Congress’ health agenda barrels toward 2020 buzz saw

That would be fine with some well-financed interest groups still eager to influence the debate. Doctor Patient Unity — a dark money group largely funded by two private equity-backed physician staffing companies — was the most prominent of the outside groups to spend heavily to influence the surprise billing debate, dropping more than $53 million on ads over the last half of 2019 to attack a leading surprise billing fix, according to Advertising Analytics.

Congressional leaders blocked an effort to revive the legislation as part of a year-end spending package, instead setting a May deadline for lawmakers to work out an agreement.

“A lot of concerns were expressed” by health care interests since the Senate HELP Committee approved a surprise billing fix in June, said Sen. Tim Kaine (D-Va.). “You hold the patient harmless, but then you allocate the responsibility to providers and insurers. And maybe the allocation was a little more okay with the insurers than the providers. Now we’re back to work to see if we can calibrate it to hit the right balance in the allocation of responsibility.”

The new May deadline — tied to the expiration of funding for several health programs — should give House and Senate negotiators time to iron out the details of legislation that can speed through Congress and retain White House support, lawmakers involved said.

Yet it will also invite a fresh round of high-pressure lobbying that could test vulnerable lawmakers in the House, and give skeptics nearly five months to build a case against a compromise.

Speaker Nancy Pelosi in her end-of-year open letter to the House Democratic Caucus said a top 2020 priority is “ending the financial unfairness of surprise billing.” A senior House Democratic aide told POLITICO the letter was a message to the Energy and Commerce and the Ways and Means committees — whose jurisdictional battle over the issue helped derail any potential action in 2019 — to “figure it out and get this done.”

Senate Majority Leader Mitch McConnell, meanwhile, has not yet said whether he’d bring surprise billing legislation up for a vote, even if House and Senate negotiators reach a deal. Senate Democratic Leader Chuck Schumer of New York remains hesitant as well, amid intense pressure from his powerful home state hospital lobby.

“I’m going to do everything I can to keep surprise medical billing on the front burner between now and May,” said Senate HELP Chairman Lamar Alexander (R-Tenn.), who has made resolving the issue a top goal before he retires this year. “It’s a bill almost everyone wants passed, except a handful of people and the private equity firms that benefit from it.”

Congress faces an even bigger partisan gulf on drug pricing as Democrats and Republicans feature the issue prominently in their 2020 health care agendas. A bipartisan proposal negotiated between Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), the chairman and ranking member of the Finance Committee, has gained little traction despite backing from Trump administration officials, with party leaders more intent on accusing each other of inaction as they fight for control of the Senate in 2021.

Senate Republicans led by McConnell balk at a provision in Grassley and Wyden’s bill that would fine drugmakers that hike prices beyond the rate of inflation, deriding it as a path to price controls.

Leadership’s opposition to holding a vote has turned up the acrimony, with Grassley frequently taking to Twitter to try to enlist President Donald Trump’s help and Wyden repeatedly accusing McConnell of shielding the pharmaceutical industry.

Pelosi and top House Democrats, meanwhile, are insisting that any major drug price deal authorize the government to directly negotiate drug prices — a longtime liberal priority that’s a nonstarter with Republicans.

“My view is that if we don’t have negotiated prices, we’re not accomplishing much,” said House Energy and Commerce Chairman Frank Pallone (D-N.J.).