WASHINGTON — Just a handful of Republicans have ever endorsed the progressive idea to let Medicare negotiate drug prices.
But now, less than five months since they were sworn in, two GOP lawmakers who defied party orthodoxy by campaigning on that plank already appear to have abandoned it.
Both Reps. Dan Crenshaw of Texas and Pete Stauber of Minnesota have retreated from their campaign pledges on the issue — a sign, experts said, of both the political appeal of pledging to lower drug prices and the trepidation that comes with crossing the party line on a divisive issue. The political liability that comes with quickly abandoning a campaign-trail promise, too, could be substantial.
“My expectation is that most voters will believe they flipped because they have succumbed to the money and influence of the drug manufacturers, which creates a donor-whammy,” said Geoff Garin, a left-leaning pollster who has conducted surveys on the politics of health care for Arnold Ventures, a group largely opposed to pharmaceutical industry tactics. “Being wrong on the issue and an appearance of corruption.”
Their backpedal stands in contrast to a pair of GOP lawmakers who have held firm in their support of Medicare negotiation. Rep. Anthony Gonzalez (R-Ohio), another first-term congressman, said on the campaign trail that “allowing Medicare to negotiate prices directly would be a good start.” And his office told STAT this week that he’s still on board with that pledge — even if he hasn’t yet signed onto any of the three House bills that have been introduced to achieve that goal.
Just one Republican, Rep. Francis Rooney (R-Fla.), has been willing to sign onto a Democratic bill to let Medicare negotiate prices. Most of his party — including health secretary Alex Azar — does not support negotiation. Sen. Chuck Grassley (R-Iowa) even highlighted it in a speech this week.
“There is one policy out there … that I don’t agree with,” Grassley said. “That is repealing the non-interference clause in Medicare Part D.”
Many Democrats, in contrast, have pushed for Medicare negotiation since Congress authorized the program’s prescription drug benefit in 2003. Even among Democrats, though, the policy has proven contentious in recent months, with warring camps arguing over whether the government should wield drug companies’ intellectual property as a negotiating tactic.
Crenshaw is one of the best-known lawmakers among the new class of Republicans. A former Navy SEAL who lost his right eye while deployed to Afghanistan, he generated instant fame in a November appearance on “Saturday Night Live.”
“The congressman is less convinced that the heavy hand of Medicare drug negotiation is the best approach” to lowering drug prices, said a spokeswoman, Kerry Rom, confirming that Crenshaw has shifted his position. “One way we’ve begun trying to address this in Congress is by getting more generics to market.”
Crenshaw had previously spotlighted drug prices in his platform, citing the Department of Veterans Affairs — which does negotiate drug prices — as a model.
“We need to allow Medicare to negotiate drug prices and establish simple, preliminary and common formularies, much like the VA does with access to other medicine if needed,” Crenshaw’s campaign still lists on its issues page.
In a campaign Q&A published by numerous Minnesota news outlets, Stauber similarly listed “allowing Medicare to negotiate drug prices with pharmaceutical companies” as a means of lowering the national debt.
Stauber, whose office did not respond to requests for comment, has not yet signed on to any of the legislative proposals that would achieve that policy. A former professional hockey player, Stauber represents a swing district stretching from the Minneapolis suburbs to the state’s far north, one of just three districts to shift from Democratic to Republican control in the 2018 election.
Gonzalez and Rooney, the two Republicans who have continued to support Medicare negotiation proposals, have shown that there is at least some room in the Republican conference for a historically unpopular perspective on drug prices.
Gonzalez — also a former athlete, who was elected after a football career that included stardom at Ohio State University and a half-decade playing professionally — has signed onto the CREATES Act, which aims to promote generic drug development, but not legislation allowing Medicare to directly negotiate for prices. Gonzalez said via a spokeswoman that he remains supportive of Medicare negotiation, making him the second sitting Republican, after Rooney, to publicly support the proposal.
Rooney, a third-term lawmaker who has served as a corporate executive and U.S. ambassador to the Vatican, has not just supported the policy — he has openly questioned why Republican leaders have remained so resistant.
Crenshaw, Stauber, and Gonzalez are the only freshman legislators who campaigned on the policy among the relatively small class of Republicans who arrived on Capitol Hill in January, following a wave election in which Democrats captured 40 House seats.
But their decision to make the campaign pledges in the first place was a remarkable shift for the GOP, and embodied a midterm cycle dominated by the issue of health care costs and high drug prices in particular.
Whit Ayres, a Republican pollster who conducted a recent survey with Garin, said bold pledges to rein in the pharmaceutical industry often enjoy widespread political support.
But polling often shifts once drug companies and some conservatives emphasize a common fear resulting from Medicare negotiation that features closed drug formularies: the loss of access to some cutting-edge medicines.
“Anytime you start talking about not letting grandma have the drugs she needs, people become very uneasy,” Ayres said. “We did not test Medicare drug negotiations for all drugs for seniors — we tested Medicare negotiation for drugs with no competition in the marketplace, for sole-source drugs.”
Still, many Republicans this year have shown a willingness to embrace ideologically left-wing concepts on the issue of drug pricing — most notably, the Trump administration proposal to use a reference of international prices to cap U.S. payments for drugs.
The incentive for Democrats and Republicans alike to campaign on robust drug negotiation, Garin said, is apparent in districts across the country.
“The bottom line is that the instincts of those Republicans who said they were for it are exactly right,” he said. “It’s a strong position with Republican voters who feel as deeply unhappy with the price of expensive drugs as anybody in this electorate.”