Thread by @ASlavitt

I’m leaving DC after 2 days. Congress is back so the halls were 8 thick with lobbyists.

At one point, someone near me mistook me for a lobbyist.

I met with 2 Ds, 2Rs in House & Senate.

Some notes follow; follow if interested.

Big talk in health care: surprise medical bills, rx drug costs and what makes it in end of year package.

Some talk: ACA adds, prez politics.

No talk: repeal, what to do next 2/

There is a seriousness to addressing drug costs now.

Reason— Dems have traditionally been there. Now there’s a short window where Grassley is Chair of Senate Finance. If something is going to happen, everyone believes it will be with this Chair or wait until Ds are in control.3/

Credit to @RonWyden.

House Dems have a serious, significant far reaching bill.

The accepted wisdom is it is all up to Mitch McConnell. And he won’t want anything to come to the floor. Only way he would is public consistent strong pressure from Trump.

And, well...4/

“Consistent” and “Trump” cause a lot of eye rolls.

Even more so, I heard a fair amount of “Pharma wants...”, “Pharma says...”, “Pharma tells us...”

It is clear they are everywhere putting pressure.

So which will win, the lobbyists or the 2018 election results? 5/

My prediction of a possible scenario: Trump talks a good game, but doesn’t push McConnell.

Then in 2020 at the last minute he think better do something that looks good and creates some executive action that all drug prices come down or allows for importation. 6/

There is real bipartisan support for ending surprise medical bills which haunt consumers.

But recently private equity firms are funding tens of millions of dollars to defeat it. And the members I talked to are pissed. 7/

khn.org/morning-breako…

One R said “This will blow up in their faces. I’m a capitalist but this is wrong.” The Ds are having a hearing.

I hope he’s right. A show of political courage would be a welcome surprise.

Realistically, it may live or die by what ends up in a year end must pass package.8/

I know this is getting long... so I’ll move along...

The thought of the courts throwing out the ACA was not something Republicans appeared to want to think about.

And Dems wanted to work on how to build on it and pass improvements. 9/

Some Friday over the next month or two there’s a good chance the conservative court of appeals, with Trump’s prodding, will say the ACA can be overturned pending a Supreme Court appeal.

Here’s what would be lost. 10/

https://twitter.com/aslavitt/status/1029480767343276039?s=21

And in the midst of chaos, lobbyists thrive.

(If no smart person ever said this they should have.) /end