Hill Democrats search for the next big health care target

Illustration: Gabriella Turrisi/Axios

First, it was passing the Affordable Care Act. Then, it was defending it. Then it was allowing Medicare to negotiate drug prices. But with those big boxes checked, it’s not clear what congressional Democrats’ next big health care goal is.

Why it matters: Taking too long to agree on the next big thing could create a policy vacuum heading into a presidential election cycle — and deprive lawmakers and outside groups of a target to aim for.

• It could even cede some important health issues to Republicans, though the GOP has struggled to find major health targets after the failure of Obamacare repeal.
• Most Democrats asked about their agenda favor wonkier, incremental initiatives over crafting new landmark laws.

What they’re saying: “There’s a lot of good ideas out there, but this often happens, once you get a big victory you often need a little time to form consensus on what’s next,” Sen. Chris Murphy (D-Conn.) told Axios.

Between the lines: Senate Finance Chairman Ron Wyden (D-Ore.) pointed to President Biden’s call to expand drug price negotiations, as well as work on mental health issues, including targeting insurers for inadequate provider networks, when asked about the next big thing. “Mental health is really big,” he told Axios.

• Two outside groups that advise Democrats — the Center for American Progress and Families USA — pointed to health care costs, and in particular focusing on hospital costs, not just drug prices.
• That could mean dusting off some of the ideas that got left behind in a bipartisan Senate health committee bill from 2019, such as measures on competition and price transparency, said Emily Gee, senior vice president for inclusive growth at the Center for American Progress.
• Jen Taylor, senior director of federal relations at Families USA, added: “Talking about site neutral payment feels really obscure until you are like, ‘Wait a minute, I’m now charged more because the hospital bought up my old doctor’s office. I’m getting the same thing and now I pay twice as much’ … that connects with people.”

Remember the public option? On a larger scale, there was a time (2019, not all that long ago) when it seemed like all Democrats could do was argue about full-on Medicare for All versus variations of the public option.

• That focus on coverage, as opposed to costs, faded even before Republicans won the House, making the ideas even more dead for the moment.

• “There’s a lot more people with coverage today,” Murphy said. “We have been successful in bending the cost curve; it’s not spiraling upwards out of control like it was a decade ago. So I think there is some level of decreased angst about health care.”

Of course, Sen. Bernie Sanders (I-Vt.) is now the chairman of the HELP Committee. But even he isn’t putting a ton of emphasis on Medicare for All these days. “We don’t have the votes,” he told the New York Times last month.

• Instead, he’s been using his bully pulpit on issues like the price of the Moderna vaccine and insulin.
• Another of Sanders’ big ideas — adding dental, vision and hearing benefits to Medicare — came a bit closer during the Build Back Better debate, but still faces hurdles, including the cost.
• Hospitals could receive growing scrutiny after pharma took its beating in the Inflation Reduction Act. But the politics of taking them on are tough.
• “People love their local hospital,” Taylor said. “But they also don’t love getting home and opening a $35,000 bill for something that they have no idea why that happened.”

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