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Centrists throw wrench into House Democrats’ drug pricing plans

“I support many of the proposals discussed this week, but I do not support the advancement of policies that are not fiscally responsible and undermine the bill’s final passage,” Rice said.

The stalemate came as the energy and trade panel marked its part of the giant package to pass using the obstruction-proof budget reconciliation process. And the outcome of the clash could determine whether Democrats can spend up to $ 700 billion in projected savings over a decade on other health policy priorities, like adding dental, visual, and other benefits. hearing aid to Medicare, making the improved Affordable Care Act grants permanent, and providing Medicaid coverage to the 2 million people in red states who refused to expand the program.

But the Peters-led plan is a failure for progressives, who argue it makes it easy for the pharmaceutical industry to get away with it and would generate far fewer savings to apply to other health priorities.

As members of President Nancy Pelosi clash, uncertainty over drug prices makes it harder for her team to move the social spending program to the House this month. Individual committees are expected to report their portions to the House Budget Committee by Wednesday so the panel can begin assembling legislation for ground action later this month.

If Peters, Rice and Schrader joined all Republicans on the panel in voting against the drug pricing section of the bill, preventing it from leaving the committee, it would mark an embarrassment for the leadership, after the President’s Democrats Joe Biden to Senate Budget Chairman Bernie Sanders (I-Vt.) Has spent months pledging to cut direct health care spending for tens of millions, if not hundreds of millions of people. Democrats noted, however, that if all else fails, they could add the provisions later in the process, when the committee’s entire package is submitted to the budget committee.

A spokesperson for the Energy and Trade Committee said efforts on the bill are “underway” and that Pallone “continues to work to reflect favorably on all of the committee’s legislative reconciliation recommendations. “.

Still, many Democrats are worried.

Schrader has previously signaled that he would likely vote against the committee bill. Democrats are still trying to get Peters and Rice, who have privately threatened to oppose only the drug pricing portion of the legislation.

“It doesn’t look good,” an aide to a Democrat on the committee told POLITICO, predicting that the entire drug pricing section of the bill will not be able to move forward. “In the state of the votes, it looks like the window is closing.”

The centrist revolt also sparked panic among progressive advocacy groups like the Center for Popular Democracy, which issued alerts on Tuesday urging their members to call out members of Congress and urge them to vote for the more aggressive bill. on drug prices.

The dispute over how aggressive the government is in negotiating drug prices will likely decide other ongoing Democratic battles over the allocation of funding between Medicare, Medicaid, and Obamacare. This is because savings in drug prices effectively establish how much spending lawmakers will have to work with.

“There is an independent reason for successful drug price negotiations, and that is that we often pay three times what everyone else pays for drugs,” said Rep. Peter Welch (D-Vt.) , who sits on the committee and is among those leading the push for medicare negotiation. “But only if we are successful will we be able to debate how to use these savings. “

With pressure on Democrats to raise enough revenue to fund major expansions of other health care programs, the bill will save an estimated $ 700 billion over ten years, compared to the $ 492 billion saved by the previous version, according to the Joint Committee on Taxation.

Moderate dissenters argue that the language of drug prices backed by the leadership is not going anywhere in the Senate – and that Democrats should not be subjected to what could be a difficult political vote for no reason.

Two other moderate Democrats, Reps Lou Correa and Stephanie Murphy, co-sponsored Peters’ alternative drug bill, signaling potential problems for a future floor vote, as the party can only lose three votes and still pass the overall package.

Meanwhile, Senate moderates are trying to downsize the overall bill. The full Democratic caucus carried out a “temperature check” on the issue during its weekly lunch on Tuesday, but failed to reach a final consensus, an aide said in an interview, addressing the issue on condition of anonymity. . Senator Ron Wyden (D-Ore.)

One sticking point is that the House leadership’s drug pricing plan would tie negotiated drug prices in the United States to what is paid in countries that use a metric called Quality-Adjusted Years of Life to determine the value of a drug. This measure of health outcomes and quality of life has been criticized for its discrimination against people with disabilities.

Many House Democrats have said they don’t want to take tough votes on anything that could not pass the Senate. Yet getting rid of international benchmarking alone would threaten the overall effort, explained a source close to the Energy and Trade Committee, as hundreds of billions of savings come from this provision alone.

Along with their own internal divisions, Democrats will need to overcome stiff opposition from powerful healthcare industry lobbies in order to get a bill across the finish line. Key groups have spent years arguing over how many drugs should be subject to government bargaining rules, to what benchmark prices will be indexed, and whether the lower prices will apply to employer-sponsored plans and to which other private insurance companies, and are currently devoting resources to advertising and lobbying aimed at blocking passage of the bill.

Welch and others pushing for a radical bargaining bill attribute the revolt of moderates to the industry lobbying blitz and donations to Peters, Schrader and others opposed to the legislation.

“There is angst,” he said of Democrats’ current struggle against drug prices. “But the angst comes from the pharmaceutical industry that we are actually going to lower the cost of prescription drugs, and that translates into arguments that are substantiated to prevent us from continuing.”

Until the party can find common ground on a drug bill that satisfies the concerns of both moderates and progressives, all other party struggles over health policy remain unresolved. .

“The general dynamic is that things are always fluid,” a senior Democratic official said in an interview. “It depends on how much money can be collected. “

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