美国国家公共电台 NPR How Sen. Orrin Hatch Shaped America's Health Care In Controversial Ways

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STEVE INSKEEP, HOST:

The arrival of the new Congress means the retirement¹ of Utah Senator Orrin Hatch.

NOEL KING, HOST:

Hatch was elected 42 years ago in 1976, when Gerald Ford³ was president. Presidents have come and gone since then - seven presidents from Carter to Trump⁴ - but Hatch has always been there.

INSKEEP: In public, Orrin Hatch has always been quotable, often partisan⁵, yet noted⁶ for working with key Democrats⁸.

KING: And behind the scenes, he was deeply influential⁹ on health care legislation. His bills affected¹⁰ millions of consumers and many health care companies.

INSKEEP: Erik Neumann of our member station KUER in Salt Lake City has an evaluation¹¹.

ERIK NEUMANN, BYLINE¹²: During his 42 years in the Senate, Orrin Hatch sponsored major pieces of health legislation. There was the 1983 Orphan¹³ Drug Act to promote drug development for rare diseases and, in 1990, the Ryan White CARE Act to treat people with HIV who were uninsured.

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ORRIN HATCH: AIDS does not play favorites. It affects rich and poor, adults and children, men and women, rural communities and the inner cities. We know much, but the fear remains¹⁴.

NEUMANN: It was a bold stance at the time. It was also an example of how well Hatch, a Republican, worked with Democrats. Hatch co-sponsored a number of bills with Democrat⁷ Ted² Kennedy. The two men were sometimes called the odd couple. In 1997, they proposed the Children's Health Insurance Program, or CHIP. It was a major achievement, according to Joan Alker, a health policy analyst¹⁵ at Georgetown.

JOAN ALKER: This is an area the country has made enormous progress on. And it's something we should all feel proud of, and Senator Hatch should, too.

NEUMANN: At the time, the number of uninsured children in America was around 10 million. Today it's less than half that. Hatch's influence on American health care came from the sheer number of bills he sponsored and because he was chairman of several powerful committees.

DAVID SUNDWALL: History was on his side because the Republicans were in charge.

NEUMANN: That's Dr. David Sundwall, a Utah professor who worked as Hatch's health director in the 1980s. When Reagan became president, the Senate also became Republican for the first time in decades. And Hatch nabbed the chairmanship of the committee that oversees¹⁶ the Food and Drug Administration, the CDC and the National Institutes of Health.

SUNDWALL: He was virtually catapulted into this chairmanship role. This is astonishing, that he had chairmanship of an umbrella committee in his first term in the Senate.

NEUMANN: In 2011, Hatch got a seat on the even more powerful Senate Finance Committee and later became chairman. Now he had oversight¹⁷ of Medicare, Medicaid and CHIP. Hatch's growing power did not go unnoticed by health care lobbyists. The watchdog group Center for Responsive Politics ranks Hatch as a top recipient¹⁸ in Congress for health industry contributions. And a lot of Hatch's money came from the pharmaceutical¹⁹ sector²⁰.

JEREMY GREENE: Clearly he was pharma's man on the Hill.

NEUMANN: That's Dr. Jeremy Greene, a medical historian at Johns Hopkins University. He says Hatch did work on lowering drug prices, but his overall record was mixed. Take a law he sponsored in 1984 with Democrat Henry Waxman. The Hatch-Waxman Act was meant to spur the development of more generic²¹ drugs.

And generic sales did increase. Still, companies that sold the more expensive brand-name drugs didn't lose out. The act gave them longer patents on their drugs. And Greene says that soon drugmakers figured out how to exploit the law's weaknesses.

GREENE: The makers²² of brand-name drugs began to craft larger and larger webs of multiple patents around their drugs to try and help find ways of preserving monopolies after the initial patent expired.

NEUMANN: Hatch has also gotten mixed reviews for his work with another industry, supplements. That's a catch-all term for vitamins, herbs and other natural health products. The multibillion-dollar industry is concentrated in Hatch's home state of Utah. Loren Israelsen is a former Hatch staffer who now leads a supplements trade group.

LOREN ISRAELSEN: There was really no place for these natural health products.

NEUMANN: As the industry grew, a debate began over how to regulate it. In 1994, Hatch responded by sponsoring the Dietary Supplement Health and Education Act.

ISRAELSEN: It was necessary to have someone who would be a champion to say, all right, if we need to change the law, what does it look like, and let's go.

NEUMANN: The act reined²³ in the FDA oversight, saying supplements did not have to go through safety testing like prescription²⁴ drugs. That's led to ongoing²⁵ questions about whether supplements work and how they interact with other medications. Hatch co-sponsored the supplements law with Democrat Tom Harkin.

That bipartisanship was how he worked for decades, but in recent years not so much. He strongly opposed the Affordable²⁷ Care Act. And at one time, he called its supporters the stupidest people he'd ever met. Hatch is now 84. In his farewell speech on the Senate floor, he lamented²⁸ the polarization that's overtaken Congress.

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HATCH: Gridlock is the new norm. And like the humidity here, partisanship²⁶ permeates²⁹ everywhere, everything we do.

NEUMANN: And as Orrin Hatch prepares to leave Washington, there's no sign of relief. For NPR News, I'm Erik Neumann.

INSKEEP: This story is part of a reporting partnership³⁰ with local member stations and Kaiser Health News.