Congressional Health Care Package In Turmoil

The slim Republican majority in the U.S. House has complicated passage of health care legislation which would, among other things, impose new limits on pharmacy benefit managers:

https://www.politico.com/live-updates/2025/01/16/congress/health-care-reconciliation-00198630

Path forward on health care package causing heartburn
The chance that a bipartisan health care package could be broken up for cost savings for the House GOP's reconciliation bill has the potential to cause a partisan rift.

By Ben Leonard - January 16, 2025

House Republicans are considering including parts of a bipartisan health care package in their partisan domestic policy and tax bill — and Democrats are warning against it.

It underscores the pressure Republicans are under to find ways to pay for their massive budget reconciliation bill, which they plan to use to enact President-elect Donald Trump’s legislative agenda.

At issue is the future of a deal Democrats and Republicans struck at the end of the last Congress to lower prescription drug costs with new regulations on pharmacy middlemen.

It remains among the few areas ripe for bipartisan policy-making with full Republican control of Washington. It was included in the original spending bill lawmakers cobbled together in December to fund the government through March 14, but fell out after Trump and Elon Musk complained the stopgap spending measure was too bloated with extraneous provisions.

Now top House members in the negotiations — House Energy and Commerce Chair and Ranking Member Brett Guthrie (R-Ky.) and Frank Pallone (D-N.J.), and Health Subcommittee Chair and Ranking Member Buddy Carter (R-Ga.) and Diana DeGette (D-Colo.) — are weighing how to get the package over the finish line, they said in interviews this week.

Certain programs in the package, especially new regulations on pharmacy benefit managers, could be attractive pay-fors for Republicans who need to make sure their ambitious reconciliation bill is largely offset.

But DeGette and Pallone are lobbying for lawmakers to vote on it as a standalone proposition or tacked onto a non-reconciliation bill, fearful it could get caught up in unrelated policy battles.

“I don't want all those important priorities to get held hostage to internal disagreements among Republicans on reconciliation,” DeGette said.

Democrats also won’t be able to vote “yes” on those bipartisan policies if they are put into a conservative reconciliation bill, which Pallone said will “have a lot of bad things in there” his party would never support – things like deep cuts to Medicaid and rollbacks of Biden-era climate programs.

And given the strict procedural rules around what policies can and can't be included in a reconciliation bill, there's deep concern, even among some Republicans, that the health care package could become cannibalized for parts.

“It’s difficult to say” what from the package would qualify for inclusion, Carter conceded.

Ultimately, Carter said, a decision on how to proceed likely won’t be made until the contours of a Republican reconciliation bill begin to take real shape. He’s not ruling out a standalone vote.

Guthrie said he is “laser-focused” on enacting Trump’s agenda through the reconciliation process, but was noncommittal on whether that should be the vehicle for the health care package.

“We’ll continue to find opportunities to get across the finish line at the appropriate time,” he said.