The framework for social spending and climate legislation that President Joe Biden is introducing Thursday does not include a key proposal to reduce the prices of prescription drugs, despite extensive attempts to craft reforms that could get full support from the Democratic caucus.
“At the end of the day, there are not yet enough votes to get something across the line that will deliver when the American people need and expect our prescription drugs,” a senior administration official said on a Thursday morning conference call with reporters.
Whether this is truly the end of the line for prescription drug reforms in the legislation remains to be seen.
Democrats have not published the final text for the bill, as its details remain the subject of internal discussions, according to several sources. One senior Democratic aide told HuffPost that working meaningful reform into the legislation is still possible.
“We are still working ― not dead,” the aide said in an email.
Dead Or Only Mostly Dead?
Biden and Democratic allies have hoped to give the federal government power to regulate prices, which is what the governments of other countries do and why name-brand drugs are so much cheaper overseas. Democrats have discussed a variety of provisions that would give the United States the ability to negotiate prices directly with manufacturers and limit year-to-year inflation.
The idea is overwhelmingly popular, even with Republican voters, polling has consistently showed. But no Republican lawmakers support it and a small handful of Democratic lawmakers have raised objections to schemes under discussion, despite extensive attempts at compromise from the White House and Democratic leaders.
Those Democratic holdouts, led by Reps. Scott Peters of California and Kurt Schrader of Oregon and Sens. Robert Menendez of New Jersey and Kyrsten Sinema of Arizona, have all received substantial donations from the pharmaceutical industry.
Those donations are part of a much larger campaign, which included advertising and lobbying, that the drug companies have waged against legislation ― as they have every time similar proposals have come before Congress.
In remarks on Thursday, Biden will say that he believes the legislation he is outlining has the support it needs to pass, according to White House officials. But lawmakers have not yet said definitively whether they would vote for this package.
Champions of strong action on prescription drugs include not just progressive lawmakers like Sen. Bernie Sanders (I-Vt.), but also a number of vulnerable House Democrats, many of them relatively conservative.
Any of these legislators could still withhold their votes in order to demand that prescription drugs be part of the package. They could also agree to a much weaker set of reforms that the holdouts have proposed.
If the bill passes without drug price reform, it would mean no immediate help with prescriptions for millions of Americans including seniors, who struggle with the high cost of drugs and frequently skip medications they need to avoid more serious, sometimes life-threatening medical issues.
Opponents of the legislation have warned, however, that too much regulation of drug prices could deter innovation, leading to fewer breakthroughs.
Action On Other Health Priorities
Whatever the ultimate disposition of prescription drug reform, the legislation would still include major initiatives on health care, Biden officials noted.
It would renew, for several years, some temporary increases in insurance subsidies available to people who buy private insurance through the Affordable Care Act. It would also make health insurance available to more than 2 million low-income Americans living in states that have not expanded Medicaid eligibility under the health care law.
These would represent the largest expansion of health care access since the Affordable Care Act became law more than a decade ago.
On a press call previewing the deal Thursday, a White House official said that Biden and Democratic leaders will continue to focus on passing meaningful drug price reform, even if it’s not part of the spending bill.
“We’re going to keep fighting to get this done and deliver lower drug prices, saving seniors money at the pharmacy counter,” the official said. “The president has campaigned on this, and he’s not going to give up until he gets it.”
But it’s not clear why or how the White House and Democratic leaders will be able to do this given the current makeup of Congress, and chances for future action seem even slimmer given that Democrats could lose one or both houses of Congress in the 2022 midterms.
A Gift To Trump Or An Opportunity For Biden?
A lack of action on prescription drugs could hand an issue to former President Donald Trump if he decides to run again in 2024.
Trump has been a frequent critic of the drug industry. As president, he ultimately did not push two pieces of legislation that were under discussion — a Democratic bill that passed the House and a bipartisan bill that went through the Senate Finance Committee. But he attempted to take some executive actions to lower the price of drugs.
Those actions are tied up in court battles and unlikely to succeed. But they do suggest an alternative that Biden could pursue.
The executive branch can take a number of steps to limit drug prices on its own, up to and including breaking patents for high-cost drugs, thereby allowing competition that could lower prices.
Exercising that option would likely invite court challenges as well. But it’s one path forward if the administration is determined to find a way to bring down drug prices, as Biden and his advisers have said he is determined to do.