WASHINGTON (GA Recorder) — Among the most potentially transformational changes in the Democrats’ massive social and climate bill pending in the Senate are a set of long-sought changes intended to tamp down the fast-rising cost of prescription drugs.
The $2 trillion spending package would ensure Americans don’t pay more than $35 when they pick up a new vial of insulin from their pharmacy and would penalize drugmakers if they hike medicine prices faster than the inflation rate.
It also would, for the first time, allow Medicare to negotiate the prices of some of the most expensive drugs it provides to seniors.
But it’s not clear if several of the provisions aimed at finally taking substantive action on soaring drug prices will remain in the final version of the bill, known as “Build Back Better.”
That decision will be up to the Senate parliamentarian, who has been meeting privately with senators from both parties to issue guidance on whether certain pieces of the massive bill comply with the chamber’s rules.
The path forward is tricky logistically because Democrats are using the reconciliation process to advance the measure with just 50 votes instead of the typical 60 needed. That means they can push through legislation without winning support from any Republicans.
Chances for passage through reconciliation dimmed Sunday when Sen. Joe Manchin III, a West Virginia Democrat, said he plans to vote against the Biden administration’s latest spending plan.
The closed-door discussions have not been publicly relayed by lawmakers in the room. But reports from Politico and other news outlets have suggested that GOP opponents are challenging whether aspects that apply to private insurance plans comply with a Senate rule requiring provisions in a reconciliation bill to directly affect federal spending or revenue.
Democrats have said they are cautiously optimistic the provisions will survive, and have defended them as long overdue help for those struggling to afford health care.
“They’re way out of step with the American people if they somehow think that a $35 insurance copay (for insulin) … is somehow not something the American people approve of,” said Sen. Ron Wyden, an Oregon Democrat and the top lawmaker on the Finance Committee, which is heavily involved in crafting the proposal.
Sky-high drug prices
Should the drug-pricing provisions survive, experts say the proposed set of policy changes would make a start toward price reductions, though the effort won’t entirely solve the drug-pricing crisis
“The pharmaceutical industry is perhaps the most powerful lobby of any of the lobbies in the country,” said Dr. Paul Ginsburg, a professor of health policy at the University of Southern California and a nonresident senior fellow at the Brookings Institution.
“They are a formidable opponent. Some people are pleasantly surprised that anything can be done that lowers drug prices.”
Some proposals are recycled from past legislation, such as capping out-of-pocket drug costs for those enrolled in Medicare Part D, and the inflation cap, which previously passed out of the Senate Finance panel but never were taken up on the floor.
The out-of-pocket cap for Medicare Part D would start at $2,000 in 2024. Drugmakers also would be required to pay rebates to patients if they raise prices faster than inflation.
On negotiating drug prices, the Democrats’ package doesn’t go as far as a recent House measure, H.R. 3, which Ginsburg characterized as changing minds about what the federal government could do to implement pricing reforms.
That earlier measure would have made deeper price cuts, tying prices to cheaper ones abroad, and more drugs would have been reviewed. Still, the version in Build Back Better, which would begin in 2025, would start with negotiations over 10 high-priced drugs, and increase the number over time, reaching 100 in six years.
“I think it will be a building block,” Ginsburg said, noting the strong public support for continuing to find ways to reduce rising costs.
House Democrats touted the pending provisions when they released a scathing report recently blasting the business practices of drug manufacturers that have led to the soaring prices.
“The evidence overwhelmingly supports the need to pass the Build Back Better Act, which will empower Medicare to negotiate for lower prices, restrain price increases, and cap out-of-pocket patient costs for insulin and other drugs,” wrote House Oversight Committee Chairwoman Carolyn Maloney, (D-N.Y.).
The bill wouldn’t address some practices criticized in the House report, such as manufacturers making small tweaks that allow them to avoid competition for longer periods of time.
Still, the spending package has drawn strong opposition from the pharmaceutical lobby, which has said it ignores the role of insurance companies in rising prices and would curtail research investments needed to make breakthroughs on new treatments.
“The bill inserts the heavy hand of government into America’s medicine cabinet, and we know when government bureaucrats set the price of medicine, patients ultimately have less access to treatments and cures,” said Stephen Ubl, president and CEO of Pharmaceutical Research and Manufacturers of America, the largest drugmaker lobbying group.
‘We will wait for a call’
It’s unclear when the Senate parliamentarian, Elizabeth MacDonough, may offer guidance on the drug-pricing provisions.
MacDonough, who is nonpartisan and provides advice and help on Senate rules and procedures, already nixed a set of immigration proposals from the bill. That section was aimed at providing temporary protections for undocumented immigrants.
“The parliamentarian is the umpire,” Wyden told reporters during a recent Capitol hallway scrum. “We will wait for a call, and then we’ll make decisions.”
President Joe Biden has urged the Senate to get the bill to his desk, holding a recent event at the White House with a young woman who has struggled to afford her insulin.
“We can agree that prescription drugs are outrageously expensive in this country,” Biden said at the White House. “It doesn’t need to be that way.”
Bookman: Naming names, former Sens. Perdue and Loeffler conspired against democracy
About the author: Jay Bookman covered Georgia and national politics for nearly 30 years for the Atlanta Journal-Constitution, earning numerous national, regional and state journalism awards. He is the author of “Caught in the Current,” published by St. Martin’s Press. The views expressed in this commentary are his own.
Anyone in public life who supported, advocated, justified, participated in, financed or helped to organize the scheme to void the 2020 Electoral College vote, take away the voice of the people, and MacGyver state legislatures into keeping Donald Trump in the White House is guilty of conspiring to end American democracy.
History will record that as a fact.
Now, some might disagree. I mean, it’s not as if Republicans just hyped themselves into a frenzy with a totally groundless story about “voter fraud,” then used that frenzy as an excuse to throw out tens of millions of legitimate votes, cancel the election, overrule the American people and re-install a president whom voters had clearly and definitively rejected. If all that had happened, even the skeptics would have to agree they had conspired against democracy.
Of course, all that did happen.
So let’s call out some names:
You, David Perdue. You conspired to end American democracy. As a U.S. senator sworn to defend the Constitution, you instead supported efforts to trash that document. You conspired to throw out the 5 million votes that were cast legally and in good faith by your fellow Georgians so that Republican legislators could substitute their will for the will of the people. You did so for no other reason than you didn’t like the outcome.
You had – and have – no evidence of voter fraud to justify such breathtaking action. The laughable lawsuit that you recently filed accuses Fulton County election officials of “unlawful, erroneous, negligent, grossly negligent, willful, malicious, corrupt, deceitful, and intentional manipulation of votes.” It claims “Fulton County permitted great multitudes of fraudulent persons to fraudulently vote in the General Election using the name(s) of qualified and eligible Georgia voters.”
If what you allege is true, then thousands of legally registered voters in Fulton County – if you believe Trump, tens of thousands – must have been barred from voting on Election Day because when they got to their precincts, they would have been told that somebody else had fraudulently cast ballots in their name through the absentee process.
So produce these “great multitudes.” You cannot. You cannot because they exist only in the land of unicorns, fairies, magic rainbows and GOP lawsuits.
I know, I know – we’ve all heard the excuse: The lawsuits are necessary to uncover the evidence that you’re sure is there. Yet that in itself is a damning admission. Given your support a year ago for blocking the transfer of power to President Biden, it is a confession that you were willing to subvert American democracy based on evidence that to this day you do not have.
Furthermore, in your campaign for governor you have made it clear that you would use the powers of that new office to do even worse in the next election, if given the chance. Indeed, that promise is the entire animating force behind your candidacy. And if you’ve somehow managed to convince yourself that all this nonsense is true, if that self-delusion helps you sleep better at night, it doesn’t make the Big Lie any less of a lie. It just makes you a bigger fool.
But of course, Perdue is far from alone.
You, then-Sen. Kelly Loeffler, joined Perdue last year in supporting a Texas lawsuit that would have rendered 5 million Georgia voters voiceless in the presidential election, based on the false claim of 80,000 forged absentee ballots in our state. Your fellow Republican, Georgia Attorney General Chris Carr, had condemned that suit as “constitutionally, legally and factually wrong,” but that didn’t deter you in the slightest. No defender of the Constitution or democracy would have taken the momentous step of trying to throw out millions of ballots without overwhelming evidence. You did so with no evidence whatsoever.
Twenty-eight state legislators also joined in supporting that ridiculous lawsuit, as did seven House members from Georgia. Again, we should name names: House members Jody Hice, Rick Allen, Buddy Carter, Doug Collins, Drew Ferguson, Barry Loudermilk, Austin Scott: You too have conspired against American democracy. When the vote of the people of Georgia went against your candidate, you tried to silence their voice, and all but Scott did so again on the House floor on Jan. 6.
Hice is now running for Georgia secretary of state, the office entrusted with the sacred power of guaranteeing the fairness and legitimacy of our democratic republic. As with Perdue, the entire reason for Hice’s candidacy is his eagerness to use the powers of that office to succeed next time where he and others failed last time. He has no other platform, no other agenda.
Hice, Perdue and too many other GOP candidates are asking the people of Georgia not just to validate their past attempts to subvert democracy. They are asking that you join in that conspiracy, that you participate in it.
Don’t do that.