Drugmakers Notch a $5 Billion Win in Republicans' Policy Bill
The legislation allows more medications to be exempt from Medicare's price negotiation program, which was created to lower the government's drug spending. Now, manufacturers will be able to keep those prices higher.
The change will cut into the government's savings from the negotiation program by nearly $5 billion over a decade, according to an estimate by the nonpartisan Congressional Budget Office.
'This is essentially giving $5 billion back to the pharmaceutical industry,' said Dr. Benjamin Rome, a health policy researcher at Brigham and Women's Hospital in Boston. 'It's done in a way that is designed, on its face, to solve the problem of some misaligned incentives, but I don't think it solves those problems.'
Under existing law, costly drugs are exempt from price negotiations if they are approved to treat a single rare disease — one that affects fewer than 200,000 Americans. Drugmakers have complained that this policy discourages them from running studies and seeking approval to treat a second rare disease, and that it ultimately deprives patients of new treatments.
In response, the new bill spares drugs that are approved to treat multiple rare diseases. They can still be subject to price negotiations later if they are approved for larger groups of patients, though the change delays those lower prices.
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Rahm Emanuel 00:00:02 Candidates focused on the core things, middle class economics, middle class values, are winning. And we didn't. And so they're disappointed in us. And therefore, they're not letting us out of the penalty box until we earn it. And that's the right place for them to be, and that's a wrong place for us to be. And we have to take that seriously. David Chalian 00:00:22 Rahm Emanuel is not shy about criticizing his own party. Lately, he's called out Democrats for being too, quote, "weak and woke." He's known for his candor during his more than three decades in the political spotlight. And in that time, he's held a long list of titles: ambassador, mayor, congressman, chief of staff, senior advisor. He also isn't shy about the fact that he's interested in one more: president of the United States. He's definitely made it clear he's eyeing a potential 2028 run, and he joined me this week to talk about the state of his party, where he sees its future and what he thinks Democrats are getting wrong in their fight against Donald Trump. I'm CNN's Washington Bureau Chief and Political Director David Chalian, and this is the CNN Political Briefing. Rahm, thanks so much for doing this. Really appreciate it. Rahm Emanuel 00:01:15 Thanks for having me this morning. David Chalian 00:01:17 'I want to start obviously with the bill and President Trump's domestic agenda all in this one bill. Obviously, you and I are talking Wednesday morning. It's passed the Senate. It still has to get through the House. It's clearly, I would imagine, going to get through the house. So let's assume- Rahm Emanuel 00:01:30 Moments like this, there's always, is it more dangerous to get to the other side of the river or to swim backwards and everybody, like in other big bills I've seen in my tenure, you basically keep rowing and get to the other side. David Chalian 00:01:45 Which is why we've heard Johnson and Thune and others say failure's not an option here, right? They just gotta get to the other side, as you say. So let's assume it becomes law. Now, tell me, does this become the centerpiece of the conversation with the American people for the '26 Midterms? Rahm Emanuel 00:02:00 If it doesn't, we're fools. As I've argued before, the bills should be just captured. Tax cuts for the wealthy, healthcare cuts for the many. People get that. It's already underwater. There's nothing about reducing healthcare benefits for working people that is gonna make it more popular. And the way I would sharpen this, two examples, just not just to use rhetoric. I mean, when the bill is on the floor in the Senate, Jeff Bezos is having a $50 million wedding event. He's gonna get massive tax cuts, not that he needs it to afford the wedding, and close to 20 million people are going to lose their healthcare. That should have been the image. Another way of doing this was at a podium at a press conference, portraits of every wealthy person who attended the Trump Inaugural, a portrait of them, their net worth below them, and 40 kids on the other side of the podium, and say, these children want to see their pediatrician. These guys are going to get a tax cut that they don't even know they're going get, but their accountants will. Now, I think these kids are more important for America's future than these billionaires. But the contrast is the core crux of this argument for Democrats. David Chalian 00:03:08 And, as you noted, the bill is already under water, so I feel like your side has sort of a head start to this argument that you're making here now. Rahm Emanuel 00:03:14 Yeah. That doesn't mean you win, but we are being spotted 20 yards here. David Chalian 00:03:19 But that's what I want to ask you, though, because you can start sensing how Republicans are going to argue this because they understand that they have a sales job with the American people, right? They're going to focus on what they think are some popular measures in this bill, like no tax on tips, no tax on overtime and making the argument that what's wrong with saying that able bodied Americans should have to work to get benefits and that that has some resonance with the Americans people. So what about how the Republicans may sell this, do you think Democrats have to be most concerned about? Rahm Emanuel 00:03:49 'Well, we've got to go hit this bill hard for what it does, and you don't have to make it up. It's right there in print. It's all been headlined, and it's more than headlined, the argument. Second, David, your argument is correct at a macro level. This is a fight in about 40 congressional districts and about three or four Senate districts. The fight is not for public opinion. The fight is for the public opinion of independent swing voters. The reason these districts are swing, they have a higher concentration of swing voters. So, what moves that voter? Well, to me, the crux argument beyond the bill, step back, is corruption, cruelty, and chaos. And the corruption is not just the way the elite understand it. The corruption comes in many ways around the way the public understands it, which is the Jeff Bezos, Tim Cook, Elon Musk get a tax cut. They don't deserve it. They didn't even ask for it. It's so massive. And all these kids are getting healthcare cuts. That is the corruption where they know that this system is self-dealing in the self-interest of the well-connected. So, and in those districts, independents are aligned with Democrats in a mirror image of this bill. Yes, they'll talk about interest rate deduction on car loans or tips, et cetera, but that's not in a swing district. Now, we're making, I'm also making a generalization of the 40-plus that are in play. That's not what's gonna move them. And it's gonna be what Republicans did here. And what's ironic, and it's kind of what really is in a more, not just about the politics of the bill. The Republicans' voters have become more working class, yet their policies benefiting the wealthy have not caught up to their politics. You could argue in the same way if you look at the Democrats, we argue about a series of policies, et cetera, affecting poor, correctly, and lower middle class, working class. Yet, our vote base is somewhere else. So both parties have an incongruity between their policies and their politics that make up the coalition that elect them. David Chalian 00:05:48 That's really interesting that the policy proposals are part of coalitions that have already sort of shifted and that the policy proposals are a little behind where your coalition of voters are. Rahm Emanuel 00:05:58 And both parties and, you know, it's not that I agree with Senator Hawley on anything, but he's right about this in the sense that what we're doing here is either you could dress it up and say it's a legacy of the past or, more importantly, it's suicide here because you're literally, your policies are antithetical to your politics. That is also true here. Now let me draw another point that hasn't been said about electoral politics, at least on our side. You have cases here, and this gets to the Democrats, what we need to do better on. Look in New York, in the primary, the person that focused on cost won. The person that focused on getting arrested at an ICE detention center did not win. New Jersey in the Democratic primary, and again, these are not general elections, so I don't want to extrapolate too much, but in New Jersey, the mayor of Newark got elected at an ICE detention center. The candidate that got nominated for the Democrats in a big turnout, you had five choices, all the way from the very far left progressive to centrist, Blue Dog Democrat in New Jersey. Who focused on cost and affordability, won. That's the lesson, not just for Democratic parties, but in the general elections and swing districts. And so, to me, both the politics and the policies and what happened in certain primaries are revealing, and this doesn't take a PhD from the Kennedy School or a Master's from the Kennedy School. Your policies are out of sync with your politics, and both parties are committing that kind of crime. David Chalian 00:07:27 Just to be clear, you don't have a PhD, right? Rahm Emanuel 00:07:29 Never. David Chalian 00:07:29 Yeah, okay. Rahm Emanuel 00:07:30 I couldn't get accepted. But on weekends I borrow Zeke's, my older brother's. David Chalian 00:07:37 'I want to go back to what you were saying about this playing out in swing districts and how swing voters may make a different calculus here, which brings me to a question about President Trump specifically. And we could get into, I'd love to hear your thoughts about if your party is too consumed with how to respond to Trump or not, or how Trump gets into the psyche, or if you think that actually is a necessary component for success since he is so dominant in our politics. But my question is this, in all your time in doing this, Rahm, does the president's approval still matter where it stands in terms of electoral outcomes, and is part of the Democratic mission, like it was for you at the D-Trip in 2005, 2006, to bring his numbers down? Like, does that still matter broadly, politically, for electoral outcomes, do you think? Rahm Emanuel 00:08:24 'I'll tell you a funny anecdote. To President Bush's credit, when I was chair of the D-Triple-C the day after the election, he called me. And we got along. We disagreed on everything but respectfully got along, and he said, I want to congratulate you. I said, well, Mr. President, I wanna thank you. He goes, why do you wanna thank me? I said because you did everything we needed you to do and everything we wanted you to do. And he started, oh you – he started going after me. So look, it matters still where a president's job approval is. It's mattering less and less. It still counts because in every election, it's fought in battleground swing districts, and that still matters because you're doing everything on the margins, and it matters among independent voters significantly. Now don't confuse 2026 and 2028. In general, 2026 is a referendum on the Republicans. 2028 is a choice among Democrats and Republicans. And there's an architecture to when one party controls both the pulpit and the gavel. That is playing out right now, we can see it in every special election. High turnout among opposition, saw it in the New Jersey primary, you see it in all the specials. Independents breaking two-to-one for the opposition and a lower turnout among the incumbent party. And I would say to you, watch, everybody's kind of looking where the polling is, et cetera. Watch where independent swing voters are, who have voted in past midterm elections, and they right now are two-to-one negative. And I would then just say, Donald Trump needs a check. Now, beyond this bill, David, there's what the Supreme Court did, the unilateral activity of the president, what he's doing to universities. It's leaving a bad taste. This is not how swing voters want to think. And they do not, and you can see this in not just polling but in focus groups, they do want an unhinged, untethered president. And every decision gets a filter, and they're all combined. So it's not like they look in this channel, Big, Beautiful Bill, Supreme court decision on birth, citizenship birth, you know, they don't look at it in kind of silos. And the combination is, this is a Republican rubber stamp, Republican Congress of Donald Trump's. You know, they have sat here and basically as timid souls and that this needs a checkmate, a speed bump. David Chalian 00:10:46 He does have a more firm floor, right, of support? Rahm Emanuel 00:10:49 Well, he has both. He doesn't get above X. You can look at the last seven working days. He's had a pretty good run. As far as I can tell. Now, maybe I'm missing a poll that I didn't see, and you saw. His numbers don't move. So, he has both a ceiling and a floor. David Chalian 00:11:02 Yeah, and that's why I think what you're saying is like lumping the rubber stamp Congress in with him – Rahm Emanuel 00:11:10 Because, at the end of the day, both 2025 and 2026 will be a referendum. David Chalian 00:11:26 You mentioned New York and the primary there, and I take your point that the New York City Democratic mayoral primary is not like the roadmap or what the Democratic party means nationally. Rahm Emanuel 00:11:38 I mean, New Jersey is a better bellwether. Virginia is a better bellwether. David Chalian 00:11:44 'I take that point, never mind they're state-wide races that you're talking about, as well. And I take the point. And I read your letter to the editor in the Wall Street Journal. You do, as you just said to me a few moments ago, acknowledge that the Mamdani core message that he was running on, that affordability thing, that is a lesson that can be learned, you think, from those running in your party. You say just don't follow the Democratic Socialist playbook, and I just wonder, is there nothing else that you saw in what Mamdani was able to accomplish that is worth your party exploring – yes, okay. Rahm Emanuel 00:12:19 Let me, let me clear my throat, first of all. David Chalian 00:12:21 Go ahead. Rahm Emanuel 00:12:22 'I'm serious about this. As somebody who's been targeted as a Jew, lay off his faith. Enough. As a mayor who had Iftar dinners every year, as also an ambassador, he's a man of faith. I don't agree with his ideas or his solutions, but they're on the margins where we disagree, and I'll lay that out in a second. Lay off his faith. That is wrong, it's un-American, and I'm proud of the fact that, as a Muslim, he is true to what he believes the Quran teaches. I really, as somebody who's had spray paint, Nazi signia on my home. Enough already. David Chalian 00:13:02 And we saw some of that in the primary, right? They were like darkening his beard, lengthening his beard. Rahm Emanuel 00:13:09 You wanna have a fight about ideas? Great. That's the American way. Attacking his faith is not. Now, number two, let me say this, there's a – everybody gets into the tactics, and there's something to see about the energy, et cetera. Here's my analysis of what he did well. He talked about affordability, a host of issues, and he made it consistent as a head and tail of change. So it wasn't just affordability over here, absent. It was both a combination heads and tails, of both change and affordability, the way he did it stylistically, but more than stylistically. Because he was running in a perfect, you know, story, he was running against a perfect foil for that change to take hold. Could not, maybe not have happened in another race. Second, I think what's ironic here in the lesson, the very thing that moderates want to talk about, which is get back to kitchen table kind of affordability issues, is exactly what he talked about. So there's more agreement there about the critique of the problem, which is the system is rigged against you. It's rigged in favor of Jeff Bezos and Elon Musk. And it's rigged against you. That is correct. Now, what breaks down? Look, as a mayor, I dealt with food deserts. They're a real problem. I used to say, and I believe this, you know, where Amy and I live, within a mile we have five options. Other people have to drive five miles to get a single option. That is wrong. Now, my answer was if you build a grocery store in a food desert, I'll treat all your others as a single permitting process. I'll save you time and money, and time is money, also. That was my solution. We did, when we attacked, looking at it, 20 to 30 percent of the food deserts, some more consistent than others because it's very hard. You know, free busses, I don't agree with that. But that said, he understands that transportation costs, getting from where you live to the jobs is one of the biggest issues, which is why we modernized the first piece, the Red Line on the south. But his analysis, correct. The fact that today, you don't get a shot at the American dream, you get the shaft. You and I, David, grew up in a time where if you worked hard, you'd get ahead. Today, if you work hard, you run in place, and all you do is break a sweat. And that's wrong. It's fundamentally wrong. And the American people know it. The system is rigged to yours and my success, our kids' success, and it's rigged against everybody else. And he got that. And I get that. Now, I do think that, deeper down, it's ironic to me that the Bronx, which is heavily African American and Hispanic and working poor, voted 18 points in favor of Andrew Cuomo, the downtown moneyed candidate. Brooklyn and the Upper West Side and Park Slope and other neighborhoods that have higher concentration of college educated than all of New York, rather, voted for the socialist. So my conclusion is you've got to be rich enough to be a socialist. David Chalian 00:15:58 'Although he did better with some of those communities, like African-American communities he thought he would get pummeled by Cuomo, and he made up some ground there at the end. Rahm Emanuel 00:16:06 Look, I'm being flippant, also. David Chalian 00:16:09 But you get at the divide that exists inside your party. Rahm Emanuel 00:16:11 Yeah, but here's the other thing. In the very week that we should have been focusing and making headway on what Donald Trump's doing and the Republicans are doing on tax cuts for the wealthy and healthcare cuts for the many, we had a firing squad in a circle focused on each other on what the Democrats, what does it mean to have a Democratic Socialist lead in New York primaries. We lost, not lost all the opportunity because this bill will be, in my view, paying political dividends down the road, but it was at a strategic hour. Jeff Bezos is gonna go spend millions of dollars on a wedding in Venice, and kids are getting a healthcare cut, and they can't see their pediatrician. I say that as the son of a pediatrician, I know you thought I was gonna say something else, but as the son of a pediatrician. David Chalian 00:16:54 Two things can be true, Rahm. Rahm Emanuel 00:16:57 You are able to hold two contradictory thoughts at the same time. David Chalian 00:17:01 What you said about ICE and ICE detention and Ras Baraka and Brad Lander and what have you. Rahm Emanuel 00:17:07 I just think there's examples there. David Chalian 00:17:09 No, I know, but it rings to me what you have also said, which we have seen just this week in polling, I think from Gallup, like democracy is top of mind for American voters. And I've heard you make the argument, Democrats in '24 talking about democracy. There's not a single voter who's persuaded by that message who's not already with the Democrats. But my question is to you, so does that mean you don't talk about it? If you see democratic norms being chipped away, if you see real problems, does that means that you don t give voice to that simply because it may not be a conversion effort to win swing voters? Rahm Emanuel 00:17:43 'Here's my analysis of that. You want to focus on the, you know, chipping away at the rights of access and voting, et cetera. The moment the American dream becomes unaffordable is exactly when our politics became unstable. You want to restore confidence in democracy? Restore confidence and belief in the American dream. They're not inseparable. Only people going to the Aspen Institute to read the Brookings Institute reports think that it's democracy over here. And I'm for – look, they've eviscerated the Voting Rights Act. And Justice Robert's stupidity, oh, racism is over, you don't need the Voting Rights Act anymore. Having participated in Motor Voter and passing legislation that made it easier, same-day registration, I get that. But restoring confidence in the American Dream and its accessibility and its success for the American people is how you restore the workings of democracy. It's not an intellectual exercise. People lost confidence in democracy because they participated in something that ended up screwing them. And so I don't think it's the way you just, I mean, I get why you asked the question the way you asked it, David, and it's legitimate. I actually think the argument is off-kilter and doesn't understand it. Again, it's not a coastal problem. It's not a problem for little hikes up in the Aspen Mountains. You know, listen, go back to our politics. You've heard me talk about this. You and I have had this conversation. You had an Iraq war that was built on a lie. Thousands of people lost their lives and are maimed for life. We spent a trillion dollars, and everybody accountable for that lie never faced one day of either career or professional justice. Second, you had the liar loans that propped up a housing and financial bubble. People lost their homes, and bankers are arguing for their bonus and never got the Old Testament justice that they deserved. And then third, we left communities totally abandoned to fight China by themselves like Peoria or, you know, Battle Creek, Michigan could take on China by ourselves. And so in those three cases, the wealthy and the well-to-do and the well-connected were taken care of, and everybody else got the shaft. And so, yes, they're angry. And that's why democracy is unstable. Not because Voting Rights Act and – David Chalian 00:20:04 I get it, but I just want to ask: So, do you think it is a worthwhile thing for Democrats to make an argument against aggressive ICE detentions or to ignore that issue? David Chalian 00:20:13 'No, no, no. I do think it's worth making the argument. It's not a singular, isolated, walled-off argument, but make it as part of and sequentially after you've talked about grocery bills, gas bills, housing costs, or the lack of housing. I mean, it's crazy that people have multiple homes and a young family doesn't get a starter home. It's crazy that your 401(k) backstops your paycheck. It's crazy, and I say this seriously, my father was a pediatrician, my mother was a radiologist. When my dad asked for a second opinion on a child's health, he called another doctor or another nurse, some healthcare professional or a researcher. He didn't call an insurance bureaucrat that said, that's not covered. That's not the second opinion in healthcare, but that's what's happening in this system. People are spending hours fighting with somebody on the other line who doesn't understand the doctor prescribed this, and, yes, my policy has to cover this medication, and, yes, it should cover this procedure. David Chalian 00:21:15 Two last questions for you. Rahm Emanuel 00:21:17 Four last answers. David Chalian 00:21:20 I've gotten the ratio down here. Why, in your mind, and I think it is off of this conversation perhaps, when we see Donald Trump in the low forties, when we congressional Republicans in the basement, when we see Independents fleeing the Republicans, why are Democrats still at 27% favorable with the American people? Like, why is it not binary? Why in our system, why is that not benefiting your party right now? David Chalian 00:21:45 'Here's my view, the Democrats disappoint, and the Republicans stab you in the back. And we disappointed people. We took our eye off the ball. We've made a number of mistakes going in recent history, mainly around Joe Biden running for a long time for reelection, and then how we conducted certain things. So, to me, we disappointed voters. And they are, and they have every right to be angry. And not only did we disappoint them, we got caught off on things that we cared about. And, you know, this is gonna get me nothing but hate mail, but they kept telling you it was cost of living, et cetera. We're talking about climate change, abortion, access to a bathroom and a locker room, not access to the, not the – you know, it's not about access to a bathroom, it's about classroom excellence. And we didn't focus on what they wanted us to focus on. And it's not an accident. Take New Jersey, Virginia, and New York right now and take all the other special elections since November. Candidates focused on the core things, middle-class economics, middle- class values, are winning. And we didn't. And so they're disappointed in us. And therefore, they're not letting us out of the penalty box until we earn it. And that's the right place for them to be, and that's the wrong place for us to be. And we have to take that seriously. David Chalian 00:22:57 So winning, you think, will improve the impression of the party with voters. David Chalian 00:23:00 'You have to win, and you have to prove you're true to your word. Not just win, because if you go back to winning and disappoint. Now look, in the end of the day, if you through at least recent, and I think this is important, I'm not interested in comparing presidential numbers to 50 years ago. I'm interested in comparing 10 years ago, because I think we can both agree on this. Politics is fundamentally different than what it was, and that benchmark of 50 years ago just doesn't apply anymore. So, to me, at least for the Midterm, you don't have to be at up to 40% job approval – it would be better if you were – but you don't have to be if you make this the referendum on Republican stewardship. That's why Democrats that argue, oh, the do-nothing Democrats. But you're focusing on the wrong audience. The audience is them. They're in charge. You don't have a gavel, and you don't have a bully pulpit. So stop putting this on yourself and changing the electoral structure. Second, though, you have to improve your image as a viable, both the candidate and the party, as a viable alternative, because 2028 is a choice election. 2026 is a referendum election. David Chalian 00:24:02 On 2028, which I know you've talked about, you're considering a presidential run and all that jazz. What would be the, like, do you think the most important metric or consideration for how you'll make that decision? David Chalian 00:24:17 'Oh, well, that's a there's a professional, and there's a personal. One is first and foremost is personal. Where I was when I ran for Congress, you know, our kids were six, four and three. Today they're in their twenties through college, et cetera. They're well on their way in their career. They're more protected, and they're all their own individuals. So there will be a personal decision for the family, given that. Then on the professional, which I think you're more interested, but, to me, in both the congressional, the mayoral, even chief of staff, which was not an electoral, is how does this impact our family, as a family, and our children? That's going to be a crux issue for me. Second, do I have something that I think both the country first and then the party second, not the other way around, that I think I'm offering that other candidates aren't? And that is, to me, the American dream is unaffordable, and that is unacceptable. And I may not solve this, because we didn't get into this ditch in three years; we got into it in 30 years, but every day are we making progress on housing affordability, home ownership, retirement security, healthcare security, and access to education. Side note, when I made community college free in Chicago – first city, if you earned a B average. The relief I saw on parents' eyes, the way they were crying, know that the policies we do in the government in the public space really can matter in a family's life. So that core question, am I doing something, saying something, not just rhetorically, do I have the answers to that issue, both middle-class economics, middle- class values. And then, third, you know, I think right now, I don't know if it's what, 28 of us thinking about running? Is it 30? David Chalian 00:26:11 Something like that. Rahm Emanuel 00:26:12 'Yeah, okay. I think there's a lane, and David, you've known me for years. You started this this way. There's a place in the Democratic Party for candor, authenticity and strength. In my career, when it came to taking on the NRA on the assault weapon ban, I got the call. When it came the taking on the insurance companies to give 10 million children healthcare, got the call. When it came to taking on the banks and passing fundamental reform, I got the call. When it came the taking on the educational bureaucracies and institutions for free community college, free pre-K and kindergarten, I got the call. When it came to taking on the pharmaceutical industry, first city ever to sue over opiates three years before a state or another city, I made that decision. So do you have strength? Do you have character? Do you you have authenticity? And I think there's a currency in that. Could be wrong. David Chalian 00:27:03 That last bit there almost sounded like you were in debate prep already, that was – David Chalian 00:27:06 No, but it's, but I think, look, I think people can talk about things, but the, you know, the real question of leadership – now I'm putting you around the dinner table with people when my kids, when we all talk – do you have the ideas to know why you're doing what you're doing? And do you have the strength to make it a reality? If you look at every successful executive in public life, it's not just that they're intellectually smart and have all the solutions to all the problems. They have the political moxie to make it happen. And, to me, that combination is key. Now, David, I love you, but I hear the brown and the rainbow trout calling my name, and I gotta go. David Chalian 00:27:46 Go, I appreciate your time. Thanks so much, Rahm. Rahm Emanuel 00:27:47 Thanks, brother. David Chalian 00:27:49 That's it for this week's edition of the CNN Political Briefing. Remember, you can reach out to us with your questions about Trump's new administration. Our contact information is in the show notes. CNN Political Briefing is a production of CNN Podcasts. This episode was produced by Emily Williams. Dan Dzula is our technical director, and Steve Lickteig is the executive producer of CNN Podcasts. Our senior producers are Faiz Jamil and Felicia Patinkin. Support from Alex Manasseri, Robert Mathers, Jon Dianora, Leni Steinhardt, Jamus Andrest, Nichole Pesaru, and Lisa Namerow. We'll be back with a new episode next Friday. Thanks so much for listening.
