Democrats push to add drug pricing, Medicare measures to Biden plan

Leading congressional Democrats are pushing to add drug pricing measures and even an expansion of Medicare eligibility to President Biden’s American Families Plan after the White House left the proposals out of the $1.8 trillion package.

Biden made a rhetorical call to pass drug pricing legislation in his address to Congress on Wednesday, but the administration’s decision not to include the measure in the president’s human-focused infrastructure proposal, despite pressure from Democratic lawmakers, is raising questions about his commitment.

Now, congressional Democrats such as House Energy and Commerce Committee Chairman Frank Pallone Jr. (N.J.) and Senate Finance Committee Chairman Ron Wyden (Ore.) say they might add measures to lower prescription drug prices when the American Families Plan moves through Congress.

A vocal group of lawmakers, including progressive leaders like Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.), is also pushing to include a measure lowering the eligibility age for Medicare to 55 or 60. That proposal, however, has received less attention from committee chairmen and leadership than the drug pricing effort.

“We’re going to look at every possible vehicle, and that’s starting today,” Wyden said Wednesday of a measure to lower drug prices, when asked if he wanted to see it in the families plan.

Pallone was even more explicit.

“It’s critical that we level the playing field by giving the federal government the ability to negotiate lower prescription drug costs, and this will be one of my top priorities as we work to pass the American Families Plan,” he said in a statement.

The drug pricing proposals have a powerful backer in Speaker Nancy Pelosi (D-Calif.), who has pushed for House Democrats’ signature legislation on that front, known as H.R. 3.

Pelosi affirmed Thursday that there is “big interest” in passing drug pricing legislation. 

There is an element of uncertainty in the discussions, given that it is not fully clear how Biden’s array of proposals on infrastructure, paid leave, child care and other areas will be packaged as they move through the House and Senate.

“What is in one bill or another is not really what is important,” Pelosi said, leaving some wiggle room on the question of where drug pricing would fit.

Still, many Democrats expect that several of the major proposals will be combined into one massive bill that moves through the fast-track procedure known as budget reconciliation to avoid a Republican filibuster in the Senate. Backers of the health care measures want to have the proposals included in that eventual package.

In the days leading up to Biden’s speech on Wednesday, he faced pressure from a wide range of congressional Democrats on both the drug pricing and Medicare measures.

More than 80 House Democrats, including moderates like Reps. Jared Golden (Maine) and Conor Lamb (Pa.), along with Jayapal, the chair of the Congressional Progressive Caucus, wrote to Biden calling on him to include drug pricing and lowering the Medicare age in the plan.

On the other side of the Capitol, Sanders and 16 Democratic senators sent a similar letter, calling for Medicare benefits to be expanded to include dental, vision and hearing.

“We have an historic opportunity to make the most significant expansion of Medicare since it was signed into law,” the senators wrote.

But the lobbying efforts fell short, as the White House chose not to include the drug pricing or Medicare measures. Another Biden campaign pledge — to create a public option for health insurance to compete alongside private insurers, and open to people of all ages — has largely fallen out of the discussion, as lawmakers focus on other health care measures.

Backers of drug pricing legislation, however, took solace in Biden’s call to action Wednesday night.

“Let’s do what we’ve always talked about for all the years I was down here in this body in Congress,” Biden said. “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices.”

“Let’s get it done this year,” he added.

There is a question about whether the House’s drug pricing bill, H.R. 3, could be too far-reaching to get through the 50-50 Senate.

The bill’s expansive provisions include capping drug prices for a minimum of 50 drugs per year based on the price paid in a group of other wealthy countries. The secretary of Health and Human Services would then be able to negotiate lower prices even below that cap, and drug companies would be hit with a steep tax of up to 95 percent of a drug’s revenue if they refused to negotiate.

Wyden indicated there may need to be changes to the legislation, which the House has yet to vote on this year, though he did say that allowing Medicare to negotiate prices is key, along with limiting price increases in Medicare.

“My sense is what the president has decided to do is give the Congress the space to find an agreement and that job begins now,” Wyden told reporters.

Alex Lawson, executive director of the progressive advocacy group Social Security Works, called on the Senate not to abandon the House bill for a weaker measure.

“The Senate is not there [on the House bill], so all of our effort is going to be focused on getting the Senate there,” he said, noting the intense negotiations between progressives and moderates that already went into the House drug pricing bill in 2019 that passed in a 230-192 vote.

“We have to just clue in the Senate: No, no, no we already fought this out,” he added.

There has also been debate among Democrats about whether to spend the roughly $500 billion in savings over 10 years from the drug pricing bill on improvements to the Affordable Care Act (ACA) or on the Medicare changes.

Biden’s American Families Plan includes $200 billion to extend increased ACA subsidies that give people greater help in affording their premiums.

By leaving out additional health care measures, Biden puts himself in a better position to avoid fights with the health care industry or internal debates among Democrats. Pharmaceutical companies strongly oppose the House drug pricing bill, which they warn will harm innovation that leads to new drugs, and an even wider swath of the industry would oppose lowering the Medicare age.

Rep. Peter Welch (D-Vt.) urged his Democratic colleagues to set aside the savings debate and instead focus on getting drug pricing legislation across the finish line.

“Focus on that and how hard it is to achieve that before we get into discussions about spending money that we haven’t saved yet,” he said.