President Donald Trump is turning up the heat on his own party over drug pricing, pressing Republicans for an ambitious solution aimed at slashing costs and taking control of a health care issue key to his 2020 reelection.
But the effort is already running into a familiar problem: Republicans on Capitol Hill have little idea what exactly the president wants, and where to start.
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Republican lawmakers are struggling to keep up with the evolving — and often contradictory — positions staked out by the Trump administration and GOP leaders on prescription drugs, paralyzing the party even as House Democrats move decisively to advance sweeping proposals to rein in skyrocketing drug prices.
“It always helps when the administration has a path forward established that’s got some consensus,” Sen. Mike Rounds of South Dakota told POLITICO, adding that he’d welcome more specificity from Trump. “This is one of those things that’s never been easy to address in the past and I don’t think it’s going to be easy to address now.”
Trump has thrown his support behind drug policies that have crossed traditional GOP red lines, while repeatedly shifting goals — jumping from priorities like international reference pricing, to importation, to reforms of the drug rebate system. In no case, to date, has he fully followed through on any initiative. Without clear, strong commitment on a particular plan from the White House, Republicans are likely to be hesitant to move away from their long-held positions on the topic.
“Just because the president is sort of vaguely nodding at these ideas every once in a while isn’t a compelling enough reason for a lot of these offices to up and change the way they are approaching this issue,” said Benedic Ippolito, a health policy researcher at the conservative-leaning American Enterprise Institute.
Senate Majority Leader Mitch McConnell has denounced the Democratic proposal as “socialist price controls,” and vowed to block any vote on it. Republicans on the House’s top health care panel echoed the sentiment soon after the bill’s rollout last Thursday, promising full-scale opposition.
But a few hours later, Trump tweeted a wholly different take: Speaker Nancy Pelosi’s signature drug price legislation was, in his mind, “great to see.”
And in the interim, Health and Human Services Secretary Alex Azar had trekked to the Hill to encourage House Republicans to seek a bipartisan compromise — talking up separate legislation from Sens. Chuck Grassley and Ron Wyden that has administration support, but little backing so far from Grassley’s Republican colleagues in the Senate.
The head-spinning developments have left rank-and-file Republicans feeling unsteady on what could be a defining health care issue for voters in 2020. As Congress enters its year-end sprint, GOP lawmakers indicated they were eager to do something big on drug prices — if only Trump would tell them what that something should be.
“We all want to do something together,” said Rep. Brett Guthrie of Kentucky. “It would be good to have what they say they would move.”
The Trump administration push for a legislative deal represents a new campaign on an issue that Trump has sometimes talked up, but one where his administration has struggled to make a dent.
A major regulatory initiative to effectively eliminate drug rebates was abandoned earlier this year amid internal squabbling and worries it would hike premiums on seniors. A proposal last fall to tie the cost of certain medicines to their prices overseas has deeply divided the GOP, and remains a work in progress.
And despite Trump’s claims that drug prices have fallen on his watch, the list prices of thousands of drugs continue to increase as total spending on prescription medicines rise.
As the administration’s options dwindle and Democrats stake their own claim to the issue, the White House is turning to Congress in search of a signature win.
Azar has urged Republicans to line up behind Grassley’s proposal, billing it as the makings of a compromise that would limit prices while sidestepping more liberal measures like empowering the government to directly negotiate the cost of drugs.
In his members-only meeting with House Republicans last Thursday, he and Grassley encouraged lawmakers to at least embrace the proposal’s broad framework as a starting point, Republicans in the room said.
Trump officials have also sought to open fresh channels with Democrats, meeting privately earlier this month with a group of moderate Democrats and on Thursday hosting another session focused on finding common ground. Azar in that meeting also focused mostly on the Grassley-Wyden proposal, lawmakers said, and did not comment on House Democrats’ just-released legislation.
Soon after Azar left the Hill, Trump tweeted praise for the Senate drug pricing plan — and acknowledged Pelosi’s bill.
Grassley had sought that endorsement for months. The Iowa Republican is hoping it will boost his measure’s popularity among Senate Republicans, who have warily eyed a provision that restricts drugmakers’ ability to annually hike prices more than inflation — seeing it as too intrusive on the free market.
Yet that measure is at the crux of Grassley and Wyden’s delicate agreement; a Democratic aide called it the “floor of what Democrats are willing to accept,” and, according to a source familiar with his thinking, Grassley has no interest in jeopardizing that bipartisan support by budging on the issue.
Grassley and Wyden intend to seek support for their plan among a broad group of senators this week, pitching it as a Trump-backed proposal that can win 60 votes in the Senate and force House Democrats to the negotiating table.
Yet many Republicans are still far from sold, with House lawmakers awaiting a signal from their Senate counterparts that there’s real momentum behind the proposal.
“My understanding now is there’s not a lot of support in the Senate,” Rep. Mike Kelly (R-Pa.) said of the administration’s favored approach. “So you’re trying to figure out, what is it they’re trying to get to?”
Senate Republicans, in turn, are taking their cues from McConnell, who has yet to voice any enthusiasm for taking a tough vote heading into an election year against a pharmaceutical industry that’s long been a party ally.
“No Republicans are going, ‘Oh God, I have to get on Grassley[‘s bill] right now because of the Pelosi bill,” said one health care lobbyist with close ties to the Senate GOP. “They have to see whether Pelosi is a real bill … that can pass the House.”
Trump’s unpredictable track record on policy matters is further complicating the issue, with Hill Republicans wary of taking a firm stance that the president could contradict at any moment. On the campaign trail, Trump voiced support for the direct negotiations that House Democrats’ plan envisions — only to appoint an HHS secretary in Azar who has long opposed the concept.
One Republican close to Trump told POLITICO there is now “zero” chance the White House will accept any potential deal that includes government negotiation, even as Pelosi has insisted that negotiation must be at the center of any bill that hopes to win Democratic support.
And though the administration is now pushing hard for a bipartisan compromise, Trump has abruptly abandoned negotiations with Pelosi several times before — including on a plan to invest trillions in infrastructure and efforts to avoid a lengthy government shutdown. Pelosi’s endorsement of an impeachment inquiry on Tuesday casts any prospects for a drug pricing deal in limbo. Earlier in the day, Trump tweeted Democrats “are so focused on hurting the Republican party and the president that they are unable to get anything done” on legislation addressing issues including lowering drug prices.
That’s left most Republicans stuck in a holding pattern, anxious to move on an issue energizing voters nationwide and yet waiting for Trump to signal which direction.
“We know we have to address prescription drugs,” Rep. David McKinley said recently in an interview just off the House floor. “Let’s get something done. We’ve been talking about this for years.”
Asked if it’d be easier for Republicans to get it done if they knew what Trump supports, the West Virginia lawmaker would only laugh and shake his head. “It’s a good question,” he said.