The vision of Life Science Leader is to help facilitate connections and foster collaborations in pharma and med device development to get more life-saving and life-improving therapies to market in an efficient manner. Connect, Collaborate, Contribute
Issue link: https://lifescienceleadermag.epubxp.com/i/406276
CAPITOL PERSPECTIVES column By J. McManus LIFESCIENCELEADER.COM 12 NOVEMBER 2014 WHAT A REPUBLICAN SENATE MAY MEAN FOR HEALTH POLICY exchanges. Those individuals obtained coverage in the federal exchange through the portal, infamously inoper- able for weeks, known as Healthcare. gov. Several other states, including Nevada and Oregon, are presently abandoning their dysfunctional state exchanges and enrolling their resi- dents in the federal exchange. The September U.S. District Court rul- ing for Pruitt v. Burwell, invalidating subsidies in the federal exchanges, is important because it establishes anoth- er split in the lower courts and may prompt the high court to take a closer look at the case and consider whether to take it up immediately or wait for pending appeals to conclude. Federal Judge Ronald White, who issued the Pruitt ruling, dismissed political arguments in the previous cases, stating "This is a case of statutory interpretation. The text is what it is, no matter which side benefits. … Such a case does not 'gut' or 'destroy' anything. On the contrary, the court is upholding the act as written. Congress is free to amend the ACA to provide tax credits in both state and federal exchanges, if that is the legislative will." JOHN MCMANUS is president and founder of The McManus Group, a consulting firm spe- cializing in strategic policy and political counsel and advocacy for healthcare clients with issues before Congress and the administration. Prior to founding his firm, McManus served Chairman Bill Thomas as the staff director of the Ways and Means Health Subcommittee, where he led the policy development, negotiations, and drafting of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Before working for Chairman Thomas, McManus worked for Eli Lilly & Company as a senior associate and for the Maryland House of Delegates as a research analyst. He earned his Master of Public Policy from Duke University and Bachelor of Arts from Washington and Lee University. Would Chief Justice Roberts hold a similar view that clear language means something? Or would he contort lan- guage to divine legislative intent just as he did in his landmark decision upholding the constitutionality of the individual mandate, where he deemed the word "penalty," which appeared 27 times in the Affordable Care Act statute, actually meant "tax?" Who knows? But a Supreme Court decision that upholds Pruitt lands the issue squarely in the Republicans' lap. How do they respond? Republicans would likely be unwilling to amend the Affordable Care Act to authorize subsidies through the federal exchange. They could make a federal- ism argument and suggest that each state has the ability to decide whether to establish its own exchange and the subsidies that would flow. But many of those states are the very same con- servative strongholds that refused to expand Medicaid even though the fed- eral government was picking up 90 to 100 percent of the tab. What would be the political fallout of turning the subsidy spigot off for mil- lions of lower and middle income peo- ple who finally obtained health insur- ance coverage? This is precisely why Republicans were fixated on disman- tling Obamacare before the subsidized coverage commenced in January 2014. It's always easier to block theoretical benefits than take away tangible ben- efits people say they currently depend upon. If Republicans do not quickly develop a concrete and coherent alter- native to Obamacare, Democrats may finally be able to turn the tables and blame Republicans for taking away coverage that people relied upon. Perhaps Republicans could find com- mon ground with a president who may be more interested in building a leg- acy than appeasing his base. Putting Medicare and other entitlements on a more sustainable course requires bipartisan cooperation so neither party can be unfairly maligned. It's an issue House Republicans like Ryan are eager to take up. But progress also can be made in more incremental fashion. Targeted fixes to the ACA can be foreseen, such as repeal- ing the medical device tax — a measure that has strong bipartisan support. A delay of the individual mandate is a priority for Republicans and yields sub- stantial revenue that could be used for SGR reform or other fixes. It's hard to see how the president maintains his opposition to this penalty, when delays have already been granted to employers. A repeal of the Independent Payment Advisory Board (IPAB) has been a priority for the health industry, because it is empowered to inflict arbi- trary and nonreviewable Medicare cuts to healthcare providers and pharma- ceuticals alike. Of course, all of this speculation of a Republican Congress and legislating on simmering health policy problems may be wishful thinking. Many of the Senate races will be decided by a percentage or two, and the final outcome may not be known until January after several states have runoffs. There is still a good chance that Democrats retain control of the Senate (by the slimmest of mar- gins), and the nation grinds through a couple more years of virtual gridlock while we wait for a new president. l Perhaps Republicans could find common ground with a president who may be more interested in building a legacy than appeasing his base.