Democratic leaders are considering changing a provision in their signature $3.5 trillion reconciliation bill that would limit the costs of prescription medication, a provision that key moderate swing voters have found especially odious.
Specifically, the provision would cap the price of prescription drugs to a level consistent with the prices paid for the same medication in other developed countries.
For weeks, prominent Democrats have marketed the provision as a key part of their reconciliation package.
Sen. Bernie Sanders (I-Vt.), the author of the original budget proposal, emphasized the importance of the provision and the pharmaceutical industry’s efforts to kill the provision in a tweet.
Sanders wrote: “Pharma has spent hundreds of millions opposing our efforts to lower prescription drug costs. Meanwhile, the six major drug companies made $50 billion in profits last year and pay their CEOs outrageous salaries. We must stop Pharma greed and pass the Reconciliation Bill.”
Speaker of the House Nancy Pelosi (D-Calif.) and Senate Majority Leader Chuck Schumer have also often emphasized the measure’s importance over the past few weeks at various press conferences.
Other House progressives, including Rep. Alexandria Ocasio-Cortez (D-N.Y.), have joined the chorus of voices praising the provision.
But now, Democrats are in negotiations with moderates who could tank the bill, and are trying to find a compromise on the measure that could win the support of these critical voters. The details of these negotiations are unclear, but they come against a backdrop of organized resistance to the measure in both chambers of Congress.
Slate of House Moderates Reject Measure, Propose More Limited Bill
In the House, the original proposal has faced stiff opposition from moderates who have demanded an alternative provision be inserted into the final bill.
Presaging these troubles for House leadership, Reps. Scott Peters (D-Calif.), Kurt Schrader (D-Ore.), and Kathleen Rice (D-N.Y.) voted against moving the drug pricing provision out of committee.
Schrader and Peters went a step further, introducing a significantly reduced reform to take the place of Democrats’ original proposal.
The suggested compromise bill would allow Medicare to negotiate lower drug costs, which it cannot currently do. However, this would not extend to private insurance companies. The new bill would also not make all prescription drugs eligible for negotiation.
The bill’s purpose, the lawmakers wrote, is “To amend … the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients’ out-of-pocket costs, and to ensure accountability to taxpayers.”
Schrader and Peters were joined by co-sponsors Rice, Rep. Lou Correa (D-Calif.), and Rep. Stephanie Murphy (D-Fla.).
Schrader has in the past sponsored similar legislation, and has, like other moderate skeptics, indicated a desire to lower the price of drugs where possible without cutting into the profits of the pharmaceutical industry and thereby limiting innovation.
Peters expressed as much when he unveiled the bill, saying “Nobody should have to choose between putting food on the table and filling a prescription.” On the other hand, he emphasized the importance of “preserv[ing] American jobs and investment in future innovation.”
These defections bode poorly for Pelosi, who can only spare three votes to pass the reconciliation bill through the House.
Details on negotiations with these moderates are still hazy, but without their key support, the Democrats’ reconciliation bill will not make it to the Senate.
Critical Senate Moderates Uncertain About Drug Pricing Plan
In the Senate, as well, the support of three standout moderates, Sens. Joe Manchin (D-W. Va.), Kyrsten Sinema (D-Ariz.), and Robert Menendez (D-N.J.), is crucial for passage of the reconciliation bill.
Manchin has been in the brightest spotlight among Senate moderates since Sept. 2, when he wrote that he rejected his party’s budget resolution. Later, he re-upped this challenge, saying that even after a month of negotiation he thought that the bill was still “fiscal insanity.”
Manchin, who has said little about the specifics of the Democrats’ prescription drug pricing plans, did give some indication of his stance on the larger issue.
On Sept. 23, the West Virginia Democrat said that he opposed any effort to expand Medicare, and indicated that he preferred to address the program’s long-term viability.
Manchin told reporters: “I will say this about Medicare. We need to stabilize it. By 2026, you understand, the trust fund is going to be insolvent. That means there’s going to be an awful lot of cuts to a lot of people who depend on the Medicare they’re getting today. I want to make sure that we are stabilizing what we have before we start going down this expansion.”
In his initial rejection of the budget bill, Manchin said near the same, emphasizing concerns that huge government spending would cause inflation, and would hurt existing government programs like Medicare/Medicaid, Social Security, and others.
This divides Manchin from his moderate counterparts in the House, whose bill would expand Medicare.
Two other key moderates, Sinema and Menendez have been far less open about their positions on the matter.
Sinema has held positions close to Manchin’s throughout the budget reconciliation process, joining the rogue Democrat in rejecting any $3.5 trillion reconciliation package.
Sinema herself has said little about her policy positions, instead giving indications of these through her spokesman. Her spokesman reported that Sinema was “reviewing various proposals” around drug pricing, but refused to give any details about the specifics of these or Sinema’s attitudes.
Menendez did not commit to supporting his party’s current drug pricing plan, telling reporters “Show me a proposal and I’ll tell you how I feel.”
In the Senate, Democrats have the narrowest-possible majority, controlling 51 votes (including Vice President Kamala Harris’ tie-breaking vote) to Republicans’ 49. Because the vice president only votes in the event of a tie, Democrats cannot spare even a single defection.
Given their narrow control of the upper chamber, Democratic leaders, including President Joe Biden, have focused their efforts and negotiations on the Senate. Sen. Mark Warner (D-Va.), de facto leader of Senate moderates, summarized these negotiations as pitting “progressive demands” against “moderate expectations.”
Drug pricing negotiations fall into line with a slew of other issues that moderates in the Senate have touched on during their weeks of negotiations with leaders.