Illustration: Eniola Odetunde/Axios

The year-end spending bill in Congress epitomizes the power of health care interests.

The big picture: There are lots of goodies for the industry, while patients will get the worst kind of holiday surprise — more medical bills.

The bill includes some of the usual health care "extenders" — keeping money flowing to rural hospitals and community health centers, and again delaying cuts to hospitals that treat the poorest patients.

  • But in the weeds of the negotiations, industry came out even better than you may have realized. The health care industry's lobbying clout isn't new, but it's striking to see how this end-of-2019 package turned around.
  • This was the bill that, once upon a time, might have been the vehicle for deals to reduce drug prices and crack down on unscrupulous billing practices. Instead, it became an industry giveaway.

A fix for surprise medical bills didn't make the cut, and drug pricing fell apart months ago.

  • Congress was close to a fix for surprise bills, but dropped it at the last minute, punting the issue to next spring at the earliest, which means patients will still be on the hook for bills they never saw coming.
  • The bill also doesn't include changes to secretive contracting terms in the pharmaceutical supply chain and in hospitals.

Congress did find time, however, to repeal several Affordable Care Act taxes — a particularly big win for health insurers that sell Medicare Advantage plans.

  • The bill also gives more drugs — for example, some that treat diabetes or osteoporosis — 12 years of market exclusivity instead of the five years they would have gotten. "That's a big win for pharma," said Peter Maybarduk, a policy expert at Public Citizen. Industry lobbied in favor of this earlier this year.
  • Hospitals that perform certain stem cell transplants will now get paid by Medicare for the costs associated with acquiring those stem cells. Hospitals and industry-backed groups have long lobbied for this policy, which will add an average of $50,000 to $65,000 in extra pay for each procedure.
  • Companies that make some radioactive substances for PET scans will get an extra nine months of higher pay from Medicare.
  • Clinical labs won a one-year delay on price-reporting requirements. This will give them more time to collect data from higher-priced labs, which will be used to drive up their pay in the face of recent Medicare cuts.

The big picture: All of these policies will materially benefit pretty much every sector within an industry that already wields more financial power than ever.

  • Aside from a provision that stops brand drugmakers from blocking generic drugmakers from getting their medicines, patients aren't getting a whole lot — other than an inevitably higher spending tab.

Go deeper

NYT: Trump paid $750 in federal income taxes in 2016 and 2017

Photo: Chip Somodevilla/Getty Images

The New York Times has obtained more than two decades worth tax-return data from Trump and the companies that make up his business, writing in an explosive report that the documents "tell a story fundamentally different from the one [the president] has sold to the American public."

Why it matters: The Times' bombshell report, published less than seven weeks before the presidential election, lays bare much of the financial information Trump has long sought to keep secret — including allegations that he paid $750 in federal income taxes in 2016 and 2017, and has over $300 million in personal debt obligations coming due in the next four years.

Updated 16 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 6:00 p.m. ET: 32,945,376 — Total deaths: 995,608 — Total recoveries: 22,786,066Map.
  2. U.S.: Total confirmed cases as of 6:00 p.m. ET: 7,105,604 — Total deaths: 204,724 — Total recoveries: 2,750,459 — Total tests: 100,492,536Map.
  3. States: 3 states set single-day coronavirus case records last week — New York daily cases top 1,000 for first time since June.
  4. Health: The long-term pain of the mental health pandemicFewer than 10% of Americans have coronavirus antibodies.
  5. Business: Millions start new businesses in time of coronavirus.
  6. Education: Summer college enrollment offers a glimpse of COVID-19's effect.

How Trump, Biden plan to score at Tuesday's debate

Illustration: Sarah Grillo/Axios

President Trump has been practicing with flashcards and prepping with former New Jersey Gov. Chris Christie before Tuesday's presidential debate.

Behind the scenes: Top aides tell Axios he's been testing his attacks on the campaign trail for weeks, seeing what ignites his crowds or falls flat. One of the biggest themes Trump plans to drive home is his "tough guy" persona, which advisers see as an advantage with voters in key states.