POLITICS

Will GOP follow Trump on drug haggling?

Jason Stein
Milwaukee Journal Sentinel

President Donald Trump is proposing new directions for his party on health care, but Wisconsin Republicans aren't racing to back them all.

For years, GOP members of Congress have balked at Democratic proposals to allow Medicare to negotiate with pharmaceutical companies over which drugs for seniors will be covered and how much they will cost.

But with Trump now floating the same solution to the problem of paying for the drugs, Republicans like U.S. Sen. Ron Johnson of Wisconsin are remaining cautious and waiting for more details.

"The senator awaits the specifics of the ... plans and will comment after he has time to consider that information," said Johnson aide Patrick McIlheran.

As Trump takes office, he hasn't held back from offering more of his campaign-style promises and unorthodox positions. The president raised Republican eyebrows a week ago when he told the Washington Post he would provide "insurance for everybody" and force pharmaceutical makers to lower Medicare prescription drug prices for seniors, saying the companies were no longer "politically protected."

In an interview Monday with WKOW-TV in Madison, Speaker of the House Paul Ryan of Janesville didn't touch on the Medicare drug negotiation but did downplay Trump's promise to cover everyone after the repeal of the Affordable Care Act, saying congressional Republicans are more focused on ensuring that all Americans have access to coverage.

"The uninsured rate — that's up to a person whether they want to buy health insurance or not. The government's not going to force you to buy something you don't want and you can't afford," Ryan said.

Republicans' reticence to jump behind Trump's grand vision is a signal of the ideological differences that the president and congressional leaders like Ryan will need to overcome as they pursue shared goals like repealing big parts of Obamacare and remaking the nation's health care sector.

For their part, Democrats haven't hesitated to grab hold of Trump's trial balloon on Medicare. That's not surprising, given that Democrats have been pushing for allowing negotiation on Medicare drug prices for more than a decade.

Ten days before Trump's comments on Medicare, Sen. Tammy Baldwin of Wisconsin and other Democrats unveiled their own proposal to allow negotiation over drugs in the Medicare Part D program, which covers 41 million seniors.

Baldwin raised the issue again in the Senate confirmation hearing Wednesday for Rep. Tom Price (R-Ga.), Trump's nominee for Health and Human Services secretary. Price repeatedly avoided saying whether he supported the proposed negotiation for drug prices and whether he would press Congress to make that change.

"Was that a yes? Or was that a no?" Baldwin asked, repeating the basic question four times in different ways.

"Well, it depends on that activity," Price said.

Though allowing negotiation over drug prices could save money for taxpayers, it would come with trade-offs.

A study by the Congressional Budget Office in 2004 noted that Medicare would have to be willing to exclude certain drugs from its program or impose other restrictions on coverage to have any leverage in the negotiations, according to a brief by the Kaiser Family Foundation. If drugmakers aren't worried about losing out on Medicare, they wouldn't have an incentive to lower prices.

The private insurers who offer Medicare Part D prescription drug plans can make such restrictions by threatening to exclude a product from their list of approved drugs or put it in a more expensive tier for patients seeking to purchase it.

But if the overall Medicare program took those steps, it could annoy some consumers and create political problems for Congress and the Trump administration.