HealthCare Roundtable e-News – December 22, 2021

Biden Health Care Agenda Upended as Manchin Signals Opposition to Current Build Back Better Deal

After many months of negotiations, Sen. Joe Manchin pulled the plug on the president’s signature Build Back Better bill over the weekend creating uncertainty for a number of the bill’s health care reforms, including Medicare drug price negotiation, Medicare hearing benefits, closure of the Medicaid coverage gap and extension of the enhanced Affordable Care Act tax credits. (InsideHealthPolicy)

On Sunday, the West Virginia Democrat said on Fox News that he will not vote for Democrats’ social spending bill because it is too costly, even though he had already forced Democrats to cut the bill in half and scale back its health reforms.

Manchin, whose vote is needed to pass the partisan budget reconciliation bill, said he worries about increasing the debt. Democrats wanted to add several Medicare benefits, but only the hearing benefit was left in the $1.7 trillion bill. Unlike other health care measures, the Medicare drug price negotiation title would save the government money, and Manchin supports the drug pricing reforms. Some Republicans also support drug-price and -cost controls; in 2019, a few Republicans voted for making drug companies pay back Medicare when drug prices rise faster than inflation.

Government negotiation of drug prices is a tough sell to the GOP, but the Medicare price negotiation measure was significantly scaled back from earlier versions; the original goal of Democrats’ Medicare negotiation proposal was to control launch prices, but the House BBB bill would delay negotiation until several years after product launches.

Also, most of the voting public wants Congress to control drug costs, and 2022 is an election year, so the dynamics that typically thwart legislation as elections near might help the prospects of drug pricing legislation even if the broader social spending bill stalls.

It’s not clear whether Democrats would continue to use the budget reconciliation process, which avoids the 60-vote margin needed to override the filibuster, or attempt stand-alone legislation to control drug costs.

Manchin made his announcement before the Senate parliamentarian determined whether budget rules allow drug cost controls in the commercial market.

It’s also not clear whether the deal that Democrats struck among themselves on the drug pricing title would hold if Build Back Better dies. If Democrats try to get Republicans on board, or if they merely start over, reforms to the rebates and pharmacy fees that pharmacy benefit managers negotiate could be added to the legislation, even though the repeal of the Trump-era ban on rebates accounted for a big chunk of savings from the current drug pricing title.

On Sunday, Democrats were fuming over Manchin’s announcement and hadn’t begun discussing a possible path forward on drug pricing and other health care measures.

House progressives agreed to pass the infrastructure bill separate from Build Back Better based on a promise from the president that he would broker a deal with Manchin. Moderates voted on policies that leave them exposed to attacks in next year’s elections based on the House speaker’s promise that they would only vote on measures that could pass the Senate.

White House Press Secretary Jen Psaki said the president wants to keep negotiating with Manchin, but she also accused him of bad faith, which does not bode well for future negotiations.

“If his comments on FOX and written statement indicate an end to that effort, they represent a sudden and inexplicable reversal in his position, and a breach of his commitments to the President and the Senator’s colleagues in the House and Senate,” Psaki said. (InsideHealthPolicy)