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H.R. 19 (116th): Lower Costs, More Cures Act of 2019

This bill of bipartisan healthcare fixes would be much more likely to pass the Republican Senate and earn President Trump’s signature.


In December, the House passed the Democratic-led Elijah E. Cummings Lower Drug Costs Now Act. Voting Democrats were unanimously in support 228–0, while Republicans almost entirely opposed it 2–191. The two supportive Republicans were Reps. Brian Fitzpatrick (R-PA1) and Jaime Herrera Beutler (R-WA3).

A few days before the vote, when House passage appeared imminent, congressional Republicans introduced a healthcare bill called the Lower Costs, More Cures Act which featured only bipartisan provisions.

Republicans challenged Democrats to vote for this more bipartisan iteration, which could ostensibly earn the Republican president’s signature, instead of Democrats’ own iteration which was much further left and almost certainly doomed not to pass.

What the bill does

The Lower Costs, More Cures Act is a 352-page bill implementing many bipartisan reforms, including a number which had previously passed the House Energy and Commerce Committee unanimously. Among the most notable:

  • Making permanent the medical expense tax deduction. In 2017, the threshold of income at which medical expenses could be deducted was temporarily reduced from 10% to 7.5% for two years.
  • Capping seniors’ out-of-pocket healthcare costs for any given year in the Medicare Part D program.
  • Ending a current practice called “pay for delay,” in which would-be producers of generic drugs are paid by larger companies to postpone the introduction of their competitor.
  • Mandates insurance companies provide drug costs at a doctor’s office, prior to a prescription being written for a patient.

The House version was introduced on December 9 as bill number H.R. 19, by Rep. Greg Walden (R-OR2). The Senate version was introduced a week and a half later on December 19 as bill number S. 3129, by Sen. Michael Crapo (R-ID).

What supporters say

Supporters argue the legislation improves the medical system by potentially improving health outcomes while simultaneously reducing expenditures.

“We need to incentivize innovation, we need to come up with more cures, but we also need to tackle the bad behavior by the pharmaceutical companies when they stop generics from coming to the market and block access to some of these newer drugs that would bring down the cost,” Rep. Walden said in a press release. “This legislation deals with all of that, lowers cost and gets us more cures as well.”

The legislation “builds on the market-based principles of Medicare Part D to leverage competition, flexibility and transparency to bring affordable drugs to patients,” Sen. Crapo said in a separate press release. “For the first time, Part D patients will have a maximum out-of-pocket cap to protect them from high costs. Providers will have access to information to recommend lower-cost alternatives, and Medicare Part B will appropriately pay providers for prescribing the best drug for their patient.”

What opponents say

Opponents counter that — while they support many or most of the legislation’s provisions — the Democrats’ own version is preferable because of more aggressive strategies to lower costs, even ones that Republicans contend are too harmful to businesses.

“The problem… is it doesn’t tackle the fundamental problem, which is reducing drug prices,” Rep. Katie Porter (D-CA45) said on the House floor about the Republicans’ version (page 74 in that PDF). “[The bill] fails to solve the main problem of actually lowering drug prices.”

“Today, 9 out of 10 big pharmaceutical companies spend more on marketing, sales, and overhead than they do on research,” Rep. Porter continued. “We have to tackle the fundamental problem here, which is that pharmaceutical companies are gouging Americans, they are overcharging them, and they are leaving lifesaving drugs out of the hands of the American people each and every day. This amendment does not tackle that fundamental problem.”

Odds of passage

The bill has attracted 145 cosponsors, all Republicans — despite Rep. Walden’s office calling it “bipartisan” on their press release.

It awaits a potential vote in either the House Energy and Commerce, Judiciary, or Ways and Means Committees. Odds of passage are slim in the Democratic-controlled chamber, particularly because it was deliberately designed as a response to a Democratic-led bill that subsequently passed the House.

Last updated Feb 11, 2020. View all GovTrack summaries.

The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jan 21, 2021.

Lower Costs, More Cures Act of 2019

This bill establishes and modifies several requirements to address prescription drug prices under Medicare, Medicaid, and other programs.

The bill generally

limits payment amounts for drugs and biologics under Medicare medical services, reduces cost-sharing under the Medicare prescription drug benefit, modifies certain authorities and requirements under the Medicaid Drug Rebate Program, revises provisions relating to regulatory approval and commercial availability of generics and biosimilars, and establishes several reporting requirements for drug manufacturers with respect to drug prices.