Congress can work together to advance good policy

We hear a lot about what Congress does not do well — namely, work together to get things done.

Frankly, I share these justified criticisms. But, I am also happy to report about an issue where senators have been working well together to fix some problems for Idahoans and all Americans. I serve as ranking member of the Senate Finance Committee that oversees federal social safety net and health care programs. This Committee recently advanced legislation I have been working on with Finance Committee Chairman Ron Wyden, D-Oregon, to reduce out-of-pocket medication costs for seniors, enhance accountability in our federal health care programs, improve access to high-quality mental health services, and extend critical support for clinicians and suppliers, without adding to the federal deficit.

The Committee passed the Better Mental Health Care, Lower-Cost Drugs and Extenders Act (the Better Act) by a vote of 26-0. That’s right. The committee voted overwhelmingly in favor of this legislation that builds on the Modernizing and Ensuring PBM Accountability Act, which the committee passed in July. The legislation would expand mental health care and substance use disorder services under Medicaid and Medicare; reduce prescription drug costs for seniors at the pharmacy counter; extend essential Medicaid and Medicare provisions; and increase Medicare payments to support physicians and other providers. 

Most importantly, this comprehensive, deficit-cutting, bipartisan package is entirely offset, and in fact generates an estimated nearly $1 billion in savings. This is legislating responsibly. 

Specifically, these fixes include provisions to provide better oversight and legislative improvements to Medicare Part D’s pharmacy benefits that have become opaque and highly concentrated, driving up costs. Over the past five years, out-of-pocket costs for Medicare seniors have risen at nearly three times the rate for commercially insured consumers. According to a recent report from the Government Accountability Office, Part D beneficiaries pay more than their insurers for 79 of the 100 most highly rebated drugs under the program. The warped, distorted rebate system that dominates the program curbs access to lower-cost medications. Taxpayers and seniors finance the program. We are the client. We have a responsibility to promote accountability and improvement, particularly for the most vulnerable and high-need Americans. The legislation our Committee passed would chip away at this outdated model, providing relief to patients with chronic conditions and capping cost-sharing for all Part D enrollees at the net price of any given drug, inclusive of rebates.

We also passed policies that would increase seniors’ pharmacy choice and provide for a much-needed focus on independent community sites in medically underserved areas. Additionally, mental health provisions would drive care integration, improve telehealth access and help to address workforce strain. The legislation would extend key flexibilities for states to ensure appropriate sites of care for behavioral health needs. Further, frontline health care providers would retain incentives to enter into value-based payment models. Clinicians would also receive targeted relief from reimbursement cuts triggered by the volatility of the Physician Fee Schedule. And, further cuts to doctors across our states, which could otherwise exacerbate ongoing shortages, would be averted.

The Finance Committee has created a robust roadmap for collaborative work, marking up two near-unanimous health care bills in the last six months to reform pharmacy benefit manager practices, improve mental health care, lower drug costs and extend essential Medicaid and Medicare programs. Virtually all Members of the Committee contributed — in meaningful, essential ways — to the patient-focused, fiscally sound and evidence-driven final product. The Committee’s work on this issue is a prime example of how Congress should operate. 

Mike Crapo represents Idaho’s First Congressional District in the U.S. Senate. He can be reached at crapo.senate.gov.