Former Congressperson Steven Horsford, with the backing of the Democratic Party’s campaign arm, won the primary in the race for Nevada’s 4th District seat on Tuesday night. He defeated five other contenders, including Amy Vilela, whose long-shot candidacy gained national attention due to her compelling personal story: In 2015, as she recounted, Vilela’s 22-year-old uninsured daughter died weeks after being turned away from an emergency room.
Vilela attributes the fact that her daughter did not receive health care to the fact that she told medical personnel she was uninsured, and Vilela’s campaign was motivated by her passion for single-payer plans, which would close the types of coverage gaps that hurt her daughter.
Horsford, the establishment candidate, has been difficult to pin down on health care — focusing instead on lowering the cost of prescription drugs by increasing the speed with which generic drugs go to market — but finished with 62 percent of the vote. Vilela came in third with just 9 percent.
The race highlighted that the varying commitment to health care reform exhibited by candidates on the left does not always have decisive implications at the ballot box.
Both Vilela and Horsford made health care a major issue in their campaigns. On the trail, Horsford cited his six-way open-heart bypass surgery as a source of empathy for high medicinal costs.
“I survived my close call and was able to receive the medical attention I needed,” Horsford said. “But I shudder at the thought of so many of our neighbors and seniors facing near-death experiences as they ration the pills they can barely afford.”
Notably, Horsford zeroed in on the high cost of prescription drugs at the expense of more sweeping systemic reforms.
Horsford’s plan revolves around three things: helping to get generic drugs to market faster; making it easier for patients and others to take legal action against drug companies for market manipulation and efforts to block generic alternatives; and establishing a commission to address drug pricing.
But experts on drug pricing aren’t impressed by his proposal. “There are always some unnecessary delays with the FDA, but that is nickel-and-dime stuff,” Dean Baker, a senior economist at the Center for Economic and Policy Research who has studied the issue for years, told The Intercept of Horsford’s proposal to speed up the marketing of generic drugs.
Baker also thinks Horsford’s proposal focuses far too much on market manipulation.
“The cases where drug companies have ‘manipulated’ the market by charging high prices for generic drugs are few and far between. They get lots of attention and these guys should be busted, but if you stopped every last one, it would barely be noticeable in the total drug bill,” he said. “The big cost is with patented drugs, and under the law, they get to charge whatever they want.”
James Love, an expert on drug pricing and trade issues at Knowledge Ecology International, offered similar thoughts. “From what little detail there is, I think the Steven Horsford plan is similar to the Trump Admin plan in that it focuses on addressing evergreening, or blocking generics, without much of a focus on dealing with the high prices for new drugs under patent,” he said in an email.
Diane Archer, a longtime consumer advocate who founded the Medicare Rights Center in 1989, stressed the need for greater depth in the plan. “From a policy perspective, bringing generic drugs to market faster is one important way to bring down the cost of drugs,” she told The Intercept. “The devil is in the details. How much faster? Will there be the necessary competition, or will it be quashed? Greater accountability and greater penalties on drugmakers who manipulate the market are absolutely a good solution. How would it work? How long would it take to work through the process and impose the penalties and would they be large enough to prevent future bad behavior?”
By contrast, Vilela supports a range of health care interventions, including allowing Americans to purchase pharmaceutical drugs from Canada, where they are considerably cheaper. The Congressional Budget Office has estimated that one legislative proposal to allow for the importation of Canadian drugs would save almost $7 billion over 10 years.
Democrats blocked importation from becoming part of the Affordable Care Act in 2009, with over 30 votes in opposition, as part of a deal with the pharmaceutical industry to win support for the legislation. They also voted in large numbers to oppose importation as part of a Food and Drug Administration bill in 2012. More recently, a Senate vote in favor of importation failed in January 2017, after 13 Democrats joined a majority of Republicans to oppose it, while 13 Republicans supported it.
Vilela also planned to empower Medicare to negotiate for lower drug prices. By law, Medicare is barred from doing so, and the pharmaceutical industry has successfully lobbied Congress to prevent the government from simply negotiating for lower pricing — despite the fact that other programs run by the federal government, including Medicaid and the Veterans Administration, do negotiate. (A group of House and Senate Democrats introduced a Medicare drug price negotiation bill last year that they estimate would save between $15.2 billion and $16 billion a year if Medicare paid the same prices for drugs as the VA and Medicaid.)
Although neither of these proposals are in Horsford’s plan, his campaign told The Intercept that if he were elected, he would support them.
Perhaps the biggest distinction between the candidates was that Vilela is committed to H.R. 676, better known as former Rep. John Conyers’s “Medicare for All” bill. His single-payer universal health care bill has gained immense popular support among voters and in Congress following Sen. Bernie Sanders’s 2016 primary campaign, of which single payer was a central plank: As of October 2017, the bill had 120 co-sponsors — a majority of House Democrats. But although the bill has become a litmus test of sorts for 2020 candidates, the issue remains divisive among Democrats more broadly.
In fact, Vilela’s decision to run was prompted by a tense meeting with her then-Congressperson Ruben Kihuen about supporting H.R. 676. After telling Kihuen about her daughter’s tragic death, Vilela says Kihuen nodded to show empathy. “Thank you for sharing that story, and I’m very sorry for your loss,” he told her. But he declined to back the bill, explaining that protecting the Affordable Care Act was his priority, not passing single payer. “For me it’s not that I oppose H.R. 676 or that I’m against it. For me right now, it is of utmost importance … spending every bit of energy that I have to protect what we have right now in place,” he said.
For people like Vilela, who have suffered great losses despite the Affordable Care Act, protecting the Affordable Care Act isn’t enough.
Horsford’s position on single payer is hard to pin down. He didn’t co-sponsor the single-payer bill when he was in Congress, and he’s been agnostic about the policy when asked about single payer on the campaign trail.
“I’m a supporter of the need to provide health care for all Americans, he told the Nevada Independent in February. “There are many policies and approaches that will accomplish that. ‘Medicare for All’ is a viable proposal but it does have its shortcomings.” He told the Independent he was concerned about the impact of single payer on the Veterans Administration.
In a statement to The Intercept about whether he’d support the House single-payer bill, Horsford continued to assert that there are “many ways” to achieve health care for everyone, with “Medicare for All” being just one of those options he may back.
“I support efforts to move us to a universal health care system, because health care is a right, not a privilege,” he said. “There are many ways to achieve that, including Medicare for All. Any legislation I support would have to go through an appropriate legislative process that ensures our veterans, union members, and those who benefit from certain employer-provided policies that cover more than Medicare do not see a disruption in their care. We should address those issues, and if we do, I support this legislation.”
Horsford has sought to buttress his credibility on health care by vowing to not take any money from the pharmaceutical industry during this bid for Congress. The National Republican Congressional Committee was quick to pounce on him, pointing out he received over $70,000 from the industry during his previous tenure in Congress. (You can read the Pfizer political action committee’s annual report listing Horsford as a Democrat they gave to here.)
But the NRCC’s missive overlooked the reality that swearing off industry PAC money does not always mean that the funds don’t still find their way into a campaign.
Drug companies are among the biggest patrons of politicians, and many of the committees that have given to Horsford are partially financed by the drug industry. But it is much harder politically for a candidate to refuse that money. The Congressional Black Caucus PAC, for instance, gave Horsford $5,000. That PAC, where Horsford previously sat on the board, is partially financed by Amgen, Johnson & Johnson, Pfizer, Eli Lilly, and Merck. The Congressional Hispanic Caucus Bold PAC, which also gave Horsford $5,000, is partially financed by Amgen and AstraZeneca. Bridge PAC, associated with South Carolina congressperson and Democratic Whip James Clyburn, also gave Horsford $5,000. It is partially financed by Abbott Laboratories, Eli Lilly, and Pfizer.
When The Intercept asked about drug industry money coming in through other committees, Horsford’s campaign clarified, “Horsford will not take any direct contributions from the pharmaceutical industry.”
Vilela made the rejection of corporate PAC money a theme of her campaign. Just as a number of potential 2020 Democratic contenders have taken this modest step, she was one of two candidates in the primary who agreed to swear off all corporate PAC money (the other being high school principal John Anzalone).
“I’ve had over 7,000 individual donations averaging $24 a donation. I have the people behind me. I didn’t go down to Washington, D.C., and do a shakedown of everyone in Washington, D.C.,” she told The Intercept. In the end, it wasn’t enough, but Vilela has vowed that her fight for single-payer health care in her daughter’s name is far from over.