Thune wins

Sen. John Thune (R-S.D.), the newly elected Senate majority leader, hails from a frontier state where the health care sector is made up mostly of hospitals. For that reason, he is big on telehealth and rural hospitals. He's also a fan of increasing transparency for drug middlemen. Conveniently, Congress is expected to extend Medicare telehealth flexibilities, and drug middlemen reforms could be a way to pay for it.

In choosing Thune, Republicans went with an establishment candidate with close ties to the outgoing and long-time Senate Republican leader Sen. Mitch McConnell (R-Ky.), and they rejected Sen. Rick Scott (R-Fla.), the favored candidate of Trump's allies.

As majority leader, Thune will be in charge of coordinating the entire Republican policy agenda, and it's too early to tell how health care will fit into the mix. During his first brief public appearance following his election, Thune said his priorities included border security, energy production, and streamlined bureaucracy. He didn't directly mention health care.

Power play

So do House Republicans

It took a while, but it's now official: Republicans have retained control of the House. With full control of Congress, President-elect Trump and his fellow Republicans have the power to assert their will over health care policies.

Major health care issues could be at stake, including subsidies for Affordable Care Act plans, Medicaid funding, restructuring of massive federal agencies like the FDA and CDC, access to telehealth, how Medicare pays doctors, drug middlemen reforms, drug price negotiations, and China's rise in biotechnology.

Consigned to the minority, Democrats are in a weak position to push for their policy preferences, including renewing the enhanced subsidies for ACA plans. Still, Congress' arcane rules and splits within the GOP could potentially give the party at least some openings. In the Senate, 60 votes are needed to overcome a filibuster, and Republicans are short of that number.

THE TRUMP TRANSITION

Would RFK be DOA? Hard to say.

Even if they've bucked Trump in the past, moderate Republican senators are in no mood to talk about RFK Jr.

Rachel Cohrs Zhang, Sarah Owermohle, and I started asking moderate senators whether they'd be willing to confirm him. In true senator form, they declined to respond to a hypothetical. But they didn't say no, either. Thune too dodged questions about whether he is concerned about any of Trump's Cabinet nominees, some of whom are controversial and have scant governing experience.

Trump hasn't nominated an HHS secretary yet, and his transition team co-chair Howard Lutnick said RFK Jr. won't get that nomination. Still, Trump promised to let Kennedy "go wild" on food and medicine regulation. It's not out of the question that he would nominate Kennedy. See what key GOP senators told us.

INFLUENCE

No, Susie Wiles is not a pharma lobbyist

The Make America Healthy Again universe was ablaze with rumors that President-elect Trump's new chief of staff Susie Wiles lobbied for the pharmaceutical industry, which supporters viewed as a betrayal. The furor got to the point where right-wing strategist and Trump pardon recipient Roger Stone had to weigh in to defend her, my colleague Rachel Cohrs Zhang reports.

According to federal campaign finance disclosures, Wiles has not lobbied for pharmaceutical companies. As a managing partner at Ballard Partners, she is listed as lobbying for health care clients including the Children's Hospital Association, primary and behavioral health care company Citrus Health Network, and diagnostics company Labcorp. With Mercury Public Affairs, she was registered for the tobacco company Swisher.

Mercury Public Affairs, where Wiles worked as a co-chair, lists Gilead and Pfizer as clients, though the firm isn't currently registered to formally lobby on the pharma companies' behalf. Wiles was registered as a lobbyist on behalf of Mercury as recently as the first quarter of 2024.

farewell tour

Biden officials' hazy crystal balls

Officials from the FDA and the CDC are wary and uncertain of what lies ahead for their agencies under the incoming administration, according to dispatches from Lizzy Lawrence, Helen Branswell, and Anil Oza.

Kennedy has been hostile toward civil servants, promoted the disproven belief that vaccines cause autism and other conditions, and promised to overhaul federal health care agencies.

FDA Commissioner Robert Califf worries that Kennedy could make it difficult for FDA to hire and and retain skilled employees. CDC Director Mandy Cohen and Peter Marks, the FDA's top vaccine regulator, worry that RFK's Jr.'s influence could lead to fewer childhood vaccinations.

"No one wants to see a child paralyzed, a child die from something that we can prevent," Cohen said.

lawsuits

Another 340B lawsuit

There are so many lawsuits over the 340B drug discount program that there are litigation trackers dedicated to them.

Add Johnson & Johnson to the list. My colleague Ed Silverman reports that the company has sued a U.S. government agency over a dispute focusing on payment methods for some hospitals that participate in a federal drug discount program.

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