Congress set to attack costs of health care

WASHINGTON — Lawmakers are trying to set aside their irreconcilable differences over the Obama-era Affordable Care Act and work to reach bipartisan agreement on a more immediate health care issue: lowering costs for people who already have coverage.

Returning from their holiday recess, the Senate and House are pushing to end surprise medical bills, curb high prices for medicines and limit prescription copays for people with Medicare.

Partisan disagreements could derail the effort, but lawmakers fear the voters’ verdict in 2020 if politicians have nothing to show for all their handwringing about drug prices. President Donald Trump also has political exposure because the big price cuts he promised haven’t materialized. On Friday, he promised an executive order that he said would enable the U.S. government to pay lower prices for prescription drugs. The U.S. would pay no more than the lowest amount paid by other nations or companies, he said.

“Frankly, the issue is so urgent for Americans who are facing increasing drug costs that, to us, it’s really not about who gets the credit,” said Rep. Diana Degette, D-colo., who serves on the House Energy and Commerce Committee, which has a role in shaping the legislation. “It’s about what kind of relief we can give to consumers.”

In the Senate, Republican Lamar Alexander has shepherded bipartisan legislation on surprise medical bills through the Health, Education, Labor and Pensions Committee that he leads. That bill also would raise the legal age for buying tobacco products to 21.

“What we’ve done is shift our focus to the larger topic — or the different topic — of reducing health care costs,” Alexander said.

The Senate seems to hold the keys to what can pass because Republicans and Democrats have to work together to avoid gridlock on the Senate floor. A look at some of the major pieces:

• Medicare drug negotiations. House Democrats are pushing for a floor vote on authorizing Medicare to directly negotiate prescription drug prices. Legislation from Rep. Lloyd Doggett, D-texas, would empower the government to license generic competition if the manufacturer of a brandname drug refuses to deal.

• Medicare “inflation rebate.” Senators of both parties and key representatives are looking at requiring drugmakers to pay rebates to the government if medication prices covered by Medicare rise faster than inflation.

That wouldn’t solve the problem of high initial “launch” prices for brand-name drugs, but it could restrain cost increases for long-available medications such as insulin. Democrats say it could be a fallback if they’re not able to get Medicare negotiation authority.

• Limit on Medicare drug copays. “Part D” prescription drug benefit currently has no limit on out-of-pocket costs paid by patients, which means beneficiaries taking very expensive medications may wind up with copays rivaling a mortgage payment.

• Surprise medical bills. Alexander’s committee has approved legislation that would hold patients harmless from “surprise” out-of-network bills that can run to tens of thousands of dollars.