By John Gessner, The Sun This Week — Nov 18, 2021
Representative led charge to restore drug price provisions
Fearing that a plan to reduce prescription drug prices lacked the needed votes in Congress, President Joe Biden’s administration dropped it from a late-October version of the hotly debated Build Back Better Act.
U.S. Rep. Angie Craig, a Democrat representing Minnesota’s 2nd District, was not happy.
“I went from disappointed to just absolutely incensed that the promises that we had made our voters in 2018, in 2020, were not going to be included in this bill,” the Eagan resident said in an interview this week.
But by Nov. 2 Democrats had reached a deal to restore parts of the prescription drug package, including provisions allowing Medicare to negotiate some drug prices and capping out-of-pocket prescription costs at $2,000 a year for Medicare Part D recipients.
Along with the prescription drug package Build Back Better includes expansion of Medicaid in a dozen states and extension of tax credits that help people buy insurance under the Affordable Care Act. It would be a milestone achievement, says Craig, who calls health care her No. 1 issue in Congress.
“I ran on expanding access and lowering the cost of health care,” said Craig, who was first elected in 2018 and reelected in 2020. “Lowering the cost of prescription drugs is a huge part of that.”
The $1.75 trillion Build Back Better Act, a sprawling social spending bill, hadn’t been up for a House vote as of Wednesday. A Congressional Budget Office analysis, demanded by some Democrats, of whether the bill is paid for with proposed tax increases was expected by Friday. The bill also has to pass an evenly divided Senate.
Craig led a group of 15 House Democrats in electorally vulnerable districts in pressuring colleagues and the White House to restore the prescription drug package, according to a Nov. 1 story in The Hill, a Washington, D.C.-based news outlet.
Those lawmakers “brought this Democratic Party their majority” in the House, which has 221 Democrats and 213 Republicans, Craig said.
In a letter to House leadership, she wrote: “As majority-makers in competitive districts, we promised our constituents that we would come to Washington to fight on their behalf for lower drug prices. We cannot turn back now on our promise to the American people.”
Craig said she heard affirmation of the lawmakers’ leverage from U.S. Health and Human Services Secretary Xavier Becerra on a Nov. 10 visit to M Health Fairview Ridges Hospital in Burnsville for a roundtable on prescription drug prices.
“What I can tell you is when Secretary Becerra was in Burnsville with me and Sen. Klobuchar last week, he let me know that the 15 Democratic front-liners standing up and stepping forward and saying we cannot move forward without prescription drug negotiation in Medicare had a huge, huge weight with the House in pushing these forward,” Craig said. “Without the 15 of us, it is impossible for this party to move a bill forward.”
Big pharmaceutical companies have fought Medicare price negotiations at every turn, Craig said.
“Most of us back home have already faced hundreds of thousands of dollars in negative ads from Brand Name Pharma,” she said. “I’m no different. I’ve had negative ads run already by Brand Name Pharma companies who are trying their best to send me a message. If I take Brand Name Pharma attacks into my next election, I’m going to wear those as a badge of honor.”
The prescription drug package is a compromise from earlier versions. Under the revised plan, the most Medicare would pay would be 75% of what commercial U.S. insurers pay on average for drugs that have been on the market for nine to 12 years, according to news site Vox. Earlier proposals set a maximum price of 120% of the average of what other wealthy nations pay for the same drug, Vox reported.
And fewer drugs would be subject to negotiation. Under the new plan, the government would start by negotiating the cost of 10 drugs in 2025 and expand to 20 after a few years, Vox reported.
Craig said the drugs subject to negotiations the soonest are some of the most popular drugs, whose patents ran out a long time ago.
Most important, she said, is the $2,000 cap on out-of-pocket drug spending for seniors, which news site Politico reported would begin in 2024.
“That’s all a senior will have to pay for prescription drugs if we can get this bill across the finish line,” Craig said. “That’s just significant for seniors who are on multiple drugs that have only been jacked up in price over the years.”
The package also caps the cost of insulin at $35 per month, which Politico said would begin in 2023.
“We all know the horror stories of young people who rationed their insulin and ended up dying,” said Craig, who serves on the health subcommittee of the House Energy and Commerce Committee. “This would make a real difference in the lives of Minnesotans, the lives of the people that I represent.”
Build Back Better closes the “Medicaid gap” by providing coverage to millions of low-income residents in 12 states that refused expanded Medicaid coverage provided by the Affordable Care Act signed by President Barack Obama, Craig said.
“We’re damn near close to universal coverage if we can get Build Back Better across the finish line,” she said.
The bill also extends through 2025 tax credit enhancements for purchase of health plans. The credits, originated by the Affordable Care Act, were expanded under the American Rescue Plan COVID-19 relief legislation, which would have allowed the expansions to expire in 2022, according to the Center on Budget and Policy Priorities.
Craig said Build Back Better also includes her proposal for a federal reinsurance program, which helps fund the most expensive catastrophic health claims. That helps insurers contain premium prices, according to Craig. Minnesota has a reinsurance program.
Other parts of Build Back Better
Craig said she’s “much more comfortable” with the $1.75 trillion “compromise” bill than the original $3.5 trillion proposal.
In addition to prescription drug prices, she said she wanted to see two other elements to earn her support.
One was support for family farmers and rural communities, she said, pointing to the bill’s $1 billion for biofuels infrastructure.
On the tax side, she said she opposed raising revenue through a “stepped-up basis” that she said would have raised the inheritance tax and forced many farmers to sell part of their land to afford it. That would have promoted more farm consolidation, Craig said.