Multiple Democratic sources have described the prescription drug pricing bill H.R. 3 to The Uprising as House Speaker Nancy Pelosi’s “baby” and “pet project.” The Hill has dubbed it Pelosi’s “signature” legislation. But the bill has met opposition from Pelosi’s fellow Democrats who have suggested it is not “bipartisan” and lacks needed support in the Senate and “ from a majority of Americans and stakeholders in the public and private sectors.”

One of those H.R. 3 opponents, Rep. Jake Auchincloss (D-MA) sat down with The Uprising last week. We talked about his issues with the bill, his own proposal to lower drug prices, the difficulty of pursuing compromise on Capitol Hill in the wake of the January 6 attack, and internal disputes within the Democratic Party. 

Auchincloss, a freshman who was elected last year, helped lead a letter that was sent to Pelosi earlier this month from ten Democrats who raised concerns about whether the bill has sufficient support. Due to the slim Democratic majority in the House, that was widely seen as a signal to the speaker that she might not have enough support within the caucus to pass H.R. 3. When asked if the letter was meant as a warning to the speaker, Auchincloss instead described it as a push for a “truly progressive plan.”

“I think that Democrats are going to pass drug pricing legislation. We’ve campaigned on that and our constituents deserve that,” Auchincloss said. “What I’m trying to do in concert with some of my colleagues is pass truly progressive drug pricing legislation.”

Pelosi’s office did not respond to a request for comment. The bill backed by the speaker would allow the secretary of Health and Human Services to negotiate lower prices for certain drugs and it would place a cap on these prices based on those paid in other countries. Progressives, including Rep. Pramila Jayapal (D-WA) and Sen. Bernie Sanders (I-VT) have backed this approach, which is vehemently opposed by the pharmaceutical industry. 

Against this backdrop, Auchincloss and the other Democrats who signed on to the letter have been described as “moderates.” He disputes this characterization of the debate.

“I want to unpack progressive drug pricing legislation, because I think the narrative right now is that H.R. 3 is the progressive version of drug pricing. My argument is, let’s zoom out and let’s think about … when we talk about drug pricing what do we want to accomplish,” he explained. 

For Auchincloss, the main goals of prescription drug pricing legislation should be to “rein in bad actors in the pharmaceutical industry,’ “encourage drug development to cure diseases like cancer and Alzheimers,” “to lower out of pocket costs,” and creating jobs.  

“Those are the four legs, to me, of the stool for drug pricing legislation,” Auchincloss said. “The essence of progressive drug pricing, to me, is making progress on those four dimensions and my concern with H.R. 3 is, it doesn’t.” 

Auchincloss argues the legislation doesn’t actually lower costs outside of a limited group of Medicare beneficiaries. But his main concern is the international price controls, which he believes discourage drug development and would “destroy tens of thousands of jobs in my state and up to a million nationally.”

“Price controls … because of the uncertainty they create, are a massive deterrent to risk capital that invests in the next generation of drugs,” he said. “We are going to significantly delay innovation in Alzheimers and cancer treatments, for example, by spooking risk capital.”

Auchincloss said that, when it comes to research and development, he wants to “untangle the R and the D.” His vision for this involves “doubling the [National Institute of Health] budget” to increase funding for “academic medical institutions” where much drug research takes place. 

“Let’s boost public sector funding for the R and then let’s ensure that we maintain the incentives for risk capital to fund the drug development,” Auchincloss explained. 

In his mind, the main issue with Pelosi’s legislation is the “international reference pricing,” which Auchincloss believes creates “uncertainty” for investors.

“Investors cannot make investments with uncertainty in 15 years time about what their ability to capture value will be,” Auchincloss said, adding: “I mean, they’d have to worry, like, what the French foreign minister thinks the value of this drug should be 15 years from now. ... Who wants to invest capital on that premise?”

With his concern for investors and efforts to block a bill that is backed by some in the left wing of the Democratic Party and opposed by the pharmaceutical industry, it’s easy to see why Auchincloss has been labeled a moderate. Yet Auchincloss is adamant that’s not his approach. 

“I just reject that label because I am a liberal Democrat who is … pushing for the most progressive drug pricing portfolio of ideas that is on the table right now,” he said.

Auchincloss provided The Uprising with a copy of a proposal outlining elements of a prescription pricing bill that he believes is more likely to have the support needed to pass. It includes making a federal/state purchasing pool that could act as a Pharmacy Benefit Manager. It also has measures to curb patent abuse and a requirement that copays be tied to net price. Auchincloss suggested this proposal would do more to lower out of pocket costs for consumers without disincentivizing pharmaceutical investment.

“We’re talking about a bill that’s called ... ‘Lower Prescription Drug Prices Now,’ we better lower prescription drug prices now,” Auchincloss said. “By going after out of pocket costs rather than drug prices, it brings insurers and the pbms to the table.”

In contrast, Auchincloss said the current approach is focused on making drug makers negotiate without involving insurers.  

“This legislation is progressive because it makes me more progress on lowering out of pocket costs, on developing cures, and on creating jobs,” he added. 

Auchincloss is used to Democratic infighting over how to define progressivism. During his congressional campaign last year, Auchincloss was criticized by progressives for not supporting Medicare-For-All legislation. The fact he was a registered Republican for a few months in 2013 and 2014 while working on behalf of Massachusetts’ current GOP governor, Charlie Baker, also made headlines. Auchincloss has defended that move by pointing to the fact Baker faced a far more conservative primary challenger. And he argues against Medicare-For-All by saying the best way to provide “choice and quality affordable care is to have both a public option and private options.”

Ultimately, Auchincloss defines himself “as a liberal Democrat who believes in economic growth.”

“I think the progressive case for Jake is that I'm trying to always discern the best way for us to make progress. The best way for us to make … progress, I think, for Americans ... is to have the opportunity to live their fullest life, to manifest their biggest ambitions. And the way that you do that is with a growing economy that’s creating lots of good jobs and with a lot of choices for them.”

He describes the bill backed by Pelosi as “the beginning of an important conversation.” 

“This letter was the next step of that conversation,” said Auchincloss. “Legislation that I'm working on and that others in the caucus are working on is the next step in that conversation.”

Even if Democrats can agree on a prescription drug pricing proposal, it would need to pass the Senate where they have just a single member majority. Auchincloss is among the Democrats who have called for the abolition of the filibuster, which prevents some legislation from passing the Senate with less than 60 votes. However, under the current system, it is hard to imagine prescription drug pricing legislation passing without some Republican backers. Auchincloss believes his proposal could be more palatable to the other side of the aisle. 

“Real drug reform is unlikely to fit under reconciliation,” Auchincloss said. “It’s going to need Republican support. That’s not a political statement it’s kind of an arithmetic statement.” 

But bipartisan compromise has become more complex in the wake of the January 6 attack when supporters of former President Trump stormed the Capitol as President Biden’s election victory was certified. Auchincloss and other Democrats have refused to lead legislation with Republicans who declined to certify Biden’s win. That divide has already torpedoed some bipartisan drug reform proposals. Nevertheless, Auchincloss believes there is room for a compromise on drug pricing. 

“I'm not willing to co-lead legislation with Republicans who don't recognize that Joe Biden is the legitimate winner of a free and fair election. ...I can't represent my district values without adhering to that,” Auchincloss said. “But I also can't represent my district’s priorities, without working with the Republicans who do register Joe Biden as legitimate winner. And so, I do see a path there.” 

“Is it hard? Yes,” he added. “But that's what we're sent to Congress to do is to find agreement with people, with whom we disagree.” 

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