Funding for the ACA continues to be reduced. “As part of a 1.4 trillion dollar spending package the Senate passed [December 19, 2019] and which President Donald Trump has said he'll sign, three taxes that were created to fund the Affordable Care Act are set to be repealed. The outgoing fees include the "Cadillac tax," the health insurance tax and the medical device tax. While lowering taxes has remained one of the few points on which politicians from both parties can (sometimes) agree, removing the funding mechanisms from the Affordable Care Act has raised questions over how to responsibly expand access to health care. According to an analysis from Congress's Joint Committee on Taxation, getting rid of the levies will cost the government $373.3 billion in lost revenue over the next decade.”
2019 closed with no legislative action on surprise medical bills. “A bipartisan push to curb the practice of surprise medical billing was delayed until , with Senate Minority Leader Charles E. Schumer (D-N.Y.) working behind the scenes to raise objections to the package, according to three people familiar with the talks who spoke on the condition of anonymity to share details of private negotiations.”
Senator Chuck Grassley’s efforts to advance legislation intended to lower drug prices had a similar fate. “Grassley said [December 18, 2019] that Senate Majority Leader Mitch McConnell is responsible for his colleagues’ apparent lack of enthusiasm about his bipartisan bill to lower drug prices. When asked by reporters during a briefing why more Senate Republicans haven’t supported the legislation, the Senate Finance Committee chairman said because McConnell ‘asked them not to.’ … When asked for comment, a spokesperson for McConnell directed CNBC to a report where McConnell is quoted saying the Senate’s path forward on drug costs is still ‘under discussion’ and he is ‘looking to do something on drug pricing.’” The bill would have changed Medicare to add an out-of-pocket limit for beneficiaries and placed price controls on price increases.
A bill passed by the House in December and sponsored by Nancy Pelosi is unlikely to be taken up by the McConnell led Senate. The proposed legislation would have permitted the Department of Health and Human Services to negotiate drug prices on behalf of Medicare.
“Vilified by lawmakers from both parties for months, the health-care industry [in 2019] appeared to face an existential threat to its business model. But … pharmaceutical companies, hospitals, insurance companies and medical device manufacturers practically ran the table in Congress, winning hundreds of billions of dollars in tax breaks and other gifts through old-fashioned lobbying, re-exerting their political prowess. ‘It’s the ‘no special interest left behind bill’ of 2019. That’s what it feels like this is,’ said Andy Slavitt, a former health administrator who served in the Obama administration. ‘There’s no other explanation.’”
Data from 2017 and 2019 illustrates the power of lobbyists on behalf of the health care industry. In 2017, “Healthcare lobbying outpaced all other industries — the second closest industry was the finance, insurance and real estate lobby, which spent $517 million; (ii) Broken down, pharmaceutical companies were the biggest spenders with $277.78 million spent on lobbying in 2017; hospitals and nursing homes were the second-largest spending group with $99.63 million; and health professionals the third, spending $89.53 million.”
Opensecrets.org reports that the total spent in 2019 was almost $594 million, on behalf of 1,296 clients. It reports that there were 2,775 lobbyists, 53.84% of which were former government employees. Again pharmaceutical companies spent the most, $295 million.
Given the magnitude of the lobby and the fact that there is a presidential election in 2020, one wonders whether health reform in 2020 will fare any better than in 2019.
 Newsweek, Hunter Moyler, December 19, 2019. https://www.newsweek.com/affordable-care-act-taxes-repealed-1478323.
 The Washington Post, Jeff Stein and Yasmeen Abutaleb, “Congress showers health care industry with multibillion-dollar victory after wagging finger at it for much of 2019,” December 20, 2019, https://www.washingtonpost.com/business/economy/congress-showers-health-care-industry-with-multi-billion-victory-after-wagging-finger-at-it-for-much-of-2019/2019/12/19/9422aa6a-2028-11ea-9146-6c3a3ab1be6c_story.html.
 CNBC, Bernard Lovelace, Jr., “GOP Sen. Grassley says Mitch McConnell sabotaged support for his drug pricing bill,” December 18, 2019, https://www.cnbc.com/2019/12/18/grassley-says-mitch-mcconnell-sabotaged-support-for-his-drug-pricing-bill.html.
 Supra, Note 2.
 Becker’s ASC Review, Eric Oliver, “Healthcare-related lobbying hits $555M in 2017 — 6 statistics on lobbying in healthcare,” January 31, 2018, https://www.beckersasc.com/asc-coding-billing-and-collections/healthcare-related-lobbying-hits-555m-in-2017-6-statistics-on-lobbying-in-healthcare.html.