WASHINGTON — With Republicans set to take control of the Senate in January, a new cast of lawmakers will gain power and influence on health care policy.
The GOP will have at least 51 seats in the chamber next year, after defeating the Democratic Sherrod Brown in Ohio and winning the West Virginia seat left open by Joe Manchin. Republicans also fended off challengers in states like Nebraska and Texas.
Republican lawmakers will have chairmanships of plum committees, which carry the ability to schedule hearings, mark up legislation, conduct investigations, and hold subpoena votes. Their offices will also get more staff and resources to execute their visions.
The Senate has been under Democratic control for the past four years, so newly empowered committee chairs will have a bigger platform to advance their policy initiatives.
The Republican victory in the Senate also makes the race to replace Senate Majority Leader Mitch McConnell (R-Ky.) more important, as the leader of the caucus will determine what legislation gets a vote on the Senate floor, and will be a more influential negotiating partner with the House and White House on key legislation.
Congress will be facing some big-ticket health care issues next year, including deciding whether to renew Affordable Care Act premium subsidies that expire at the end of 2025.
STAT takes a look at six lawmakers who will be poised for influence in health care when Republicans take power in early January.
Sen. Bill Cassidy (R-La.)
Cassidy is the heir apparent to run the Senate health committee, having been the panel’s top Republican this Congress.
Cassidy has expressed interest in reforming public health agencies including NIH and CDC, which he would oversee under the health committee’s jurisdiction.
What’s on the docket for Congress post-election: Chinese biotech, Medicare payments, ACA subsidies
As chair, Cassidy will also run the confirmation process for the new administration’s Food and Drug Administration commissioner, National Institutes of Health director, and Centers for Disease Control and Prevention director. This administration will see the first Senate-confirmed CDC director, as the requirement was recently added in pandemic preparedness legislation.
Cassidy has taken an interest in drug pricing issues, specifically in how to pay for expensive gene therapies. He has also started work on a Medicare hospital payment reform with Sen. Maggie Hassan (D-N.H.) that would equalize payment between hospital outpatient departments and physician offices for the same services.
Sen. Mike Crapo (R-Idaho)
It’s finally going to be Crapo’s time to shine, after playing second fiddle on the Senate Finance Committee for four years. As a tax lawyer, he’s going to be a key player on dealing with the expiration of the Trump tax cuts next year, as well as the expiring Affordable Care Act premium subsidies.
Crapo showed during his time with Sen. Ron Wyden (D-Ore.) that the pair can negotiate on major bipartisan health packages, like the committee’s hefty pharmacy benefit manager reform legislation this Congress.
Sen. John Thune (R-S.D.)
The current Senate minority whip, Thune is up for a promotion after McConnell retires as the conference’s second-in-command, and has announced his intentions to run for Senate majority leader. Thune sits on the Senate Finance Committee, and has engaged with several efforts to make bipartisan health care legislation this Congress.
Over the past two years, he’s signed on to efforts to streamline prior authorization, joined a working group to reform the way that physicians are paid, and collaborated to develop draft legislation to reform the 340B drug discount program. The efforts could signal what health issues would be most important to him moving forward.
Thune represents South Dakota, so expect rural health care and supporting rural hospitals to be a top consideration for him.
Sen. John Cornyn (R-Texas)
The other John running for the top slot in the Senate Republican conference is Cornyn, who has experience as the GOP whip navigating vote counts, and has shown a sophisticated interest in patent reform in the pharmaceutical industry.
Cornyn holds positions on both the Finance and Judiciary Committees, which have been involved in drug pricing debates in recent years. Cornyn helmed a drug patent reform bill targeted at reducing patent thickets that drugmakers use to keep generics off the market, and it passed the Senate unanimously earlier this year — though it was significantly watered down from its original form.
As he’s from a border state, Cornyn has worked to address the opioid crisis by supporting policies to decriminalize fentanyl test strips and stem the flow of fentanyl into the United States.
Sen. Roger Marshall (R-Kan.)
Though he isn’t in line to lead a health committee, Marshall has proven he’s willing to be an independent thinker and bipartisan dealmaker.
The best example of his open-mindedness and interest in health care was when he partnered with Senate health committee chair Bernie Sanders (I-Vt.) on legislation to better fund primary care. Though that specific legislation didn’t advance, he definitely raised some eyebrows.
As an obstetrician, he also has credibility in the Senate GOP on health care issues. The header on his website lists his name as “Doc Marshall.” He also partnered with Thune, whose star could be on the rise, on legislation to streamline prior authorization processes.
Sen. Marsha Blackburn (R-Tenn.)
Blackburn is another senator who’s been willing to forge unexpected partnerships to advance health priorities.
During debates over pharmacy benefit manager policy, she introduced legislation that would have regulated the fees that PBMs can receive from pharmaceutical companies, and she partnered with Democrats including Sen. Elizabeth Warren (D-Mass.) to call for more scrutiny of Medicare Advantage plans.
She’s from Tennessee, a state with a significant health care industry presence, such as the for-profit hospital giant HCA Healthcare.
