Pelosi works her health care strategy from the ground up

WASHINGTON (AP) — House Speaker Nancy Pelosi is laying out her strategy on health care and first up is improvements to "Obamacare" and legislation to lower prescription drug costs. "Medicare for all" will get hearings.

Pelosi and President Donald Trump have been sounding similar themes about the need to address the high drug costs. But her plans to broaden financial help for health insurance through the Affordable Care Act are unlikely to find takers among Republicans.

Either way, Democrats believe voters gave them a mandate on health care in the midterm elections that returned the House to their control.

Pushing her agenda, Pelosi is working from the ground up through major House committees. Her relationships with powerful chairmen and subcommittee chairs stretch back years. She's "playing chess on three boards at once," said Jim McDermott, a former Democratic congressman from Washington state, who predicts Pelosi's most difficult challenge will be "herding new members" impatient for sweeping changes.

Responding to written questions from The Associated Press, Pelosi called the ACA "a pillar of health and financial security," comparing it to Medicare, Medicaid and Social Security. "Democrats have the opportunity not only to reverse the years of Republicans' health care sabotage, but to update and improve the Affordable Care Act to further lower families' premiums and out-of-pocket costs, and expand coverage."

Legislation from Energy and Commerce Chairman Frank Pallone, D-N.J., Ways and Means Chairman Richard Neal, D-Mass., and Workforce and Education Chairman Bobby Scott, D-Va., would broaden the number of people who can get financial assistance with their premiums under the Obama health law, and undo the "family glitch" that prevents some from qualifying for subsidies. It would also restore the HealthCare.gov advertising budget slashed by Trump and block some of his administration's health insurance alternatives.

Those issues are separate from legal questions raised by ongoing Republican litigation to overturn the health law. As one if its first acts, the Democratic-led House voted to intervene in the court case to defend the law.

The ACA package has little chance as a stand-alone bill. But parts of it could become bargaining chips when Congress considers major budget legislation.

The 2010 health law belonged as much to Pelosi as to former President Barack Obama, said McDermott. "She's taking 'Obamacare' and very carefully figuring out where you have to support it," he said. "What you are seeing right now is a very methodical and thoughtful planner."

On prescription drugs, Trump and the Democrats are occupying some of the same rhetorical territory, an unusual circumstance that could bring about unexpected results.

Both sides say Americans shouldn't have to keep paying more for medications than consumers in other economically advanced countries where governments regulate prices.

The Trump administration has designed an experiment to apply international pricing to Medicare "Part B" drugs administered in doctors' offices.

Pelosi wants to expand price relief to retail pharmacy drugs that seniors purchase through Medicare's "Part D" prescription drug benefit, a much bigger move. A bill introduced by leading Democrats would authorize Medicare to negotiate directly with drug companies using international prices as a fallback.

"President Trump said he'd 'negotiate like crazy' to bring down Medicare prescription drug prices, and since the midterm election he's spoken about working with Democrats," Pelosi wrote to AP. "We have an opportunity to enact the tough legislative negotiating authority needed to actually lower prescription drug prices for consumers."

One of the top Senate Republicans on health care says he's not inclined to do that. Finance Committee Chairman Chuck Grassley of Iowa says having private insurers negotiate with drug companies has worked.

"Part D is the only federal program I've been involved with that has come in under budget," said Grassley. "If it's working, don't mess with it."

Nonetheless, former Health and Human Services Secretary Mike Leavitt, a Republican, said Medicare is "a good example of places where the administration might surprise."

"Prescription drug pricing is in a category where both the president and the Democrats have made a commitment," Leavitt added. "There will be a lot of division, but in the end there is a very good chance they will find a way that they can both claim victory."

But the biggest health care idea among Democrats is "Medicare for all," and on that, Pelosi is cautious. To those on the left "M4A" means a government-run health care system that would cover every American. That would require major tax increases and a big expansion of government.

Pelosi has tapped two committees, Budget and Rules, to handle "Medicare for all." Health care legislation doesn't usually originate in either of them.

The Budget Committee can be a forum to explore ideas, and Chairman John Yarmuth, D-Ky., has asked the Congressional Budget Office for a report on policy and design issues with instituting a single-payer health care system. The Rules Committee is a legislative traffic cop for the House floor, often acting as an arm of the Speaker's Office.

Says Pelosi: "We're going to have hearings."