Much rides on who controls the Senate
If Democrats gain control of the upper chamber, Senate Minority Leader Chuck Schumer (D-N.Y.) would take on an outsize role shaping health policy. In his home state, Schumer has a fierce hospital lobby to contend with, and he’ll likely weigh its concerns in any debate over healthcare prices or a public insurance option.
“He would likely make sure the provider rates aren’t pegged to Medicare, and the rates are not draconian,” Capitol Street Managing Director Ipsita Smolinski said.
It’s unclear where Schumer would fall on prescription drug pricing, specifically supporting a price negotiation mechanism like the one championed by House Speaker Nancy Pelosi (D-Calif.). Senate Democrats voiced dissatisfaction with a bipartisan drug-pricing package assembled this year that didn’t allow Medicare to negotiate prices with drugmakers.
Schumer would also have to decide whether to accede to progressive Democrats’ demands to eliminate the filibuster and let legislation be passed without minority party support. The filibuster is “hugely important for healthcare, especially for partisan issues like drug-price negotiation or healthcare coverage,” said Matt Kazan, a senior health policy adviser at Avalere Health who was a Senate Finance Committee aide for more than a decade.
Shakeups at two key committees
Regardless of the power balance in the Senate, two committees with jurisdiction over healthcare will see major leadership shakeups.
If Republicans retain control, Senate Finance Committee Chair Chuck Grassley (R-Iowa) has reached his term limit for leading the committee, so he will be instead retake the helm of the Senate Judiciary Committee. Sen. Mike Crapo (R-Idaho) is the likeliest senior committee member to take over, though he would have to give up his post as chair of the Senate Banking, Housing and Urban Affairs Committee.
Crapo indicated some of his healthcare views when he introduced a drug-pricing package compiled by House Republicans as an alternative to the bipartisan compromise co-authored by Grassley. Many conservatives objected to a policy Grassley pushed that would require drugmakers to pay back Medicare if they raise prices faster than inflation. “Almost overnight the default Republican position on some pretty significant Medicare Part D policies changes,” Kazan said.
Ranking Democrat Ron Wyden (D-Ore.), who would likely assume the chairmanship if Democrats prevail, is engaged on healthcare and has participated in negotiations with Grassley.
Health committee
The future of the Senate Health, Education, Labor and Pensions Committee is less clear-cut, as Chair Lamar Alexander (R-Tenn.) is retiring. If the GOP retains control of the Senate, the next committee member in the line of seniority is Sen. Richard Burr (R-N.C.). However, Burr is under investigation for insider trading in the early days of the COVID-19 pandemic, and resigned his chairmanship of the Senate Select Committee on Intelligence.
North Carolina is a major pharmaceutical and biotechnology hub, and Burr is generally seen as a friend to industry interests. He pushed for repealing the Affordable Care Act’s medical-device tax and for the FDA to speed its approval process.
Sen. Patty Murray (D-Wash.), the panel’s ranking member, has worked closely with Alexander on healthcare issues, including healthcare contracting and surprise billing.
The Senate health committee also has jurisdiction over the FDA, which will be critical as the agency navigates approving vaccines and therapeutics to combat COVID-19.
The House of Representatives is likely to remain under Democratic control, but Appropriations Committee Chair Nita Lowey (D-N.Y.) is retiring. Appropriations health subcommittee Chair Rosa DeLauro (D-Conn.) is one of the top contenders for the powerful perch. DeLauro would likely support party leadership positions on coverage or drug-pricing legislation and prioritize women’s health issues, Smolinski said.