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Parliamentarian weakens Democrats’ drug plan in Inflation Reduction Act, as Senate prepares to vote

The Senate parliamentarian on Saturday dealt a blow to Democrats’ plan for curbing drug prices but left the rest of their sprawling economic bill largely intact as party leaders prepared for the first votes on a package containing many of President Joe Biden’s top domestic goals.

Elizabeth MacDonough, the chamber’s nonpartisan rules arbitrator, said lawmakers must remove language imposing hefty penalties on drugmakers that increase their prices beyond inflation in the private insurance market. Those were the bill’s chief pricing protections for the roughly 180 million people whose health coverage comes from private insurance, either through work or bought on their own.

Other major provisions were left intact, including giving Medicare the power to negotiate what it pays for pharmaceuticals for its 64 million elderly recipients, a longtime goal for Democrats. Penalties on manufacturers for exceeding inflation would apply to drugs sold to Medicare, and there is a $2,000 annual out-of-pocket cap on drug costs and free vaccines for Medicare beneficiaries.

Her rulings came as Democrats planned to begin Senate votes Saturday on their wide-ranging package addressing climate change, energy, health care costs, taxes and even deficit reduction. Party leaders have said they believe they have the unity they will need to move the legislation through the 50-50 Senate, with Vice President Kamala Harris expected to cast votes to break ties, since all of the Republicans are expected to oppose the bill.

“This is a major win for the American people,” Senate Majority Leader Chuck Schumer, DN.Y., said of the bill, which both parties are using in their election-year campaigns to assign blame for the worst period of inflation in four decades.

“At a time of seemingly impenetrable gridlock, the inflation reduction act will show the American people that when the moment demands it, Congress is still capable of taking big steps to solve big challenges,” Schumer said. “We will show the American people that, yes, we are capable of passing a historic climate package and rein in drug companies and make our tax code fairer.”

In response, Senate Minority Leader Mitch McConnell, R-Ky., said Democrats “are misreading the American people’s outrage as a mandate for yet another reckless taxing and spending spree.” He said Democrats “have already robbed American families once through inflation and now their solution is to rob American families yet a second time.”

Dropping penalties on drugmakers reduces incentives on pharmaceutical companies to restrain what they charge, increasing costs for patients.

Erasing that language will cut the $288 billion in 10-year savings that the Democrats’ overall drug curbs were estimated to generate — a reduction of perhaps tens of billions of dollars, analysts have said.

Schumer said MacDonough’s decision about the price cap for private insurance was “one unfortunate ruling.” But he said the surviving drug pricing language represented “a major victory for the American people” and that the overall bill “remains largely intact.”

The ruling followed a 10-day period that saw Democrats resurrect top components of Biden’s agenda that had seemed dead. In rapid-fire deals with Democrats’ two most unpredictable senators — first conservative Joe Manchin of West Virginia, then Arizona centrist Kyrsten Sinema — Schumer pieced together a broad package that, while a fraction of earlier, larger versions that Manchin derailed, would give the party an achievement against the backdrop of this fall’s congressional elections.

The parliamentarian also signed off on a fee on excess emissions of methane, a powerful greenhouse gas contributor, from oil and gas drilling. She also let stand environmental grants to minority communities and other initiatives for reducing carbon emissions, said Senate Environment and Public Works Committee Chairman Thomas Carper, D-Del.

She approved a provision requiring union-scale wages to be paid if energy efficiency projects are to qualify for tax credits, and another that would limit electric vehicle tax credits to those cars and trucks assembled in the United States.

The overall measure faces unanimous Republican opposition. But assuming Democrats fight off a nonstop “vote-a-rama” of amendments — many designed by Republicans to derail the measure — they should be able to muscle the measure through the Senate.

The House is returning Friday to vote on the bill.

“What will vote-a-rama be like. It will be like hell,” Sen. Lindsey Graham of South Carolina, the top Republican on the Senate Budget Committee, said Friday of the approaching GOP amendments. He said that in supporting the Democratic bill, Manchin and Sinema “are empowering legislation that will make the average person’s life more difficult” by forcing up energy costs with tax increases and making it harder for companies to hire workers.

The bill offers spending and tax incentives for moving toward cleaner fuels and supporting coal with assistance for reducing carbon emissions. Expiring subsidies that help millions of people afford private insurance premiums would be extended for three years, and there is $4 billion to help Western states combat drought.

There would be a new 15% minimum tax on some corporations that earn over $1 billion annually but pay far less than the current 21% corporate tax. There would also be a 1% tax on companies that buy back their own stock, swapped in after Sinema refused to support higher taxes on private equity firm executives and hedge fund managers. The IRS budget would be pumped up to strengthen its tax collections.

While the bill’s final costs are still being determined, it overall would spend more than $300 billion over 10 years to slow climate change, which analysts say would be the country’s largest investment in that effort, and billions more on health care. It would raise more than $700 billion in taxes and from government drug cost savings, leaving about $300 billion for deficit reduction — a modest bite out of projected 10-year shortfalls of many trillions of dollars.

Democrats are using special procedures that would let them pass the measure without having to reach the 60-vote majority that legislation often needs in the Senate.

It is the parliamentarian’s job to decide whether parts of legislation must be dropped for violating those rules, which include a requirement that provisions be chiefly aimed at affecting the federal budget, not imposing new policy.

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These 11 GOP senators voted against the Honoring Our Pact Act

The US Senate passed the Honoring Our PACT Act on Tuesday night in an 86-11 vote, expanding health care for 3.5 million of America’s veterans who were exposed to toxic burn pits in the post 9/11-era.

The legislation also covers health benefits for other veterans exposed to chemicals, such as Agent Orange during the Vietnam War, during their military service.

The measure was sent to the White House after Republicans had blocked the legislation last week, objecting to the inclusion of $400 billion in mandatory spending that would not be subject to annual appropriations review — unlike the usual discretionary spending for federal agencies and programs that Congress reviews and approves annually.

Republicans argue that under the PACT Act, Democrats could theoretically spend $40 billion annually over 10 years on other needs unrelated to veteran care because the $400 billion authorization over a decade is considered mandatory.

But supporters of the bill noted that Republicans had previously supported the measure’s mandatory spending. Democrats argued the GOP was shifting its position because it was unhappy with a separate deal worked out by Sens. Charles Schumer (DN.Y.) and Joe Manchin (DW.Va.) on climate change, health care and taxes.

The GOP came under tremendous pressure to shift from veterans who were camped out on the US Capitol steps. Those veterans had a high-profile ally in Jon Stewart, the former “Daily Show” host.

Before the vote on final passage, the Senate agreed to three cost-controlling amendments on the bill, which led a number of Republicans to back it.

But these 11 GOP senators still voted against the package on final passage. The Hill has reached out to all 11.

Sen. Pat Toomey (Pa.)

Toomey led the opposition effort to the bill last week when he complained about the mandatory spending, which he called a “budgetary gimmick” on the Senate floor.

“My concern about this bill has nothing to do with the purpose of the bill,” Toomey said. “This budgetary gimmick is so unrelated to the actual veterans issue that you have to do with burn pits, that it’s not even in the House version of this bill.”

Sen. Rand Paul (Ky.)

Shortly before the Senate voted Tuesday, Paul railed against the bill and said it would put the economy at risk.

“This bill would cost hundreds of billions of dollars at a time when the national debt is climbing over $30 trillion and inflation is at a 40-year high,” Paul said on the Senate floor.

Sen. Mike CrapoIdaho

Crapo told The Hill he has co-sponsored four other bills in the Senate that would address veterans exposed to toxic burn pits and related injuries.

In a statement, the senator said he is “committed to ensuring health and disability benefits are provided to veterans exposed to toxic substances while on their tours of duty.”

He ultimately did not support the PACT Act because he said it authorized a “slush fund” in mandatory spending.

“I have a strong record of supporting veterans to ensure they have access to high-quality health care, opportunities to thrive following their transition from the military and protecting their Second Amendment rights,” Crapo said.

“I, too, remain committed to Idaho veterans impacted by burn pits and toxic exposure and will continue to support bipartisan legislation that can withstand necessary fiscal standards to ensure solvency and endurance, not additional slush fund spending placed on the American people,” he added .

Sen. Thom Tillis (NC)

Tillis told the Raleigh News Observer he had doubts about the ability of the Department of Veterans Affairs (VA) to deal with backlogs and wait times for veterans seeking care.

“Congress has an obligation to ensure the VA can effectively and efficiently implement any comprehensive toxic exposure legislation and, unfortunately, I continue to have reservations about the Department’s ability to do so,” he told the news outlet.

The PACT Act will aid veterans who were exposed to toxic chemicals at North Carolina military bases Camp Lejeune and Marine Corps Air Station New River.

Sen. James Lankford (Okla.)

In a Facebook live video Tuesday night, Lankford said the legislation “limits access to outside physicians,” creating roadblocks for veterans who wish to seek care at places other than the VA.

“Many want to go to a family physician or one that’s closer to them,” Lankford said. “With many areas in rural Oklahoma, the people have to drive a very long way to be able to get to a VA hospital and I am very passionate about them getting to one that’s close to them.”

And like Tillis, the senator raised additional concerns with wait times, suggesting the bill increases waiting periods at the VA and does not resolve lengthy backlogs for veterans seeking care.

Sen. Mike Lee (Utah)

The Hill has requested comment from Lee’s office.

Sen. Cynthia Lummis (Wyo.)

On Tuesday night, Lummis said 168,000 vets were currently waiting for VA services, which she called “unacceptable.”

“If we pass the PACT Act, as is, that number jumps to over a million,” she tweeted, offering another bill from her colleague, Sen. Marsha Blackburn (R-Tenn.), which would allow veterans to seek care at facilities in their communities.

Sen. James Risch (Idaho)

A spokesperson for Risch’s office said the senator was a strong supporter of veterans but did not support the $400 billion in mandatory spending.

“Unfortunately, Democrats wrote in a $400 billion hole in the discretionary budget they can fill with spending totally unrelated to veterans,” the spokesperson said. “It is inappropriate to use a bill for veterans as a backdoor to usher in huge sums of unrelated spending.”

sen. Mitt Romney (Utah)

Romney’s office pointed to remarks the senator made in June about the legislation, when he raised concerns about adding “hundreds of billions of dollars to the national debt” and with implementing a “dramatic expansion of qualifying conditions that aren’t necessarily service-connected disabilities .”

“We should absolutely help veterans who have contracted illnesses as a direct result of toxic exposure during their service. However, the scope and cost of this bill is astronomical and unjustified,” he said, according to the remarks forwarded to The Hill.

“We have a collective responsibility to the veterans who have served our country, and I would support legislation that better targets disability eligibility requirements based on scientific evidence and research,” the senator added.

Sen. Richard Shelby (Ala.)

Shelby tweeted Tuesday night that he “remained a strong advocate for our veterans” but could not support the $400 billion mandatory spending provision.

“The PACT Act would reclassify nearly $400 billion in VA funding, allowing Dems to instead spend that on their liberal wish list,” he wrote. “I want to support the PACT Act, but this budget gimmick must be fixed.”

sen. Tommy Tuberville (Ala.)

in to Twitter thread on Tuesday night, Tuberville said he was concerned about the “many provisions in the bill that require amending to ensure the VA can deliver on this law.”

“I want to know that the VA can implement this comprehensive bill in a fair and effective way, and right now, I am not confident that that is the case,” the senator wrote.

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