House Speaker Nancy Pelosi unveiled her long-awaited drug pricing measure on Thursday, an ambitious bill that would allow the federal government to negotiate the prices of up to 250 brand-name drugs in Medicare.

Designed to help Democrats address voter concerns about drug prices and replicate their 2018 success winning House control by championing health care concerns, the measure faces wide opposition from congressional Republicans. However, President Trump’s strong desire to address prescription drug costs before the 2020 election is a potential wild card that could affect the bill’s fate.

In a tweet Thursday evening, Trump indicated he supported Pelosi’s bill. “The American people need Congress to help,” he wrote. “I like Sen. Grassley’s drug pricing bill very much, and it’s great to see Speaker Pelosi’s bill today. Let’s get it done in a bipartisan way!”

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Even if there is no deal with the White House, the Democrats’ bill is a baseline for future efforts to address prescription drug costs under a Democratic president and Senate.

The measure would require the Health and Human Services secretary to negotiate the prices of up to 250 drugs in Medicare that do not have competitors and would impose severe financial penalties on drug companies that failed to come to an agreement. The negotiated prices would be available to all purchasers, not just Medicare beneficiaries.

It would also cap seniors’ out-of-pocket prescription drug costs at $2,000 a year. And it would require drug companies that have raised their prices above the inflation rate since 2016 to either lower their prices or rebate the portion back to the U.S. Treasury.

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There were already signs of division among Democrats, as the party’s progressive flank expressed concern the legislation did not negotiate prices on enough drugs.

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“We still are watching a few things. You can have everything great in the world, but if you have a few handfuls of drugs negotiated, then it’s not going to look the same to the public as something more substantive,” Rep. Mark Pocan (D-Wis.), co-chair of the congressional Progressive Caucus, said Wednesday.

Congressional Republicans expressed unanimity in their opposition to the measure. All 24 of the House Energy and Commerce Committee’s Republicans issued a joint statement criticizing the measure.

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“Speaker Pelosi is back at it — pushing a socialist proposal to appease her most extreme members,” the statement said.

Sen. John Thune (R-S.D.), the Senate’s no. 2 Republican, called the bill “really bad policy” and said it was “dead on arrival” in the Senate.

Nonetheless, Pelosi said Thursday she believed her proposal could gain White House support. Her office has been in conversations with White House advisers for several months about drug pricing legislation.

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“My conversations with the president have been about making this a priority,” Pelosi said. “I think we can have their cooperation.”

Trump has backed a more moderate drug pricing bill that was rolled out by the Senate Finance Committee in July. That proposal also faces opposition from many Republicans.

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Health and Human Services Secretary Alex Azar and White House domestic policy director Joe Grogan met with a group of moderate House Democrats last week to discuss drug pricing measures, according to a lobbyist briefed on the meeting who spoke on the condition of anonymity because he was not authorized to share details. They told the group the White House is open to Medicare drug price negotiations but supported measures that could pass the Republican-controlled Senate.

The House Democrats’ legislation proposes establishing a maximum price on negotiated drugs, based on an average of the typically lower prices paid by six other countries: Australia, Canada, France, Germany, Japan and the United Kingdom. Those countries’ prices, which are directly negotiated with manufacturers, are almost always lower than the prices paid by Americans.

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The Trump administration has its own proposal that would base the price of some Medicare drugs on an average of the lower prices paid by other countries.

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Some of the House proposal’s provisions are similar to elements of a bipartisan Senate Finance Committee drug pricing package, which is backed by the White House but opposed by a significant number of Senate Republicans.

The Senate bill would cap out-of-pocket costs for seniors using Medicare’s prescription drug benefit, called Part D, at $3,100 a year starting in 2022, while limiting drug price increases to the rate of inflation. Drugmakers that raise their prices faster than the rate of inflation would have to pay a rebate to the federal government.

The Congressional Budget Office estimates the Senate bill would save the federal government $100 billion over 10 years. Yet that bill faces steep hurdles: A majority of the Senate Finance Committee’s Republicans opposed it in a committee vote, although it still passed. Senate Majority Leader Mitch McConnell has not said whether he will bring it to the floor for a vote.

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