The Republican Party’s clumsy dance with health care policy is about to get even more awkward. A conservative “victory” in the King v. Burwell Supreme Court case will mean that millions of low-income people will lose their health insurance subsidies. Many of them will lose coverage as a result. This will almost certainly take much of the satisfaction out of an Obamacare court victory.
Politically, a Burwell “win” doesn’t have much upside for Republicans, who will need to deal with its aftermath at the state and federal level. Party infighting is likely, as pragmatic Republicans may want to ameliorate the hit on lower-income voters. Meanwhile, purist Republicans likely won’t budge on supporting, in any way, anything that is related to Obamacare or represents an increase in government health care spending.
This seems like a particularly bad time for Republicans to be standing up and fighting for pharmaceutical companies in a battle that pits Big Drugs against low-income patients. The 340B prescription drug program — which requires drug manufacturers to offer deep discounts to hospitals with a high percentage of low-income patients — is the subject of a pending regulation, due for release this summer, that could expand or contract the program’s benefits. Opinions on whether the program should be reined in or allowed to flourish are already running hot.
Interestingly, the arrangement under 340B doesn’t affect taxpayers or the federal budget. It’s a straightforward case of the government forcing a pricing structure on one part of the pharmaceutical manufacturing industry. It’s not exactly a free-market dream come true, but in the grand scheme of government bloat and health care dysfunction, probably not the battle I’d pick to fight first.
So while I sympathize with Republicans’ desire to protect the private sector from the heavy hand of government, there are times when they simply must pause and consider the optics of a situation, particularly when entering a presidential election cycle.
Republicans would do well to show their populist side as we build up to the fall of 2016. They can be pro-business, certainly, but they may want to take a bit of a break from being pro-really-big business. In the case of 340B, it doesn’t take an especially politically savvy person to see that Republicans who rail against the program are probably hoping to score points with the deep PAC pockets of pharmaceutical manufacturers — whose ongoing defense against giving discounts to poor people will almost certainly be “well…we need profits for research and development.”
A bit cringe-worthy, yes? Research and development doesn’t play well when juxtaposed with a sick low-income person whose bronze-level Obamacare plan doesn’t cover the full cost of a hospital stay, or against administrators of a hospital in an under-served neighborhood who contemplate closing their doors due to the increasing cost of common prescription meds.
After all, most people are a little suspicious about just how much money pharmaceutical manufacturers need to make. The research and development argument is murky, and these big businesses are in the same collective mental space as big insurance — companies with household names that seem awfully cozy with government officials.
Regular people get the sense that, no matter what happens in health care, big insurance and big pharmaceuticals will do just fine, the politicians they support will get re-elected and the rest of us will eat the bill.
So let’s imagine a summertime in Washington that includes millions losing their health insurance after Burwell and Republican leaders in Congress standing up for big drug companies on 340B. It’s enough to want to remind conservatives that they may want to take a powder. It’s time to step back from the health care dance floor for a few minutes, cool off and think about who you want to partner with in this dance.
Jean Card is a writer and communications consultant with expertise in public policy and small business issues. She is a former speechwriter for the U.S. secretaries of Labor and Treasury as well as the attorney general. Follow her on Twitter: @JeanCard. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
