Friday, December 16, 2022

Rep. Guthrie, in line to head health panel, says priorities include Medicare oversight, Covid-19 origins and price transparency

U.S. Rep. Brett Guthrie, R-2nd District (C-SPAN screenshot)
U.S. Rep. Brett Guthrie of Bowling Green discussed several health issues that Republicans will focus on when they take over the House during an interview with Caitlin Owens of Axios, including price transparency, investigations into the origin of Covid-19 and oversight of the Medicare drug-negotiation provision in the Inflation Reduction Act. 

Guthrie, a Republican who represents the Second District, is in line to lead the health subcommittee of the House Energy and Commerce Committee when the new Congress convenes next month. 

Asked about the evolution of the GOP's health agenda since the days when the party wanted to "repeal and replace" the Affordable Care Act of 2010, Guthrie said there are still things that need to be done with the ACA, noting that the Inflation Reduction Act recently "took $288 billion out of Medicare . . . and put it into subsidies for the Affordable Care Act." 

Actually, $288 billion was not literally removed from Medicare to pay for the ACA subsidies that were increased as part of the Inflation Reduction Act. Instead, the Congressional Budget Office estimated that provisions in the Act to lower prescription-drug costs in Medicare and reduce drug spending by the federal government would reduce the federal budget by $288 billion over 10 years.

Asked about this, Guthrie's office explained in an e-mail that under budget reconciliation rules, new spending cannot be added to the deficit without it being offset. The cost of the enhanced ACA subsidies was only $33 billion, but his office said, "Rep. Guthrie was making the argument, given the score and the reconciliation rules, that these savings from Medicare are being used to offset other parts of the Inflation Reduction Act, including ACA subsidies."

Guthrie's office said he introduced an amendment to the Act to not allow the savings from Medicare to be used to "pay for or offset any program, activity or expenditure that is not with respect to the Medicare program under such title," but the amendment was not considered. 

In the Dec. 7 Axios interview, Guthrie said of the ACA, "It's not sustainable.  . . . Prices keep going up, we subsidize it and it's pricing people out of the marketplace, which still needs to be addressed."

Guthrie said another priority for his subcommittee will be oversight of the implementation of the provisions in the Inflation Reduction Act that authorize Medicare to negotiate prices with drug manufacturers.

He said that the worst thing that can happen in the negotiations is that they will reduce innovation by drug makers, noting that one company has already announced it will not do a third-phase study of a new drug because of concerns about pricing going forward.

"We want more innovation, not less," Guthrie said. "And I'm afraid that's where we're going." 

The CBO estimates that the drug pricing and negotiation provisions in the Act "will have a very modest impact on the number of new drugs coming to market in the U.S. over the next 30 years; 13 fewer out of 1,300 or a reduction of 1%," reports the Kaiser Family Foundation.

Guthrie said Republicans will also focus on price transparency, calling it a bipartisan issue that has not yet been resolved. The Trump administration required hospitals to disclose the rates they privately negotiate with insurers and also provide online, searchable rates for 300 common services. 

"I think we need to make sure that information is out there," Guthrie said. "We need to expose if the price is right, then that's what the price is, but my guess is there seems to be a lot of steps in the supply chain of health care and we're not sure of the value of every step." 

Guthrie also said it will be important to investigate where Covid-19 originated as a way to prepare for future pandemics. "The purpose is to lead to legislation or information that we need to move forward," he said. "One of my biggest concerns as we look at what's moving forward is bringing trust back into our institutions. . . . We need to know that the groups that are supposed to put forth science are putting forth science in the public sphere so the policy makers can make decisions in the public and have confidence." 

As an example, he pointed to White House medical adviser Dr. Anthony Fauci's early dismissal of the idea that the virus came from a lab in China, even though "We now know that it probably did come from there." That is a matter of opinion, and the stated view of most experts is that the virus originated naturally.

Guthrie is co-chair of the Republican Healthy Future Task Force, which has put together a list of proposals that seeks to improve health-care choices for workers and small business owners, promotes innovation and transparency and lowers costs and increases options through competition. 

Inside Health Policy, reporting on its own interview with Guthrie, says that "If tapped as chair, he would focus on medical-product innovation, price transparency and health-agency oversight, including looking into FDA’s use of emergency use authorizations to ascertain lessons for future pandemics and the agency’s response to the infant-formula shortage to improve its handling of ongoing drug-supply issues."

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