Policy & Politics

While lobbying expenditures from the health care industry have been rising in recent decades, drugmakers and providers — not insurers — are the main drivers of that spending growth, according to recent research. Still, experts tell AIS Health, a division of MMIT, that the managed care sector’s influence over policy shouldn’t be underestimated.

“Overall, the fact that the industry keeps lobbying means that this investment has some good return; otherwise, they would have stopped,” says Ge Bai, Ph.D., a professor at Johns Hopkins University’s schools of business and public health.

Lobbying spending by the health care industries reached $713.6 million in 2020, a 70% increase over the past two decades, according to a recent JAMA Health Forum analysis based on data compiled by OpenSecrets. The growth was mainly driven by pharmaceutical and health product manufacturers and providers. Expenditures were highly concentrated among a small subset of firms, especially for payers, with the top 10% of health plans responsible for 70.4% of spending.

With midterm elections over, the soon-to-end 117th Congress will turn its attention to the biannual lame-duck session, and D.C. insiders say that health care items like reforms to telehealth and behavioral health care policies could be on the agenda. Meanwhile, the new Republican majority in the House of Representatives will soon hold inter-caucus votes on leadership roles, including Speaker of the House chairs — and those polls could dictate what is possible in health care policy when the 118th Congress begins work.

The lame-duck session is the final gathering of an outgoing Congress, a last hurrah for members who have been voted out or will retire. Such sessions revolve mainly around prosaic government funding bills, which must be passed in order to keep agencies running in the new year. They also offer a chance for urgent policy considerations to advance; additional COVID-19 funding and pandemic preparedness legislation could get a hearing during this year's lame duck, D.C. insiders tell AIS Health, a division of MMIT. A lame duck session will typically pass an omnibus spending bill, which D.C. wags joke is a "Christmas tree" — in many years, nearly every member gets to decorate the end-of-year package with their own pet amendment.

While lobbying expenditures from the health care industry have been rising in recent decades, drugmakers and providers — not insurers — are the main drivers of that spending growth, according to recent research. Still, experts tell AIS Health, a division of MMIT, that the managed care sector’s influence over policy shouldn’t be underestimated.

“Overall, the fact that the industry keeps lobbying means that this investment has some good return; otherwise, they would have stopped,” says Ge Bai, Ph.D., a professor at Johns Hopkins University’s schools of business and public health.

Lobbying spending by the health care industries reached $713.6 million in 2020, a 70% increase over the past two decades, according to a recent JAMA Health Forum analysis based on data compiled by OpenSecrets. The growth was mainly driven by pharmaceutical and health product manufacturers and providers. Expenditures were highly concentrated among a small subset of firms, especially for payers, with the top 10% of health plans responsible for 70.4% of spending.

In an executive order released Oct. 14, the Biden administration directed the CMS Center for Medicare and Medicaid Innovation (CMMI) to “to consider additional actions to further drive down prescription drug costs,” building on the Medicare drug price negotiation stipulations of the Inflation Reduction Act (IRA). D.C. insiders tell AIS Health, a division of MMIT, that CMMI could pull old policy proposals off the shelf when it works to “test new ways of paying for Medicare services that improve the quality of care while lowering costs,” as the administration puts it.

The executive order isn’t specific about what policies the White House would prefer CMMI look into. However, the administration will know the possibilities fairly soon: CMMI will have 90 days to develop recommendations. Per a White House fact sheet, the final product will be “a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries.”

A South Dakota ballot initiative that would finally bring Medicaid expansion to the state triumphed in the midterm elections, passing with 56% of the vote. It’s the latest in a string of successful ballot initiatives in expansion holdout states — and perhaps the last. While there have been rallying cries of support for expansion in some of the 11 remaining holdout states, the efforts of Democratic governors and organizing committees working to get expansion on future ballots have been stymied for years.

With a few midterm races unresolved as of mid-November, Democrats are projected to narrowly retain control of the Senate while Republicans will take back the House in the next Congress. That raises numerous questions about the future of health care policy, but D.C. insiders say House Republicans are likely to pursue achievable items rather than reach for the stars. Regardless of who controls each chamber, however, the experts suggested that more accountability and oversight is expected in Medicare Advantage.

“For once, repeal and replace isn’t the defining backbone of Republican health policy in Congress,” said Tarplin, Downs & Young Partner Jennifer Young, referring to multiple GOP efforts to scrap the Affordable Care Act, during a Nov. 4 webinar hosted by Kaiser Family Foundation (KFF). “It took us years, but I think we have learned that repeal and replace was not a winning issue and I think there’s been an acknowledgment that a Democratic president…isn’t likely to sign repeal and replace into law,” said Young, who served as assistant secretary for legislation at HHS and senior counselor to then-Secretary Mike Leavitt during the George W. Bush administration.

In an executive order released Oct. 14, the Biden administration directed the CMS Center for Medicare and Medicaid Innovation (CMMI) to “to consider additional actions to further drive down prescription drug costs,” building on the Medicare drug price negotiation stipulations of the Inflation Reduction Act (IRA). D.C. insiders tell AIS Health, a division of MMIT, that CMMI could pull old policy proposals off the shelf when it works to “test new ways of paying for Medicare services that improve the quality of care while lowering costs,” as the administration puts it.

The executive order isn’t specific about what policies the White House would prefer CMMI look into. However, the administration will know the possibilities fairly soon: CMMI will have 90 days to develop recommendations. Per a White House fact sheet, the final product will be “a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries.”

Since the COVID-19 pandemic began, the federal government has spent tens of billions of dollars purchasing vaccines, treatments and tests and providing them for free to the public. Congress has also passed legislation ensuring private and public payers cover those countermeasures for as long as the public health emergency (PHE) is in place.

However, that may soon be ending as Congress has yet to authorize additional COVID-specific funding and the PHE is likely to expire sometime next year. That could lead to questions about access, pricing and insurance coverage, according to panelists who spoke during a Kaiser Family Foundation (KFF) webinar on Oct. 19.