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Democrats are trying to resurrect part of Build Back Better — again

Sen. Joe Manchin (D-WV) walks to a meeting in 2021, in Washington, DC. | Kevin Dietsch/Getty Images

Their latest iteration focuses on provisions to reduce prescription drug prices.

This month, Democrats are, once again, trying to resurrect parts of the Build Back Better Act after the broader package imploded last year.

To do so, the party is focusing on provisions aimed at lowering prescription drug costs, something that has the full support of all 50 Senate Democrats. Negotiations on more contentious climate and tax policies, meanwhile, are ongoing.

On Wednesday, following an agreement between Senate Majority Leader Chuck Schumer (D-NY) and Sen. Joe Manchin (D-WV) — one of the key holdouts on the original BBB package — lawmakers officially submitted the prescription drugs plan to the Senate parliamentarian for review. The parliamentarian, a nonpartisan procedural expert, will determine if the proposal can qualify for the budget reconciliation process, which enables policies that affect the budget to pass with 51 votes in the Senate, rather than the 60 needed if a bill is filibustered under normal rules.

Schumer and Manchin are still in talks about additional climate and tax provisions that could be included in the legislation, but it’s uncertain whether those will make it into a final bill. It also isn’t clear where Sen. Kyrsten Sinema (D-AZ), who once opposed certain corporate tax hikes in the original BBB bill, stands on those two issues. (Previously, Sinema appeared satisfied with some of the updated BBB tax policies that had been negotiated last year.)

Although there are still outstanding subjects to work on, Democrats are hopeful that movement on prescription drugs will both allow the party to achieve a longtime goal, and to signal to midterms voters that Democratic lawmakers can make progress on something.

The prescription drugs proposal — though much narrower than its previous iteration — is significant: It would enable Medicare to negotiate prices on a select group of drugs beginning in 2023 and cap Medicare patients’ out-of-pocket drug costs at $2,000 a year. But if it is all Democrats are able to pass, the party will have fallen far short of what it had initially strived to achieve with the Build Back Better Act, which included substantial funding for green energy tax credits and social programs as well.

What Democrats have agreed on so far

Thus far, Democrats are aligned on their prescription drugs plan and not much else. The plan aims to make some drugs more affordable, though it drops some original BBB proposals, like a $35 monthly cap on insulin costs.

As Manchin had previously said, his goal is for the legislation to be a deficit-reduction bill, with about 50 percent of the revenue it’s bringing in going to paying down the deficit, and the other half going to cover new spending. A major chunk of new revenue is likely to come from the prescription drug policies, since they could include billions in savings for Medicare. Here are the prescription drug provisions that Democrats agree on so far:

  • Allowing Medicare to negotiate drug prices: Medicare has historically been barred from negotiating on most prescription drug prices, meaning it pays drug prices set by the market. This bill would change that. In doing so, it could mean drastic price reductions on specific drugs for people covered by Medicare, since the government has huge buying and negotiating power.

The savings would not apply to people covered by private insurance, however, Reuters reports. The legislation guarantees that Medicare can begin negotiations in 2023, starting with 10 drugs, which will be chosen by the Department of Health and Human Services.

  • Capping out-of-pocket drug costs for Medicare recipients: The legislation would cap annual out-of-pocket drug costs for Medicare recipients at $2,000. After that, Medicare would pay for additional expenses. It would be a major change since there is currently no cap, meaning people can spend thousands more for a single drug.
  • Requiring rebates for price hikes: If pharmaceutical companies raise the costs of a drug at a rate faster than the rate of inflation, they would be forced to refund the difference to people paying for the drug.
  • Expanding prescription drug subsidies for low-income seniors: Currently, seniors who are at or below 150 percent of the federal poverty line are able to receive a partial subsidy for their prescription drugs. The legislation would enable them to receive a larger subsidy for these expenses.
  • Making vaccines free for seniors: The legislation would make all vaccines free for seniors, a notable change in coverage. Currently, Medicare covers some vaccines, like the flu shot, but not all immunizations are included.

Democrats are trying to do what they can before the midterms

Although Democrats’ electoral chances in the Senate are looking better than they are in the House, it’s possible the party loses control of one or both chambers of Congress following the November midterms. With the elections fast approaching, Democrats are scrambling to capitalize on their existing majorities in case they are no longer able to pass legislation next year.

This reconciliation bill could be the party’s last major chance to approve new prescription drugs, climate, and tax policy — all of which would be far less likely to advance if Republicans retake just one chamber of Congress. If they are able to make quick progress in the coming weeks, it’s possible that Democrats could hold a vote on the reconciliation bill as soon as the end of July.

Republicans are aggressively pushing back on these efforts: Senate Minority Leader Mitch McConnell has threatened to pull support on a bipartisan bill aimed at investing in the US’s supply chain unless Democrats abandon reconciliation. Democrats have responded by claiming McConnell is trying to deter the reconciliation bill in order to protect pharmaceutical companies.

To successfully push through a reconciliation bill, however, Senate Democrats need all 50 members of their caucus on board with the legislation, as well as approval from the parliamentarian — who can advise against including provisions if they aren’t seen as sufficiently related to taxing and spending. House Democrats, many of whom have pushed for a more ambitious bill in the past, would need to vote in favor as well. Recent comments from House Speaker Nancy Pelosi suggest that some lawmakers would be open to a smaller bill if it meant getting part of the package done.

For now, the submission of the prescription drugs proposal indicates that Democrats are at least trying to pass a bill, even if there’s no guarantee that other, more expansive provisions will be included.

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