Illustration: Maura Losch/Axios
The Senate committees overseeing health policy could be in for big changes next year, depending on the outcome of the elections. And that could have especially big implications for new rounds of drug price negotiations and the future of enhanced ACA subsidies.
Here are the top committee leadership posts to watch in the Senate for health policy:
Senate HELP Committee
If Republicans win the Senate:
- The likely chair would be Bill Cassidy, the current ranking member.
- Rand Paul is in line to take the position, but people in the health world expect that he'll pursue the gavel of the Homeland Security and Governmental Affairs Committee instead. Paul has not fully ruled out a shift, and his office did not respond to a request for comment.
- Another scenario: If Mitch McConnell takes the Appropriations chair, it could in theory leave Susan Collins in a position to lead HELP.
- But a Collins spokesperson told Axios, "Senator Collins will not be seeking to become the chair or ranking member of the HELP Committee" and that she "fully anticipates" being the top Republican appropriator, while acknowledging it's still McConnell's call.
- McConnell spokesperson David Popp said: "Leader McConnell is focused on finishing the 118th Congress strong and helping Senate Republicans regain the majority."
Cassidy's office declined to comment on his priorities should he become HELP chair, but he has put out white papers and investigations that hint at his plans.
- Those include an inquiry into the 340B program. Cassidy told Axios over the summer that he wants to return the program to its "original intent."
- He has also released proposals to "modernize" NIH, including ensuring it focuses enough on early-stage research.
- He has worked in a bipartisan way with Bernie Sanders on a PBM reform bill, which could still be on the agenda if it does not get done this year.
If Democrats hold the Senate:
- Sanders would be set to continue as chair — a role he has used to shine a light on health industry practices he views as predatory, particularly around drug pricing and, most recently, weight-loss drugs.
- Sanders spokesperson Anna Bahr said he will continue to prioritize "substantially reducing the outrageous cost of prescription drugs," as well as making primary care more available, addressing the health care worker shortage, and taking on the role of private equity in health care.
- On the primary care and health worker front, Sanders did find some support on the GOP side, putting forward a measure with Roger Marshall that includes a major boost in community health center funding.
- But that bill faces a tough path to passage, given that many other Republicans do not support it, and because of controversy over the offsets.
- The HELP Committee has been bipartisan in its oversight of private-equity-linked Steward Health Care, though broader legislation targeting private equity has not received such widespread agreement.
Senate Finance Committee
If Republicans win the Senate:
- Mike Crapo is in line for the chairmanship. He brings a more traditional Republican view on health care than the most recent GOP chairman, Chuck Grassley, who was more of a drug industry critic than many of his fellow Republicans.
- Crapo has sharply criticized the IRA's drug price negotiations, arguing they harm research and development.
- In next year's coming battle over renewing the enhanced ACA subsidies, Crapo has signaled that an extension would be a difficult lift, pointing to the over $300 billion cost over 10 years and saying the subsidies "camouflage" flaws in the individual market.
- On a more bipartisan front, Crapo has worked with current Chair Ron Wyden on PBM reform, which could be on the agenda if it doesn't pass this year.
- Beyond that, Crapo spokesperson Phoebe Keller also pointed to support for rural hospitals and reforming the Medicare physician payment system as priorities for next year.
If Democrats hold the Senate:
- Wyden is set to remain the chair and to try to build on his work enacting the IRA drug pricing measures and enhanced ACA subsidies.
- Wyden spokesman Taylor Harvey said he would prioritize "protecting and strengthening the drug pricing measures in the Inflation Reduction Act," as well as extending the enhanced ACA subsidies, and "continuing to shine a light on health care middlemen that are consuming more and more of America's health spending."
- Wyden held a hearing last month on extending the subsidies and said he was "all in" on the fight.
- He told Axios over the summer he wants to pair the extension with his bill to crack down on unscrupulous insurance brokers, which could help push back on GOP concerns about the subsidies fueling fraud.
- Wyden has also been pushing hard for his PBM bill with Crapo, repeatedly stressing that it advanced out of committee on a 26-0 vote.
