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Trump called on Congress to pass a drug prices bill. Democrats reminded him they already did.

The impromptu Democratic protest at Trump’s State of the Union, briefly explained.

House Democrats hold up three fingers in support of their drug prices bill at President Trump’s State of the Union speech.
Toni L. Sandys/The Washington Post via Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

President Trump largely glossed over health care in his State of the Union speech, but he did try to put one item on Congress’s to-do list: He promised if the body passed a bipartisan bill to reduce prescription drug costs, “I will sign it into law immediately.”

It was a statement that didn’t sit too well with some House Democrats, who passed comprehensive legislation to cut drug prices just a few weeks ago. So a few of them stood up, held three fingers in the air, and shouted “H-R-3” (the number of their bill) — interrupting Trump for a few awkward moments in the middle of his speech.

Democrats and Republicans actually do agree on the need to reduce drug costs. But not on how to do it. So despite Trump’s overtures, and the forceful Democratic response, it’s going to be hard for anything to get done.

There’s two approaches to drug pricing reform — and both are stalled

The House bill — H.R.3 — has a few mechanisms for reducing prescription drug prices, but most notably, it would allow the US health department to directly negotiate the prices it will pay for up to 250 drugs every year. The Congressional Budget Office (CBO) has estimated the bill would save Medicare up to $450 billion over 10 years because of those new negotiating powers. CBO has also projected about eight fewer drugs (out of an expected 300 over 10 years) would come to the market in the next decade because of the decrease in revenues for drug makers.

Despite Trump’s promises on the 2016 campaign trail that he would support proposals allowing Medicare drug negotiations, the White House threatened to veto the House plan. They called it a plan to institute government “price controls,” and said it would limit access to medicine, a favored talking point of the pharmaceutical lobby.

Even without this veto threat, H.R.3 is expected to be dead-on-arrival in the Senate. Senate Majority Leader Mitch McConnell has shown no interest in taking up the bill. It did, however, garner some small measure of bipartisan support — although Trump has thrown the weight of the White House against the bill, it did receive two House Republican votes in December.

Instead, Trump has aligned himself more with Republican Sen. Chuck Grassley, who has advanced a narrower set of reforms from his perch as the Senate Finance Committee chair. (Grassley has also accused McConnell of sabotaging his bill, which moved out of Grassley’s committee with bipartisan support.)

His committee sent a bill to the full Senate in the fall, though it has languished there in the months since. It’s unclear if Trump’s quasi-endorsement — he did not call out Grassley’s bill directly Tuesday night, instead praising the senator generally for his individual work on the issue — will provide any new momentum for the plan. Grassley’s bill, as the Brookings Institution documented, achieves pricing reform through a mix of technical changes to the rebates that drug makers pay under Medicare and Medicaid as well as provisions to cap out-of-pocket drug costs for seniors.

Right now, neither of the bills seems on a fast track to anywhere. Part of this is because Trump’s interest in drug pricing has been scattershot at best, and many Republicans are reluctant to place too many new regulations on an innovation industry.

But, the president clearly knows health care is a vulnerability for him, which is why he devoted a few minutes to the topic at his State of the Union. Recent polling by the Kaiser Family Foundation showed just 30 percent of Americans approved of his work on the issue. But with his administration firmly against the House Democratic bill, and no sign of movement in the Republican Senate, Trump’s rhetoric on Tuesday might end up being empty.

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