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5 things to know about congressional bills to cut drug prices

Senator Chuck Grassley (R-Iowa) speaks in the Hart

Senator Chuck Grassley (R-Iowa) speaks in the Hart Senate Office Building in Washington on Sept. 4, 2018. Credit: MICHAEL REYNOLDS/EPA-EFE/REX/Shu/MICHAEL REYNOLDS/EPA-EFE/REX/Shutterstock

It might seem like the impeachment inquiry and Ukraine are taking up all the energy in Washington.

While that process moves forward, politicians also are scurrying to make progress on what they think will be an issue for all voters in 2020: Prescription drug prices.

Key committees in the House, controlled by Democrats, advanced a drug pricing plan last month. That sets the stage for a vote of the full House, possibly soon.

Meanwhile, a Republican and a Democrat are pushing the Senate to take up a separate, bipartisan measure. And, perhaps surprisingly, the staffs of President Donald Trump and House Speaker Nancy Pelosi have been having conversations about drug costs despite the public fireworks over impeachment.

 Here are 5 things to know:

 The House could vote on drug pricing bill soon.

Democrats have quickly advanced a bill — called the “Lower Drug Costs Now Act” — to allow Medicare to negotiate prices on up to 250 of the most expensive drugs, including insulin, and apply those discounts to private health plans across the United States.

The proposal also would initiate a pricing index designed to bring costs here more in line with costs in other nations, penalize drug companies that raise prices faster than the rate of inflation and cap out-of-pocket expenses for Medicare patients at $2,000 annually.

The nonpartisan Congressional Budget Office (CBO) says the plan could save Medicare $345 billion over 10 years.  

The bill is not without critics.  

Progressives: The bill allows negotiations on anywhere from 35 to 250 drug prices and if it winds up on the lower end, the savings per household will be reduced greatly.  

Conservatives: The plan could limit choice, especially for seniors, and hinder the free market.

Drug companies: It will end a market-based system that “has made the United States the global leader in developing innovative, lifesaving treatments and cures,” Pharmaceutical Research and Manufacturers of America president Stephen J. Ubl said when Pelosi unveiled the bill.

Grassley, Wyden say their bill is one the GOP-led Senate can pass.

Sens. Charles Grassley (R-Iowa) and Ron Wyden (D-Ore.) say their proposal, the “Prescription Drug Pricing Reduction Act,” represents a middle ground. They say it would lower Medicare and Medicaid prices like the House bill by imposing penalties for raising drug prices higher than the inflation rate. It caps out-of-pocket Medicare expenses at $3,100 annually.

But it doesn’t allow for negotiation on drug prices. Further, the CBO says indexing prices to inflation isn’t as effective as a price control; it tags the potential savings at $100 billion.

Politicians, voters all say they want something done.

Elected officials in both parties are stressing the need to accomplish some policy breakthroughs before the 2020 election.

“The point I make is we need to work on a bill, like prescription drugs, that resonates with everybody in America,” Rep. Tom Suozzi (D-Glen Cove) told Newsday. “This is one that cuts across every age group, demographic group, geographic group, and, on top of that, it’s an issue the president campaigns on.”

Suozzi backs the Pelosi bill because it would save consumers more. Asked about the Grassley-Wyden bill, he said: “We’re going to have to find something that meets in the middle.”

Grassley has noted 22 incumbent Republican senators are up for reelection and the party’s hold on the chamber could hinge on “kitchen table issues” such as this.

“The day-to-day political dramas that shroud Beltway insiders don’t represent the wants and needs of most Americans,” Grassley and Sen. Kevin Cramer (R-N.D.) wrote in a recent opinion column. “It’s the kitchen table issues, such as the high cost of prescription drugs, that folks in North Dakota, Iowa, and other states want and need solutions for.”

It’s unclear if impeachment will stymie or spur action.

The House impeachment inquiry centering on Trump's dealings with Ukraine dwarf every other issue. That doesn't mean House and Senate members have dropped everything else. Even the staffs of Trump and Pelosi have had continuing discussions about drug prices and health care.

 "I think (the inquiry) increases momentum because we really want get something done," Suozzi said about the impact of impeachment on legislation.

But that might not be the prevailing view at this point.  

Liberals in the House increasingly are voicing concerns with Pelosi's bill and a few vulnerable Republicans in the Senate are endorsing Grassley's. Now, layer on top of that the high stakes and partisan tensions over impeachment and experts are calling the prospects of a deal on drug prices dim.

A lawsuit over 'Obamacare' could change the debate.

 A federal appeals court in New Orleans may soon issue a ruling in a lawsuit that could upend Obamacare, also known as the Affordable Care Act, which has expanded health insurance coverage to millions of people.

A group of Republican governors and attorneys general claim the requirement that most people have insurance is unconstitutional and, if the mandate is illegal, the entire act should be struck down.

This is a slightly different case than opponents made in 2012, when the U.S. Supreme Court upheld the law, in part saying the mandate was legal under Congress’ power to tax. In short, opponents say that when Congress in 2017 eliminated the individual penalty for not having insurance, tax statutes no longer apply and the mandate becomes unconstitutional.

The losing side certainly will appeal and request a stay, which, if granted, would mean nothing would change immediately. But it would change the course of discussion about any of the bills — with an election on the horizon.

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