DEMS HIT NEW CROSSROAD IN DRUG PRICING TALKS — As House Democrats prepare to send the social spending package to the Senate this week, they’ve hit another roadblock: The way the plan would extend price controls beyond Medicare to private health coverage is stoking another battle over the package. At issue is Democrats’ push to penalize drugmakers if they hike prices of medicine faster than inflation, a provision Republicans and the drug industry see as government overreach — and, they say, a violation of the Senate’s parliamentary rules for considering the bill because it’s a non-budgetary item, Alice Miranda Ollstein and Megan Wilson write. Republicans are "likely to challenge everything and anything that looks or smells like [controlling] private markets,” said one pharmaceutical lobbyist, who asked not to be identified to speak candidly about the next steps. “That is their operating plan.” The outcome could determine to what extent Democrats can make good on their pledge to rein in drug costs for all Americans — a promise some lawmakers view as central to keeping their slim congressional majorities in the midterm elections. Drug industry lobbyists are urging Republican senators to scuttle the drug-pricing language with parliamentary challenges while looking for cracks in the Democrats’ ranks after the industry fought off more aggressive House attempts to impose drug price controls. THERE ARE MIDTERM IMPLICATIONS … EVEN IF DEMS SUCCEED — The caucus is close to making good on long-held promises to lower prescription drug costs and make health care more affordable. But even if they settle these issues, voters won’t feel the effect until after the 2022 elections, Alice and Laura Barrón-López report. The party is increasingly banking its midterm prospects on passage of the president’s domestic agenda in the coming weeks, convinced that it can help counteract concerns of inflation and inaction in D.C. But voters are not convinced right now, and infrastructure hasn’t moved the needle (more on that below...). House Majority Whip Jim Clyburn (D-S.C.) told POLITICO that the party’s physical infrastructure bill that Congress recently sent to Biden’s desk isn’t enough, and pointed to the health provisions of the still-pending $1.75 trillion social spending bill as the types of measures that could win over voters. “When people see the roads and bridges in their communities, when they see water systems being created ... and they see the $65 billion in broadband expenditures, that is a big, big deal,” he said. “But if you do that and do that only, what would you have done for prescription drugs? Nothing, that's in the other bill.” “So Build Back Better has got to get done because the highest polling thing yet is the prescription drugs,” Clyburn added, referring to the name of the social spending bill coined by the White House. Back to the inflation question. Backers fear both practical and political consequences if that drug pricing measure is stripped out — warning that pharmaceutical companies could hike prices for the roughly 180 million people on employer health plans or other private insurance to make up for the revenue they stand to lose from Medicare price negotiations and other provisions of the bill. “I’ve insisted on [inflation caps] applying to the commercial sector,” Senate Finance Chair Ron Wyden (D-Ore.) told reporters. “What that means is that, not just for seniors but for millions of Americans, their drug prices wouldn’t go up more than inflation unless the companies are willing to pay a penalty.” BIDEN DIDN’T GET AN INFRASTRUCTURE BUMP — President Joe Biden’s approval rating is down to 41 percent, with 53 percent of respondents disapproving, according to a Washington Post-ABC poll out Sunday. The issue for Biden: The poll was conducted Nov. 7-10, so after Congress passed the bipartisan infrastructure package poised for a shiny White House signing event today. It gets worse: Nearly two-thirds of respondents said Biden has accomplished “not very much” or “little or nothing” so far in his presidency, worse than figures for Donald Trump, Barack Obama or Bill Clinton at similar points. Education has forged ahead as a major issue for registered voters while perceptions of the president’s pandemic response — positive among voters early in his administration — are continuing to fade. Americans are now roughly divided on his response, with 47 percent approving and 49 percent disapproving. There’s more: Just over half of respondents said they’d be likely to vote for Republican congressional candidates if there were an election right now, another sobering figure for Democrats ahead of next year’s midterms, the Post’s Dan Balz, Scott Clement and Scott Guskin write. But respondents are still deeply divided on partisan issues, and roughly two-thirds say both parties are out of touch with voters’ priorities. What’s next: Don’t expect the president’s $1.75 trillion social spending package to be passed soon. While the House is slated to consider the measure this week, Senate Majority Leader Chuck Schumer (D-N.Y.) said Sunday that his chamber will turn to the annual defense policy bill, the National Defense Authorization Act, first. Schumer’s plan makes it all the more likely Congress will be working well into December to finish out Biden’s domestic agenda, POLITICO’s Burgess Everett writes. The Senate parliamentarian needs to go through the reconciliation bill before bringing it to the floor, making sure none of the language runs afoul of the bill’s protections from a GOP filibuster. Schumer said he hopes to finish that process this week. | 
