WASHINGTON — Democratic leadership and the party’s progressive flank are feuding over how best to lower drug prices.
In recent weeks, tensions between the two camps have escalated, and some fights have even spilled into public view. In a high-profile tug of war, lawmakers hoping to strike an accord with the Trump administration have been forced to confront a faction pressing Democrats to instead pursue a bolder progressive agenda — albeit one that the GOP-controlled Senate would surely ignore.
At a recent meeting of the Democrats’ most liberal members, several lawmakers scolded Wendell Primus, a veteran aide to House Speaker Nancy Pelosi, for aggressively pitching pharmaceutical policy they said fell short of the speaker’s campaign promises. Much of the controversy has been driven by Rep. Lloyd Doggett (D-Texas), who last week publicly dressed down a veteran committee aide, accusing her of misleading him and shaping legislation to favor drug companies. And it’s not just the lawmakers — outside progressive advocacy groups aligned with Doggett are also fighting with more centrist organizations over the best path forward.
The skirmishes have highlighted the tension between Democrats’ ambitious left flank and what that group views as the party’s unjustifiably pragmatist leadership, and have kept Democrats from forming a cohesive strategy to lower drug prices 100 days into the new Congress. They have also raised questions about whether the new House majority can reach consensus on what has become a top-tier policy issue.
“I think everyone kind of thinks their idea is the best one,” said Rep. David Cicilline (D-R.I.), a prominent member of the Congressional Progressive Caucus. “There’s disagreement, maybe, about the best way to achieve the objective, [but] there’s absolute consensus that we have got to address this issue.”
Even before the opposing factions’ bickering became public, Pelosi’s office assembled a team of policy experts to flesh out the details of an eventual compromise that she and other Democratic leaders hope to strike with President Trump.
Members of the informal group, whose names have not been previously reported, say they have also engaged in discussions with a variety of Trump administration officials, including the drug-pricing adviser John O’Brien and Katy Talento, another administration health policy aide.
They include: Lauren Aronson, a lobbyist, Obama administration veteran, and longtime Democratic congressional aide; Johns Hopkins professor Gerard Anderson; and Harvard professor Richard Frank, who previously worked in the Obama administration. Many within the hand-picked group appear to stand firmly on Primus’ side.
“Sometimes the reality is different than what you want to do, so I think Wendell is trying to come up with some practical ideas as opposed to the broadest concept,” Anderson said. “Wendell wants to get things passed, and we’ll see how successful he can be working with John.”
But even Frank’s presence in the group highlights a central policy fight, progressives fret: whether Pelosi will advance the longtime Democratic pledge to allow Medicare to negotiate directly with manufacturers for drug prices, or soften it in favor of a policy Frank has detailed in his post at Harvard.
Primus has enthusiastically pitched Frank’s proposal, which would allow Medicare to enter into a binding arbitration process for select expensive medicines. It stands as an alternative to wholesale government negotiation with drug companies.
Progressives say the policy represents Pelosi backtracking from her promises before the 2018 midterms, and as a softening of a longtime Democratic plank. Pursuing Frank’s binding-arbitration concept, numerous Democratic aides warned, could risk losing the support of the 100-plus progressives clamoring for a more forceful approach.
A Pelosi spokesman, however, cautioned that the speaker’s office is still gathering feedback. The spokesman, Henry Connelly, said in a statement that Democrats are still pursuing “tough prescription drug negotiation” but did not cite a specific mechanism.
Primus’ exploration of policy alternatives, however, has sat poorly with the Congressional Progressive Caucus, which has stressed that such negotiations should take place in public forums, and that they should be led by elected lawmakers. Seasoned aide though he is, lawmakers and aides have openly fretted that Primus’ approach violates both principles.
In interviews, lawmakers said they would prefer that Democratic leadership weigh legislation that has already been introduced, even if the proposals are eventually altered.
“I don’t think it’s about Wendell, necessarily,” said Rep. Pramila Jayapal, the co-chair of the Progressive Caucus and author of a universal health insurance proposal in the House. “I think we just want to make sure that we are pushing our proposal — most of our members are very much in favor of Lloyd Doggett’s prescription drug pricing bill, and we want to make sure that gets a fair shot.”
Doggett’s proposal highlights the left flank’s two biggest policy goals on drug pricing: not just allowing Medicare to negotiate drug prices, but effectively threatening the monopolies of manufacturers who fail to strike a deal with the government. His bill has more than 100 House co-sponsors.
Doggett’s ascendancy to a powerful chairmanship also appears to have thrown a wrench into Democrats’ ability to reach consensus. He has served in Congress since 1995, and this year became chairman of the House Ways and Means health subcommittee, which allocates its top positions largely based on seniority.
The ideological divide between Doggett’s office and that of Rep. Richard Neal (D-Mass.), the chairman, was on full display last week, as Doggett lambasted Amy Hall, the committee’s top health policy aide — an almost unheard-of occurrence in Washington, where lawmakers and aides typically sort out policy disagreements in private.
“It’s solely at the discretion of the manufacturer what they submit,” Doggett told Hall at one point, criticizing language within a bill to force drug companies to justify price hikes. “Which is the opposite of the bill you told me this provision was based upon.”
Doggett appeared visibly upset that the committee was marking up the STAR Act, a hodgepodge of drug transparency measures, rather than his controversial Medicare negotiation bill.
“It is a fundamental mistake to believe that we can join hands with drug companies in a great kumbaya moment,” Doggett said, warning leadership against “holding hands” and settling for the proposals “most acceptable to big pharma.”
A Doggett aide did not respond to multiple requests for comment.
Outside progressive organizations have also worked to fan the flames. Two groups closely aligned with Doggett — Public Citizen and Social Security Works — have vocally supported his proposal and criticized the party’s unwillingness to rally around it.
“I think part of the problem right now is people are dug in,” said Topher Spiro, a health policy advisor at the Center for American Progress, an outside group largely aligned with establishment Democrats. “But we are getting to the point where this is our top issue as Democrats, and we can’t screw this up. … From my perspective, we should have passed legislation by now.”
Spiro — who has also attended at least one meeting with Primus — also pitched his own organization’s idea to use the tax code to police high launch prices and cap year-over-year price increases. While available details are scant, he said the proposal would address price hikes by taxing the value of any increase beyond the rate of medical inflation.
Spiro also argued that provisions dealing with intellectual property, like those in the Doggett bill, have proven confusing and controversial.
“A corporate tax on profits is very easy to understand,” he said. “It’s very populist.”
With Republicans in control of the Senate and White House, Democrats will eventually be forced to choose between pushing ambitious legislation in 2020 that serves largely as a messaging tactic — or strike an ostensibly more moderate compromise with the Trump administration.
“All progressives are going to have to ask the question: do I want to see a real true powerful change happen, or do I want something that is a high-water mark that we can fight for during the next two, three, four years?” said Frederick Isasi, the executive director of the progressive advocacy group Families USA.
If they are to strike a deal, however, political experts fear it needs to happen within the next several months. Waiting until late this year, lobbyists and aides have speculated, could bog down the process in 2020 politics.
Many of the senators most involved on drug pricing issues are those contending for the Democratic nomination, leaving a scenario in which President Trump is left to sign bills backed by his own 2020 challengers.
Aides have also speculated it would be unwise for the many 2020 hopefuls campaigning on drug pricing — Sens. Elizabeth Warren, Bernie Sanders, and Amy Klobuchar, among others — to take the issue off the table by passing legislation, potentially handing Trump a win on an issue most voters list as a top priority.
The tension lies between “wanting to actually be legislators and doing the job of shaping the laws of this county, versus being politicians who have to think about the cycle and what they’re going to run on,” Isasi said. “That is a valid concern.”