Whose Interests Are These Obstructionists And Saboteurs Actually Serving?

According to a new Kaiser Family Foundation Health Tracking Poll:

Initially, 83% of the public say they favor allowing the federal government to negotiate with drug companies to lower drug prices on behalf of people enrolled in Medicare beneficiaries and private plans. This includes 91% of Democrats, 85% of independents, and 76% of Republicans, as well as majorities of seniors (84%), who would be most affected by such a provision.

When asked specifically about each argument, most (84%) of the public, including three-quarters (78%) of Republicans, say the argument in favor – “this is needed because Americans pay higher prices than people in other countries, many can’t afford their prescriptions, and drug company profits are too high” – is convincing.

The Washington Post’s Jennifer Rubin asks the obvious question, Why would West Virginia and Arizona senators balk at a bill that helps their states so much?

At times, figuring out what Sens. Joe Machin III (D-W.Va.) and Kyrsten Sinema (D-Ariz.) want in President Biden’s Build Back Better plan is hard, if not impossible. Which is odd, since it sure seems like an awful lot of the items in the plan would help their states.

Take Medicare expansion. Manchin seems to oppose extending Medicare benefits to cover vision, dental and hearing benefits — among the most popular components of the bill. Supermajorities of Democrats and voters in general support this proposal. In Manchin’s home state, as of 2020, more than 442,000 West Virginians receive Medicare. (In Arizona, the number is about 1.35 million people.) So he wants to swim against the tide of overwhelming public opinion? If his argument is that spending on the elderly should be a lower priority than spending on children and families with children, he has yet to articulate it.

And what about children and families in his state? Given that West Virginia as of 2019 had a child poverty rate of roughly 20 percent, he should be the first one cheering the proposed extension of the child tax credit, universal pre-K and subsidized child care.

Likewise, the Children’s Action Alliance reports on data from the Annie E. Casey Foundation: “Since 2019, more Arizona children are living in high poverty areas, and more children in the state are without health insurance. . . . In Arizona, 15% of children live in high poverty areas compared with the national average of 9%, and in 2019, 9% of Arizona children are without health insurance compared with the national average of 6%.” Sinema should be all in favor of programs that cut child poverty, make child care affordable and make education available earlier. Why wouldn’t she be cheering this bill?

Then there is the Medicare drug proposal that would allow the federal government to negotiate drug prices with manufacturers. This would save money — lots of it. The Kaiser Family Foundation estimated, “CBO estimated over $450 billion in 10-year (2020-2029) savings from the Medicare drug price negotiation provision in the version of H.R. 3 in the 116th Congress, including $448 billion in savings to Medicare and $12 billion in savings for subsidized plans in the ACA marketplace and the Federal Employees Health Benefits Program.” If Manchin worries about federal deficits and spending, shouldn’t he be out front pushing for this item?

Likewise, the Guardian recounted: “A one-time progressive activist, Sinema campaigned on lowering drug prices in her 2018 Senate race, and she was still calling on Congress to address rising drug costs as recently as last year, boasting on her Senate website that she was fighting to ‘ensure life-saving drugs’ would be more affordable.” So she should be on board as well? Well, Sinema, the recipient of hundreds of thousands of dollars from Big Pharma, reportedly does not like this part of the bill. Arizona voters might consider such a reversal to be bait-and-switch.

As for the bill’s tax hikes, the West Virginia Center on Budget and Policy found that the plans to hike individual taxes on the superwealthy would have virtually no effect in this poor state. “In West Virginia, these tax increases would affect only 0.5 percent of all taxpayers, with 100 percent of the tax increases paid by the wealthiest 1 percent of taxpayers in the state,” the center found. Meanwhile, far more West Virginians would get tax relief from the plan: “The boost to the Child Tax Credit will benefit an estimated 346,000 children in West Virginia, dramatically reducing child poverty, while the expansion of the Earned Income Tax Credit for childless workers will benefit an estimated 110,000 West Virginia workers.” Shouldn’t Manchin favor these tax revisions?

Similarly, if Sinema were listening to voters back home, she would be happy to sign onto the tax proposals. The Children’s Action Alliance reports on a poll from Hart and ALG Research: “Biden’s proposals to raise taxes on those making over $400,000 meet with wide approval (71% support) in Arizona, including his proposal to tax capital gains at the same rate as income from wages (61% support). Arizona voters believe that raising taxes on those earning $400,000 or more will help the economy by a 35-point margin.” In addition, “Increasing the corporate tax rate to 28% is embraced by 62% of Arizona voters, who also favor taxing foreign profits at 28% (66% support) and setting a minimum corporate tax rate of 15% (69% support).”

Finally, while it might make sense for a West Virginia senator to oppose green energy measures (although coal is a declining segment of the state’s economy), there is no excuse for Sinema to object to this aspect of the package. She has previously supported investment in solar energy — understandable for someone coming from a state that, as the Arizona Capitol Times reports, has experienced “significant growth in advanced energy jobs, with a recent industry report showing 69,000 jobs in the sector and a growth rate of 3.5%.”

Virtually everything in the Build Back Better plan would aid one or both of the states Manchin and Sinema represent. The package is popular overall, especially with Democrats. If cost of the package is the problem, then at least both holdouts should embrace the savings afforded by the Medicare drug provision. Unless they are simply out for attention or attempting to woo a sliver of right-wing voters and lobbyists back home (at the risk of alienating progressives), their opposition is inexplicable. No wonder progressive negotiators in the Senate and House haven’t heard much from them.

And yet …

Politico reports, Dems fear Sinema’s still not there on a prescription drug plan:

Joe Biden has a problem, and a tight time frame to fix it.

The deadline to reach an agreement on the president’s social spending package hits in a matter of weeks and Democrats have yet to bridge their differences over one of the most important components: How aggressively to take on drug prices.

“There’s not 50 votes for anything yet,” said Rep. Scott Peters (D-Calif.), a pharmaceutical industry ally who is pitching House and Senate centrists on a narrower plan than the one party leaders were counting on to fund planned expansions of Medicare, Medicaid, Obamacare and home health care.

In particular, Peters said, Sen. Kyrsten Sinema (D-Ariz.) [aka “Pharma Girl”] hasn’t wavered from her stance nearly a month ago opposing the current drug price reforms up for debate.

“Senator Sinema is not yet for any proposal to deal with prescription drugs,” he said in an interview this week. “And I’m trying to get her to come my way because I think frankly, I think it would just be good to put this issue to rest.”

Sinema’s spokesperson John LaBombard [does “Silent Sinema” ever speak for herself?] refuted Peters’ characterization of the senators’ position, saying Sinema is “carefully reviewing various proposals around this issue” in her “direct negotiations” over the $3.5 trillion package. Sinema generally supports the idea of lowering drug prices but has declined to say what, if any, proposals she would back.

Nevertheless, the inability to reach a consensus on the issue of prescription drug prices is just one of many hurdles remaining for Democrats as they race to meet their new October 31 deadline. Though a number of other Democrats are known to be hesitant to support the drug pricing provision, Sinema’s support is absolutely necessary in the 50-50 Senate. To reach a breakthrough, Biden’s team is increasingly involved in shaping the talks as they decide how many programs to trim and which to slash entirely from the plan.

For months, the White House had largely deferred to leaders on Capitol Hill to iron out disagreements around the pivotal prescription drug policy. But in recent weeks, it’s actively reached out to moderates in the House and Senate to press for their support and has stressed the importance of drug pricing in meetings with lawmakers. Peters said the White House has more directly engaged him on drug pricing recently and that “we understand where each other is better.”

White House officials have also taken notice of the unlikely agreement between Sens. Bernie Sanders (I-Vt.) and Joe Manchin (D-W.Va.) on allowing Medicare to negotiate drug prices, and consider the provision one of many big priorities in the package, according to a source familiar with the administration’s thinking. Lowering prescription drug costs is one of the more popular elements of Biden’s plan and many Democrats see it as key to their success in the 2022 midterms and beyond. That’s particularly true as prior pledges to lower the age of Medicare and create a public insurance option have been sidelined.

Many lawmakers, including Peters, say they’re confident they can still find a middle ground between the sweeping HR.3 bill favored by progressives that would empower Medicare to bargain directly with drug companies, and the version pushed by House centrists that would negotiate lower prices for a far narrower set of drugs. The members argue a watered down drug negotiation bill may be the best they can hope for given Democrats’ narrow voting margins and an onslaught of opposition from the pharmaceutical industry.

“There will still be some [drugs] that will stay at the higher price, but that’s the way the compromise is getting worked out,” said Rep. Susan Wild (D-Penn.), a frontline member active in the talks on the policy. “I’m okay with that if that’s what we need to get it through. But I still cringe at the idea that Americans would ever pay more than other countries for an identical drug. I just think that’s outrageous.”

House progressives, outside advocacy groups and Sanders are still pushing for the most aggressive version of the bill possible and are accusing those who oppose it of shilling for the pharmaceutical industry. People in this camp say they’re worried that a narrower, more moderate prescription drug bill will fail to generate the federal savings necessary to pay for the party’s plans to expand Medicare, Medicaid and Obamacare, and fail to deliver on campaign trail promises to substantially cut health costs for patients.

Though negotiations are continuing behind the scenes, lawmakers in both camps say they lack clarity on where one another stands.

“I have heard that [Sen. Sinema] is opposed to have Medicare negotiate prescription drug prices,” Sanders told reporters on Thursday, lamenting that he has not heard directly from her on what she is willing to vote for. “That’s what I have heard. Maybe I’m wrong.”

Sen. Bob Menendez (D-N.J.), a key unknown on drug pricing who has previously slammed his colleagues for using the pharmaceutical industry as a “piggy bank” to pay for other priorities, is also frustrated by a lack of specifics.

“Discussions versus actually receiving a proposal are two different things,” he said. “Show me a proposal and I’ll tell you how I feel.”

Members of Congress and outside advocates said the recent showdowns on raising the debt ceiling and passing a temporary spending bill have distracted them and eaten up valuable time they could have spent working on the drug pricing provision and other pieces of the reconciliation bill.

And with just a few weeks left to come to an agreement, the list of unresolved questions around the bill remains long. How many and what kind of drugs will be subject to negotiation? Will the government use an international or domestic benchmark for those negotiations, and how will they penalize drug companies that refuse to comply? How much can the government claw back from companies that raise their prices faster than inflation?

Another key hang up around the bill is whether Democrats can and should apply the prices Medicare negotiates outside of Medicare, so that people who get their insurance through work or on the individual market can benefit.

Many lawmakers and outside advocates say the Senate parliamentarian is likely to nix an attempt to extend the lower prices to private insurance plans, though her office has yet to formally rule on the question. Some are already arguing that losing the broader policy is an acceptable sacrifice.

“History shows that changes made in Medicare almost always migrate to the private sector,” Senate Finance Chair Ron Wyden (D-Ore.) recently told reporters. “Because Medicare is the flagship federal program, and when the private sector learns about [the lower drug prices], they’re going to insist on it.”

Hanging over the entire debate around prescription drug policy is the prospect of failure and what it would mean for both the Democratic Party and the larger bill itself. Some in the party fear it would be tempting serious backlash, for instance, if it promises to lower drug prices across the board but leaves out the majority of the country enrolled in private insurance.

“I don’t think it’s going to be pretty popular to tell voters: ‘Sorry, you’re too young to have access to affordable prescriptions,’” one advocate familiar with the negotiations told POLITICO.

Sanders agreed, telling POLITICO Democrats should still fight for the policy’s inclusion even if it’s at risk of getting eliminated by the parliamentarian, rather than preemptively taking it out.

Democrats are also warning that if lawmakers scale back the prescription drug policy too far, it will force them to make additional, painful sacrifices elsewhere.

“HR.3 came up with a certain amount of revenue,” Rep. Peter Welch (D-Vt.). “What if, suddenly, that revenue is cut in half? That will really adversely affect what we can do on health care, and members will get upset about that. For every action there are collateral reactions.”