By Tory Newmyer
March 20, 2017

Last week, this note explored how the pharmaceutical industry had managed to endure the latest healthcare reform debate without so much as a scratch on its bottom line. After all, Big Pharma was one of President Trump’s favorite rhetorical tackling dummies on the campaign trail last year. Plus Republicans could use some extra money to mitigate the coverage reductions their replacement plan will impose — and there’s no better place to get it than from an unpopular industry.

Trump has only returned to the issue of medicine prices occasionally since taking office. And he’s sent mixed signals about his intent to squeeze more savings for taxpayers from the companies that manufacture them. But the president appeared to make news on that front Monday night. At a campaign-style rally in Louisville, Ky., aimed at boosting intraparty support for the Obamacare replacement plan, Trump called drug costs “outrageous” and said he wants to attack them in the bill that the House is set to take up Thursday. “Medicine prices will be coming down — way, way, way down — and that’s going to happen fast,” Trump said. “We’re just adding that to the bill. I said, ‘We’ve got to add that to the bill.’” Specifically, Trump appeared to be endorsing a tweak that would allow for the commercial importation of name-brand drugs from abroad. “The cost of medicine in this country is… many times higher than in some countries in Europe and elsewhere. Why? Same pill, same manufacturer, identical,” he said. “You know why? Campaign contributions, who knows? But somebody’s getting very rich. We’re going to bring it down.” It’s not entirely clear what Trump would do about it, but his comments on the topic were his most extensive on possible changes to the broader measure.

Alas, hours later, House Republican leaders unveiled a package of changes to the bill, and the drug industry once again is escaping untouched. Trump did leave himself some wiggle room Monday night by noting if he can’t get his tough-medicine edits in the legislation moving this week, “we’re going to do it right after” in a follow-up bill. But that one will require 60 votes to clear the Senate, a fact that’s prompted conservative hardliners like Ted Cruz of Texas to dismiss it as stillborn. The bigger point, perhaps, is that Trump just demonstrated his apparent ignorance about a basic fact of a bill that will go a long way toward determining his domestic agenda’s fate. He’ll presumably need a working knowledge of the measure — what it actually does and does not do — in order to convince Republican lawmakers facing a potentially career-ending vote to keep faith with him. He’s meeting with House GOPers this morning to press his case. The next 72 hours will tell the tale.

Publishing note: Friday’s edition will be the last of this newsletter. After nearly seven very rewarding years at Fortune, I’m leaving for a new assignment that I’m looking forward to announcing imminently. Starting Monday, if you aren’t already, you’ll receive the TIME Politics newsletter, helmed by our sister magazine’s White House correspondent, the scary-good Zeke Miller. To make sure it lands in your inbox, please add to your address book. I’m sorry we had such a brief run, but I’m reassured knowing I’m leaving you in such capable hands. More soon.

Tory Newmyer


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