Complicating matters further, the top Senate Republican and Democrat have yet to embrace the legislation, though for opposite reasons.
“Everybody agrees that prescription drug prices are too high. The dilemma is how do you get there, and we have divisions in the Republican Party on that, and with the Democrats on that,” said Senate Majority Leader Mitch McConnell (R-Ky.). “Whether we can all pull together and get a solution, I’m not prepared to predict today.”
The proposal, introduced over the summer by Sens. Charles E. Grassley (R-Iowa) and Ron Wyden (D-Ore.), would limit price increases in Medicare’s prescription drug benefit to the rate of inflation or otherwise force companies to pay a penalty in the form of a rebate, and it would limit seniors’ out-of-pocket drug costs to $3,100 a year. Some Republicans have said the legislation is akin to price controls, which they have long abhorred.
Prescription drug prices consistently poll as a top voter concern, as many consumers say they cannot afford their medication and prices often rise year after year. They had shown signs of leveling off recently, but prices on hundreds of drugs rose an average of 5.8 percent in January, according to an analysis from Rx Savings Solutions. Medicare spends more than $100 billion per year on prescription drugs.
Trump has publicly supported the bill through tweets and in his State of the Union address this month, when he called on Congress to pass bipartisan legislation and personally recognized Grassley for his leadership on the issue. Vice President Pence gave the bill a nod of support this month in an interview with Fox News. Yet Trump has not lobbied individual senators to support the measure or personally pressured McConnell for action, said four people familiar with the situation who spoke on the condition of anonymity to discuss private deliberations.
Throughout the fall, Grassley said that he asked White House advisers to get Trump involved in winning support for the legislation and speaking publicly about it, but that they were reluctant to involve Trump to that degree. Grassley said he “never got a good reason” as to why advisers did not want to involve the president.
After the House began impeachment proceedings in September, however, Trump and White House staff members were largely consumed by working to keep Senate Republicans unified in supporting the president. Advisers avoided strong-arming members on divisive legislative issues. It remains unclear whether Trump will more directly engage in the coming weeks and months.
Meanwhile, McConnell presided over his party’s unsuccessful attempt to repeal and replace the Affordable Care Act shortly after Trump took office and has since then shown little interest in revisiting health-care legislation, a divisive issue within the Republican Party. For now, McConnell stands as an obstacle to Grassley’s bill. McConnell has not committed to bringing up the legislation for a vote and indicated that he had little interest in doing so because it divides his caucus.
The pharmaceutical lobby is a major contributor to Republicans, including McConnell, and has spent millions lobbying against the bill. Both the drug industry and influential outside conservative groups have said the Grassley-Wyden bill could stifle innovation and interfere in the free market.
Democrats successfully used health care as a cudgel in the 2018 election, retaking control of the House as they repeatedly accused Republicans of trying to undermine coverage for people with preexisting conditions. They could try to replicate this strategy later this year if no action is taken.
Grassley has repeatedly warned that without a vote on his bill, Republicans could lose their majority in the Senate — especially after House Democrats, led by Speaker Nancy Pelosi (Calif.), passed their own progressive bill late last year to lower drug prices. The House bill would allow Medicare to negotiate the price of up to 250 drugs and includes elements of the Grassley-Wyden bill.
Medicare negotiating is highly popular with the public, with 88 percent of people, including more than 90 percent of Democrats and 85 percent of Republicans, favoring allowing the federal government to negotiate drug prices for Medicare beneficiaries, according to a Kaiser Family Foundation poll in October.
Several senior White House and administration officials pointed to Trump’s public declarations of support for the measure and its mention in the State of the Union address as signs that he was on board.
"Many excellent provisions are being considered on Capitol Hill, including Grassley-Wyden, which is a genuine bipartisan approach, and the White House remains in close contact with members as we work to move a solution forward that advances the president’s priorities,” White House spokesman Judd Deere said.
Trump has shown that his personal involvement in legislation can be key, such as when he backed a divisive criminal justice reform bill in 2018 that ultimately passed the Senate by an overwhelming margin and was signed into law. And in 2017, he toured the country to whip up support for a big tax cut package that eventually won congressional approval.
Grassley pointed to Trump’s support of the bill in the State of the Union as one of the biggest boosts of support he could ask for.
“I can’t just rely upon the president saying that if we put a bill on his desk, he’ll sign it,” Grassley said. “Since the president stated this in his State of the Union message, we’ve had a lot of Republicans express interest that probably wouldn’t have.”
Health care has been top of mind for Trump as he gears up for his reelection bid, and exit polls in Iowa and New Hampshire showed it to be a top issue. Last month, Trump called his Health and Human Services secretary, Alex Azar, and yelled at him on speakerphone in the middle of a campaign meeting after he was briefed on internal polls that showed voters trusted Democrats more than Republicans on health care.
Lawmakers face a May deadline over federal funding for community health centers and say they hope to use that deadline to take up other health-related legislation that could address drug pricing and health-care costs. But the effort is complicated by intraparty and partisan divisions, and it remains unclear whether Congress will be able to pass a bill of this magnitude just months before a presidential election.
Grassley said he and Wyden hope to begin discussions with Pelosi in the coming weeks to see if the House would be willing to pass legislation similar to the Senate bill. Some Republicans have expressed skepticism that Democrats would be willing to give Republicans a legislative win on health care, suggesting that instead they plan to use the passage of the House bill to attack Republicans on the campaign trail.
Indeed, although the Grassley-Wyden bill has strong support in the Democratic caucus, it’s uncertain whether Senate Democratic leaders would join an effort to pass it. Senate Minority Leader Charles E. Schumer (D-N.Y.) said he supports the House bill, refusing to say whether he backs the Grassley-Wyden bill.
“We don’t want to settle,” Schumer said. “Our first goal is [the House bill]. Period.”
Those close to McConnell say he is personally opposed to the bill because of price caps it imposes on drug companies and because he does not like to take up legislation that splits his party.
So far, the bill has 12 Republican backers, including several vulnerable senators facing tough 2020 reelection fights. Sen. Joni Ernst (R-Iowa) endorsed the bill on Tuesday; Sen. Martha McSally (R-AZ) endorsed it last week; and Sen. Susan Collins (R-Maine) also is on board. Sen. John Cornyn (R-Texas) voted for the bill in the Finance Committee despite expressing reservations; he said last week that a “pared-down version” would be more likely to find consensus. Grassley said he hopes to have more Republican support soon, but for now he’s far short of the threshold he believes is necessary to win over McConnell.
For Republicans, inaction on prescription drug pricing legislation would be just their latest failure on health care after they spent much of the Obama administration voting to repeal his Affordable Care Act, only to fail to produce a replacement once Trump took office. The Trump administration is now fighting the ACA in the courts, while still claiming the White House will offer an alternative at some later date that would protect people with pre-existing conditions.
By taking on the narrower issue of lowering prescription drug prices, Grassley sought to focus in on one element of the health care industry that receives bipartisan support. But that’s proving difficult for some GOP senators who know the issue is crucial for their constituents but may not be willing to take on the pharmaceutical industry.
Sen. Mike Braun (R-Ind.), a freshman senator and supporter of Grassley’s bill, criticized the health care industry for operating as a “monopoly,” something he said his fellow GOP senators have failed to recognize at their own peril. He predicted Democrats will use it against Republicans once more in the election this year.
“It’ll be the one issue they’ve got on us and they’ll try to take it all the way to November of 2020," Braun said. “And I don’t know that we can say we’ve got much to hang our hat on.”