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Stakes high as long-awaited drug pricing vote nears in House

Parties, president could seek broad compromise before 2020 election as signal to voters

Ways and Means Health Subcommittee Chairman Lloyd Doggett is pushing for amendments to the Democratic drug pricing bill that would extend Medicare prices to uninsured individuals and give Medicare the ability to negotiate for all drugs, not just the most expensive products. (Tom Williams/CQ Roll Call file photo)
Ways and Means Health Subcommittee Chairman Lloyd Doggett is pushing for amendments to the Democratic drug pricing bill that would extend Medicare prices to uninsured individuals and give Medicare the ability to negotiate for all drugs, not just the most expensive products. (Tom Williams/CQ Roll Call file photo)

When House Democrats vote Thursday on their signature drug pricing negotiation measure, they will be seeking to show that they are addressing an issue that prompted voters to give them the majority and demonstrate that impeachment isn’t stopping them from legislating. 

The political power of the drug price issue isn’t lost on either party. House Republicans unveiled their own drug pricing bill Monday, soon after Senate Finance Chairman Charles E. Grassley of Iowa announced changes to his own version on Friday. The Democratic National Committee and five state parties are launching new web videos and hosting several events aimed at drawing a contrast on health care with Republicans, according to plans shared first with CQ Roll Call.

But actually enacting a major compromise that will significantly reduce drug prices is not likely this year. At this point, there is more momentum behind other health care issues and more modest drug pricing changes that could be tucked into a year-end spending bill. On Monday, the leaders of House and Senate committees released a summary of a compromise draft bill backed by the White House that would ban surprise medical bills and make minor changes to spur prescription drug competition. 

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Reaching a broader compromise in 2020, in the wake of impeachment and against the backdrop of the presidential campaign, would depend on how badly House Democrats, Senate Republicans and President Donald Trump want to show more progress on drug prices before the election. 

[Deal banning surprise medical bills also ups tobacco purchase age to 21]

Polling shows that voters say Trump is doing more on drug prices than Congress — although most say no one is getting much done. A November poll by the nonpartisan Kaiser Family Foundation found that 22 percent of respondents said Trump was doing “enough” to bring down the cost of drugs, compared with 17 percent who said congressional Democrats were doing enough and 15 percent who said congressional Republicans were doing enough.

Although Trump often calls for action to lower drug prices, many pieces of his regulatory plan on the issue have stalled.

And while White House officials say the president backs Grassley’s plan, many Senate Republicans oppose the most significant part, which would give Medicare the power to penalize drug companies that raise prices faster than inflation, a provision similar to one in the House Democrats’ bill. Among the Senate’s 53 Republicans, only about 10 support the Finance bill, including Grassley. 

Grassley warned Republicans who oppose his bill that they would soon have “to face their constituents and won’t have a believable explanation for why they chose not to act” on drug prices. 

House debate

In the meantime, the House still needs to vote on its bill, and some Democrats unhappy with its scope will push for changes this week before the floor vote. The House Rules Committee is set to meet Tuesday night to discuss the terms for the floor debate and decide whether there will be any votes on amendments.

The House Democratic bill would require Medicare to negotiate the price for up to 250 prescription drugs a year and cap Medicare prices for those drugs, based on lower rates paid in other countries. The bill would also impose a $2,000 out-of-pocket spending maximum for seniors in Medicare’s prescription drug program.

Speaker Nancy Pelosi’s bill seems likely to pass despite misgivings from some Democrats who are concerned that it wouldn’t help the uninsured and is limited to a subset of drugs. The Congressional Progressive Caucus is pressing for amendments, with some lawmakers hinting that they might seek to defeat the rule if their amendments don’t get a vote. 

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Leaders of the Progressive Caucus and Ways and Means Health Subcommittee Chairman Lloyd Doggett of Texas are pushing for amendments that would extend the Medicare prices to uninsured individuals, expand rebates for excessive price increases to employer-sponsored insurance plans and give Medicare the ability to negotiate for all drugs, not just the most expensive products.

“The idea is to provide uniformity in the price that’s charged and not to impose higher charges on the people that are the most vulnerable,” Doggett said. 

Government drug price negotiation has been a priority for Democrats ever since Congress created the Medicare Part D prescription drug coverage program in 2003. But as they wrote this year’s bill, Democrats faced the competing pressures of putting forward their boldest plans, as progressives want, or accepting compromises that fall short of their ideals but that might stand a chance of getting signed into law, as moderates prefer. 

Changes to the bill could make it that much harder for members in competitive districts to cast a vote that will almost certainly be met with accusations of socialism by Republican opponents and attack ads from groups backed by the pharmaceutical industry. For now, many House progressives seem willing to accept the bill even if it doesn’t meet all their goals.

“Let’s appreciate how far this bill does go because it will make a huge difference for a lot of Americans, and I think that’s an opportunity worth seizing,” said Democratic Rep. Jared Huffman of California, a member of the progressive group. 

While Huffman said he would prefer to completely eliminate a prohibition on government negotiation in Medicare, rather than the bill’s call for negotiation only on 35 to 250 drugs, he and others aren’t likely to oppose the bill on Thursday. 

House Republicans say the alternative bill they introduced Monday speaks to voters’ concerns better than the Democrats’ measure, which they said would hurt innovation. The drug price bill by top GOP members of House committees includes dozens of bipartisan policies.

The Republican bill has some provisions in common with the Democrats’ measure, such as imposing an out-of-pocket spending maximum for seniors in Medicare drug plans. The GOP bill also includes provisions that the drug industry won’t love, such as requirements to explain price increases and include prices in television advertisements. 

Republicans hope to offer their bill as a substitute when amendments are considered on the House floor and as part of a planned motion to recommit the Democrats’ bill. 

“This is a solid alternative that will help the American people in terms of lowering drug costs and bring new innovations to the market,” said Rep. Greg Walden of Oregon, the top Republican on the Energy and Commerce Committee. “Everything in there has some kind of bipartisan element to it so that it could become law.” 

Even Democrats who have pushed expanding the scope of the House bill are starting to express openness to a compromise — at some point in the future. 

Rep. Judy Chu of California, one of the few Democrats who voted during a Ways and Means Committee markup to extend the bill’s negotiated prices to the uninsured and expand the number of drugs subject to negotiation, said the House should be open to considering bills from the Senate as long as they don’t have unintended provisions that could inadvertently drive up costs. 

“If it moves the ball forward, and it can pass both the House and the Senate, I think that’s something that we should support,” Chu said. “Health care is at the top of the people’s agenda.” 

Mary Ellen McIntire and Bridget Bowman contributed to this report.