Democrats' big challenge on health care costs

The big picture: There's already speculation about what a Democratic unity health care agenda would look like, and what progressives' midterms success means for Medicare for All.

• But that's largely geared toward the 2028 presidential race or a possible Democratic administration.
• The short-term reality is that any ambitious policies that significantly expand the government's role in health care are almost certain to collide with Trump's veto pen.
• Strategists say the Democrats' most realistic option is to find piecemeal affordability fixes next year and play the long game when it comes to reshaping the health system.

"If you read history, people make the biggest mistakes when they win. That's when they take their eye off the ball and they don't do the right thing," said Zeke Emanuel, an adviser in the Obama White House and a professor of medical ethics and health policy at the University of Pennsylvania.

• "This is an affordability election. We need to do affordability, but I do agree with the idea that this is a two-step process," he added. "There's going to have to be longer-term reforms."
• "For those debating whether the new Congress should consider big and bold reforms or pass practical help for people right away, the answer is yes. Voters can and should expect action on multiple fronts," Families USA executive director Anthony Wright said in a statement.

Between the lines: Democrats' top priorities for the next Congress are restoring enhanced Affordable Care Act subsidies and reversing the Medicaid funding cuts in last year's GOP reconciliation law.

• Their unexpectedly large majorities in each chamber will give them leverage, but no guarantee of a victory, if there's a standoff with Trump.
• Even if they prevail, it won't help the 157 million Americans with workplace coverage who are feeling the strain of higher premiums, deductibles and other out-of-pocket costs.
• "Congress thinks of Medicare, Medicaid, and to some extent the exchanges. But they have to remember half the American population and a lot of people complaining about affordability are in the private sector," Emanuel said.

What they're saying: Senate Democratic Leader Chuck Schumer told MS NOW yesterday that health costs will be a top focus for Democrats.

• Incoming Senate Finance Committee Chair Ron Wyden (D-Ore.) said his committee "will create a new foundation for America's health care system that guarantees health care for all, gives Americans cheaper and better health care, and ends the corporate chokehold on our nation's health care system."
• And House Energy and Commerce Committee senior Democrat Frank Pallone of New Jersey called for "an agenda that puts working people first and focuses on resolving the outrageous price increases."

The intrigue: Drug pricing could be one area ripe for a deal, considering the Trump administration's efforts to get the Republican Congress to write into law the "most favored nation" deals it struck with major manufacturers.

• "It's very hard for the public to hear both Democrats and the president say they care about this issue and fail to find a way to ... provide greater cost relief for their medications," said Democratic health care consultant Chris Jennings.
• Emanuel said Democrats should also push for site-neutral hospital payment policies, caps on hospital costs and an end to copays and deductibles for generic drugs in Medicare and ACA markets.
• The question is whether many Democrats are willing to scale back their ambitions for the sake of striking a deal with a weakened president. Many of those policy options would generate budgetary savings that could instead be used to help pay for sweeping coverage expansions.

The bottom line: Voters couldn't have been clearer about how they're being squeezed by the health affordability crisis. Democrats have to figure out how to respond to pressure to act now.