Democrats unite against corporate health care

Driving the news: While expanding Medicare, reversing GOP Medicaid cuts and reviving enhanced Obamacare subsidies are getting most of the attention, there's a subtle shift in rhetoric and policy positions toward blaming big health companies for the affordability crisis.

• It reflects the reality that a substantial expansion of the federal government's role in health care isn't in the cards while President Trump is in office, but populist themes could unite the rank-and-file and even draw in some Republicans.
• Even candidates who didn't constantly rail about drugmakers or insurers have adopted policy ideas that, until recently, were confined to left-leaning think tanks.

Case in point: Incoming Texas Sen. James Talarico ran on breaking up big health care companies and "stop[ping] hospitals and insurance companies from overcharging patients." (He also supports allowing Americans under 65 to join Medicare.)

• South Carolina Sen.-elect Annie Andrews ran on limiting insurer profits per enrollee, expanding the number of drugs subject to Medicare drug price negotiations and banning private equity-owned hospitals.
• Incoming Kansas Sen. Adam Hamilton supports expanding Medicare drug price negotiations and extending the negotiated prices to private health plans, as well as addressing Medicare Advantage overpayments from the federal government.
• Other targets include medical debt, pharmacy benefit manager practices and caps on out-of-pocket drug costs.

Many of these ideas already have buy-in from more-senior progressives.

• Sen. Elizabeth Warren (D-Mass.) has sponsored the Break Up Big Medicine Act, which is co-sponsored by Republican Sen. Josh Hawley of Missouri, which would prohibit common ownership of health plans and providers.
• Incoming Michigan Sen. Abdul El-Sayed, an avid Medicare for All supporter, ran on support of the Warren-Hawley bill, as well as expanding Medicare drug price negotiations.
• The House's health care working group, made up of both progressives and moderates, pitched capping "excessive" hospital prices and enacting site-neutral payments.

The big picture: Voters have made clear that they want lower health care costs. So while a broad overhaul of the health system may not immediately be on the table, Democrats are looking for ways to deliver.

• Powerful health industry groups are poised to push back, arguing that the populist policies would threaten patient care and access in some communities.
• But the ideas under discussion could gain favor with some Republicans.

What they're saying: When asked at an Axios event on Tuesday whether Congress should address ownership ties between insurers, PBMs and pharmacies, Rep. Morgan Griffith — the top Republican on the House Energy and Commerce's Health Subcommittee — said, "I've only heard the case for breaking them up."

• "There's just something in your gut that bothers you when your pharmacy, your PBM and your insurance company are all owned by the same people," he added.

What we're watching: Forcing drugmakers to lower prescription drug prices could be a particularly compelling target, given Trump's demonstrated interest in the topic.

• He has previously called on Congress to codify the "most-favored-nation" deals he made with pharmaceutical manufacturers that require the companies, in some cases, to offer Americans prices on a par with what's paid abroad.
• The Senate Finance Committee's top Democrat, Ron Wyden of Oregon, told reporters this week that he's open to a deal codifying those agreements in exchange for an expansion of the number of drugs Medicare can negotiate on, according to InsideHealthPolicy.

The bottom line: It was only four years ago that Democrats struggled to find enough votes for the modest drug price negotiations that exist today, marking the first successful legislative attempt to directly lower health care costs in any sector by either party.

• Now, they're more willing to push for change and confront big industry players.