This Piece Of 'Build Back Better' Is Still A Political No-Brainer

The case for prescription drug reform may be even stronger than it was before.

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When Congress returns from recess next week, Democratic leaders hope to start one last run at major legislation to address climate change, health care costs and maybe one or two other needs.

They’re not calling it “Build Back Better” anymore, or talking about Franklin D. Roosevelt-style transformations. At this point, the goal is merely to rescue a few of that legislation’s components and package them into a much smaller bill. And even that could prove difficult.

They need to secure support from the likes of Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.), each with their different sets of objections. They need to hold support from progressives, who had wanted to do so much more and already feel burned by the process. And they need to do all of this while President Joe Biden’s approval ratings are in the tank, the public is angry about inflation and the nation is still dealing with COVID-19.

Sen. Joe Manchin (D-W.Va.) killed Build Back Better, saying it was too expensive and poorly designed. But he has said he will discuss passing a smaller, more focused piece of legislation and thinks prescription drug reform should be part of it.
Sen. Joe Manchin (D-W.Va.) killed Build Back Better, saying it was too expensive and poorly designed. But he has said he will discuss passing a smaller, more focused piece of legislation and thinks prescription drug reform should be part of it.
Alex Wong via Getty Images

Still, the dire political circumstances should also give Democrats extra incentive to pass something. They need an accomplishment to show the voters in November, plus this might be their last chance to legislate in a long time.

And there’s one particular piece of the old Build Back Better legislation whose political logic may be even stronger than it was a few months ago. At the same time, it’d represent a major policy achievement that, if not Rooseveltian in scale, could at least redefine the role of government in a way that could shape policy for generations.

I’m talking about the proposal to address prescription drug prices.

The Deal Democrats Already Made

The difficulty Americans face with prescription drug prices is no secret. More than 5 million people on Medicare skipped medication because of cost or faced some other affordability problem in 2019, the most recent pre-pandemic year, according to a recent government report. Millions more who aren’t on Medicare face similar problems.

There are two reasons for this. One, too many Americans either don’t have insurance or have coverage with high out-of-pocket expenses, leaving them on the hook for big copays and deductibles when they go to the pharmacy. Two, the federal government can’t directly negotiate or regulate drug prices, like the governments of every other economically advanced nation can, leaving Americans to face the world’s highest drug prices.

Democrats have long said they want to address both problems ― and, in early December, they reached an agreement to do just that.

Under the terms of the deal, Medicare would finally have some power to negotiate drug prices with manufacturers. There would also be “inflation caps” ― financial penalties on manufacturers that raise prices substantially from year to year. People with insurance would pay no more than $35 a month for insulin, and Medicare beneficiaries would finally have a hard limit ($2,000) on their out-of-pocket drug costs.

“Reducing the cost of prescription drugs is among the most popular and effective ways for Democrats to prepare for the midterm elections.”

- Sean McElwee, Data for Progress

In order to win over Sinema and a handful of other lawmakers with ties to the drug industry, Democratic leaders made concessions that weakened the proposal substantially.

The Medicare negotiation proposal, for example, would apply to only 20 drugs that fall into certain categories ― and, even then, only after those drugs had passed their period of “exclusivity” when the law protected them from generic competition. The inflation caps couldn’t stop drugmakers from simply launching new drugs at higher prices, as some are sure to do. The insulin price cap would do nothing for uninsured people.

In short, the proposal is a far less ambitious version of what Democratic leaders originally hoped to pass, which in turn was a far less ambitious version of what the likes of Sen. Bernie Sanders (I-Vt.) would have preferred to enact.

But simply creating mechanisms for government negotiation of drug prices would have long-lasting repercussions. In the future, lawmakers could always make those mechanisms stronger ― by making more drugs subject to negotiations, for example. It’s easier to ratchet up a program than create one from scratch.

In the meantime, the program could deliver tangible relief to Americans struggling with drug prices. Not all of them would feel the impact of the changes, but many would ― especially when it comes to the new limits on out-of-pocket expenses in Medicare.

Given the close attention seniors pay to their own drug bills, it’s safe to assume a large proportion would be aware of the new protection. That could have an outsize impact on the elections, especially given the disproportionate role seniors tend to play in them.

The polls bear this out. The reforms that Democrats support are wildly popular, even with Republican voters ― and despite heavy advertising from the drug industry making the case that the reforms would harm innovation and lead to fewer future cures. That popularity is why some of the most outspoken champions for the reforms are relatively conservative Democrats like Reps. Elissa Slotkin (D-Mich.) and Susan Wild (D-Pa.) who need support from Republican voters in order to hold their seats.

“Reducing the cost of prescription drugs is among the most popular and effective ways for Democrats to prepare for the midterm elections,” Sean McElwee, executive director of Data for Progress, told HuffPost. “Voters strongly support allowing Medicare to negotiate prescription drug prices and it is the most immediate way for Democrats to immediately lower costs for American families.”

A Not-So-Secret Plan To Fight Inflation

To be clear, drug prices per se are not the top concern of voters right now. Inflation is. But one way to address inflation is to bring down the price of everyday goods, and reducing drug prices is one way to do that. And because the Democratic proposal would bring down prices, it would reduce the deficit on net, according to independent and government projections.

“American families are demanding action to address rising inflation,” Sen. Ron Wyden (D-Ore.), who chairs the Senate Finance Committee, told HuffPost. “Democrats are unified on a plan to lower drug prices through Medicare negotiation, an inflation cap, and an out-of-pocket limit on drug costs for seniors. I am hard at work to get that legislation to the president’s desk.”

Of course, the real test are the holdouts in Congress ― including Manchin, whose objections to Build Back Better killed that legislation in December. But Manchin has said that fighting inflation and reducing government spending and deficit reductions are top priorities for him, and he’s said frequently that he would support strong efforts to regulate drug prices as part of a deal.

“You’re probably as familiar with [Manchin’s] public comments as I am and nothing we’ve heard contradicts those,” Sara Lonardo, senior communications director at the health care advocacy group FamiliesUSA, told HuffPost. “Pulling back a little bit I’d say the senator’s recognition that we need to finally lower the cost of prescription drugs is widely shared among his colleagues and should be a no-brainer for inclusion in any legislation.”

Whether that’s really enough to seal the deal, of course, is another question. The fate of prescription drug reform may ultimately depend less on its particular merits and more on the ability of Democrats to get together on the rest of a legislative package ― and it’s not clear how close they are, especially on issues like taxes.

But the opposite is also true. If prescription drug reform is a political no-brainer, and it’s part of the larger legislation, Democrats will have even more reason to enact it. It wouldn’t solve all of their problems, obviously, just as it wouldn’t solve all of the country’s. But it could be a start.

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