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Where McConnell successors stand on health care

McConnell, Barasso, Thune, Cornyn

McConnell with Barrasso, Thune and Cornyn in 2017. Photo: Samuel Corum/Anadolu Agency/Getty Images

The three likeliest senators to succeed GOP Leader Mitch McConnell are seasoned veterans of the Obamacare and drug pricing wars who've shown pragmatic streaks while generally toeing a conservative line.

Why it matters: The new GOP leader could elevate issues from PBM practices to pharma drug pricing and the 340B drug discount program, depending who Republicans pick in November.

  • Here's a look at the health care records of "the three Johns" — Sens. John Thune, John Cornyn and John Barrasso.

1. John Thune: The second-ranking Republican in the chamber has occasionally staked out moderate positions, though he's still well to the right of centrists like Sen. Susan Collins.

  • Thune led an effort during the 2017 Obamacare repeal debate to make the subsidies in the GOP replacement plan more generous — though he still voted for all three of the final GOP repeal bills, as did Cornyn and Barrasso.
  • Thune has opposed Democratic efforts to curb drug prices and also voted against the Grassley-Wyden drug price bill in committee in 2019.
  • Last year, he introduced a bill targeting PBMs over "steering" patients to certain pharmacies, a measure that was praised by the National Community Pharmacists Association.
  • He's also been active on the 340B discount drug program, a priority of providers in his home state of South Dakota. This month, he was part of the group that released a 340B draft discussion bill that would require drugmakers to provide discounts to contract pharmacies, an issue that drugmakers have previously sued about.

2. John Cornyn: Cornyn was the GOP whip during Obamacare repeal efforts, leading the ultimately doomed efforts to round up votes for a replacement.

  • He takes a harder line on pharma drug pricing practices than many of his GOP colleagues, which could be a warning sign for the industry if he becomes leader.
  • To be sure, he's certainly not aligned with Democratic calls for Medicare to negotiate drug prices, but he has sponsored a bipartisan measure opposed by pharma to crack down on "patent thickets" and "product hopping" to delay generic competition.
  • "I'm not an enemy of pharma," Cornyn told Axios last year, discussing his bill. "I think obviously they do amazing things, and I'm a strong believer in patent protection and intellectual property protection, but this is very obviously gaming the system, and that needs to stop."
  • Cornyn also voted for the Grassley-Wyden bill in committee in 2019, though he opposed the provision to limit drug price increases to the rate of inflation.

3. John Barrasso: The Senate's No. 3 Republican is generally seen as the most Trump-aligned of the three contenders.

  • But that doesn't mean Barrasso agrees on policy with some of Trump's more unorthodox health care ideas. On drug pricing, Barrasso has aligned with others in the party opposing Medicare price negotiations.
  • He cosponsored the rival GOP bill to Grassley-Wyden in 2019, which was more modest and more friendly to pharma.
  • He is one of the Senate's leading foes of Obamacare, in past years giving frequent floor speeches slamming the law.
  • Barrasso was an orthopedic surgeon and rodeo doctor before arriving in Congress, and has lent a hand to doctors looking to move their priorities on Capitol Hill. He signed a letter this month calling for a reversal of Medicare payment cuts to doctors, while Thune and Cornyn did not sign.
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