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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

Scoop: Gina Haspel threatened to resign over plan to install Kash Patel as CIA deputy

CIA Director Gina Haspel. Photo: Win McNamee/Getty Images

CIA Director Gina Haspel threatened to resign in early December after President Trump cooked up a hasty plan to install loyalist Kash Patel, a former aide to Rep. Devin Nunes (R-Calif.), as her deputy, according to three senior administration officials with direct knowledge of the matter.

Why it matters: The revelation stunned national security officials and almost blew up the leadership of the world's most powerful spy agency. Only a series of coincidences — and last minute interventions from Vice President Mike Pence and White House counsel Pat Cipollone — stopped it.

Updated 12 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Coronavirus deaths reach 4,000 per day as hospitals remain in crisis mode — CDC warns highly transmissible coronavirus variant could become dominant in U.S. in March.
  2. Politics: Biden says, "We will manage the hell out of" vaccine distribution — Biden taps ex-FDA chief to lead Operation Warp Speed amid rollout of COVID plan — Widow of GOP congressman-elect who died of COVID-19 will run to fill his seat.
  3. Vaccine: Battling Black mistrust of the vaccines"Pharmacy deserts" could become vaccine deserts — Instacart to give $25 to shoppers who get vaccine.
  4. Economy: Unemployment filings explode againFed chair: No interest rate hike coming any time soon —  Inflation rose more than expected in December.
  5. World: WHO team arrives in China to investigate pandemic origins.

John Weaver, Lincoln Project co-founder, acknowledges “inappropriate” messages

John Weaver aboard John McCain's campaign plane in February 2000. Photo: Robert Schmidt/AFP via Getty Images)

John Weaver, a veteran Republican operative who co-founded the Lincoln Project, declared in a statement to Axios on Friday that he sent “inappropriate,” sexually charged messages to multiple men.

  • “To the men I made uncomfortable through my messages that I viewed as consensual mutual conversations at the time: I am truly sorry. They were inappropriate and it was because of my failings that this discomfort was brought on you,” Weaver said.
  • “The truth is that I'm gay,” he added. “And that I have a wife and two kids who I love. My inability to reconcile those two truths has led to this agonizing place.”