WASHINGTON -- As a White House candidate, Donald Trump said he could save Medicare billions of dollars by negotiating prescription drug prices.
Legislation expected to pass the Democratic-controlled House on Thursday would deliver that and much more.
But Trump's not on board, the White House is threatening a veto and Republicans who run the Senate say they will ignore the bill by House Speaker Nancy Pelosi, D-Calif., because they say the government shouldn't negotiate drug prices.
That's not stopping Democrats from savoring the moment. They contend Trump's disapproval shows a lack of conviction behind some of his populist pitches.
They're also betting that Pelosi's plan will prove popular with 2020 voters, helping elect Democrats who will eventually be in a position to pass something like it.
The bill would cap drug copays and deductibles at $2,000 a year for Medicare recipients. It would use about $360 billion of its projected 10-year savings from lower drug costs to create Medicare coverage for dental care, hearing, and vision, filling major gaps for seniors.
“We were sent to Washington with a mandate to bring down the cost of prescription drugs and to deliver for the American people — this will untie the hands of the federal government to negotiate prices,” said Rep. Haley Stevens, D-Mich., as debate got underway. She is a member of the freshman class that enabled Democrats to regain control of the House in 2018; her district went for Trump in 2016.
White House officials say Pelosi's bill is unworkable and that Trump wants something that can pass now. Near unanimous opposition from congressional Republicans means it would never clear the Senate.
Republican lawmakers predict Pelosi's bill would stifle innovation and they urged House Democrats to seek a bipartisan compromise.
“Drugs that save lives will not be around,” said Rep. Greg Walden, R-Ore. “Innovation goes on the rocks; lives will be lost.”
A major concern about the legislation is that it will result in fewer drugs coming to market. But there's debate about the extent. The nonpartisan Congressional Budget Office estimates about 3% to 10% fewer new drugs, while the White House Council of Economic Advisers says it could be much higher, up to one-third of new medications.
Rep. Bobby Scott, D-Va., who helped write the Pelosi bill, said Republicans predicting the drug pipeline will dry up are using scare tactics.
“Any drug that’s out there, we’re going to have access to,” he said. “The U.S. would still be the biggest market.”
The pharmaceutical industry is strongly opposed to the bill. Among the groups backing it is AARP.
High prescription drug prices consistently register in polls as the public's top health care concern. But it's unclear in a capital divided over Trump's impeachment that any major legislation will pass before next year's elections.
There's a bipartisan Senate bill that would also cap seniors' out-of-pocket costs, at $3,100 a year, and require drugmakers to pay Medicare rebates if companies raise prices above inflation. The plan has Trump's support but Senate Majority Leader Mitch McConnell, R-Ky., hasn't said if or when he'll bring it to the floor.
Inflation rebates are included in Pelosi's bill as well, so there is considerable overlap between the two major pieces of legislation before lawmakers. But Pelosi's measure goes further with several unique features, including:
— Medicare would be authorized to negotiate prices for costly medications, using a formula based on lower prices paid in other economically advanced countries.
— Drugmakers who refuse to negotiate would be hit with steep sales taxes for the medication at issue. Republicans say proposed taxes as high as 95% are unconstitutional. The budget office projects that most pharmaceutical companies would opt to accept lower prices from Medicare.
— Private health insurance plans would be able to receive Medicare's discounted prices.
— Congressional budget experts estimate the price negotiations provisions of Pelosi's bill would save $456 billion over 10 years. After subtracting for new Medicare dental, hearing and vision coverage, that still leaves money to increase spending on medical research, community health centers, and countering the opioid epidemic.
Democrats have named the drug legislation after the late Rep. Elijah Cummings, D-Md., who early on sought to open a discussion with Trump on drug prices. Cummings, as chairman of the House Oversight and Reform Committee, was a target of Trump outbursts on Twitter.