Democrats are showing little interest in cooperating with the Republicans who control Congress on legislation to dismantle the Obamacare health insurance law but some are signaling a willingness to collaborate on action to curb rising drug prices.
Republican U.S. President-elect Donald Trump pledged two weeks ago to bring down drug prices, addressing an issue that could appeal to voters in both parties. He did not say how he would accomplish this although he previously suggested he was open to allowing importation of cheaper medicines from overseas.
Nineteen Senate Democrats this week urged Trump to push the issue with Republican lawmakers, many of whom have resisted government action to rein in medication costs.
Persistently rising drug prices have imposed a heavy burden on consumers. Many Americans cannot afford their medicines or face increasing co-pays on prescription drugs.
The 2010 Affordable Care Act, dubbed Obamacare, enabled about 20 million Americans who previously had no medical insurance to get coverage. It is considered outgoing Democratic President Barack Obama's signature legislative achievement and an important accomplishment for his party.
Republicans, who will control both the White House and in 2017, condemn it as a government overreach. Trump and congressional Republicans have vowed to repeal and replace it. Senate Majority Leader Mitch McConnell has said senators will start the repeal process shortly after Jan. 1. Trump takes office on Jan. 20.
A House of Representatives leadership aide told reporters drug pricing was one of several areas Republicans would use to reach out to Democrats to solicit their involvement in Obamacare replacement legislation, along with the Medicaid insurance program for the poor, and children's healthcare.
"We are going to try and find where the other side wants to engage," the aide said.
Democrats may be difficult to persuade. Democratic Senator Amy Klobuchar of Minnesota said drug-pricing proposals might have been part of a bipartisan healthcare reform package to address Obamacare issues, if Republicans were not insisting on repeal first, placing the two parties in opposite camps.
"My vision before the election was that we would have some form of reform package, and now that's murky because of this effort to repeal," Klobuchar said in a telephone interview.
Republican lawmakers have angered Democrats with their plan to use arcane congressional budget procedures to repeal Obamacare as quickly as possible, without having to secure any Democratic votes. This approach would thwart procedural hurdles Democrats could pursue under normal circumstances.
Republicans including Senator John Thune of South Dakota, a member of his party's Senate leadership, have said they want Democrats to work with them to replace Obamacare once it is repealed. They will almost certainly need them.
In the 100-seat Senate, Republicans need a super-majority of 60 to clear procedural hurdles and pass replacement legislation. With 52 Republican senators, they would need to attract at least eight Democrats.
"If they genuinely wanted to work with us on fixing the Affordable Care Act, we would have that conversation before they repealed," Democratic Senator Chris Coons of Delaware said of the Republicans.
Americans can obtain health insurance from private insurers through the Affordable Care Act by buying it on state or federally run exchanges.
In 2016, costs on the individual insurance market rose. Insurers including UnitedHealth Group Inc and Aetna Inc pulled out for 2017, saying they were losing too much money. More insurers may drop out for 2018, making insurance plans more expensive.
Lawmakers in both parties expressed outrage after Mylan NV raised the price of a pair of the generic drugmaker's lifesaving EpiPen allergy treatments to more than $600 this year from $100 in 2008.
Klobuchar has worked with Iowa Republican Senator Charles Grassley on drug-pricing issues, introducing legislation that would help put an end to brand-name drug companies paying generic drugmakers to delay marketing low-cost competing medications.
She was among the Democrats who sent Trump the letter on drug costs. They suggested five areas of cooperation: allowing the Medicare insurance program for the elderly to negotiate prescription prices, increasing transparency, stopping abusive pricing, encouraging incentives for innovation, and supporting generic competition for branded drugs.
In addition, Republican Senator Susan Collins of Maine Democratic Senator Claire McCaskill of Missouri this week released a report detailing drug-pricing abuses at Valeant Pharmaceuticals International and Turing Pharmaceuticals.
Health policy expert Joe Antos of the American Enterprise Institute think tank said Democrats may refuse to work on Obamacare replacement legislation for some time, especially if Republicans delay the repeal's effective date by up to three years.
"Democrats can just say, we don't have to do it now," Antos said.
Stuart Butler of the Brookings Institution think tank said it will get harder for Democrats to stay on the sidelines after a repeal because hospitals, insurers and Americans who may lose their coverage will press for action.
"I think they (Democrats) will get as much political capital out of not engaging as they can, and then I think their own constituents will start to push them," Butler said.
(Reporting by Susan Cornwell in Washington and Caroline Humer in New York; Editing by Will Dunham)