Prescription drug prices are hitting Americans particularly hard. The average American now spends approximately $1,200 per year on medication – more than anyone else in the world. Prescription drug spending and price increases have surged far more in the U.S. in the last decade than in other countries. Price surges for insulin have particularly attracted interest because it is so widely used and because the price in the U.S. for this century-old medicine has doubled, and in some cases tripled, in the last decade.

Several factors contribute to rapidly rising drug prices in the America. Most countries control and negotiate drug prices. The U.S. government does not. There are unique challenges to bringing generics to market in America. Pricing and business practices in the pharmaceutical industry are less transparent in the U.S. than in other countries.

Because the surging costs of prescription drugs negatively affects so many Americans, there is rising bipartisan resolve to do something about it. President Biden has made it a top priority. The Problem Solvers Caucus, a group of 28 Democratic and 28 Republican members of the House, and the Common Sense Coalition, a group of 16 moderate senators from both sides of the aisle led by Senators Susan Collins (R-ME) and Joe Manchin (D-WV), are also focused on prescription drug prices.

Senators Charles Grassley (R-IA) and Ron Wyden (D-OR) introduced one leading example of a bipartisan measure to address the problem in September 2019 – the Prescription Drug Pricing Reduction Act. According to the non-partisan Congressional Budget Office (CBO), the bill would save seniors and Americans with disabilities $72 billion in out-of-pocket costs in Medicare Part D and reduce premiums by $1 billion. The CBO estimated that the entire bill could save taxpayers more than $94 billion over the next decade. The bill would impose some stringent price reporting controls on the pharmaceutical sector, as well as continuing some significant rebates from drug manufacturers. Pharmaceutical companies remain opposed to the bill.

Although the bill had bipartisan support in the last Congress, then Senate Majority Leader McConnell (R-KY) did not put the legislation on the Senate’s calendar. Some of the bill’s provisions were included in the appropriations bill signed into law at the end of 2020. Other provisions, including insulin price controls, will likely be reintroduced in the 117^th Congress with bipartisan support.

Other proposals focus on more specific aspects of the problem. There is bipartisan interest in Congress in cracking down on backroom deals that keep lower-priced generics off the market. The Federal Trade Commission has found that pay-for-delay agreements slow generics getting to market by an average of 17 months. In the meantime, consumers must continue paying brand-name drug prices, which can be as much as 85 percent higher than the prices of their generic counterparts.

One example of bipartisan legislation that is aimed to make it easier to bring generic drugs to the market is the Preserve Access to Affordable Generics and Biosimilars Act. It was introduced in the last Congress in the Senate by Senators Chuck Grassley (R-IA) and Amy Klobuchar (D-MN) along with three additional Republican and three additional Democratic Senators. It was introduced in the House by three Democratic Representatives and two Republican Representatives. The purpose of the bill is to limit anticompetitive pay-for-delay deals that slow the introduction of affordable follow-on versions of branded pharmaceuticals. This bill, or something similar, is expected to be reintroduced on a bipartisan basis in this Congress.

A growing bipartisan consensus concludes that there is a crucial need to solidify U.S. leadership in scientific innovation through investments in discovery, creation, and commercialization of technology. American’s innovation in semiconductors, in particular, undergirds our entire innovation economy. Unfortunately, our complacency has allowed our competitors – including foreign adversaries – to catch up. While the U.S. leads the world in chip design, most of those chips are manufactured outside the U.S.

On May 27, 2020, Senators Todd Young (R-IN) and Chuck Schumer (D-NY), along with Representatives Ro Khanna (D-CA), and Mike Gallagher (R-WI) introduced the bipartisan Endless Frontier Act, an initiative to solidify United States leadership in scientific and technological innovation through increased investments in the discovery, creation, and commercialization of technology fields of the future. It targets support to ensure new research investments translate into new American companies, manufacturing and high-tech jobs, and opportunities for regions across the country to become global centers of emerging technology industries.

The Endless Frontier Act would provide $100 billion to the National Science Foundation over five years to lead investment and research in artificial intelligence and machine learning; high-performance computing; robotics, automation, and advanced manufacturing; and more.

An additional $10 billion would be authorized to designate at least 10 regional technology hubs, awarding funds for comprehensive investment initiatives that position regions across the country to be global centers for the research, development, and manufacturing of key technologies.

On July 20, 2020, Senators Mark Warner (D-VA) and John Cornyn (R-TX) introduced the Creating Helpful Incentives to Produce Semiconductors (CHIPS) for America Act which would restore America’s edge in semiconductor manufacturing by increasing federal incentives to stimulate advanced chip manufacturing, enable cutting-edge research and development, secure the supply chain, bring greater transparency to the microelectronics ecosystem, create American jobs, and ensure long-term national security. Representatives Doris Matsui (D-CA) and Michael McCaul (R-TX) introduced this legislation in the House on July 21, 2020.

President Biden has expressed strong support for these competitive efforts, including taking some initial actions by Executive Order. Senator Majority Leader Chuck Schumer (D-NY) has also instructed Senate committees to prepare a legislative package that will have the Endless Frontier Act as the “centerpiece” and include “emergency funding” to implement the CHIPS Act.

The United States has fallen chronically far behind the rest of the world in meeting its needs for infrastructure, creating agreement among President Biden and Republicans and Democrats in Congress that the country needs to act.

While there is bipartisan agreement on the goal of addressing infrastructure, partisan disagreement on significant details have prevented meaningful bipartisan action for years. Some of the disagreement is over what should be included in an infrastructure package. There is general bipartisan agreement that the country needs to address inadequacies in the capacity and maintenance of our highways, roads, and bridges. The Highway Trust Fund is less than a year from insolvency.

Partisan differences emerge, however, in what beyond highways, roads, and bridges should be included. Democrats, for example, are more enthusiastic about investment in mass transit. There is significant bipartisan support for improving communications and digital infrastructure (see the broadband issue above) as well as some clean energy infrastructure, though Democratic support tends to be more ambitious in these areas. Democrats tend to be more supportive than Republicans of including housing in an infrastructure package.

The most significant partisan differences over infrastructure are on how much to spend and how to pay for it. The Biden Administration and congressional Democrats are currently discussing spending more than $2 trillion to modernize an expansive list of types of infrastructure over ten years. Republicans, and some Democrats, are objecting to that amount of spending, especially after legislation authorizing nearly $6 trillion in COVID relief.  Objections are also being raised to including measures they don’t believe belong in an infrastructure package. Republicans, and some Democrats, are also opposed to the significant tax increases that would be required to pay for such a large infrastructure package.

If CommonSense American members chose infrastructure as one of our topics, we would focus on bills with the best prospects of bipartisan support. One promising example is American’s Transportation Infrastructure Act (ATIA) of 2019. It was introduced on July 29, 2019, by four members of the Senate Committee on Environment and Public Works (EPW): Senators Josh Barrasso (R-WY), Tom Carper (D-DE), Shelley Moore Capito (R-WV), and Ben Cardin (D-MD). It received unanimous, bipartisan support from the Committee and is likely to be reintroduced in the 117^th Congress.

ATIA would take a significant step in addressing our nation’s $2 trillion infrastructure funding gap. It would authorize $287 billion in Highway Trust Fund spending over five years, a 27 percent increase from the last reauthorization bill. The legislation would invest $10 billion in policies and innovative projects aimed at reducing emissions. It would authorize $259 billion to be distributed to states by a formula and establish a program to support projects that would improve the resiliency of roads and bridges to natural disasters and extreme weather events.

Investment in the infrastructure needed to make sure every American has clean and safe water in another area attracting wide, bipartisan support. The experience of residents in Flint, Michigan have demonstrated the need to replace lead pipes. More than 500,00 children in the United States have elevated levels of lead in their blood, primarily from lead paint and pipes. Up to ten million homes across the country get water through lead pipes that connect the main drinking water line in the street to their homes.

The Drinking Water and Wastewater Infrastructure Act of 2021 (DWWIA 2021) would address many of these water infrastructure issues. This legislation authorizes more than $35 billion for drinking water and wastewater projects across the country with a focus on upgrading aging infrastructure, addressing the threat of climate change, investing in new technologies, and providing assistance to marginalized communities. The package includes a provision to establish new pilot programs that award grants to help low-income households pay their drinking water or wastewater bills. DWWIA 2021 also includes two programs to create new resiliency grants for water systems and treatment works to increase their ability to withstand natural hazards, including extreme weather.

On March 24, 2021, the Senate Environment and Public Works Committee voted unanimously (20-0) to approve the DWWIA 2021 bill. It was introduced by Senators Ben Cardin (D-MD), Shelly Moore Capito (R-WV), Tammy Duckworth (D-IL), Cynthia Lummis (R-WY), Tom Carper (D-DE), and Kevin Cramer (R-ND). Six more Senators (four Democrat and two Republican) co-sponsored the legislation.

Over the past decade, Big Tech corporations have captured enough of the global economy to resemble industrial cartels from a bygone era. More than likely, your personal information is regularly collected and used by several of them. Concerns about monopoly power, data privacy, responsible content, and free speech issues have caused a bipartisan groundswell in Congress to act.

One bipartisan bill to address responsible content, for example, was reintroduced on March 17, 2021, by Senators Brian Schatz (D-HI) and John Thune (R-SD). The Platform Accountability and Consumer Transparency Act or the PACT Act would create more transparency by requiring online platforms to explain their content moderation practices in an acceptable use policy that is easily accessible to consumers. The PACT Act would also narrow the liability protections social media companies have under Section 230 of the Communications Act from responsibility for content posted on their platforms. For example, the legislation would require removal of court-determined illegal content and activity within 24 hours and enable greater enforcement of federal civil laws against online platforms.

Bipartisan consensus also appears to be forming to limit Big Tech’s monopoly powers. While the Competition and Antitrust Law Enforcement Reform Act introduced by Senator Amy Klobuchar (D-MN) and nine other Democratic Senators on February 4, 2021, appears to go too far for most Republicans, many are expressing support for some antitrust changes. For example, Republican Senator Josh Hawley (R-MO) has introduced legislation that adopts some of the recommendations Democrats on the House Judiciary Committee made in the last Congress for making it harder for dominant technology companies to acquire other tech companies.

Americans in both parties can see economic, technological, and environmental benefits to seeking alternative and efficient clean energy innovation.

 One measure attracting substantial bipartisan support would address two significant obstacles to providing the country with cheaper and cleaner electricity. First, sources of renewable electricity like wind and solar are difficult to rely on because their production is so variable. The amount of energy produced changes with the weather. Unless we have a way of storing the energy produced, we will continue to use sources that are expensive and have a significant carbon footprint. Second, the sites where wind and solar electricity can be most efficiently generated are often a significant distance from where demand is. Our outdated electrical grid is not able to convey the electricity efficiently over long distances.

In 2019, Senators Susan Collins (R-ME) and Martin Heinrich (D-NM), along with Representatives Bill Foster (D-IL) and Jaime Herrera Butler (R-WA), introduced the Better Energy Storage Technology (BEST) Act to address both the storage and transmission obstacles to cheaper and cleaner electricity. It is likely that some form of this bill will be reintroduced in the 117^th Congress. Following the strategies used in the Department of Energy’s SunShot Initiative that decreased the price of solar by 75%, the BEST Act would authorize $300 million over five years to reduce the cost of promising grid-scale energy storage systems. The BEST Act would direct the Department of Energy to develop a strategic plan and cost targets for grid-scale energy storage, require research coordination on commercially viable storage systems among federal agencies and our National Laboratories, and support five demonstration projects.

Another energy and climate bill attracting bipartisan support is the Storing CO2 And Lowering Emissions (SCALE) Act introduced on March 17, 2021, by Senators Chris Coons (D-DE) and Bill Cassidy, M.D. (R-LA) and Representatives Marc Veasey (D-TX) and David McKinley (R-WV). The bill would address the U.S. lag behind other countries in carbon capture and storage (CCS) technology by supporting the buildout of infrastructure to transport CO2 from the sites where it is captured to locations where it can be used as feedstock in manufacturing processes. For example, captured CO2 is useful in the production of concrete and polymers used in plastics and pharmaceuticals. For captured carbon not used as industrial feedstocks, the act would support more secure and efficient means of transporting and sequestering it underground. Advocates argue that the SCALE Act would help the U.S. develop a crucial tool in the fight against climate change while also supplying commercially valuable feedstocks and creating regional economic opportunities and jobs

Currently, 29 states have minimum wages above the federal level of $7.25 per hour (which has not changed since 2009). There is a major push by many Democrats, unions, and progressive interest groups to raise the minimum wage to $15 per hour. Between $7.25 and $15 there is a great deal of room for negotiation. It appears that a bipartisan agreement somewhere in the middle is likely.

Many arguing against raising the minimum wage to $15 per hour point to potential job losses resulting from businesses deciding not to hire a new employee they cannot afford. Different analyses come to different conclusions about the level of potential job losses. A recent report from the Congressional Budget Office (CBO) estimated 1.4 million jobs would be lost (0.9 percent of employment) by the time the federal minimum wage reaches $15 in 2025. Other experts argue that the CBO estimate’s flawed methodology inflates the job losses. Some analyses applying different methods to CBO’s evidence conclude that the job losses from raising to $15 per hour would be just under 500,000. Most agree that a wage hike is also likely to raise the prices of goods and services.

On January 26, 2021, Senator Bernie Sanders (I-V) introduced the Raise the Wage Act of 2021 with 37 Democratic co-sponsors. The bill would raise the federal minimum wage, in annual increments, to $15 per hour by June 2025 and then adjust it to increase at the same rate as median hourly wages.

Republicans have unveiled two minimum wage bills in response to the Raise the Wage Act. Senators Mitt Romney (R-UT) and Tom Cotton (R-AR) propose a $10 federal minimum wage, to be implemented over the course of four years with a slower, phased approach for small businesses. Their bill also requires employers to use the federal government’s E-Verify program to ensure they are not hiring undocumented workers.

Senator Josh Hawley (R-MO) released another alternative to an increase in the minimum wage: a tax credit for those who make less than $16.50 an hour. The credit would be applied based on the number of hours a person worked and would be available only to those with an American social security number, barring non-US citizens and undocumented workers. A full-time worker could get up to $4,680 in tax credits a year.

In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the U.S. is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

Substance-abuse-related mortalities have drastically increased during the COVID-19 pandemic, and the opioid public health crisis continues to worsen. Consequently, there is a growing bipartisan consensus that we must do more to ensure that Americans struggling with these issues have access to safe, effective, live-saving treatments.

 On February 25, 2021, Senators Maggie Hassan (D-NH) and Lisa Murkowski (R-AK) and Representatives Paul D. Tonko (D-NY) and Michael Turner (R-OH) announced the reintroduction of their Mainstreaming Addiction Treatment (MAT) Act of 2021. This legislation would significantly increase access to life-saving addiction medicine by eliminating a duplicative bureaucratic hurdle—known as the “x-waiver”—currently blocking millions of highly trained health professionals from prescribing buprenorphine to their patients. In addition to expanding access to Medically Assisted Treatments, the MAT Act would also eliminate barriers to behavioral health and community-based therapies

On March 4, 2021, Senators Shelley Moore Capito (R-WV), Joe Manchin (D-WV), Rob Portman (R-OH), and Jeanne Shaheen (D-NH) introduced the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act. Representatives Terri Sewell (D-AL) and David McKinley (R-WV) plan to reintroduce companion legislation in the House. The legislation aims to help address barriers to non-opioid pain management for those enrolled in Medicare. Under current law, hospitals receive the same payment from Medicare regardless of whether a physician prescribes an opioid, or a non-opioid. As a result, hospitals often rely on opioids, which are typically dispensed by a pharmacy after discharge at little or no cost to the hospital. The NOPAIN Act would change this policy by providing separate Medicare reimbursement for non-opioid treatments used to manage pain in both the hospital outpatient department and ambulatory surgery center settings.

SOURCE: U.S. DEPARTMENT OF VETERANS AFFAIRS

Since the 9/11 attacks in 2001, nearly three million members of the armed forces have deployed overseas to serve their country. Many veterans face terrible personal and economic challenges upon returning home. Thousands have serious health complications.

There are over 100 bills pending in Congress that attempt to address issues that U.S. veterans are facing. If we chose the veterans topics, we would focus on the most meaningful bills that have bipartisan support.

An example of one such bill would address the problem of veterans who don’t have homes. According to the National Coalition for Homeless Veterans, over 40,000 veterans are homeless on any given night. Of the male homeless population, 20% are veterans. Of the homeless veterans, 45% are Black or Hispanic despite only accounting for 10% and 3% of the U.S. veteran population respectively.

On March 5, 2021, Senators Dick Durbin (D-IL), Rob Portman (R-OH), Chris Van Hollen (D-MD), and Elizabeth Warren (D-MA) introduced the Improving Housing Outcomes for Veterans Act to ensure the Department of Veterans Affairs (VA) is providing needed care for veterans experiencing homelessness. Companion legislation has been introduced in the House of Representatives by Reps. Anthony Gonzalez (R-OH), Kathleen Rice (D-NY), David Joyce (D-OH), Bill Johnson (R-OH), and Brian Kirkpatrick (R-PA). This legislation follows a May 2020 Government Accountability Office report that found shortcomings in the Veterans Health Administration, whose Homeless Program Office administers programs to support veterans experiencing homelessness in collaboration with local partners and other federal agencies, including the U.S. Department of Housing and Urban Development.

Passing this bill would ensure that the VA implements needed changes and provides services for veterans experiencing homelessness. The American Legion, Paralyzed Veterans of America, and The Fleet Reserve Association have expressed their support for this legislation.

Another bipartisan veterans’ bill of interest was announced on February 24, 2021, by Senators Dan Sullivan (R-AK) and Joe Manchin (D-WV), both members of the Senate Veterans Affairs Committee. They reintroduced the Veterans Burn Pits Exposure Recognition Act, which addresses a barrier currently preventing many veterans from getting Department of Veterans Affairs health care and benefits for illnesses and diseases related to exposure to burn pits. The bill would recognize and concede their exposure during deployed service.

Open air burn pits were commonly used in Iraq and Afghanistan to dispose of waste, including rubber, chemicals, paint, plastics, petroleum products, and medical and human waste.  Consequently, burn pits often exposed the men and women deployed to toxic substances.  Because the contents of any given burn pit and the amount of exposure a particular service member had are difficult to document in wartime conditions, it has been difficult to prove definitively the health consequences in particular cases.  Nevertheless, there is a growing consensus that burn pit exposure causes a wide variety of health impacts, including asthma, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, high blood pressure, and liver conditions.  More than 200,000 have joined the VA Airborne Hazards and Open Pit Registry.

The legislation is endorsed by Disabled American Veterans, the American Legion, The Retired Enlisted Association, Wounded Warrior Project, and the Military Officers Association of America and was previously cosponsored by 30 members of the Senate in the 116^th Congress, when it unanimously passed out of the Senate Veterans Affairs Committee.

Secure, accurate, and fair elections are a cornerstone of American democracy. Democrats and Republicans agree that all citizens deserve transparency and confidence that their vote counts and that illegal votes are not counted. Many Democrats and Republicans also share a growing concern about the outsize influence of special interests and dark money in our elections. So far, Democrats and Republicans do not appear to agree on how to guarantee secure, accurate and fair elections. Republicans are concerned about security from voter fraud. Democrats are worried about voter access, particularly for historically under-represented groups, as well as security from foreign interference.

The Democratic For the People Act passed the House on March 3, 2021, on a 220 – 210 vote with all but one Democrat, and no Republicans, voting for it. As written, the prospects for passing the Senate are very low.

The For the People Act is an ambitious and far reaching bill that includes provisions to make it easier to vote in federal elections, end congressional gerrymandering, reform the role of money in elections, and increase safeguards against foreign interference.

On April 30, 2021, Democratic Senator Joe Manchin (D-WV) announced that he will not be supporting the For the People Act, the Democrat-backed election reform bill, although he said he’s supportive of many provisions within the legislation. Because Senator Manchin sits at the fulcrum of a 50/50 Senate, his opposition means that there are only two ways the For the People Act will pass in the Senate and end up on President Joe Biden‘s desk: if the Democrats can convince 10 Republicans to vote in favor of it, or if they eliminate the filibuster, an option Manchin has repeatedly denounced.

Election and security officials have lamented the sporadic attention and funding from Washington. Although Congress has agreed to support elections infrastructure around the nation, it does so in large, unpredictable chunks as opposed to predictable year-over-year appropriations – which many election officials would prefer. At the end of 2019, Congress allocated $425 million for election security. The funding was a compromise as Democrats had hoped for $600 million and then Senate Majority Leader Mitch McConnell (R-KY) indicated he would support $250 million. In 2018, Congress allocated $380 million toward election security improvements. The money, in both instances, is given via grants to the states, which become responsible for deciding how it is spent.

Click and drag the issue to rank them in order of most promising (top of the list) to least promising. We define promising as the best combination of meaningful and achievable.