Healthcare industry groups spent considerable time and money this year lobbying members of Congress on two hot-button issues: surprise billing and drug pricing. It's likely that the debate will continue into the election year and the next Congress.
According to data from the Senate Office of Public Records, the list of the 25 biggest spenders in health lobbying as of Sept. 30 is largely composed of pharmaceutical companies and trade associations, including top spender Pharmaceutical Research and Manufacturers of America with $22.5 million in the first three quarters of 2019. Biotechnology Innovation Organization spent $9.1 million over the same period.
"Given the numerous pieces of legislation currently in front of Congress that could severely impact science and innovation, our top priorities here at BIO will continue to be protecting the environment that sustains biomedical innovation and ensuring patients have access to the medicines they need with out-of-pocket costs they can afford," BIO spokesman Andrew Segerman said.
One measure BIO is working on is the Senate's bipartisan, White House-backed drug pricing bill, the Prescription Drug Pricing Reduction Act. The legislation would redesign Medicare's pharmacy benefit to shift drugmakers' discounts to the catastrophic phase. Drugmakers overall would pay more, but companies making high-priced, innovative drugs would be disproportionately impacted by the policy. BIO is pushing lawmakers to spread drugmakers' share of costs more evenly throughout the benefit and allow beneficiaries with high costs early in the year to spread their payments over time.
Health insurer trade association America's Health Insurance Plans spent $7.2 million lobbying on drug pricing reform and other issues. Spokesperson Kristine Grow said that AHIP will continue to advocate for ensuring stability and choice in coverage, lowering consumer costs for prescription drugs and medical services and improving the consumer experience through better affordability, quality and use of technology.
Other top spenders in the first three quarters of 2019 were the American Medical Association with $16.1 million of lobbying spending and the American Hospital Association with $15.6 million.
Industry groups have clashed over how to address surprise medical bills. Modern Healthcare's list of largest lobbying groups only looked at direct lobbying, so it does not include such dark money groups as Doctor Patient Unity, which has reportedly spent roughly $30 million on an advertising campaign to thwart surprise billing legislation.
There's still a glimmer of chance that drug pricing or surprise billing legislation could pass this year, but the window of opportunity is quickly closing and impeachment proceedings further muddy the waters. Despite the complications, White House Domestic Policy Council chief Joe Grogan told reporters that he is optimistic that both surprise billing and drug pricing could be addressed by the end of 2019.
If no year-end package materializes, next year's landscape is also challenging since little substantive legislating is typically done in an election year.
"While there aren't a significant amount of legislative vehicles for healthcare next year, 2020 will be essential in carving out the pathway for what either party is going to prioritize in the 117th Congress," said Shea McCarthy, senior vice president at Thorn Run Partners.
Many of the healthcare agenda items being pushed by presidential candidates are being debated in Congress. Sen. Elizabeth Warren (D-Mass.) specifically named House Speaker Nancy Pelosi's drug pricing bill as a model for her own plan to lower drug costs through Medicare for All. Former Vice President Joe Biden said he wants to limit drug price increases to the rate of inflation, a policy included in both the major House and Senate bills. Democratic frontrunners also back importing prescription drugs from Canada, an idea that has been debated in Congress for decades and that Sen. Amy Klobuchar (D-Minn.) has championed.
Chris Holt, director of healthcare policy at the American Action Forum, said he will be watching for President Donald Trump's messaging on prescription drug pricing during campaign season since he's called for many of the concepts spelled out in Pelosi's legislation.
"It will be interesting to see if you have general election candidates trying to outflank each other on the left," Holt said.
President Donald Trump and several Democratic candidates have advocated for stopping surprise medical bills, but candidates have not yet taken sides on policy details that have so far stalled legislation on the issue in Congress.