华盛顿——总统乔·拜登美国呼吁授权医疗保险谈判降低处方药价格，这激发了民主党人对一个政治上受欢迎的想法的兴趣，他们已经推动了近20年，但却遇到了挫折。
但是他们仍然缺乏一个明确的立法途径。这是因为一小部分民主党人仍然对政府对制药公司的价格限制感到不安。
众议院议长南希·佩洛西和参议院多数党领袖查克·舒默将需要在一个勉强分裂的国会中获得每一张民主党选票。否则，民主党人可能不得不接受一个达不到目标的妥协方案。或者他们可以把这个问题带到2022年中期选举南
“有一条路，”民主党众议员彼得·韦尔奇说。佩洛西的副手之一。“但这也是一个挑战，挑战在于我们的利润率极低。”
“这不是一笔交易，”韦尔奇继续说道。“我们有一位总裁和一位发言人，但‘制药’非常强大。”制药是这个行业及其主要游说团体美国制药研究和制造商的昵称。
该行业挫败了总统唐纳德·特朗普美国多管齐下限制其定价权的努力。尽管特朗普上任时指责制药商“逃脱了谋杀”，并发誓要阻止它，但这些公司在他的任期内只出现了几处缺口和削减。
行业游说团体PhRMA被认为是华盛顿最熟练的运营商之一。它的使命是:保留2003年法律中的一项条款，该条款创造了医疗保险的药房福利，禁止政府干预制药商和保险公司之间的价格谈判。那是在1000美元的药丸成为旧帽子之前颁布的。
在拜登上周向国会发表演讲后，该公司首席执行官斯蒂芬·乌博(Stephen Ubl)发出通知，称该行业随时准备捍卫自己的特权。“赋予政府任意决定药品价格的权力不是正确的方法，”他在一份声明中表示，称这将扼杀创新。这种有分寸的语言掩盖了该团体的影响力。它通常是华盛顿游说和与美国联盟团体网络的前五大支出者之一。
支持医疗保险谈判的联盟“现在就降低药品价格”的竞选主任马尔加里达·豪尔赫说:“我认为没有人对我们期望从医生促进人权协会那里得到的冲击做好充分准备。”“我们将看到一场规模更大的升级游戏。”
佩洛西在2019年众议院通过了一项雄心勃勃的法案，重新引入了医疗保险谈判。医疗保险将使用其他经济发达国家的平均较低价格来谈判顶级药物。拒绝交易的公司将被课以重税。将价格提高到通胀率以上的制药商将欠医疗保险回扣。通过该法案可能节省的数千亿美元将被重新投入到其他领域医疗保健服务程序。覆盖工作年龄人群的私人保险公司将能够确保医疗保险的低价。
拜登在国会联席会议上的讲话中邀请立法者想象这种可能性。总统说:“我们省下的数十亿美元可以用于巩固《患者保护与平价医疗法案》和扩大医疗保险福利，而不会让纳税人多花一分钱。”。“我们有能力做这件事。现在就开始吧。我们已经谈得够久了。”
但是爱荷华州的共和党参议员查克·格拉斯利敦促拜登放低眼光。格拉斯利反对就医疗保险的权威进行谈判，但支持要求制药商为高于通胀率的价格上涨支付回扣——这是一种潜在的妥协。格拉斯利说:“我希望总统重新考虑自由派的白日梦，支持两党大获全胜。”。
民意调查一贯显示，公众强烈支持授权医疗保险进行谈判。“这是选民非常关心的问题，也是拜登在竞选中大力承诺的，”政策专家约翰·罗泽尔说，他长期以来一直倡导控制药品价格。众议院能源和商业委员会将于周二就此问题举行听证会。
佩洛西和舒默的一个选择是将医疗保险立法纳入一项庞大的法案，兑现拜登关于社会项目和基础设施的“美国就业计划”承诺。这种工具似乎为通过药品定价限制提供了最大的机会。但是每个议院的政治动态是不同的。在众议院可能行得通的东西，在参议院可能毫无用处。
参议院以50比50的比例分裂，看起来像是一个瓶颈。绝大多数民主党人支持医疗保险谈判，但少数人没有申报。
其中包括新泽西州的参议员鲍勃·梅嫩德斯，他的办公室表示，他认为“任何药物定价法案都必须为药店柜台的消费者带来真正的节约，而不仅仅是为政府或整个系统实现节约。”
“这将是一个沉重的负担，”政策专家罗泽尔说。“但是我觉得你不去试一试才知道肯定。”
Democrats seek narrow path to rein in cost of medicines
WASHINGTON -- PresidentJoe Biden’s call for authorizing Medicare to negotiate lower prescription drug prices has energized Democrats on a politically popular idea they've been pushing for nearly 20 years only to encounter frustration.
But they still lack a clear path to enact legislation. That's because a small number of Democrats remain uneasy over government price curbs on pharmaceutical companies.
House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer will need every Democratic vote in a narrowly divided Congress. Otherwise Democrats may have to settle for a compromise that stops short of their goal. Or they could take the issue into the 2022 midtermelections.
“There is a path,” said Rep. Peter Welch, D-Vt., one of Pelosi's lieutenants. “But there’s also a challenge, and the challenge is we’ve got razor-thin margins.”
“This is not a done deal,” continued Welch. “We've got a president and a speaker, but ‘pharma’ is very powerful.” Pharma is a nickname for the industry and for its main lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA.
The industry thwarted PresidentDonald Trump's multi-pronged efforts to constrain its pricing power. Even though Trump came into office accusing drugmakers of “getting away with murder" and vowing he'd put a stop to it, the companies emerged from his term with just a few nicks and cuts.
The industry lobbying group PhRMA is considered one of the most skilled operators in Washington. Its mission: to preserve a clause in the 2003 law that created Medicare's pharmacy benefit barring the government from interfering in price negotiations among drugmakers and insurers. That was enacted before $1,000 pills became old hat.
PhRMA CEO Stephen Ubl served notice after Biden's speech to Congress last week that the industry stands ready to defend its prerogative. “Giving the government the power to arbitrarily determine the price of medicines is not the right approach,” he said in a statement arguing that it would stifle innovation. Such measured language belies the group's clout. It's usually among the top five spenders on Washington lobbying and networks with allied groups in the states.
“I don’t think anybody is fully prepared for the onslaught we expect from PhRMA,” said Margarida Jorge, campaign director for Lower Drug Prices Now, a coalition backing Medicare negotiations. “We are going to see a much bigger stepped-up game.”
Pelosi put Medicare negotiations back in play with the reintroduction of an ambitious bill she powered through the House in 2019. Medicare would use an average of lower prices in other economically advanced countries to negotiate on top drugs. Companies that refused to deal would be hit with a steep tax. Drugmakers who hike prices above the rate of inflation would owe rebates to Medicare. Hundreds of billions of dollars potentially saved through the legislation would be plowed back into otherhealth careprograms. Private insurers covering working-age people would be able to secure Medicare's lower prices.
In his speech to a joint session of Congress, Biden invited lawmakers to imagine the possibilities. “The money we save, which is billions of dollars, can go to strengthening the Affordable Care Act and expand Medicare benefits without costing taxpayers an additional penny,” the president said. “It is within our power to do it. Let’s do it now. We've talked about it long enough.”
But Republican Sen. Chuck Grassley of Iowa is urging Biden to lower his sights a bit. Grassley opposes negotiating authority for Medicare but supports requiring drugmakers to pay rebates for price hikes above the inflation rate — a potential compromise. “I hope the president reconsiders the liberal pipe dream in favor of the big bipartisan win,” said Grassley.
Polls have consistently shown strong public support for authorizing Medicare to negotiate. “This is very high among the concerns of voters, and also heavily promised by Biden in the campaign,” said policy expert John Rother, a longtime advocate of drug price curbs. The House Energy and Commerce Committee will hold a hearing Tuesday on the issue.
One option for Pelosi and Schumer would be to splice the Medicare legislation into a mammoth bill delivering Biden's “American Jobs Plan” promises on social programs and infrastructure. Such a vehicle would seem to offer the greatest chance to pass drug pricing curbs. But the political dynamics are different in each chamber. What might work in the House may get nowhere in the Senate.
With its 50-50 split, the Senate is looking like the choke point. The overwhelming majority of Democrats are in favor of Medicare negotiations, but a few are undeclared.
Among them is Sen. Bob Menendez of New Jersey, whose office says he believes "any drug pricing bill must deliver real savings for consumers at the pharmacy counter, not just achieve savings to the government or overall system.”
“It's going to be a heavy lift,” said policy expert Rother. “But I don't think you know for sure until you try it.”
