House Democrats on Thursday are set to take their first major step toward lowering drug prices, but not before they make life difficult for the Republicans who helped them get there.
The House will vote on three bipartisan drug pricing bills that Democratic leaders combined with a set of proposals aimed at reversing Trump administration efforts to undermine Obamacare. The move is likely to force most Republicans to sink the package and go on record as opposing efforts to control drug costs. Mixing Obamacare with drug pricing would also effectively kill the legislation’s chances in the GOP-controlled Senate.
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The tactic has infuriated Republicans who spent months negotiating legislation cracking down on pharmaceutical companies, and even prompted grumbling from moderate Democrats eager to show some semblance of bipartisanship on a top health care priority.
“I’m not very happy at all,” said Rep. Buddy Carter (R-Ga.), whose bill limiting generic drug makers’ ability to block competitors was included in the package. “They know that we’re not going to be able to support this, and for them to put that in there I think is just poor policy.”
House Democrats defend the maneuver as a budgetary necessity. The trio of drug pricing bills would collectively save about $4 billion over a decade, making them valuable offsets for the Obamacare bills that call for greater federal spending to shore up the health law’s insurance markets and reverse cuts imposed by the administration.
None of the drug pricing measures are expected to dramatically lower the cost of medicines. But they would restrict anticompetitive behavior by pharmaceutical companies and address an issue that polls show is resonating with voters of all political stripes.
Energy and Commerce Committee Republicans who unanimously backed advancing the bills to the floor last month tried unsuccessfully to persuade Democratic leaders to hold stand-alone votes on the drug pricing measures during a House Rules meeting Tuesday night — and accused them of sacrificing good legislation to score political points.
“It didn’t have to be this way,” said Rep. Greg Walden (R-Ore.), the committee’s ranking member. “But they’re just waiting to cut the TV ads.”
The hard feelings could seep into other common-ground health policy priorities like protecting patients from “surprise” medical bills and a series of key health care policy extensions.
“For Republicans, they say okay we did this once, but we’ll have to trust you again,” said Rodney Whitlock, a health consultant and former GOP congressional aide. “This is the first time — if there is a second time, there won’t be a third.”
The inclusion of the Obamacare provisions makes it all but certain that the Senate will ignore the combined package, leaving the drug pricing measures in limbo.
House Democratic leaders tentatively plan to revive those bills later this year and roll them into broader must-pass legislation, said one person familiar with the thinking. Yet that could prove risky, and delay action for up to half a year.
“Generally speaking, the House puts itself in a stronger negotiating position with the Senate when they do bipartisan work,” Whitlock said. “This is effectively saying they are not going to be.”
Democratic leaders concluded the political benefits of devising a single health care package outweighed those risks, according to people familiar with the strategy, especially on an issue the party has made central to its platform ahead of the 2020 elections.
The Democrats already have found a handful of Republicans willing to buck the Trump administration on health care. Four moderate Republicans last week broke ranks on legislation reversing Trump guidance encouraging states to dodge key Obamacare patient protections.
But the Democrats also worried that the GOP would seize on a bipartisan drug price vote as evidence President Donald Trump is following through on his vows to slash pharmaceutical costs. That could cost Democrats leverage in negotiations over bigger priorities like empowering Medicare to negotiate directly with drug makers.
And the tactic puts the Senate on the spot, potentially making Republican leaders appear to be obstructing progress on drug pricing if they don’t take up the House package.
“I would be very surprised if the ACA stuff survives that [House and Senate] conference unless Democrats ultimately decide they would rather have no deal and live to fight another day,” said drug industry lobbyist Michael Werner, who lobbied on some of the pharmaceutical bills. “We’ve got about a year until we’re in full political season anyway, and then all bets are off.”
Some Democrats who had pushed for a standalone drug pricing vote expressed misgivings ahead of Thursday’s vote, arguing it was important to claim an early bipartisan win after the party campaigned nationwide on slashing pharmaceutical costs.
“Maybe I’m naive … I like people to get along,” said swing-district freshman Rep. Jeff Van Drew (D-N.J.), who emphasized he’ll still support the package. “It’s nice to be able to go home and say we passed legislation that was signed and is now law. That’s the point. Just doing bills to do bills is a little bit tough going.”
House Energy and Commerce Health Subcommittee Chairwoman Anna Eshoo (D-Calif.) had pushed for separating the drug price and ACA bills alongside Rep. Peter Welch, who has spearheaded much of the committee’s work on drug pricing. Reps. David Cicilline (D-R.I.) and Kurt Schrader (D-Ore.), each lead sponsors of drug bills included in the package, were also among those with a preference for a standalone vote.
“For now, it’s fine. I think we’ll live to fight another day,” Schrader said. “Our leadership’s still figuring out how to play in the sandbox right now, it’s all new to them. So I’ll give them some slack, they’re doing a good job.”