Of the many, many provisions that could end up in the $3.5 trillion spending package Democrats are hoping to pass with their ultra-thin majorities in Congress, allowing Medicare to negotiate lower prices for prescription drugs is among the most popular.
It’s so popular, in fact, that a group of the most vulnerable incumbent Democrats in Congress are pleading with Democratic leaders to pass it. Standing in their way? A group of fellow centrists, many of whom have campaign war chests full of pharmaceutical companies’ money and comparatively little risk of losing their seats.
While the idea that progressive Democrats’ loyalty to activist groups harms the party is frequently discussed in the media and in Washington, the split over drug pricing shows how centrist members of Congress’ loyalty to politically powerful industries can be just as harmful to Democratic electoral hopes.
A Kaiser Family Foundation survey found two-thirds of Americans thought allowing prescription drug negotiation should be a top priority for Congress, with only 4% declaring their opposition to the idea. Another poll, conducted by Gallup for the nonprofit West Health, found 81% of adults supporting the idea, including 97% of Democrats, 80% of independents and 61% of Republicans. The proposal is especially popular among seniors, the most reliable voters in off-year elections.
So it was not all that surprising on Wednesday when a group of Democrats holding swing seats, many of them ideological moderates, sent a letter to congressional leadership demanding the idea’s inclusion in a final package.
The letter itself noted a host of policy reasons for its inclusion: Pharmaceutical companies are constantly raising the prices of crucial drugs, often at rates that greatly outpace inflation; Americans often pay far more than people in other countries for the same drugs; the money saved through negotiation could pay for other reforms to the health care system.
“The number one issue I hear about in my district is the cost of prescription drugs. We have got to get something done. We can’t afford to wait.”
But the identity of the signatories, and the letter’s final line ― which cites the popularity of drug price negotiation ― indicate another reason they are hoping for action: It will help them win tough races for reelection in 2022, when the political environment is expected to favor Republicans.
“The number one issue I hear about in my district is the cost of prescription drugs,” said Rep. Susan Wild (D-Pa.), the letter’s lead author. “We have got to get something done. We can’t afford to wait.”
While state legislatures are set to redraw congressional lines before the 2022 elections, the Democratic signatories ― including Michigan Reps. Haley Stevens and Elissa Slotkin, Kansas Rep. Sharice Davids, and Texas Reps. Colin Allred and Lizzie Fletcher ― currently represent districts with a Cook Partisan Voter Index score of R +1. (The Cook PVI, which is based off of recent election results, is widely used by political professionals to estimate the partisan lean of a district or state.)
Key Democrats, including House Speaker Nancy Pelosi (Calif.) and Senate Finance Committee Chair Ron Wyden (Ore.), also support giving Medicare the power to negotiate drug prices.
The biggest hurdle seems to action, at least for now, is a relatively small number of moderate Democrats, most of whom signed on to a separate letter in May threatening to vote against any action on pharmaceutical prices that did not have bipartisan support. The party’s small majority in the House means that these centrists could block any action.
“We must garner bipartisan, bicameral support, with buy-in from a majority of Americans and stakeholders in the public and private sectors,” the nine moderates, led by California Rep. Scott Peters, wrote in a letter that echoed pharmaceutical industry talking points about the need to balance affordability with innovation. “If this pandemic has taught us anything, it’s that we all, truly, must be in this together.”
“Gottheimer has regularly attacked progressives, suggesting they hurt Democrats’ electoral chances. Now, he and his allies are distracting the party from passing politically potent legislation that could help the party’s most vulnerable members.”
While this group of moderates does include some members who hold swing seats, many of them ― including Peters, New Jersey Rep. Josh Gottheimer and Massachusetts Rep. Jake Auchincloss ― also have a history of taking significant donations from the pharmaceutical industry. In contrast with the members demanding action on drug prices, the moderates pushing back represent districts with an average PVI of D +9.
Gottheimer, in particular, has regularly attacked progressives and suggested they hurt Democrats’ electoral chances. “If you are spending all of your resources and time fighting with each other instead of fighting the other team, that is a huge distraction,” he told The Washington Post this week, explaining why he formed a PAC dedicated to fending off progressive primary challenges.
But this time, he and his allies are distracting the party from passing politically potent legislation that could help the party’s most vulnerable members.
The pharmaceutical industry, by many accounts, is the most powerful lobby in Washington. The industry spent more than $92 million on lobbying in the first quarter of 2021 alone, according to OpenSecrets. And PhRMA, the industry’s major trade group, has already declared its total opposition to reforms in a statement on Thursday.
“This isn’t about lowering costs for prescription drugs,” said Debra DeShong, the group’s executive vice president of public affairs. “The real goal of this budget is to upend Medicare to help pay for Tesla tax credits and other government programs at seniors’ expense.”
“Pharma’s going to put out all the stops,” said Margarida Jorge, the campaign director at Lower Drug Prices Now. “There’s nothing they’re not willing to do. There’s going to be scare tactics.”
The electoral fight has already begun: American Action Network, a political nonprofit group controlled by House Republican leadership, received a $4.5 million donation from PhRMA in 2019. In May, it began running $5 million worth of ads attacking 45 different Democrats for supporting Medicare drug price negotiation, arguing it would outsource drug manufacturing to China. The Democratic Congressional Campaign Committee responded with digital ads of its own, defending vulnerable members from attacks.
Wild was one of the Democrats targeted by PhRMA, but she insists she does not fear the political blowback.
“I’m happy to take on the pharmaceutical industry if that’s the price it takes to get something done,” she said. “I think this is such a winning issue that I don’t mind.”