What to Know in Washington: Drug Prices Jump as Solution Evades Lawmakers

As lawmakers across Capitol Hill this week debated ways to tackle the rising costs of prescription drugs, a report out this morning from Bloomberg Law highlights just how stark the problem is.

The cost for 22 drugs shot up more than 500 percent per dose from 2013 through 2017, according to an analysis of Medicare Part D data released by the Centers for Medicare & Medicaid Services.

The median increase among drugs offered through Medicare’s primary prescription plan was 28 percent from 2013 to 2017, but some medications went up in price more than others. The median is the midpoint of the spending-change distribution, meaning that the same number of drugs changed in price more and less than 28 percent.

“Those very high prices on individual drugs can be barriers to any beneficiary using them at all,” said Stacie Dusetzina, a drug pricing researcher and professor at Vanderbilt University Medical Center. “Right now a lot of people end up being in a situation where they can’t even afford their out-of-pocket costs to use those drugs.”

Bloomberg Law analyzed 2,174 out of the 2,879 drugs with reported weighted averages for per-dosage spending in both 2013 and 2017. Overall, Medicare spent about $154.8 billion on 42.7 million Americans with Part D coverage in 2017. The CMS in March reported an average annual spending increase of 10.6 percent from 2013 through 2017.

Congress wants to address high drug prices, especially in the federal health programs, but there is little agreement on how to get there. House Democrats say Medicare should be able to negotiate with drugmakers on what it pays for drugs, allowing the largest single purchaser of medicine in the U.S. to try to get better prices. But most Republicans reject that idea. Madi Alexander, Alex Ruoff and Jacquie Lee have the full story.

Bloomberg

Immigration Purge Draws GOP Backlash

Donald Trump’s purge of U.S. immigration agencies is drawing backlash from Republicans on Capitol Hill while exposing an ideological divide within the president’s party and even inside the White House.

Hard-line aides to Trump, led by senior adviser Stephen Miller, believe that the elevation of Kevin McAleenan, who takes control of the Department of Homeland Security today, portends a soup-to-nuts overhaul of the administration’s immigration personnel and policy. They expect swift action to reduce illegal crossings of the border with Mexico, including new regulations to make it harder for migrants to claim asylum or work in the U.S. while their cases are adjudicated.

But Senate Republicans are alarmed by the bloodletting within Homeland Security as well as the absence of any clear strategy to regain control of the border. Immigration is the president’s signature issue, and he has already declared it will be central in his re-election campaign next year. The personnel and policy turmoil muddies his case.

Sen. Ron Johnson (R-Wis.), who chairs the Homeland Security Committee, said he was gathering signatures on a letter warning Trump not to remove the department’s general counsel, John Mitnick. Sen. Chuck Grassley (R-Iowa), who chairs the Finance Committee and is one of the longest-tenured members of the Senate, called on the White House to prevent the removal of two former aides believed to be in Miller’s sights.

“I said two years ago – more than two years ago, when the administration first came in, if you want to work in the Trump administration, know your blood type because this is a very dangerous place to be,” Speaker Nancy Pelosi (D-Calif.) said at a news conference yesterday. “You’ll be thrown under the bus sooner or later.” She added that the situation at the border is a “downward spiral of indecency.” Read more from Justin Sink.

Vitiello Resigns: The acting director of U.S. Immigration and Customs Enforcement also quit yesterday. The announcement came after Trump told reporters last week that he was pulling his nomination of acting ICE chief Ronald Vitiello for the director’s job, saying he wanted to go in a “different direction” with someone “tougher.” Vitiello, who served for more than 30 years with Customs and Border protection before joining ICE, “has protected our homeland with courage and conviction,” said outgoing Homeland Secreta ry Kirstjen Nielsen in a statement. Read more from Justin Blum.

Thompson Wants McAleenan to Testify: House Homeland Security Chairman Bennie Thompson (D-Miss.) asked Acting Secretary McAleenan to honor a commitment by Nielsen to testify before the panel May 1. Thompson in a letter also asked McAleenan to produce documents outstanding from a January request related to DHS border activities, “including separation of families at the border and construction of border wall.” Read more from Ben Livesey.

Asylum Claims Bill: Meanwhile, Johnson, citing a surge of undocumented migrants crossing into the U.S. from Mexico, said he’s readying legislation, perhaps by the first week of May, to decide asylum claims more quickly. “The realities have become so stark,” he told reporters yesterday. Read more from Michaela Ross.

Happening on the Hill

Mnuchin Misses Trump Tax Return Deadline: Treasury Secretary Steven Mnuchin declined to meet congressional Democrats’ deadline of yesterday to provide Trump’s tax returns, asking for more time to study the legality of their request. Trump has refused to release his returns since he ran for president, and the clash over their release became a key front in the battles between his administration and newly-empowered Democrats in the House. The simmering political conflict may well end up in the federal courts and spill over into the 2020 election.

“The department respects congressional oversight, and we intend to review your request carefully,” Mnuchin wrote in a letter to Ways and Means Chairman Richard Neal (D-Mass.). Read more from Joe Light and Laura Davison.

Two Trump Picks Add Diversity: Two more of Trump’s judicial selections won Senate confirmation yesterday, adding more diversity to a field of predominantly white males. Holly A. Brady, a partner at Haller & Colvin in Fort Wayne, cleared the chamber 56 to 42 and is headed to the Northern District of Indiana. David Steven Morales, a Hispanic, was confirmed 56 to 41. He’ll be seated at the Southern District of Texas. Also yesterday, three other district court picks sailed through a Senate Judiciary Committee hearing. Read more from Patrick L. Gregory.

GOP Seeks Climate Change Solutions: Sen. John Cornyn (R-Texas), who once voted against a measure that said climate change was man-made, is now helping fellow Republicans craft legislation to combat global warming through “energy innovation.”
“Coming up with lower emissions is a good thing,” Cornyn said in an interview.

He’s not alone. With the exception of Trump, Republicans have largely gone from ignoring or expressing doubt about climate change to acknowledging the scientific consensus in the face of growing public alarm over storms and wildfires and pressure to come up with an alternative to the “Green New Deal.” That’s forced them to craft a policy response that doesn’t alienate supporters in the fossil-fuel industry or contradict their long-standing emphasis on increasing energy production. Read more from Ari Natter.

Child Nutrition Bill Action Sought by August: A key Senate committee chairman said he would like to have a child nutrition program re-authorization bill approved by his panel before the annual August congressional recess. “That would be a very good goal,” Sen. Pat Roberts (R-Kan.), chairman of the Senate Agriculture, Nutrition, and Forestry Committee, told reporters following a committee hearing on the topic.

Child nutrition programs, which include the federal school lunch program and the Special Supplemental Nutrition Program for Women, Infants, and Children, better known as WIC, haven’t been reauthorized in almost 10 years. The House Education and Labor Committee and Senate Agriculture Committee have jurisdiction over the programs. Read more from Teaganne Finn.

Small Business Advocates Seek Relief: A bill that would give small business advocates a bigger say in the outcome of agency rules was introduced yesterday by James Lankford (R-Okla.), who leads the Senate’s key regulatory affairs subcommittee.

“The Small Business Regulatory Relief Act is a solution that closes the loopholes federal agencies use to ignore the economic impact of new regulations on small businesses,” said Lankford, chairman of the Homeland Security and Governmental Affairs Subcommittee on Regulatory Affairs and Federal Management. Read more from Cheryl Bolen

Trump 2020 Challengers Dodge Donors

The money race in the 2020 Democratic presidential primary is so far more Walmart than Tiffany.

The biggest war chests, according to the candidates’ self-reported figures, have largely been amassed in increments of $200 or less, and primarily online. Candidates are making a virtue out of the modest amount of their average donation — as low as $20. They’re also swearing off money from corporate political action committees and deep-pocketed donors who can give the legal limit of $2,800, but whose checks can come with an expectation of access and favors.

Much more will be known after Monday’s Federal Election Commission deadline for first-quarter disclosures of money raised and spent by the presidential candidates. But some even say they’re refusing to attend fundraisers where wealthy hosts and their friends pay large sums to sip wine with presidential hopefuls at glittery events — the opposite of the image Democratic candidates want to project to primary voters.

The low-dollar emphasis could be altering the tone and complexion of the race. Contributors making small donations online tend to be younger and more progressive than those who write bigger checks. By disengaging from establishment donors, the field is freer to shake up the status quo and espouse more radical positions, such as Medicare for all, a carbon-free economy and job guarantees. Read more from Bill Allison and John McCormick.

What Else to Know

Kim’s Warning Raises Stakes for Moon Visit: A fresh warning from Kim Jong Un — coming just as South Korea’s Moon Jae-in arrived in Washington to meet with Trump — placed new urgency on the allies’ efforts to restart nuclear talks. The North Korean leader urged top ruling party members yesterday to deal a “severe blow to hostile foreign forces” by resisting sanctions against the country, according to the official Korean Central News Agency. While the report included no direct threat of action, it underscored Moon’s challenge in finding common ground between Kim’s demands for economic relief and Trump’s insistence on greater disarmament commitments.

Moon hopes a direct appeal at the White House today can keep his efforts to build a lasting peace on the Korean Peninsula from slipping away after Trump walked away from his summit with Kim in Hanoi. Not only would new provocations put Seoul back at risk, Moon has staked much of his presidency on building ties between South Korea’s closest ally and its increasingly well-armed rival. Read more from Youkyung Lee.

Gas Plan Stokes Fears: Trump wants to allow natural gas to be shipped in railroad cars, a move that would open new markets hungry for the fuel but could risk catastrophic accidents if one were to derail. Trump yesterday ordered the Transportation Department to write a new rule permitting super-chilled natural gas to be shipped in specialty tank cars. The order follows a multiyear lobbying campaign by railroads and natural gas advocates, who argue it is needed to serve customers in the U.S. Northeast, where there aren’t enough pipelines, and making it possible to use the gas to power ships and trains.

The effort, which could help offset falling rail shipments of coal, mirrors how the oil industry turned to trains to ship crude when there weren’t enough pipelines to meet demand. But a series of spills and other accidents — including a runaway oil train that derailed and killed more than 40 people in a small Quebec town in 2013 — have safety advocates warning against putting gas on the rails. Read more from Jennifer A. Dlouhy.

Gorsuch Charts Course: Justice Neil Gorsuch has delivered almost precisely what conservatives were hoping for over his two years on the U.S. Supreme Court, even though his principles occasionally take him in other directions. He’s followed the originalist mold of the late Justice Antonin Scalia, even joining the court’s liberals at times on criminal procedure matters as Scalia often did. He’s made Clarence Thomas less of an iconoclast in arguments to overturn longstanding precedents.

But he’s also made his individual marks with bold wording on capital punishment and Native American rights, including his opinion this month that the Eighth Amendment’s protection against cruel and unusual punishment doesn’t “guarantee a prisoner a painless death.” Read more from Patrick L. Gregory and Kimberly Strawbridge Robinson.

Barring Using Grants to Arm Teachers: Education Secretary Betsy DeVos could use her authority to prevent schools from using federal money to buy guns for teachers, a top aide wrote last year in a memo made public yesterday. DeVos, by contrast, has said Congress didn’t authorize her to decide how schools should use their federal grants.

Arming teachers has emerged as a contentious issue as Americans search for ways to prevent mass shootings in the wake of the deaths of 17 and wounding of 17 others at Marjory Stoneman Douglas High School in Parkland, Fla., in February 2018. Read more from Emily Wilkins.

Trump Wants to Talk Job Numbers Faster: The White House is floating an end to a 1980s rule mandating a one-hour waiting period for comments by administration officials on U.S. economic reports, in an era in which Trump tweets about the jobs numbers minutes after their release.

The Office of Management and Budget is seeking comment on whether newer technology allowing instantaneous dissemination of federal economic indicators warrants “a shorter time delay, including no time delay at all,” according to a notice to be published today. Read more from Jeff Kearns.

Iran Divide: A fresh divide is emerging between some Trump administration officials and hard-line opponents of Iran in the Senate over how far to go in the White House’s “maximum pressure” campaign against the Islamic Republic. In a letter to Trump this week, a group of Republican senators demanded that Secretary of State Michael Pompeo stop letting Iran continue its limited civilian nuclear research program.

At issue are three waivers the Trump administration granted after it withdrew from the 2015 nuclear deal last year. They allow Iran to work with nations that remain in the deal at three sites — Fordow, Bushehr and Arak — to ensure it doesn’t seek to enrich uranium to high levels. It’s part of an effort to limit the risk of nuclear weapons proliferation. Read more from Nick Wadhams.

Ex-White House Lawyer Expects Indictment: Gregory Craig, a prominent corporate lawyer and former adviser to Democratic presidents, expects to face criminal charges arising from his work for the former pro-Russian government of Ukraine, his attorneys said in a statement last night. The attorneys for Craig, who served as White House counsel for President Barack Obama and as a lawyer for Bill Clinton, also blasted the expected indictment as “a misguided abuse of prosecutorial discretion.” Read more from Andrew Harris and Greg Farrell.

Trump Lawyer’s Alleged Scheme: New York attorney Alan Futerfas helped a client who was convicted in a pump-and-dump scheme 16 years ago hide more than $1 million from the federal government, which was supposed to be paid as part of a $25 million fine, U.S. prosecutors said. Futerfas was cited for improper conduct by the U.S. Attorney in Brooklyn, New York, Richard Donoghue. In a letter to a judge yesterday, Donoghue said Futerfas assisted a client named Myron Gushlak “in diverting” money he’d been ordered to pay. Futerfas, a veteran criminal defense lawyer, has gained attention for other, higher-profile clients in recent years — Donald Trump Jr.and the Trump Organization. Read more from Patricia Hurtado and David Voreacos.

Assange Arrested: Julian Assange was arrested by London police today after Ecuador withdrew diplomatic asylum from the Australian who had been linked to leaks of U.S. government secrets. London police said Assange was arrested moments after Ecuadorian President Lenin Moreno said on Twitter that the country had withdrawn his diplomatic asylum.

The 47-year-old has been in the Ecuadorian embassy since 2012 when he sought to escape questioning in a Swedish sexual-assault case. While those charges were dropped in 2017, Assange has remained in the small London apartment as he has continued to dodge U.K. police and American prosecutors. Read more from Anthony Aarons.

With assistance from Brandon Lee

To contact the reporter on this story: Zachary Sherwood in Washington at zsherwood@bgov.com

To contact the editors responsible for this story: Loren Duggan at lduggan@bgov.com; Giuseppe Macri at gmacri@bgov.com

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