Liberal Democrats on Capitol Hill are spoiling for a fight over how to bring down the growing cost of prescription drugs.
According to research from the Kaiser Family Foundation, per capita spending on prescription drugs has more than tripled since 1992. Nearly a quarter of Americans with prescriptions say they have difficulty paying for their medications. For years, Democrats have promised to do something about the problem. In the run-up to the 2018 election, the party pledged to “lower prescription drug prices by holding insurance and drug companies accountable.”
After Democrats took control of the House at the beginning of the year, the Congressional Progressive Caucus—a group of lawmakers that includes more than 40 percent of House Dems—quickly rallied around a proposal from Texas Rep. Lloyd Doggett that aims to reduce costs for recipients of Medicare Part D, the federal program that helps seniors pay for their medicine. It would allow the government to use its significant market power to directly negotiate lower prices with drug manufacturers. It would also permit the government to break the patents of pharmaceutical companies that refuse to bargain in good faith, allowing other manufacturers to produce a cheaper, generic version of the medication.
Since Doggett introduced his bill in early February, more than half of House Democrats have signed on. Not surprisingly, though, it faces determined opposition from the deep-pocketed pharmaceutical industry, which for years has lavished campaign contributions on members of both parties. And even as momentum for the legislation builds among activists and rank-and-file members of Congress, there are growing signs that Democratic leaders might not be on board. The fight, which has begun to spill into public view, could provide one of the clearest indications yet of just how much influence the party’s most progressive officials will be able to exert over a critical public policy issue.
“We’re at the point where a deal is getting made on drug pricing, and this bill is the one that is progressive, bold, and has a huge amount of support,” says an aide to one CPC member. “This is the moment to throw down.”
The fact that there’s a need to “throw down” at all baffles some activists who have closely followed the debate. Even President Donald Trump recognizes that the cost of prescriptions has reached a crisis level: Last May, he announced the “most sweeping action in history to lower the price of prescription drugs” and promised to give Medicare new tools to negotiate lower prices. Before Doggett introduced a version of his proposal last summer, then-House Minority Leader Nancy Pelosi and Wendell Primus, her senior health care staffer, had been supportive of the idea, according to sources familiar with the conversations.
Indeed, Democrats have been critical of Medicare Part D ever since President George W. Bush pushed it through Congress in 2003, when GOP lawmakers’ last-minute maneuvers ensured that only insurers, not the government, could negotiate the cost of prescriptions. But in the 16 intervening years, Democrats have missed opportunities to address high drug prices, thanks in large part to pharmaceutical companies’ persistent, bipartisan lobbying efforts.
After Democrats won back the House in 2018, rumors began to swirl that party leaders viewed Doggett’s proposal as too extreme. Politico reported in February that Primus was instead looking to lower prices through a third-party arbitration process that would cover only a subset of drugs, a plan reportedly being crafted to win support from the Trump administration, which had signaled an openness to such tactics. Progressives’ biggest criticism of that approach was that arbitration would reportedly be voluntary, allowing companies to opt out of the process without consequence—though Pelosi’s office later suggested that wasn’t the case.
(In a statement Tuesday, Pelosi spokesperson Henry Connelly said, “Bold, tough prescription drug negotiation legislation is what the American people want, and we’re looking at every option to maximize the leverage needed to drive down prescription drug prices. Our entire Caucus is determined to confront out-of-control drug prices, and we’re continuing to incorporate Members’ feedback and ideas on how we can develop the strongest possible drug price negotiation bill.”)
Disappointed by the early resistance, the CPC leadership dug in for a fight. When Doggett reintroduced his legislation in February, the group’s co-chairs, Pramila Jayapal (Wash.) and Mark Pocan (Wis.), hustled to line up Democrats behind the bill. They also pointed to internal polling from dozens of swing districts showing that three-quarters of voters supported allowing Medicare to negotiate lower drug prices.
This demonstration of popularity—among both voters and lawmakers—would be key to winning over House leadership, Pocan told me at the time.
“We’re doing all this behind-the-scenes stuff for that bill so [Doggett] can go to leadership and say, ‘I have a majority of the caucus on it,’” he said. “We come to the table and help because we’re going to have a prescription drug package coming from Democrats. We just want to make sure that everything is heard.”
By mid-March, a majority of Democrats had signed on to the bill, and Jayapal and Pocan devoted a number of their weekly meetings with Pelosi to the subject. “We have commitments from leadership that it will be given full consideration, as any proposals are given,” Pocan told reporters that month.
But behind the scenes, things looked a little less certain. On February 26, the CPC hosted Alex Lawson of Social Security Works and Robert Weissman of Public Citizen, leaders of two progressive advocacy organizations that had assisted Doggett in crafting the bill. Activists and staffers describe that period as the height of a “whisper campaign” against Doggett’s proposal, and Lawson and Weissman came in to defend its merits.
That day, the two activists walked lawmakers through the bill’s details and complained that House leaders were throwing up roadblocks to their efforts. “We wanted Medicare negotiation, and then suddenly we’re talking about something else, like binding arbitration on some subset of drugs,” Lawson said to the group. “It’s just not going to fly.”
In the weeks that followed, tensions only escalated as House Ways and Means chair Richard Neal scheduled markups for several measures related to prescription drugs, but ignored Doggett’s bill. The conflict boiled over last month at a hearing for Neal’s legislation to promote drug pricing transparency. Doggett was visibly irked that the committee was tackling transparency instead of measures that would actually address high prices—especially since Doggett felt the bill under consideration was a “substantially watered-down version of strong transparency proposals” offered by fellow CPC member Jan Schakowsky (D-Ill.).
“Transparency, even if done right, only lets us know what Pharma is doing, and perhaps why, but it will not stop them from doing it,” Doggett said. “If today’s bill becomes law, nobody would pay less, and few would learn more.”
Doggett went on to make broader criticisms of Neal’s legislative strategy, slamming his call for bipartisanship as thinly veiled coziness with the pharmaceutical industry. “While bipartisan action is very desirable—and to be sure, Big Pharma has been very bipartisan in wooing this congress—it is a fundamental mistake to believe that we can join hands with drug companies in a great kumbaya moment and all live happily thereafter,” he said.
Indeed, Big Pharma’s influence on Capitol Hill has made progressives apprehensive of any compromise proposals that might emerge. Stat News and the Intercept reported in April that a lobbyist for the insurance industry has been among those involved in conversations with Pelosi’s office and the Trump administration about drug-pricing legislation. Days earlier, the Hill reported that the pharmaceutical lobby had been working hard to reduce support for Doggett’s bill. House Democrats received nearly $7 million in campaign funds from the pharmaceutical and health products industry last cycle, according to OpenSecrets. Neal and Frank Pallone (D-N.Y.), the chairmen of two House committees with jurisdiction over drug pricing, received $282,250 and $247,700, respectively, from the industry.
On the Hill, concerns about Doggett’s proposal have largely come from the party’s moderate factions. Rep. Haley Stevens (D-Mich.), a freshman lawmaker who flipped a seat last year and faces a tough reelection battle, warned in a recent letter to a constituent that the bill could undermine innovation. “While I agree with allowing the federal government to negotiate drug prices for Medicare beneficiaries,” she wrote, “my concern with this specific Medicare negotiation proposal is that by allowing the US government to sidestep patents, it would set a precedent that could have a chilling effect on other industries and on research.” Stevens also raised concerns about the narrow scope of the proposal, which only applies to the 45 million Americans who pay for their medications through Medicare Part D. “I believe that when it comes to drug pricing, there are bigger fish to fry,” she wrote.
Supporters of the Doggett plan dismiss those critiques. They point to research showing that Medicare pricing often determines rates for private insurers. And they argue that, in countries where compulsory licensing for generics exists, it’s rarely exercised, because that backstop encourages good-faith negotiation. Moreover, they say that worries about the bill being too controversial for freshmen Democrats in swing districts are overblown, citing years of polling showing bipartisan support of Medicare negotiating drug prices.
“There’s been talk of the fact that progressives should appreciate the positions of the moderates who are going to have a hard time holding their seats,” Public Citizen’s Weissman told me. “That for sure does not apply to aggressive measures on prescription drug pricing.” Indeed, Rep. Katie Porter (D)—who flipped a seat in California’s historically red Orange County—made that same argument to Neal and Pallone when the CPC met with them last Tuesday, according to people who were in the room.
Progressives also point out that for all the controversy over Doggett’s bill, alternative legislation has yet to materialize. The Intercept reported last month that the Center for American Progress, a liberal think tank, was working with Neal on a proposal allowing the government to negotiate with drug companies that would be “broader” than Doggett’s proposal, noting that it would apply to “all payers of drugs used by Medicare.” (A spokesperson for CAP tells Mother Jones that no legislative proposals have been written, and that the plan referenced refers to “ideas for comprehensive legislation” that emerged from a report that CAP and a number of other liberal-leaning organizations recently issued.)
Activists worry that if House Democrats don’t move soon, it will be difficult to get anything through the chamber before the August recess. That deadline looms large for lawmakers, who view these next few months as the last opportunity to influence the Democratic policy agenda before the presidential primaries swallow all the attention.
“If you want to build something new and get real numbers from across the caucus, how are you going to do that now?” Lawson says. “The only bill with an apparatus behind it is Doggett. We need to get a markup in time to get it to the floor by July. I feel like this has been an unprecedented amount of patience from the CPC.”
According to Pocan, the network of progressive grassroots organizations who have allied themselves with the CPC are “about to be making more noise” on the Doggett legislation. Two of those groups, the Center for Popular Democracy and Housing Works, have been leading a nationwide effort to push House members to support the bill. On Wednesday afternoon, a number of the CPC’s allies—including Social Security Works and and the Progressive Change Campaign Committee—released yet more polling suggesting that three-quarters of swing district voters in Iowa, New Hampshire, and South Carolina support Medicare negotiation and generic competition on life-saving drugs.
The CPC’s leaders say they’re still open to alternatives—as long as the final legislation ensures that price negotiations apply to all drugs and has the teeth necessary to force pharmaceutical companies into the negotiation process. After last week’s meeting with leadership, Pocan noted that the caucus hadn’t issued an ultimatum, but he did offer a warning. “If it comes to a weak arbitration bill that doesn’t include a comprehensive list of drugs—I would have a hard time seeing something like that personally, as would many other members.” he told reporters. “If we’re going to do something big and bold, it should be big and bold.”
* This story has been revised.