WASHINGTON -- Democrats reached agreement Tuesday on a plan to lower prescription drug costs for older people, capping out-of-pocket Medicare costs at $2,000 and reducing the price of insulin, salvaging a campaign promise as part of President Joe Biden's $1.75 trillion domestic policy proposal.
Negotiators also closed in on an agreement to reinstate a federal tax deduction, eliminated in the 2017 tax cuts, for state and local taxes as the party moves closer to wrapping up negotiations.
House Speaker Nancy Pelosi, D-Calif., said she hoped to move to a vote as soon as Thursday, according to her remarks at a closed caucus meeting.
The package would provide large numbers of Americans with assistance to pay for health care, education, raising children and caring for elderly people in their homes. It also would provide some $555 billion in tax breaks encouraging cleaner energy and electrified vehicles, the nation's largest commitment to tackling climate change.
The prescription drug deal is limited. Starting in 2023, negotiations could begin on what Sen. Ron Wyden, D-Ore., called the most expensive drugs -- treatments for cancer and rheumatoid arthritis, as well as anticoagulants. Most drugs would still be granted patent exclusivity for nine years before negotiations could start, and more advanced drugs, called biologics, would be protected for 12 years.
But for the first time, Medicare would be able to step in after those periods, even if drug companies secured patent extensions or otherwise gamed the patent system.
"Fixing prescription drug pricing has consistently been a top issue for Americans year after year, including the vast majority of both Democrats and Republicans who want to see a change because they simply cannot afford their medications," said Sen. Charles Schumer, D-N.Y., the majority leader. "Today, we've taken a massive step forward in helping alleviate that problem."
Schumer acknowledged that the deal is not as sweeping as most Democrats had hoped for, but is a compromise struck with a key party holdout, Sen. Kyrsten Sinema of Arizona.
Biden sounded upbeat about winning overall backing from another holdout, Democratic Sen. Joe Manchin of West Virginia, who threw the president's plan in flux this week by refusing to endorse it.
Ultimately, "He will vote for this," Biden said of Manchin in remarks at the global climate summit in Scotland. "I believe that Joe will be there."
Biden said without divulging their private conversations that the senator was looking for the fine print of the legislation. "But I think we'll get there," he said.
Manchin has raised questions and concerns about the president's plans on social services and climate change. He said Monday that he remained undecided on the proposal.
The coal-state senator holds a key vote in the Senate, where Biden has the slimmest of majorities, and has successively killed off key parts of the administration's climate proposals. He said Monday that he was uncertain about the legislation's impact on the economy and federal debt, and was as "open to voting against" it as for it.
"It's going to be a while," Manchin said in brief comments Tuesday.
Biden insisted that no world leaders at the climate summit were pressing him on the fate of the legislation.
RUSH TO FINISH
Democrats are rushing to overcome the party battles and finish a final draft of Biden's plan. Congress is scheduled to leave for a Veterans Day recess at the end of the week.
"I think we're going to pass both bills -- hopefully this week if we get the differences that are still outstanding resolved," said Majority Leader Steny Hoyer, D-Md., referring as well to the bipartisan $1 trillion public works bill, which has been withheld as leverage as negotiations continue on the bigger package.
Some moderate Democrats said they want to see a final assessment from the Congressional Budget Office, which will offer a nonpartisan review of the larger bill's cost, before taking a vote.
Much of the cost is to be covered with higher taxes on people earning more than $10 million a year and on large corporations, which would face a 15% minimum tax in efforts to stop big business from claiming so many deductions that they end up paying zero in taxes.
Fingers have been pointing all around as negotiations have dragged on, with Democrats unable to pass the bill. Progressive and centrist lawmakers, particularly Manchin and Sinema, have fought over details of the 1,600-page package.
Manchin's outlook has angered some lawmakers who have tired of his protests, inciting criticism over the power of a single senator to hold up the party's signature domestic priority.
"I think what most people think: The situation is like, 'OK, we elected Democrats to have the majority in the House, the Senate and the presidency. They should be getting things done,'" Democratic Rep. Elaine Luria, who represents a swing district in Virginia, told reporters.
Rep. Pramila Jayapal, D-Wash., the leader of the progressive caucus said, "I don't know what Sen. Manchin is thinking, but we are going to pass both bills through the House and we are going to deliver transformative change to the people."
RX DRUG DEAL
Democrats shored up at least one unsettled provision -- the prescription drug deal that had been scrapped from Biden's framework in a blow to Democrats' yearslong effort to reduce pharmaceutical costs by allowing Medicare to negotiate for lower prices.
"It's not everything we all want. Many of us would have wanted to go much further, but it's a big step in helping the American people deal with the price of drugs," Schumer said.
Schumer said that for the first time Medicare will be able to negotiate prescription drug prices in its Part B and Part D programs. "There will be an annual cap on out-of-pocket costs, a new monthly cap on the price of insulin, and an 'inflation' rebate policy to protect consumers from egregious annual increases in prices," he said.
Democrats later said insulin prices would fall from as high as $600 a dose to $35. The penalties on drug manufacturers for raising prices beyond the inflation rate would be retroactive to Oct. 1.
Sinema's office issued a statement saying the senator "welcomes a new agreement on a historic, transformative Medicare drug negotiation plan that will reduce out-of-pocket costs for seniors."
AARP, the powerful organization for older Americans, signaled support as it waits for details. CEO Jo Ann Jenkins said in a statement that there was "no greater issue affecting the pocketbooks of seniors on Medicare than the ever-increasing costs of prescription drugs."
The compromise was hard-fought and required Democrats to overcome an onslaught of lobbying by the powerful pharmaceutical industry, which succeeded in substantially watering down an initial bid to allow the government to negotiate prices on a far broader universe of drugs.
In another concession to the industry, the inflation rebates lost a "look back" provision that would have assessed rebates on drug prices that began soaring as far back as 2012. That would have yielded one-time levies on drug companies in the billions of dollars. And some Democrats wanted Medicare to have price negotiating authority immediately, with no patent exclusivity periods.
Still, boosters of the compromise believe the negotiating powers it grants Medicare will be a first step toward the broader powers that Democrats have been campaigning on for decades. And, they said, the rules curtailing ever-extending patent protections will be key to lowering costs.
"The problem of evergreening patents so that tiny changes permit these companies to maintain monopolies for years and years and years is wrong," said Sen. Elizabeth Warren, D-Mass. "It violates the basic principle of granting these exclusivity licenses through patents and has been abused by many of the big drug companies and needs to come to a halt."
Information for this article was contributed by Lisa Mascaro, Farnoush Amiri, Kevin Freking, Alan Fram, Josh Boak, Ellen Knickmeyer, Zeke Miller and Matthew Daly of The Associated Press; and by Jonathan Weisman and Emily Cochrane of The New York Times.