WASHINGTON — The House, delivering on one of Democrats’ central campaign promises, passed ambitious legislation on Thursday to lower the rising cost of prescription drugs by empowering the federal government to negotiate prices with pharmaceutical manufacturers.
The bill, known as H.R. 3 — a numerical designation that reflects its position on Democrats’ priority list — would make significant changes to the federal Medicare program, which provides health coverage to older Americans. It passed largely on party lines, 230 to 192, and includes provisions to create new vision, dental and hearing benefits, and caps out-of-pocket drug costs for Medicare beneficiaries at $2,000.
Lowering the cost of prescription drugs is a huge priority for voters and politicians of both parties — including President Trump, who has made curbing the cost of prescription drugs a central theme of his 2020 re-election campaign.
Though Mr. Trump has vowed to veto the Democratic bill, its passage could pressure Senator Mitch McConnell of Kentucky, the Republican leader, to take up a bipartisan drug-price measure pending there, or press senators to act on other bills. Pharmaceutical makers strongly oppose both the House bill and the Senate bill, which was drafted in the Finance Committee.
At another moment, House passage might have also jump-started negotiations with the White House, but that is unlikely given that Democrats are on the verge of impeaching the president.
The central — and most contentious — provision of the measure that passed Thursday is its language enabling the Department of Health and Human Services, which administers Medicare, to negotiate the price of up to 250 commonly used drugs, including insulin. It would also require the manufacturers to offer the agreed-on prices to private insurers, giving it huge reach.
And it would require pharmaceutical manufacturers to pay rebates to Medicare if the price of their drugs increased faster than inflation — another provision loathed by drug makers.
The Senate bill, sponsored by Senators Charles E. Grassley, Republican of Iowa, and Ron Wyden, Democrat of Oregon, does not contain those provisions. But like the House bill, it would cap out-of-pocket expenses and require drug companies to pay rebates to Medicare if they raised prices faster than inflation.
House Republicans countered the Democrats’ bill with a more modest measure, which drew support from eight Democrats when it came to a vote on Thursday. That measure, an amalgam of other bills that have drawn bipartisan support, would also cap out-of-pocket expenses and require insurance companies to make information available about drug prices to patients in doctors’ offices before doctors prescribe them. But it excludes the Medicare negotiation provision.
Mr. Trump campaigned in 2016 on allowing the government to negotiate drug prices, but Republicans argued that giving that power to the government would force pharmaceutical companies to eliminate research and development, depriving the public of lifesaving medicines.
“For an issue as crucial as lowering the cost of prescription drugs for Americans, partisanship should be set aside,” Representative Kevin McCarthy of California, the Republican leader, said as he made his party’s closing argument for his bill. He warned that the Democrats’ bill was “opening the door to a government takeover of our prescription drug market.”
Representative Greg Walden, Republican of Oregon, who managed the bill for Republicans on the House floor, cited a Congressional Budget Office estimate showing that the Democrats’ measure would result in 40 fewer drugs over the next two decades.
Democrats say their bill addresses research and development concerns by allocating more than $10 billion to the National Institutes of Health for biomedical research, with the goal of advancing breakthrough cures. The Congressional Budget Office has estimated that the bill would save taxpayers $5 billion over a 10-year period.
Allowing Medicare to negotiate prices has been a long-sought goal of Democrats; because the insurance program buys drugs in bulk, it can effectively set the price for all insurers. It was a matter of intense debate in 2003, when the Republican-led Congress passed the bill creating Medicare Part D, which allows Medicare to pay for the cost of prescription drugs.
Since that time, the rising list prices of brand-name drugs, coupled with insurance plans that have increasingly raised deductibles and asked consumers to pay more out of pocket, have left many Americans facing difficult choices about whether to forgo medicine in favor of other necessities, including food.
That has created pressure on lawmakers to take action. Democrats campaigned aggressively last year on their promise to lower drug prices, which helped them regain the majority in the House. On Thursday morning, Speaker Nancy Pelosi appeared on the Capitol steps with members of the freshman class to drive home that message.
Although the bill passed on Thursday is unlikely to become law in anything close to its present form, it will serve as a campaign document for the Democrats, to show voters what their vision is on prescription drugs and that they have the will to make a substantive change in the system rather than tinker around the edges.
The bill, named the Elijah E. Cummings Lower Drug Costs Now Act, for the recently deceased chairman of the House Oversight and Reform Committee, passed with unanimous support from Democrats and the backing of two Republicans, Representatives Brian Fitzpatrick of Pennsylvania and Jaime Herrera Beutler of Washington.
Not all Democrats were happy about it. Representative Lloyd Doggett, Democrat of Texas, said the bill did not go far enough. Although he voted for the measure as “as a statement about the importance” of negotiating drug prices, Mr. Doggett said he sought a more expansive measure that would extend health coverage to the roughly 30 million Americans who lack it.
“This bill was developed to appeal to Trump on the theory that President Trump would follow the advice of Candidate Trump, who called for bidding, talked about the billions that could be saved,” Mr. Doggett said. “As it became evident that was not going to work, I felt that this bill didn’t need to move left, but it did need to deal with those who are left out.”
Hours after the measure passed, the Democratic Congressional Campaign Committee, which works to elect House Democrats, announced that it was running an advertising campaign on Facebook to use the bill’s passage to shore up Democrats and target Republicans.
Representative Cheri Bustos of Illinois, who heads the committee, said the ads were aimed at showing consumers that Republicans “will always prioritize padding the pockets of their special interest backers over the people they were elected to represent.”
