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Pelosi woos progressives on prescription drug pricing plan
Speaker Nancy Pelosi (D-Calif.) is floating a plan to lower drug prices aimed at winning over progressives, a move to shift the debate to the left.
Progressives who had pressured Pelosi to go bolder for months reacted with cautious praise to a leaked version of her signature plan to lower drug prices, even as they warned they still had concerns.
The proposal on drug prices is one of Democrats' top priorities this year, but the plan faces very slim odds of getting through the Republican-controlled Senate.
Pelosi's office is hoping that President Trump will throw his support behind the plan, given his sharp rhetoric on drug costs, and that will help bring congressional Republicans on board. But that is far from assured.
In the short term, Pelosi appears to be looking to avoid a pitched battle with her own left flank in the House.
The draft version of Pelosi's plan, which began circulating among congressional offices and lobbyists on Monday night, would allow the secretary of Health and Human Services to negotiate the prices of 250 drugs per year.
If drug companies refused to negotiate, they would be hit with a steep fee of 75 percent of the sales of the drug from the previous year.
The lower prices would apply to private insurance as well, not just Medicare, a significant step beyond the traditional Democratic proposal of allowing Medicare to negotiate prices.
Progressives are mostly pleased that, according to the draft plan, Pelosi dropped the idea of using an outside arbiter to help set the price of drugs, which progressives warned for months would be too cumbersome and weak a mechanism.
"I think one really good thing is that there's no arbitration in there," said Rep. Pramila Jayapal (D-Wash.), a co-chair of the Congressional Progressive Caucus.
But there are still tensions between Pelosi and progressives, who say they do not know how closely the draft plan will be to the final version.
Jayapal also expressed annoyance that she had to receive the draft plan not from Pelosi's office, but instead from lobbyists and reporters who were circulating it.
Progressives have been pushing Pelosi to be more open in the process for months.
Rep. Lloyd Doggett (D-Texas), another progressive leader on drug prices, said it would be "really good" if it is true that Pelosi has abandoned arbitration.
But he cautioned that he is still unclear as to whether the draft plan is final and accurate and noted that it "remains to be seen" whether imposing the fee on drug companies who do not comply will be a strong enough mechanism.
Public Citizen, a key progressive outside group on drug pricing, also praised Pelosi's plan, calling it "ambitious."
The Congressional Progressive Caucus did note in a statement that they still had some concerns, including over how effective the financial penalty for drug companies will be and why there is a cap on the number of drugs to be negotiated.
The plan is likely to stiffen GOP opposition.
Republicans traditionally oppose any form of government negotiating drug prices, arguing that it is meddling in the free market, making gaining any Republican support for Pelosi's plan a very tall task.
But top Democrats are hoping that Trump will support the plan, given that he broke with GOP orthodoxy and supported Medicare negotiating drug prices during his 2016 presidential campaign, before backing off that position once he was in office.
Pelosi's staff has been talking to the White House for months. Wendell Primus, Pelosi's top health care adviser, said in July that he was "still very optimistic" that Trump would support the plan.
But White House staffers are far more averse to negotiating drug prices than Trump is himself. And the White House has already endorsed a competing drug pricing plan from the Senate, backed by Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and the panel's top Democrat, Sen. Ron Wyden (Ore.), which does not include negotiation.
That plan is much less sweeping than Pelosi's proposal. In a sign of how hard it will be to pass anything on drug costs, though, even that bill has drawn opposition from a significant number of Senate Republicans, given a controversial provision that would cap drug price hikes in Medicare.
Many observers expect that if any drug pricing provisions will be signed into law, it will be as part of a year-end government funding package that is negotiated between the top leaders in both chambers.
The House bill and Senate bill would serve as guideposts for that negotiation.
In addition to the dance with progressives, there is also the question of winning support from moderate House Democrats.
Rep. Ron Kind (D-Wis.), a centrist, said Tuesday morning that he had not reviewed the draft yet but warned that he did not want more sweeping Democratic proposals to close off opportunities for bipartisan action on smaller items on drug prices.
"I hope that the more ambitious [plan] doesn't take down the bipartisan aspects," Kind said.
As for whether Trump will endorse the plan, Kind said Democrats cannot put their hopes on him.
"He's been all over the map," Kind said. "It's the last person in the room with this guy, so if we were to approach it based on what Trump may or may not do, we'll be spinning our wheels forever."