House Democrats overcame infighting within their ranks to deliver on a key campaign promise Thursday, passing a bill that for the first time would require the government to negotiate prices for costly drugs and securing a legislative achievement they can highlight in the 2020 election.
The measure passed 230-192, with two Republicans breaking ranks to support the measure.
The sweeping legislation delivers a long-sought Democratic priority that’s repeatedly run up against opposition from Republicans and powerful drug industry interests. Senate Majority Leader Mitch McConnell has already ruled out taking up the package.
President Donald Trump and congressional Democrats had both made a priority of addressing rising drug prices this year. But the impeachment proceedings and disagreements over the bill’s core elements doused any chance of cooperation. Trump has vowed to veto the measure in the unlikely event it would reach his desk.
Speaker Nancy Pelosi's effort to draft the legislation, meanwhile, sparked months of discord within the Democratic caucus over the bill’s scope, culminating in a showdown earlier this week between House leadership and progressives who threatened to stall the bill — a rebellion Pelosi and her deputies narrowly averted through a series of last-minute changes.
Democratic leaders nonetheless touted the legislation as an historic step toward cracking down on skyrocketing drug prices, and a warning shot at a pharmaceutical industry that, until now, has largely escaped serious congressional scrutiny over its rule in driving up the cost of medicines.
“We’ve been trying to do this for a number of years. Today we will,” Pelosi said on the House floor. “We’re finally giving Medicare the power to negotiate lower drug prices.”
The bill amounts to a blueprint for the sweeping action that Democrats could take with unified control of Washington in 2021, lawmakers said in the run-up to the vote. It would mandate that the government negotiate the price of at least 25 Medicare Part D drugs annually, ultimately requiring federal officials to hammer out the cost of at least 50 medicines a year. Commercial insurers could also take advantage of the deals.
A separate set of provisions would limit drug manufacturers’ ability to annually hike prices in Medicare, forcing them to rebate the portion of the increase that is above the rate of inflation. The bill envisions eventually expanding that requirement to the private sector under language that progressives led by Rep. Pramila Jayapal secured in negotiations with Pelosi just 48 hours ahead of the vote.
The legislation would also place a first-ever cap on out-of-pocket drug costs for Medicare beneficiaries.
Democrats directed the bulk of the bill’s projected savings toward an ambitious expansion of Medicare benefits that would extend dental, vision and hearing coverage to seniors. Additional investments are earmarked for federal research agencies like the National Institutes of Health, and efforts to slow the opioid epidemic.
The Congressional Budget Office predicted that the legislation overall would lower federal spending by $456 billion over a decade, with the expansion of Medicare benefits costing the government roughly $358 billion over a decade.
However, the bill is also projected to curtail drugmakers' ability to launch new drugs — a point that Republicans contend will harm efforts to cure major diseases. The industry would launch eight fewer drugs over the first decade under the legislation, CBO said, and 30 fewer over the subsequent decade due to lost pharmaceutical revenues that would eat into research and development.
That poses a "dangerous trade-off" between lower drug prices and new medicines, Rep. Kevin Brady (R-Tex.), ranking member of the Ways and Means Committee, argued on the House floor ahead of the vote. "Drugs prices are too high in many cases. There is no excuse for these prices spikes, none at all. But I'll tell you what: the costliest drug ever is the one that is never created," he said.
By comparison, roughly 300 new drugs are approved every decade. A Republican-led effort to replace Pelosi’s bill with a bundle of narrower bipartisan measures was rejected Thursday in a 223-201 vote, largely along party lines.
Moderate Democrats and some Republicans have insisted that there is still an opportunity to craft separate bipartisan legislation lowering drug prices, pointing to broad areas of agreement like capping out-of-pocket costs in Medicare and political support on both sides of the aisle for reining in pharmaceutical companies.
But the path to passing Pelosi’s sweeping drug pricing legislation highlighted the steep odds facing any compromise involving a diverse Democratic Party with conflicting ideas how best to position itself ahead of the 2020 election, and a GOP that has made defending Trump the centerpiece of its agenda over the next 11 months.
Top White House aides met in secret with Pelosi for months in search of a bipartisan path on drug pricing, fueled by Trump’s fixation on slashing prices and the urgings of vulnerable Democrats who viewed the issue as key to securing reelection and retaining control of the House.
Despite early vows from top Democrats to quickly pass a drug pricing bill, the high-level talks delayed meaningful progress for months. It also frustrated the vocal progressive wing, which saw little promise in negotiating with a mercurial president known for abruptly blowing up delicate negotiations.
The effort drove a further wedge through the caucus during the summer months, as top Democratic lawmakers and aides — led by top Pelosi health adviser Wendell Primus — crafted the sweeping legislation with little input from rank-and-file lawmakers.
The result was a far-reaching proposal that sought to impose harsh new regulations on the drug industry, broadly expand the government’s power and make good on years of progressive promises to lower drug prices.
Yet it has also left both sides of the Democratic caucus unsatisfied, stopping well short of liberals’ goal of allowing the government to negotiate the price of every single drug, and vexing moderates who privately lament they had little ownership over a signature Democratic health bill that now risked being overtaken by the party’s high-stakes march toward impeachment.
Even so, Democrats in the hours ahead of the vote rallied behind the bill as essential keeping control of the House and eventually win back the White House and Senate.
Trump made vague promises to cut drug prices during his 2016 campaign, House leaders argued — and Democrats are aiming to seize control of the pivotal 2020 issue by taking substantive action.
“I believe we need real, substantive reforms,” said Rep. Katie Porter (D-Calif.), a freshman who flipped her Orange County district last year, "and for a while, so did our president.”
Article originally published on POLITICO Magazine