In Health Care Debate, Congress Should Find and Build-On Common Ground

The latest election result has brought forward discussions of mandates and new agendas, with both Democrats and Republicans actively handicapping the right mix of strategies to outmaneuver the other heading into a contentious 114th Congress. In doing so, we all risk losing sight of the message that voters just sent to Washington: the status quo isn’t working and it’s time that legislators unite around instances of common ground. In fact, it is these occasions where leaders can provide the most good for the citizens that put them in office.

For many Republicans, the attack on Obamacare, an ill-advised long-term strategy, played a role in establishing an anti-administration narrative upfront. Few other domestic policy issues in recent history have stirred such strong emotions and Republicans benefited as a result. However, lawmakers on both sides the aisle now have an opportunity to return to regular order and prioritize issues that go beyond the divisions of the Affordable Care Act. Both parties have an obligation to demonstrate that consensus is possible.

A case in point is the 340B Drug Discount Program, which was established in 1992 to provide discounted medications to hospitals serving indigent patient populations. In short, the program isn’t living up to its original intent and has been documented repeatedly for abuse by bad actors due to lack of appropriate oversight. Over the years, both the Government Accountability Office and the Office of the Inspector General of Health and Human Services have independently found inadequate levels of oversight that have led to abuse and diversion of medications from the intended, low-income recipients.

As I’ve noted in recent commentaries, many hospitals that participate in the 340B program dedicate less than one percent of patient spending on charity care. Worse, hospitals are finding new ways to take advantage of the program by partnering with chain, for-profit pharmacies to increase the discounts for which they are eligible without passing those savings along to patients. Since 2005, the number of health care facilities participating in the program has ballooned from 538 to 2140, yet no additional oversight exists.

At a recent meeting, MedPAC, the organization that formally advises Congress on the Medicare program, went beyond its normal purview to deliver a presentation on 340B. The request for MedPAC to examine it apparently came directly from Members of Congress who are calling for intervention for want of action from any other authoritative body.

In doing so, however, these members have overlooked perhaps the most authoritative body that can and should intervene in the 340B program – Congress itself.  Indeed, in over twenty years of the program’s existence, only one oversight hearing has even been held on what is a rapidly growing program.  And now, even HRSA itself is asking for Congress to intervene; in a recent interview with Congressional Quarterly, Director Krista Pedley, who oversees 340B for HRSA, talked openly about the need for Congressional intervention to help the Agency in its administration of the program.

The incoming Chairman and Ranking Member of the Senate Committee on Health, Education, Labor and Pensions – Senators Lamar Alexander and Patty Murray have a history of working well together. They have a unique opportunity to join together to eliminate waste and dysfunction, achieve real reforms and changes, and ultimately safeguard critical government programs that are being jeopardized by abuse. Not only would this guarantee that patients have access to high-quality health care services through programs like 340B, but it would go a long way in assuring the American people that Congress can restore regular order and drive lasting change.

For both parties, voters would support such a move. The recent success of minimum wage ballot initiatives in Alaska, Arkansas, Illinois, Nebraska and South Dakota -four of which have voted to send a Republican to the U.S. Senate – point to an appetite for initiatives that help lower-income Americans  in a fiscally responsible way..

While it’s clear that many Republicans view the latest election result as a mandate, ignoring the need for consensus solutions will lead to Democratic gains in 2016. At the same time, Democrats can’t afford to sit idle. Voters – particularly the base -expect sensible policymaking in the next Congress and will hold incumbents accountable. As the debate around health care is becoming more contentious and toxic, some common ground might be just what the doctor ordered.


Howard Dean, MD is the former Governor of Vermont. He currently serves as an independent consultant for McKenna Long & Aldridge LLP, which represents a wide variety of clients, including those interested in health policy. Views are his own.

Morning Consult