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Democrats search for the next big thing

Illustration of a donkey wearing a pair of binoculars around its neck.

Illustration: Gabriella Turrisi/Axios

First it was passing the ACA. Then it was defending the ACA. Then it was allowing Medicare to negotiate drug prices.

  • But when we asked lawmakers and outside groups what the Democrats' next major health care goal will be, we did not get one clear answer. Instead, we got lots of smaller, wonkier answers.

Why it matters: It's a sign that the Democrats don't yet agree on the next big thing — and that could leave their health care agenda scattered in Congress over the next two years.

  • When Democrats and their allies have a clear objective, like the ACA or lowering Medicare drug prices, you hear about that one goal from all of them — not several goals as we did in our interviews for this story.

What they're saying: "There's a lot of good ideas out there, but this often happens, once you get a big victory you often need a little time to form consensus on what's next," Sen. Chris Murphy told Axios.

Between the lines: Senate Finance Committee Chairman Ron Wyden pointed to President Biden's call to expand drug price negotiations, as well as work on mental health, including his targeting of insurers' "ghost networks," when asked about the next big thing. "Mental health is really big," he told Axios.

  • Two outside groups that advise Democrats — the Center for American Progress and Families USA — pointed to health care costs, and in particular focusing on hospital costs as well, not just drug prices.
  • That could mean dusting off some of the ideas that got left behind in the Alexander-Murray Part II bill from 2019, such as measures on competition and transparency, said Emily Gee, senior vice president for inclusive growth at the Center for American Progress.
  • Jen Taylor, senior director of federal relations at Families USA, added: "Talking about site neutral payment feels really obscure until you are like, 'Wait a minute, I'm now charged more because the hospital bought up my old doctor's office. I'm getting the same thing and now I pay twice as much,' like that connects with people."

Remember the public option? On a larger scale, there was a time (2019, not all that long ago) when it seemed like all Democrats could do is argue about full-on Medicare for All vs. souped-up public option vs. normal public option, etc.

  • That talk has really faded (even before Republicans won the House, making the ideas even more dead for the moment).
  • "There's a lot more people with coverage today," Murphy said when asked about the diminished talk of a public option. "We have been successful in bending the cost curve; it's not spiraling upwards out of control like it was a decade ago. So I think there is some level of decreased angst about health care."

Of course, Sen. Bernie Sanders is now the chairman of the HELP Committee. But even he isn't putting a ton of emphasis on Medicare for All these days. "We don't have the votes," he told the New York Times last month.

  • Instead, he's been using his bully pulpit on issues like the price of the Moderna vaccine and insulin.
  • Another of Sanders' big ideas — adding dental, vision and hearing benefits to Medicare — came a bit closer during the Build Back Better debate, but still remains to be done.
  • We've written before about how hospitals could receive growing scrutiny after pharma took its beating. But the politics of taking them on are tough.
  • "People love their local hospital," Taylor said. "But they also don't love getting home and opening a $35,000 bill for something that they have no idea why that happened."
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