Speaker Nancy Pelosi is facing an uphill battle in her attempt to insert legislation that would enable the federal government to negotiate prescription drug prices in the planned Democratic $3.5 trillion infrastructure and social spending bill.
The legislation is H.R. 3, “The Elijah E. Cummings Lower Drug Costs Now Act,” which would allow the Department of Health and Human Services for the first time to negotiate on prescription drugs. HHS could negotiate prices for the 125 drugs that account for the highest spending under Medicare. The price for each drug would not be allowed to exceed 120% of the average price paid by countries such as Canada, Germany, and the United Kingdom.
Max Richtman, the president and CEO of the liberal National Committee to Preserve Social Security and Medicare, expressed doubts that the bill will get through the House without substantial changes.
“Well, hope springs eternal. We hope it gets through substantially the same as it was introduced,” said Richtman.
In late 2019, all House Democrats were on board with H.R. 3. It passed on a near party-line vote, with all 230 Democrats and only two Republicans voting for it. But then, centrist Democrats didn’t have to worry about H.R. 3 becoming law as the bill was going nowhere in the Senate, which was GOP-controlled at the time.
MEDICARE PART D BENEFIT DESIGN LEADS TO HIGHER COSTS FOR SPECIALTY DRUGS
Now, with Democrats controlling the Senate and the White House, some centrists have gotten cold feet.
In May, 10 Democrats signed a letter to Pelosi expressing reservations about the bill. The letter warned that in other nations that fix drug prices, “effective cancer treatments may not be realized by the patient community for an extended period of time. There is a balance between innovation and affordability.” The letter also called for any bill to be bipartisan, which would require substantially more support from the GOP than in 2019.
The most outspoken of the 10 centrist Democrats is Rep. Scott Peters of California. The bill “would not be negotiation, but price-fixing. It will result in the defunding of science,” he said in late May.
Peters is a member of the Energy and Commerce Committee, which is expected to take up H.R. 3 in the coming weeks. From there, it is expected to be wrapped into the planned $3.5 trillion infrastructure and social spending bill, which Democrats intend to advance through the budget reconciliation process, allowing them to pass it with only a simple majority in the Senate.
Three other Democrats on the committee also signed the May letter, including Kurt Schrader of Oregon, Kathleen Rice of New York, and Tony Cardenas of California. With Democrats holding a slim 32-28 edge over Republicans on the committee, the four centrist Democrats could force drastic changes to H.R. 3 or even defeat it, if they voted as a bloc.
Even if the Energy and Commerce Committee managed to pass H.R. 3 intact, it could face major changes before passing the full House. Again, the margin is four, as House Democrats hold a narrow 220-212 advantage over Republicans.
The recent intraparty battle over the budget and infrastructure bills shows how precarious Pelosi’s vote margin is. A group of nine centrist Democrats, led by New Jersey’s Josh Gottheimer, demanded that the House vote first on the $550 billion infrastructure package recently passed by the Senate. Otherwise, they would vote against the budget resolution, the first step in passing the $3.5 trillion bill. Ultimately, the Democrats passed the budget resolution Tuesday evening when Pelosi agreed to a compromise that would bring up the infrastructure bill for a vote no later than Sept. 27.
Two of the nine centrists, Gottheimer and Schrader, were among the 10 who signed the prescription drug letter to Pelosi.
On the off chance that H.R. 3 makes it through the House unscathed, it would almost surely face major changes in the Senate.
“I think it’s going to have some problems in the Senate,” said Richtman.
Christopher Holt, the director of healthcare policy at the conservative American Action Forum, agreed that the Senate could weigh heavily on the outcome.
“Ultimately, it won’t be the Pelosi bill that gets passed. It will be more likely whatever [Oregon Sen. Ron] Wyden ends up getting Senate Republicans and Democrats to agree to, which will obviously draw from policies in H.R. 3, but it won’t be the same,” Holt said.
In June, Wyden released a set of principles for a prescription drug bill that would allow HHS to negotiate with drugmakers while being vague on the specifics. It urges Congress to establish “clear criteria … for which drugs to negotiate the price.” In 2019, Wyden sponsored a drug bill with Republican Sen. Chuck Grassley of Iowa that did not allow HHS to negotiate drug prices. Grassley has dismissed Wyden’s most recent effort, saying that the bill they co-sponsored in 2019 is the only one that would have enough support to pass the Senate.
Groups from both sides have put considerable pressure on centrist House Democrats. In the spring, both American Action Forum’s sister organization, the American Action Network, and the free market Americans for Prosperity launched ad campaigns against H.R. 3 that targeted centrist Democrats. Groups on the Left, including Protect Our Care and Patients for Affordable Drugs Now, launched ad campaigns in the summer supporting H.R. 3.
CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER
The National Committee to Preserve Social Security and Medicare has also been pressuring centrist Democrats.
“I guess I would say they’re listening,” Richtman said. “They’re noncommittal. But they are listening.”
