enactment by both houses is legislation to limit 'surprise billing,'" Wilensky said, referring to the phenomenon in which patients go to an in-network hospital for a procedure but end up being treated by providers who are out of network, leading to unexpectedly large bills. "Even here, the challenge will be whether and how to pay physicians that are not part of the hospital's network, especially those that the patient doesn't actively choose."

Rodney Whitlock, PhD, of McDermott+Consulting, told MedPage Today in an email that McConnell likes to let his committee chairs—like Lindsey Graham (R-S.C.), of the Senate Judiciary Committee; Lamar Alexander (R-Tenn.), of the Senate Health, Education, Labor, & Pensions Committee; and Chuck Grassley (R-Iowa), of the Senate Finance Committee—take the lead.

"They are working on drug pricing, surprise billing, cost containment, and other health pieces. The Senate will work its will," said Whitlock.

Surprise billing and drug pricing may have a chance, "but would [House Speaker Nancy] Pelosi (D-Calif.) want to give Trump a platform to claim credit?" said Antos. "Maybe this year, but time is already growing short."

And, "since Trump is said to start his campaign in a few weeks, that seems like the end of serious legislation for the foreseeable future," he added. "Legislation giving more money for an anti-addiction campaign might also have a chance, but only if there isn't something else added that would drive away Republican votes."

Indeed, the election will be figuring into everyone's next moves, Carpenter said. "The closer we get to 2020, the more every decision made in D.C. will be based on how it impacts the election. Democrats, between now and the end of the year, face a choice on whether to work with the president or Republicans on anything healthcare-related that the president can then sign and claim credit for."

One area the Senate is not likely to do anything with is the Affordable Care Act (ACA), said Sabrina Corlette, JD, research professor at Georgetown University's Center for Health Insurance Reforms here. In addition to the House bill on "junk" insurance plans, the House passed a bill last week that would grant funds to states newly interested in setting up their own ACA insurance exchanges and would restore funding for ACA outreach that has been cut by the Trump administration.

"I don't see any urgency in Senate to take up those bills," Corlette said in a phone call. "Some of that is political—there is still a section of the Republican party that's like, 'Let's repeal the ACA root and branch,' and nothing will move them from that position. But there is also just a lack of urgency because the [ACA] markets, although a year or two ago there was serious concern insurers would drop out and prices would skyrocket—that concern has lessened somewhat. Insurers are staying in, even expanding their footprint, and prices are likely to stay fairly level in 2020 as they did this year, so we're not seeing external pressure in the Senate to take those bills up."

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