President Donald Trump keeps telling Democrats he wants a big bipartisan drug pricing deal. But Democrats don’t believe him — and are rolling out a series of bills that would set the framework for talks far to the left, defying Trump to stand in the way.
At the center of that effort is empowering Medicare to directly negotiate drug prices — a top liberal priority that’s faced near-universal opposition from Republicans, yet won Trump’s support when he ran for president.
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Making it the starting point for any deal would not only require the White House to buck the party’s establishment but negotiate across partisan lines on a divisive issue — a feat few Democratic lawmakers believe Trump is capable of pulling off.
“They seem incapable of negotiating in good faith on anything,” said Rep. Jim McGovern (D-Mass.), chairman of the House Rules Committee. “Quite frankly, I wouldn’t trust them to tell me the correct time, never mind be serious about a deal.”
Trump is expected to tout his progress on drug pricing during Tuesday’s State of the Union, including a proposal unveiled last week that would make the rebates drugmakers give insurance plans subject to fines under anti-fraud law. House Democrats quickly panned it, in what some interpreted as a sign they’re digging in on dictating the terms of the debate.
Drug costs remain stubbornly high — the prices of more than 400 medicines rose an average of 6.3 percent in the first weeks of January — and the administration is reaching limits of what it can do on its own. HHS Secretary Alex Azar in recent weeks met with Rep. Elijah Cummings (D-Md.) and phoned freshman Rep. Donna Shalala (D-Fla.) — a former health secretary — to discuss the issue in general. Last week, lawmakers said Trump told Speaker Nancy Pelosi directly that he wanted to work together to cut prices.
But while Democrats say they’re open to a consumer-friendly package that Trump will sign, lawmakers who have watched him blow up past negotiations on a whim are tempering expectations, especially if it means giving ground to a president they view as increasingly unpopular and particularly weak on health issues that could decide the 2020 election.
“We hope that the president will come to the table,” said Rep. Katherine Clark, vice chair of the House Democratic Conference. “But he’s tough to negotiate with. He seems to change his mind with the Fox News cycle.”
Multiple Democrats, including Energy and Commerce health subcommittee Chairwoman Anna Eshoo (D-Calif.), cast doubt on the prospect of a drug price package that would pass muster with both Trump and their own ascendant progressive wing.
“It is a top issue and we should be out front on it,“ said Rep. Pramila Jayapal, a leader of the Congressional Progressive Caucus. “Have you watched the last two years? How many times people said, ‘Oh you can strike a deal.’ There’s no deal to be struck.”
Implicit in the Democrats’ calculations is the belief no one really knows what Trump wants or trusts him to lay out a concrete position he won’t abandon sometime down the road. The president also hasn’t empowered any single administration official to negotiate for him.
So the Democrats are offering a passel of proposals to define the debate. In addition to Medicare negotiating power, they’ve floated allowing Americans to import cheaper drugs from Canada and tying prices in the United States to what companies charge in foreign countries. Presidential contender Sen. Elizabeth Warren (D-Mass.) proposed making the federal government a generic drug manufacturer, and the Democrats are also likely to push for new provisions that would force companies to lower their prices.
They’re not yet clear on what the party’s final package should look like — a process that could take months to hash out. Yet there’s little effort being made so far to be accommodating and embrace compromise positions that Trump or Republicans might support.
“What we really have to do is stop playing nice. They don’t place nice, and the facts are on our side,” said Rep. Brian Higgins (D-N.Y.) . “It’s a new game here.”
Trump has presented few proposals of his own, other than demanding that prices go down and promising to get tough on pharmaceutical companies. HHS has laid out more specific. Yet lawmakers say it’s unclear how the administration proposes converting those ideas into legislation, or if Trump even still backs much of his agency’s own blueprint.
“There’s some potential revolutionary stuff in that outline that could form the basis of a really big bill that Democrats could support,” said Sen. Chris Murphy (D-Conn.). “But I don’t think he knows what’s in that proposal he put out.”
Republicans, too, say they’re unclear what the president wants them to do. Some have bristled at HHS proposals overhauling parts of the drug price system. And big ideas Trump embraced on the campaign trail — like Medicare negotiations and drug importation — are seen as nonstarters for the GOP.
“I haven’t heard any specifics come out,” said Rep. Brett Guthrie (R-Ky.), who sits on the Energy and Commerce health subcommittee. “I think it’s an area we can work. I’m not sure of any specific policy things.”
To date, the Trump administration has largely bypassed Congress to focus on changes it can make by itself. That’s included proposals granting Medicare negotiating power for certain medicines and managing high costs for physician-administered drugs by starting patients on cheaper therapies — policies with some bipartisan appeal, but that raised the ire of free-market Republicans and drew criticism from some Democrats for not going far enough.
Azar has amplified his calls for legislative solutions over the past month, and last Thursday challenged Congress to help expand HHS’ bid to effective eliminate the big rebates drugmakers give to insurers — one of the few times an administration official has publicly pushed lawmakers for specific drug price legislation.
Azar is facing intense pressure from Trump to drive down pharmaceutical costs ahead of 2020, something none of his regulatory ideas can accomplish alone. The rebate rule HHS unveiled last week caught criticism from industry analysts and Democrats for failing to touch drug companies’ list prices.
Pelosi quickly slammed the plan for the way it would trust drugmakers to lower their prices while raising costs for seniors and taxpayers. One lobbyist characterized that as a sign Democrats won’t accept a plan that doesn’t directly confront the pharmaceutical industry.
The reality is that any meaningful drug pricing legislation that Congress passes could still take years to have a measurable impact. Still, Trump is pressing the issue.
Top Democrats say that indicates the White House is ready to deal in a way it hasn’t on issues like immigration and Obamacare. And there is clear common ground on incremental steps that boost pricing transparency and competition. But they note crafting a broad package means holding the mercurial Trump to his nearly three-year-old comments in favor of Medicare negotiation and importation, despite clear opposition in the interim from both the president’s own advisers and Republicans in Congress.
“He has many times articulated a position that’s in agreement with a lot of things that we say,” Energy and Commerce Chairman Frank Pallone (D-N.J.) said of Trump. “We’re just operating on the assumption that he’s generally supportive.”
Setting the parameters for negotiations far to the left risks alienating GOP lawmakers from the start, Republicans warn. Deep-pocketed industry interests are also likely to line up against any big deal.
But House Democrats believe they now hold their strongest negotiating position of the Trump era. Buoyed by their new majority and popular support for a broad drug price overhaul, they’re intent on dictating terms.
“Every negotiation that exists is about leverage. You either have it or you don’t,” said Higgins. “We’re going to call these bastards out.”