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Though his politics have always been right of center, and he lobbied hard against the Affordable Care Act, Republican Sen. Orrin Hatch has been key to passing several landmark health laws with bipartisan support. (Andrew Harrer/Bloomberg via Getty Images)

Sen. Orrin Hatch, the Utah Republican retiring from 42 years in the Senate as a new generation is sworn in,聽leaves聽a long list of achievements in health care. Some were more controversial than others.

Hatch聽played key roles in shepherding the 1983聽聽to promote drug development for rare diseases, and the 1984聽, which helped create a national transplant registry. And in 1995,聽when many people with AIDS were still feeling marginalized by society and elected leaders, he testified before the Senate about reauthorizing funding for his聽 to treat uninsured people who have HIV.

鈥淎IDS does not play favorites,鈥澛燞atch told other senators. 鈥淚t affects rich and poor, adults and children, men and women, rural communities and the inner cities. We know much, but the fear remains.鈥�

Hatch, now 84, co-sponsored a number of bills with Democrats聽over the years,聽often with Sen. Ted Kennedy of Massachusetts. The two men were sometimes called 鈥渢he odd couple,鈥澛爁or their politically mismatched friendship.

In 1997,聽the two聽proposed聽a broad new health safety net for kids 鈥斅�迟丑别听.

鈥淭his is an area the country has made enormous progress on, and it鈥檚 something we should all feel proud of 鈥� and Senator Hatch should too,鈥� said聽, executive director of Georgetown University鈥檚 Center for Children and Families.

Before CHIP was enacted, the number of uninsured children in America was around 10 million. Today, it鈥檚 under half that.

Hatch鈥檚 influence on American health care聽partly came from the sheer number of bills he sponsored 鈥斅犅犫�� and because he was chairman of several powerful Senate committees.

鈥淗istory was on his side because the Republicans were in charge,鈥� said聽, an emeritus professor in public health at the University of Utah and Hatch鈥檚 health director in the 1980s.

When Ronald Reagan was elected president 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. The聽powerful legislative group聽has oversight of the Food and Drug Administration, Centers for Disease Control and Prevention and the National Institutes of Health.

鈥淗e was virtually catapulted into this chairmanship role,鈥� Sundwall said. 鈥淭his is astonishing that he had chairmanship of an umbrella committee in his first term in the Senate.鈥�

In 2011, Hatch was appointed to the influential Senate Finance Committee, where he later became chairman. There he helped oversee the national health programs Medicare, Medicaid and CHIP.

Hatch鈥檚 growing influence in Congress did not go unnoticed by health care lobbyists. According to the watchdog organization Center for Responsive Politics,聽in the past聽25 years聽of political campaign funding,聽Hatch ranks聽聽for contributions from the pharmaceutical and health sector. (That鈥檚 behind Democratic senators who ran for higher office 鈥� President Barack Obama and聽presidential nominee Hillary Clinton).

鈥淐learly, he was PhRMA鈥檚 man on the Hill,鈥� said聽, referring to the trade group that represents pharmaceutical companies. Green is a professor of the history of medicine at Johns Hopkins University School of Medicine. Though Hatch did work to lower drug prices, Greene said, the senator鈥檚 record was mixed聽on the regulation of drug companies.

For example, an聽important piece of Hatch鈥檚 legislative legacy is the 1984聽, drafted with聽then-,聽an influential Democrat from California.聽While聽the law promoted the development of cheaper, generic drugs,聽it also聽rewarded brand-name drug companies by extending their patents on valuable medicines.

The law did spur sales of cheaper generics, Greene said. But drugmakers soon learned how to exploit the law鈥檚 weaknesses.

鈥淭he makers of brand-name drugs began to craft larger and larger webs of multiple patents around their drugs,鈥� aiming to preserve their monopolies after the initial patent expired, Greene said.

Other聽brand-name drugmakers聽preserved their monopolies by paying makers of generics not to compete.

鈥淭hese pay-for-delay deals effectively hinged on a part of the Hatch-Waxman Act,鈥� Greene said.

Hatch also worked closely with the dietary supplement industry. The multibillion-dollar industry specializing in vitamins, minerals, herbs and other 鈥渘atural鈥� health products, is concentrated in his home state of Utah.

鈥淭here was really no place for these natural health products,鈥� said聽, president of the United Natural Products Alliance and a Hatch staffer in the late 1970s.

As the industry grew, there was a debate over how to regulate it: Should it be more like food or like drugs? In 1994, Hatch sponsored 迟丑别听, known as DSHEA, which treats supplements more like food.

鈥淚t was necessary to have someone who was a champion who would say, 鈥楢ll right, if we need to change the law, what does it look like,鈥� and 鈥楲et鈥檚 go,鈥欌�� Israelsen said.

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聽the same safety聽and efficacy聽standards聽as聽prescription drugs.

That聽legislative clamp on regulation聽has led to ongoing questions about whether dietary supplements actually work and聽聽with other medications patients may be taking.

DSHEA was co-sponsored by Democrat Tom Harkin,聽then a senator from Iowa.

While that kind of bipartisanship defined much of Hatch鈥檚 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 迟丑别听鈥� he had ever met. (Hatch later characterized the remark as 鈥渁 poorly worded joke.鈥�)

In his聽聽on the Senate floor in December, Hatch lamented the polarization that has overtaken Congress.

鈥淕ridlock is the new norm,鈥� he said. 鈥淟ike the humidity here, partisanship permeates everything we do.鈥�

This story is part of a partnership that includes , and Kaiser Health News.