Sen. Orrin Hatch, a Utah Republican retiring from 42 years in the Senate as a new generation is sworn in, leaves a long list of achievements in health care. Some were less controversial than others.
Hatch played key roles in shepherding the 1983 Orphan Drug Act to promote drug development for rare diseases and the 1984 National Organ Transplant Act, which helped create a national transplant registry. And in 1995, when many people with AIDS were still feeling marginalized by society and elected leaders, he testified before the Senate about reauthorizing funding for his Ryan White CARE Act to treat uninsured people who have HIV.
"AIDS does not play favorites," Hatch told other senators. "It affects rich and poor, adults and children, men and women, rural communities and the inner cities. We know much, but the fear remains."
Hatch, now 84, co-sponsored a number of bills with Democrats over the years, often with the late Sen. Ted Kennedy of Massachusetts. The two men were sometimes called "the odd couple," for their politically mismatched friendship.
In 1997 the two proposed a broad new health safety net for kids — the Children's Health Insurance Program.
"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," says Joan Alker, executive director of Georgetown University's Center for Children and Families.
Before CHIP was enacted, 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 partly from the sheer number of bills he sponsored or co-sponsored — more than any other living senator — and because he was chairman of several powerful Senate committees.
"History was on his side because the Republicans were in charge," says Dr. David Sundwall, an emeritus professor in public health at the University of Utah and Hatch's health director in the 1980s.
When President Ronald Reagan took office in 1981, the Senate became Republican-controlled for the first time in decades. Hatch was appointed chairman of what is now known as the Health, Education, Labor and Pensions Committee, which has oversight of the Food and Drug Administration, Centers for Disease Control and Prevention, and the National Institutes of Health.
"He was virtually catapulted into this chairmanship role," Sundwall says. "This is astonishing that he had chairmanship of an umbrella committee in his first term in the Senate."
In 2011, Hatch was also appointed to the influential Senate Finance Committee, of which he later became chairman. There he helped oversee the national health programs Medicare, Medicaid and CHIP.
Hatch's growing influence in Congress did not go unnoticed by health care lobbyists. According to the watchdog organization Center for Responsive Politics, in the last 25 years of political campaign funding, Hatch ranks third among all members of Congress for contributions from the pharmaceutical and health sector. (That's behind Democratic senators who ran for higher office — President Barack Obama and presidential nominee Hillary Clinton).
"Clearly, he was PhRMA's man on the Hill," says Dr. Jeremy Greene, referring to a trade group that represents pharmaceutical companies. Greene is a professor of the history of medicine at Johns Hopkins University School of Medicine. Though Hatch did work to lower drug prices, Greene says, the senator's record was mixed in the regulation of drug companies.
For example, an important piece of Hatch's legislative legacy is the 1984 Hatch-Waxman Act, drafted with then Rep. Henry Waxman, an influential Democrat from California. While the law promoted the development of cheaper, generic drugs, it also rewarded brand-name drug companies by extending their patents on valuable medicines.
The law did spur sales of cheaper generics, Greene says. But drugmakers soon learned how to exploit the law's weaknesses.
"The makers of brand-name drugs began to craft larger and larger webs of multiple patents around their drugs," Greene says, aiming to preserve their monopolies after the initial patent expired.
Other brand-name drugmakers preserved their monopolies by paying generic manufacturers not to compete.
"These pay-for-delay deals effectively hinged on a part of the Hatch-Waxman Act," Greene says.
Hatch also worked closely with the dietary supplement industry. The multibillion-dollar industry specializing in vitamins, minerals, herbs and other "natural" health products is concentrated in his home state of Utah. In the early 1990s there was disagreement about whether supplements should be regulated like foods or more strictly like drugs.
"There was really no place for these natural health products," says Loren Israelsen, president of the United Natural Products Alliance and a Hatch staffer in the late 1970s.
In 1994 Hatch sponsored the Dietary Supplement Health and Education Act, known as DSHEA.
"It was necessary to have someone who was a champion who would say 'All right, if we need to change the law, what does it look like,' and 'Let's go,' " Israelsen says.
Some legislators and consumer advocacy groups wanted vitamins and other supplements to go through a tight approval process, akin to the testing the Food and Drug Administration requires of drugs. But DSHEA reined in the FDA, determining that supplements do not have to meet the same safety and efficacy standards as prescription drugs.
That legislative clamp on regulation has led to ongoing questions about whether dietary supplements actually work and concerns about how they interact with other medications patients may be taking.
DSHEA was cosponsored by Democrat Tom Harkin, then a senator from Iowa.
While that kind of bipartisanship defined much of Hatch's career, it has been less evident in recent years. He was strongly opposed to the Affordable Care Act, and in 2018 called supporters of the heath law among the "stupidest, dumb-ass people" he had ever met. (Hatch later characterized the remark as "a poorly worded joke.")
In his farewell speech on the Senate floor in December, Hatch lamented the polarization that has overtaken Congress.
"Gridlock is the new norm," he said. "Like the humidity here, partisanship permeates everything we do."
This story is part of a reporting partnership that includes KUER, NPR and Kaiser Health News.
STEVE INSKEEP, HOST:
The arrival of the new Congress means the retirement of Utah Senator Orrin Hatch.
NOEL KING, HOST:
Hatch was elected 42 years ago in 1976, when Gerald Ford was president. Presidents have come and gone since then - seven presidents from Carter to Trump - but Hatch has always been there.
INSKEEP: In public, Orrin Hatch has always been quotable, often partisan, yet noted for working with key Democrats.
KING: And behind the scenes, he was deeply influential on health care legislation. His bills affected millions of consumers and many health care companies.
INSKEEP: Erik Neumann of our member station KUER in Salt Lake City has an evaluation.
ERIK NEUMANN, BYLINE: During his 42 years in the Senate, Orrin Hatch sponsored major pieces of health legislation. There was the 1983 Orphan 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.
(SOUNDBITE OF ARCHIVED RECORDING)
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 remains.
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 Democrat Ted 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 analyst 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 oversees 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 oversight 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 recipient in Congress for health industry contributions. And a lot of Hatch's money came from the pharmaceutical sector.
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 generic 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 makers 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 reined in the FDA oversight, saying supplements did not have to go through safety testing like prescription drugs. That's led to ongoing 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 Affordable 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 lamented the polarization that's overtaken Congress.
(SOUNDBITE OF ARCHIVED RECORDING)
HATCH: Gridlock is the new norm. And like the humidity here, partisanship permeates 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 partnership with local member stations and Kaiser Health News. Transcript provided by NPR, Copyright NPR.