Pelosi offers plan to cut drug prices for seniors

Speaker of the House Nancy Pelosi, D-Calif. (AP Photo/J. Scott Applewhite)

Putting her stamp on the health care issue that worries consumers the most, House Speaker Nancy Pelosi on Thursday unveiled an ambitious plan to lower drug prices for seniors on Medicare and younger people with private insurance.

Pelosi, D-Calif., would empower Medicare to negotiate prices for up to 250 of the costliest drugs, including insulin. Pharmaceutical companies that refuse to negotiate could face steep penalties. Additionally, drugmakers that hike prices beyond inflation would have to pay rebates to Medicare.

The plan would limit copays for seniors covered by Medicare’s “Part D” prescription drug program to $2,000. And Medicare-negotiated prices would be available to other buyers, such as employer health plans.

The plan is Pelosi’s marker in what’s shaping up as a high-stakes negotiation to determine if a drug pricing compromise can pass Congress this year or if Democrats and Republicans will take their differences into the 2020 elections.

The sweeping legislation leans left politically and appears to be tailor-made for Pelosi’s Democratic majority in the House. But in a signal that Pelosi wants a deal, it also incorporates ideas from the Trump administration and from Republican and Democratic senators.

A group of House Republicans led by Rep. Greg Walden, R-Ore., quickly accused Pelosi of putting “politics over progress,” calling her plan “a socialist proposal to appease her most extreme members.”

Nonetheless, Americans across party lines say lowering prescription drug costs should be a top priority for Congress this year. Overall, 70 percent deemed that a top priority in a poll earlier this month from the nonpartisan Kaiser Family Foundation.

President Donald Trump appears eager to sign prescription drug legislation and lower costs, but most Republicans oppose the Medicare negotiations that are the centerpiece of Pelosi’s plan. The 2003 law that created Medicare’s prescription drug benefit barred the program from negotiating prices, a restriction Democrats have long opposed.

As a candidate, Trump backed Medicare negotiations. But after Trump was elected president, he seemed to revert to the traditional Republican position that price negotiations are best left to private players like insurance companies.

With tens of billions of dollars in profits at stake, drugmakers are determined to block any major changes to payment policies. But the industry’s powerful lobbying group, the Pharmaceutical Research and Manufacturers of America, has been taking fire from all sides, from liberal Democrats to pro-business Republicans. Trump once accused drug companies of “getting away with murder.”

Pelosi’s proposal would:

— Authorize Medicare to negotiate prices for up to 250 drugs with the greatest total cost to the program and the U.S. health care system. That includes pharmacy drugs covered through the popular “Part D” prescription benefit, along with “Part B” medications dispensed in doctors’ offices, which covers many cancer drugs. Medicare would negotiate for as many drugs as possible, but no fewer than 25 annually. The maximum price would be determined using a blend of international prices, similar to a more limited proposal from the Trump administration. Insulin would be included. Drug companies that balk at making a deal would face penalties that start at 65% of sales for the drug at issue, and would escalate if they hold out.

— Require drugmakers to pay rebates to Medicare if they hike their prices beyond the increase in inflation. That idea resembles a bipartisan plan from Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore. The senators’ proposal has already cleared a key committee, with Trump’s support. But many Senate Republicans oppose inflation rebates, and it’s unclear what Majority Leader Mitch McConnell, R-Ky., plans to do next.

— Limit what seniors pay out of pocket for their medications to $2,000 a year. Currently, Medicare’s pharmacy benefit has no cap on copays, and the advent of drugs costing hundreds of thousands of dollars a year has left some seniors saddled with bills that rival a mortgage payment. An out-of-pocket limit also is part of the Grassley-Wyden bill, and the idea also is backed by the Trump administration.

Pelosi’s office says her plan is to have the legislation introduced and moved through House committees to a vote on the floor. If compromise can be reached among House Democrats, the Trump White House and enough GOP lawmakers, a drug pricing package could be added to year-end budget legislation.

Movement in Congress comes at a time when criticism of the industry — from Trump and lawmakers of both parties — appears to be having an effect on prices.

The Commerce Department’s inflation index for prescription drug prices has declined in seven of the last eight months, which is highly unusual. That index includes lower-cost generic drugs.

The story is different for brand name drugs, however. A recent analysis by The Associated Press shows that on average prices are still going up but at a slower pace. Costly brand-name drugs can translate to steep copays for insured patients.

The AP analysis found that in the first seven months of 2019, drugmakers raised list prices for brand name medicines by a median, or midpoint, of 5%.

That does reflect a slowdown. Prices were going up 9% or 10% over those months the prior four years.

But there were 37 price increases for every decrease in the first seven months of 2019.

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Associated Press writer Alan Fram contributed to this report.
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Is Congress ready to avert government shutdown?

The Capitol (AP Photo/J. Scott Applewhite)

The House is set to pass a government-wide temporary spending bill to prevent a federal shutdown when the budget year ends Sept. 30.

The bipartisan measure would give lawmakers until the Thanksgiving break to pass and negotiate $1.4 trillion worth of annual agency spending bills. Those bills would fill in the details of this summer’s budget and debt agreement between President Donald Trump and House Speaker Nancy Pelosi.

Thursday’s House vote comes as the Republican-controlled Senate struggles to process its versions of the follow-up spending bills amid partisan skirmishing over the boundaries of the budget agreement and Trump’s moves to pay for the U.S.-Mexico border fence without approval by Congress.

The Senate is likely to adopt the stopgap bill with plenty of time before the deadline.

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Can Congress keep government running this time?

House Speaker Nancy Pelosi, D-Calif., speaks at the Capitol in Washington. (AP Photo/J. Scott Applewhite)

The good news is that it doesn’t look like a bitterly polarized Washington will stumble into another government shutdown.

But as Democrats controlling the House unveil a stopgap, government-wide spending bill to keep the lights on and pay the troops, there’s scant evidence that power sharing in the Capitol will produce further legislative accomplishments anytime soon.

The measure that is set for a vote this week would keep the government running through Nov. 21 and buy time for action and negotiations on $1.4 trillion in annual appropriations bills. Some items can’t wait and will be included, like accelerated funding for the 2020 census and $20 million to combat Ebola in Africa. President Donald Trump also appears likely to win authority to continue bailout payments to farmers harmed by his aggressive trade policies against China.

Since the temporary spending bill is the only must-do legislation on the immediate horizon, lawmakers are using it as a locomotive to haul other priorities into law. That bundle of provisions, negotiated behind closed doors, offers plenty of evidence of Capitol Hill’s chronic dysfunction.

It’s not just that the Democratic-controlled House and GOP-held Senate can’t agree on big issues like infrastructure, guns and health care. They also can’t agree on lower-tier items that typically pass by wide margins, such as short-term extensions of the federal flood insurance program and the Export-Import Bank, which helps finance export deals important to large manufacturers such as The Boeing Co.

The House and Senate banking committees are responsible for legislation to reauthorize both the Export-Import Bank and the flood insurance program, which is particularly important to the real estate sector in coastal areas, but there’s been no progress.

Meanwhile, a bundle of health care-related provisions, such as Medicaid payment rates for hospitals that serve mainly lower-income communities, is catching a ride on the temporary spending bill, according to a spokesman for House Appropriations Committee Chairwoman Nita Lowey, D-N.Y.

Democrats aren’t trying to use the bill as a way to take on Trump controversies like cutting military base projects to pay for his U.S.-Mexico border wall. But they’re not granting Trump any favors, either, denying provisions as the flexibility to build new border wall segments.

An early draft of the stopgap measure, circulated by Lowey, did not include Trump’s request for maintain funding for the farm bailout, but talks Monday appeared headed toward a bipartisan compromise that would allow the Agriculture Department to keep issuing checks to farmers.

The bailout started last year after China retaliated against Trump’s tariffs on Chinese exports by reducing purchases of U.S. crops. The developments have caused widespread discontent in farm country that’s already beset by lower crop prices and vanishing profits.

The House is slated to pass the stopgap spending measure this week and the Senate is expected to follow in time to meet the Sept. 30 deadline to avert a government shutdown. The effort comes nine months after Trump started a 35-day partial government shutdown when lawmakers rebuffed his border wall demands.

The $1.4 trillion in annual appropriations bills are off to a late and not particularly promising start despite a bipartisan budget and debt deal passed in July. The House has passed 10 of the 12 annual bills, but at spending levels higher than permitted under the budget deal.

The Senate is roiled by battles over Trump’s $5 billion border wall request and his moves to tap military base construction projects to pay for it. Democrats complained that Senate Republicans are giving too much funding to Trump’s cherished wall project at the expense of health and education projects.

Senate Democrats are threatening to filibuster an upcoming vote on a huge, almost $700 billion defense funding bill to protest preliminary funding decisions of Trump’s GOP allies in the Senate.

“Our Democratic colleagues would rather provoke a partisan feud with the president,” said Senate Majority Leader Mitch McConnell, R-Ky. “They’d rather have a fight with the president than stick to the agreement that we all made.”

Senate Democratic leader Chuck Schumer responded that Trump’s wall funding plan “is what Democrats oppose. That’s what Leader McConnell calls staging a political fight.”

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McConnell waiting on Trump to decide on any actions to control guns

Senate Majority Leader Mitch McConnell of Ky. (AP Photo/Manuel Balce Ceneta)

Congressional Republicans are waiting for the White House to chart a path forward on gun violence legislation, Senate Majority Leader Mitch McConnell said Tuesday, effectively putting the burden on President Donald Trump to decide the GOP’s legislative response to the spate of mass shootings that included another deadly attack in Texas over the weekend.

Asked about prospects for a Senate vote on legislation passed by the Democratic-controlled House to expand background checks for gun purchases, McConnell said, “The administration is in the process of studying what they’re prepared to support, if anything.”

The Kentucky Republican said he expects an answer from the White House next week, adding that he wants to make sure that senators “would actually be making a law and not just having serial votes” on proposals to stem gun violence.

McConnell’s comments point to the challenge ahead as Congress returns to a gun debate that emerged during their summer recess, when mass shootings in El Paso, Texas and Dayton, Ohio, left 31 people dead. While Trump has said he wants to work with Congress to “stop the menace of mass attacks,” he’s waffled on support for expanding background checks, making the next steps uncertain. Trump and other Republicans have talked of pursuing other measures to address mental health or codify “red flag” laws that allow guns to be taken from people who pose harm to themselves or others, but even those measures face skepticism among GOP lawmakers.

The dynamic appears unchanged even after a shooting rampage in West Texas over the weekend that killed at least seven people. The Texas gunman obtained his AR-style rifle through a private sale, allowing him to evade a federal background check that previously blocked him from getting a gun, a law enforcement official told The Associated Press. The official spoke to the AP on condition of anonymity because the person was not authorized to discuss an ongoing investigation.

A bill passed by the House in February would require background checks on all gun sales, including those between strangers who meet online or at gun shows. The Senate has not taken up legislation, and McConnell appeared to set a high bar for Senate action when lawmakers return next week after a five-week recess. If Trump favors background checks or other legislation he has discussed publicly in recent weeks, and senators “know that if we pass it it’ll become law,” then he’ll put it on the Senate floor for a vote, McConnell told radio host Hugh Hewitt.

Trump in a tweet Tuesday urged Congress to “get back to work,” but omitted any reference to guns, focusing instead on prescription drug prices, healthcare and infrastructure.

Trump said Sunday that any gun measure must satisfy the competing goals of protecting public safety and the constitutional right to gun ownership.

“For the most part, sadly, if you look at the last four or five (shootings) going back even five or six or seven years … as strong as you make your background checks, they would not have stopped any of it,” Trump said. “So it’s a big problem. It’s a mental problem. It’s a big problem.”

Trump’s comments were reminiscent of his wavering last year, when he vowed to support background checks in the wake of a school shooting in Parkland, Florida, only to relent after receiving pressure from the National Rifle Association.

This time there seems to be more sustained momentum to produce some sort of measure after Trump asked aides to pull together a comprehensive list of ideas. White House officials have been meeting with lawmakers and congressional staff as they try to formulate a plan that Trump can support without risking backlash from his political base.

“We’re looking at a lot of different bills, ideas, concepts. It’s been going on for a long while,” Trump told reporters Sunday after returning to the White House from Camp David.

NRA head Wayne LaPierre has repeatedly spoken to Trump and warned him about losing support from NRA members. But White House aides contend the president’s base would stick with him regardless. They point to strong support for background checks among Republicans and gun owners and believe they can fashion a proposal that the gun lobby — while not supporting — may not vehemently oppose.

Among the proposals being considered: red flag laws, more money for mental health and making sure juvenile information gets into existing background checks. Additionally, White House aides have said Attorney General William Barr is drafting legislation to speed up the death penalty for mass shooters.

Sen. Chris Murphy, a leading gun control supporter, said Trump has told him personally that he remains committed to working on expanding background checks.

Even so, the Connecticut Democrat rates the chance of Congress actually approving anything at “less than 50-50,” especially if Trump appears willing “to give the NRA veto power” over legislation such as a bipartisan bill to expand background checks being pushed Sens. Pat Toomey, R-Pa., and Joe Manchin, D-W.Va.

“I am skeptical that these efforts are going to bear fruit. I think it’s very hard to negotiate with this White House when the president’s public positions seem to change by the day,” Murphy said last month. “I’m going to try … because the stakes are so high.”

As senators continue conversations, House Democrats are moving ahead on other bills, with the House Judiciary Committee set to consider a host of proposals to address gun violence at a hearing next week. The panel postponed a hearing originally scheduled Wednesday because of Hurricane Dorian.

The committee will consider bills to ban high-capacity magazines, establish a federal program for “red flag” laws and expand bans on firearm ownership to people convicted of certain hate crimes. The panel will also hold a hearing later this month on a bill to ban military-style assault weapons.

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Associated Press writers Michael Balsamo in Washington, Jonathan Lemire in New York and Jill Colvin in Dublin, Ireland, contributed to this story.

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Massive bipartisan budget deal passes Congress

Senate Majority Leader Mitch McConnell, R-Ky., walks to the Senate chamber for votes on federal judges as a massive budget pact between House Speaker Nancy Pelosi and President Donald Trump is facing a key vote in the GOP-held Senate. (AP Photo/J. Scott Applewhite)

A hard-won budget and debt deal easily cleared the Senate on Thursday, powered by President Donald Trump’s endorsement and a bipartisan drive to cement recent spending increases for the Pentagon and domestic agencies.

The legislation passed by a 67-28 vote as Trump and his GOP allies relied on lots of Democratic votes to propel it over the finish line.

Passage marked a drama-free solution to a worrisome set of looming Washington deadlines as both allies and adversaries of the president set aside ideology in exchange for relative fiscal peace and stability. The measure, which Trump has promised to sign, would permit the government to resume borrowing to pay all its bills and would set an overall $1.37 trillion limit on agency budgets approved by Congress annually.

It also would remove the prospect of a government shutdown in October or the threat of deep automatic spending cuts.

The administration and House Speaker Nancy Pelosi, D-Calif., played strong hands in the talks that sealed the agreement last week, producing a pragmatic measure that had much for lawmakers to dislike.

Trump did step back from a possible fight over spending increases sought by liberals, and achieved his priorities on Pentagon budgets and the stock market-soothing borrowing limit. Pelosi won remarkable Democratic unity in pushing the bill through the House last week despite Democratic divides on issues such as impeachment and health care.

Democrats in the GOP-controlled Senate delivered most of their votes for the deal. Many of the more solidly conservative Republicans said it allowed for unchecked borrowing and too much spending.

The measure was an epitaph to the 2011 Budget Control Act, which came about due to a tea party-fueled battle over debt limit legislation during the run-up to President Barack Obama’s re-election. That law promised more than $2 trillion in deficit cuts through 2021, including automatic spending cuts that were put in place after the failure of a so-called deficit supercommittee.

“It’s not just Democrats. Republicans are also guilty. At least the big-government Republicans who will vote for this monstrous addition of debt,” said Sen. Rand Paul, R-Ky. “Many of the supporters of this debt deal ran around their states for years complaining that, ‘President Obama’s spending too much and borrowing too much,’ and these same Republicans now, the whole disingenuous lot of them, will wiggle their way to the front of the trough.”

The bill would lift the debt limit for two years, into either a second Trump term or the administration of a Democratic successor.

It would reverse scheduled 10 percent cuts to defense and nondefense programs next year, at a two-year cost of more than $200 billion. An additional $100 billion over two years would add to recent gains for military readiness, combating opioids and other domestic initiatives, and would keep pace with rising costs for veterans’ health care.

Follow-up legislation would fill in the line-by-line details of agency budgets when the Senate returns in September.

Those increases, assuming they are repeated year after year, promise to add $2 trillion or so to the government’s $22 trillion debt.

But the measure would deliver wins to a coalition of GOP defense hawks, Democrats seeking to preserve gains in domestic accounts, and the leaders of the House and Senate Appropriations Committees.

It also would be a triumph for Senate Majority Leader Mitch McConnell, R-Ky. He initiated the negotiations and was deeply invested in bringing order and relative predictability to the budget and debt deadlines.

“We have to invest in improved readiness to help our military commanders plan for emerging challenges, in research and development to support the U.S. military of the future, and in rock-solid support for our alliance commitments,” McConnell said. “This deal is an opportunity to do exactly that. This is the agreement the administration has negotiated. This is the deal the House has passed. This is the deal President Trump is waiting and eager to sign into law.”

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Ultimately, voters will decide Trump’s future

Former special counsel Robert Mueller returns to the witness table following a break in his testimony before the House Intelligence Committee on Capitol Hill. (AP Photo/Susan Walsh)

Robert Mueller’s testimony Wednesday sent the clearest signal yet that impeachment may be slipping out of reach for Democrats and that the ultimate verdict on President Donald Trump will be rendered by voters in the 2020 election.

Democrats had hoped the former special counsel’s appearance would be a turning point. A Marine who served in Vietnam, Mueller is the kind of square-jawed federal prosecutor to whom Americans may have once listened as a trusted source of authority. But in this era of stark political polarization, galvanizing the public is a difficult task even if Mueller wanted to produce a viral moment, which he never seemed inclined to do. Rather than swoop in to give voice to the 448-page report, Mueller said very few words.

What Mueller did say was striking: Trump was not exonerated of potential crimes. His report found Russia interfered in the 2016 election in “sweeping and systematic” fashion. Accepting foreign campaign assistance is wrong, he agreed. But Mueller’s reluctance to engage, and his one-word answers, deprived the country of a where-were-you-when moment that could bring decisive conclusion to the probe and Trump’s role in trying to obstruct the investigation.

“It was not a hoax,” Mueller testified of Russian election interference.

The result, after more than six hours at the House Judiciary and Intelligence committees, was that the sides in Washington were retrenching to their familiar outposts, leaving voters to decide what to do next.

Trump derided Mueller’s appearance — “disaster,” he tweeted — and started fundraising off it. The president’s reelection campaign set a $2 million goal over 24 hours, it said, to counter those trying to “TRICK the American People into believing their LIES.”

Allies of the White House quickly joined in. GOP Sen. Lindsey Graham of South Carolina called Mueller’s appearance “sad.” Rep. Devin Nunes of California, the top Republican on the Intelligence panel, said the hearing was the “last gasp” of the investigation.

“It’s time for the curtain to close on the Russia hoax,” Nunes said. “The conspiracy theory is dead.”

Much was riding on Mueller’s appearance, coming months after the release of his report in April. House Speaker Nancy Pelosi is weighing liberal calls for impeachment against her own instincts for a more measured approach investigating the Trump administration and laying out the findings.

Activists on the party’s left flank have been impatient with what they see as Pelosi’s slow-walking of impeachment — but they’ve also been deferential to her strategy. More than 85 House Democrats have called for the House to begin impeachment proceedings, and more lawmakers are expected to add their names after Mueller’s testimony.

Yet even though Democrats hold the House majority, they’re far from the 218 votes that would be needed to approve articles of impeachment. With Republicans controlling the Senate, many Democrats warn moving forward is a political dead end.

“If we have a case for impeachment, that’s the place we will have to go,” Pelosi said afterward.

Mueller, in his testimony, didn’t push the issue any further. While Mueller’s team declined to prosecute the president, in part because of a Justice Department opinion against indicting a sitting president, the report also suggested other remedies, including in Congress. Asked about impeachment as an option Wednesday, Mueller refused to comment on it.

The former special counsel was always going to be a reluctant witness who wanted his report to speak for itself. Democrats knew what they would encounter even if they were hoping for a Mueller of a different vintage, from his time leading the FBI after the Sept. 11, 2001, terror attacks.

Instead, they saw a less forceful public presence, hard of hearing at times, hesitant to answer many of the questions, but one still skilled enough in the ways of Washington to not read his report in a way that Democrats could exploit.

When Rep. Ted Lieu, D-Calif., asked if Mueller would read a certain section from the report, Mueller turned the tables: “I’m happy to have you read it.”

Republicans had their own expectations and tried to portray Mueller as an actor in an elaborate attempt to undermine Trump’s election. Their revived their long-running theory about the origins of the report during Hillary Clinton’s campaign and posed questions that seemed well designed to be replayed on conservative media, even if they, too, found Mueller’s answers were not entirely fulfilling.

It had all the trappings of a classic Washington political drama, yet brought little closure.

Even if Mueller had been a more eager player, he may not have been able to make a more convincing case. Gone are the Watergate-era hearings, when lawmakers crossed party lines to engage critically over then-President Richard Nixon. The impeachment proceedings against Bill Clinton changed that dynamic, and the partisan divide since has only deepened to a point of rupturing whatever’s left of political comity.

Still, Mueller’s appearance was far from a political loss for either party. Ahead of the 2020 election, both are trying to reach the slice of Americans who have not hardened to partisan positions.

A June poll by The Associated Press-NORC Center for Public Affairs Research found 31% of Americans said they didn’t know enough to say whether Mueller’s report had completely cleared Trump of coordination with Russia and 30% didn’t know whether it had not completely cleared Trump of obstruction. A CNN poll found that just 3% said they had read the whole report.

Perhaps Mueller’s testimony, with his button-down lawyer’s approach, reached some of them.

As voters consider what they’ll do, Mueller did leave them with one definitive point — a warning about what happened in 2016 and a plea that they pay attention to what may be coming.

“Over the course of my career, I’ve seen a number of challenges to our democracy,” Mueller said. “The Russian government’s effort to interfere in our election is among the most serious. … This deserves the attention of every American.”

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AP Congressional Correspondent Lisa Mascaro has covered Congress since 2010.

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