The remark drifted quietly past nearly all political watchers, but inside Congress, it reverberated like a patch of rolling thunder. “I’m not worried what Wendell thinks,” said Mark Pocan, D-Wisc., the co-chair of the Congressional Progressive Caucus, in February. “When he gets elected to Congress, it’ll matter.”
Wendell was a reference to Wendell Primus, a top policy aide to House Speaker Nancy Pelosi, who, inside the halls of Congress, needs no surname clarification. Pocan gave voice to simmering frustrations about Primus’s meddling in internal House policy debates. On the Hill, there’s a name given to people like Primus, unelected lifers who use their years of service and clout to influence the party’s direction: He’s a member/staffer. And members don’t like it when a staffer — even a member/staffer — starts setting the boundaries of their ambitions.
Primus serves as Pelosi’s sharp elbows, particularly on health policy. He is working directly with the Trump White House on watered-down drug-pricing legislation that differs from a bill favored by House liberals. And as The Intercept has reported, Primus reassured insurance executives last December, shortly after the Democratic takeover of the House, that party leadership would not favor a Medicare for All plan.
He also lashed out at Medicare for All on tape, at a little-noticed health care conference in Irvine, California, in February, homing in on regional differences in provider reimbursement rates as a signature obstacle. “The regional issues about transfers of money that were involved are enormous here and for that reason, I don’t think it’s going to happen,” he said, adding that senior Democrats all agreed with him on this. Primus even cited a right-wing study about the costs of single payer, neglecting to mention that the same study found that it would reduce overall health expenditures.
Pelosi has defended Primus publicly, touting him in the Washington Post as “probably the most progressive staff person on Capitol Hill.” Pelosi’s office wouldn’t make Primus available for interview, but in an email, spokesperson Henry Connelly said that “Wendell is the architect of some of the most sweeping and impactful progress in extending health coverage and lowering Americans’ health costs that has been signed into law in the past 50 years.”
But one line from the slide deck Primus presented to insurers reveals the disconnect between what “progressive” means to the old guard in Congress and what it means to a new generation.
Among other criticisms, Primus explained to insurers that “stakeholders are against” single payer, therefore leadership is too. This rationale for policy opposition — stakeholders are against virtually anything that would damage their interests, regardless of whether it benefits the public — represents Primus’s worldview in one phrase. You could call him the last of the loser liberals, desperate to maintain the last few scraps of the welfare state rather than forward anything more bold. The mindset views younger progressives as people to protect leadership from, and anti-government conservatives as people to bargain with. They strive not to make the world a better place, but to make it less bad than Republicans want.
Rep. Mark DeSaulnier of California has clashed with Primus, and said that he is a symptom of a broader cultural problem in Washington. “There are mostly good people in staff, but there are some people who start to think they have to protect democracy from elected officials,” DeSaulnier said. “If you even bring up something that’s hard to do or aspirational, staff are like, Oh, you can’t do that here — which is a self-fulfilling prophecy.”
Primus was once seen as the face of the principled left, fighting the ravages of Clintonism from the inside. In 1996, he resigned as deputy assistant secretary of the Department of Health and Human Services, in a public protest against President Bill Clinton’s decision to sign the welfare reform bill. At HHS, Primus produced a study showing that welfare reform would increase child poverty (a prediction that hasn’t really come true because of other policy supports for children, although overall poverty is indeed up). “To remain would be to disown all the analysis my office has produced regarding the impact of the bill,” he wrote in his resignation letter.
The resignation was an important act of defiance from the left flank of the party and should be commended. But by 2001, when studies showed two-parent families increasing, particularly among low-income African Americans, Primus told the New York Times, “’In many ways welfare reform is working better than I thought it would. … The sky isn’t falling anymore. Whatever we have been doing over the last five years, we ought to keep going.” Of course, those numbers were mainly due to a stock-fueled economic boom in the late 1990s, and when that reversed during the Great Recession, a lack of welfare benefits utterly failed the poor.
Connelly responded to this quote by saying, “You shouldn’t cherry-pick a single comment from a man who had the courage to actually resign over welfare reform.” But he didn’t answer the question of whether Primus still thinks that welfare reform worked better than expected.
The fight over welfare reform is illustrative in another way: Primus, like many liberals of his generation, was mostly engaging in the same work he does today — defending America’s meager safety net from a right-wing assault. Prior to working in the Clinton administration, he spent several years on the House Ways and Means Committee as chief economist and staff director for the Human Resources subcommittee. He penned his own welfare legislation, which was a bit kinder to the poor. In the 1980s, he helped draft the Gramm-Rudman-Hollings Balanced Budget Act, softening the most harmful implications of its automatic spending cuts. The impetus was the same: Protect the safety net.
There’s an entire cottage industry on the center-left dedicated to this purpose, with which Primus has long been associated. After leaving the Clinton administration, he joined the Center on Budget and Policy Priorities, which focuses on welfare state programs. Its tentative approach is embedded in its very name; while today’s progressives are arguing for Medicare for All and a full-blown economic restructuring around a Green New Deal, yesterday’s were weighing different budget and policy priorities, defending some while sacrificing others in an endless retreat. Primus has also written for the Brookings Institution, another similarly aligned organization that was once the beating heart of liberal policymaking, but is absent from today’s more ambitious debates.
Progressive economist Dean Baker recalled a meeting he took with Primus in 2000. At the time, there was a huge budget surplus, and Baker had just released a book calling for no cuts to Social Security. Primus asked him to soften his resistance if the cuts would pay for other important programs. Baker recalled that Primus said, “‘I’m worried about the budget in 2015, how are we going to pay for food stamps in 2015?’ And he was dead serious. Maybe I’m an optimist, but aren’t there other things to worry about [in 2000]?”
Primus and those who think like him have a well-established mindset and a narrow viewpoint on policy debates, one beaten into them by the Reagan years. They want to preserve benefits for the poor and needy, without too many painful cutbacks. They are deficit hawks who want to use resources they consider scarce to barely cover what we have today. They generally seek to protect the handful of programs that managed to survive the conservative revolution, because they believe that’s all government can do.
Without question, these organizations play an important defensive role on the left and can provide a countervailing force to the Clintonite center and the far right. They’re not inherently bad people, they’re simply creatures of their time, as we all are.
For instance, Primus joined Pelosi’s office and was a key conduit between the CBPP/Brookings axis and Capitol Hill. During the debate over the Affordable Care Act, Primus clashed so much with White House chief of staff Rahm Emanuel that the two “couldn’t be in the same room together,” according to the Washington Post. Emanuel wanted to scale back the ACA, but Primus won that battle.
“They do great work between the 40-yard lines,” said Baker. “Whenever something might be cut in Congress, they do the best stuff on why it’s bad. It’s good and useful stuff, but it’s never going to change the ballgame.”
Others who have clashed with Primus think his worldview is ultimately self-defeating. “If you followed their advice, all the programs they’re interested in saving would be cut, they would all be worse off today than right now,” said Alex Lawson of Social Security Works.
We are now in a different era than even a few short years ago. Progressives, responding to decades of stagnant wages, sinking economic mobility, and soaring income and wealth inequality have proposed structural changes across the board. This goes well beyond the “pity-charity liberalism” that grants some minor alms for society’s losers, rather than broad agency or power for the working class.
“It’s a problem throughout the caucus,” said one House aide, who sought anonymity to speak candidly. “These people who are thought of as liberal lions have not updated themselves to the politics of the moment.” Instead of fighting the Rahm Emanuels of the world, that puts Primus in opposition to the vanguard of the left. And that has created significant tension.
It doesn’t help that Primus’s portfolio primarily includes health policy, the area that won House Democrats the 2018 midterms, and where the left has constructed a defined imperative to take on the insurance and pharmaceutical industries. Primus has been the proxy for Pelosi’s fight to control the narrative on health care.
Pelosi has made clear that she follows Primus’s lead on these issues. “On health policy, ‘what does Wendell think’ is what we say all the time about this issue,” the speaker said at a 2013 town hall. “He’s very much empowered by the speaker,” said the House staffer. “The speaker is running a thing where he gets the first draft on these policies.”
The controversy between Primus and liberal lawmakers in this Congress started with his undermining Medicare for All. Pelosi has promised hearings on a Medicare for All bill during this congressional session, which is farther than any similar effort has gone. But she’s been ambivalent in public about the concept. Behind the scenes, Primus has attempted to knife it. Pelosi, said Washington Rep. Pramila Jayapal, “has made it clear that [Medicare for All] isn’t necessarily the fix that she at this moment believes in, but she is respectful of me in leading this effort, and I would expect her staff to at least follow that.”
In the slide presentation to insurers, Primus said that party leaders weren’t interested in Medicare for All and wanted to work with the Trump administration on drug-price legislation instead. Improving the Affordable Care Act would be the “most cost-effective path to universal coverage,” according to Primus’s slides. House Democrats recently proposed a package of legislation to do just that, by expanding exchange subsidies and instituting a national reinsurance program.
Primus described single payer with phrases like “implementation challenges,” “monies needed for other priorities,” and “creates winners and losers,” along with the warning that stakeholders are against it. Last week, Politico reported on a second Primus meeting, this time with health policy researchers, where he called Medicare for All an “unhelpful distraction” and solicited research to “discredit the idea, or at least amplify its risks.” Pelosi’s office denied that Primus was requesting hit pieces. “Wendell absolutely did not ask for any kind of one-sided analysis of Medicare For All, and anyone who says otherwise wasn’t actually listening,” said Connelly.
But at the health care conference in Irvine, Primus approvingly cited the Charles Blahous study for the Mercatus Center at George Mason University, a hit piece that produced an allegedly staggering cost for Medicare for All. “There are experts on the right and the left, Chuck Blahous, the Urban Institute, that have said all of that [costs] about $32 trillion,” Primus said.
Blahous’s own calculations reveal that Medicare for All would save Americans $2 trillion relative to what they would spend on health care under the current system, while covering 30 million more people. Despite that, right-wing media and campaign ads have consistently parroted the headline $32 trillion figure, without context. It’s jarring to see the alleged “most progressive staff person on Capitol Hill” do the same.
Primus seemed to recognize the minefield he was walking into in Irvine, saying about Medicare for All, “I get myself into trouble every time I say something about this.”
The Progressive Caucus demanded answers from Primus on his Medicare for All maneuvering last week, even going through the slide presentation piece by piece. Primus insisted that his remarks were distorted. But members didn’t seem to take that as a sufficient answer. “It’s really inappropriate for staff representing the speaker’s office to be undercutting members of our caucus,” said Jayapal after the meeting. “This does not help us at all and was frankly insulting to those elected to represent our constituents.”
Added DeSaulnier, “I didn’t hear an apology from him.”
On drug prices, Primus has been far more aggressive, taking the lead in dictating policy. He is known in the Capitol as a principled foe of drug industry greed. In his briefing for insurers, Primus mentioned a handful of modest but worthwhile ideas, like lifting roadblocks to generic medication production, stopping schemes that lengthen patent protections, and ending “pay for delay,” in which a drug company pays a generic manufacturer to not produce a generic version of an expensive drug. Two of these passed the House Energy and Commerce Committee last Wednesday.
But since Congress’s swearing-in, Primus has become obsessed with finding a drug proposal the Trump administration will support. In February, he backed an idea to use third-party arbitration to set the price of certain prescription drugs. This neglected the fact that, for a year, House Democrats were coalescing around a bill from Rep. Lloyd Doggett, D-Texas, to require Medicare to negotiate with pharmaceutical companies over price, and if they refused, to authorize compulsory licensing of that drug to generic manufacturers.
Doggett has 122 co-sponsors for his bill, yet Primus short-circuited it. “Pharma peeled off members from his bill,” said Lawson. “Wendell’s discussion gave those who dropped the ability to say, ‘It’s not because of my funders, but because of the same concerns that Wendell has.’”
Primus initially signaled support for Doggett, but shifted to arbitration around the same time Patients for Affordable Drugs, a group funded by former hedge fund manager John Arnold, started to favor the concept. “Arnold has spent enormous money on ads, both for and against members,” Lawson said. “Maybe he’s thinking this is the way to keep them on his side.”
The arbitration concept grew out of a 2008 study in Health Affairs from a former Obama administration official and a director at health insurer Aetna. The government and the drugmaker would submit prices, and a third-party arbitrator would select one or choose a third price based on their own research.
Primus’s version would only cover a select set of high-cost drugs, and critics fear that the arbiter would be unaccountable and the process opaque. Initial reports suggested that the arbitration would be voluntary and nonbinding, though Connelly suggested that those reports were false. “We’re continuing to incorporate feedback and ideas from members and stakeholders about how we can develop the toughest possible bill,” he said. Still, it’s unclear whether drug manufacturers would be forced to accept the arbitrated price.
We do know that pharmaceutical lobbyists appear to be more comfortable with the arbitration concept, which “comes from a fundamental misunderstanding of the debate,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Program. “It’s not a good strategy to be reasonable to the pharmaceutical lobby. You have to be bold and go after them with a fight that’s big enough that the public is engaged and mobilized in support.”
Primus has progressed to formal talks with the Trump administration, as well as Senate Finance Committee Chair Chuck Grassley, R-Iowa. As part of what’s been called a “reassurance tour” with groups inside and outside of the Capitol, Primus told Progressive Caucus members that he was not negotiating with the White House, but instead trying to find something all House Democrats could support. Doggett has said that any potential compromise must “be on something that really makes a difference in the lives of people on health care and not agreement for agreement’s sake.”
It’s hard to square Primus’s insistence that he’s not negotiating with the White House with what he said at the Irvine health care conference: “I think we will cut a deal with the administration. And I think that if we do it right in the House, that will give it enough push to get it done in the Senate.”
He added, “I think it’s going to take some time to educate members about all of this.”
Primus has also tried to derail an idea from the Trump administration some consider useful. He wants to delay an HHS rule to eliminate the legal kickbacks that pharmacy benefit managers get from negotiating rebates with drug companies. Supporters believe ending rebates will change the business model for pharmacy benefit managers and control the misaligned incentives that lead to high list prices. (The higher the list price, the higher the rebate, the story goes, and if rebates are effectively banned, PBMs would have to earn their fees from insurers by pushing list prices down.)
At the Irvine health care conference, Primus cited estimates from the Center on Medicare and Medicaid Services’ Office of the Actuary suggesting higher consumer prices and government costs from the rebate rule. “If you take away those rebates, prescription drug prices might go down a little bit, but they’re not going to come down nearly enough to offset the loss of the rebates,” Primus said. “The administration has no authority right now to force the manufacturers to lower list prices.” The speaker has said something similar.
Nobody thinks banning rebates will cure all ills in the pharmaceutical supply chain. But Primus’s complaint that the government might have to pay more fits with his longstanding concern over federal deficits.
Another slide in Primus’s insurance presentation, titled “Not Preparing for Boomer Retirement,” explained how deficits could strain health budgets as the population ages. This has been a consistent Primus concern. “We didn’t use the decade just before the baby boom generation retired to get ready,” Primus said in a 2010 roundtable on Social Security preserved on C-SPAN. “That is really one of the greatest failures of the Bush administration.” (I could think of others.)
In that roundtable, Primus advised lawmakers to “learn the lesson” of 1983, when Ronald Reagan and Tip O’Neill got together to make Social Security more solvent by, among other things, gradually raising the retirement age for full benefits.
President Barack Obama did try to reduce the cost of living adjustment in Social Security, a net benefit cut. Primus, according to several outside groups, warned them against going hard against the Obama plan, and asked them to slow-walk any calls for expanding the program. It was a replay of the conversation Dean Baker had with Primus a decade earlier. But the groups didn’t listen, rallied against Obama’s benefit cut and for Social Security expansion, and won. Two hundred House Democrats endorsed a Social Security expansion bill this year.
This rare loss for Primus didn’t alter his viewpoints on fearing deficits and debt. Lawson said that Primus was the driving force behind Pelosi including a controversial “pay-go” provision into House rules, requiring all new spending to be offset with either budget cuts or tax increases. And his top priority for the prescription drug plan, according to his remarks at the Irvine health care conference, is that it saves money for the government, which can then be plowed into other programs.
When Pete Peterson, a billionaire who spent hundreds of millions of dollars to push Washington policymakers toward austerity, died in 2018, Pelosi delivered a floor speech that praised him effusively, as if he’d dedicated his life to eradicating child malnutrition or curing cancer, rather than pouring millions into pushing for major cuts to Social Security and Medicare. “Pete was a clarion voice for fiscal responsibility, and a strong moral conscience in Washington,” Pelosi said in her House floor eulogy of Peterson, who, by 2012, had already spent half a billion dollars targeting Social Security, Medicare, and other spending programs.
If Primus didn’t write that speech, he surely supported it. “He was 100 percent the main guy behind pay-go,” Lawson said. “He thinks the thing you do as a lefty is that you reduce the deficit.”
Jayapal acknowledged Primus’s long tenure in Washington, but suggested that it wasn’t necessarily something to celebrate. “This is somebody who has been a staff for a very long time. We don’t have the health care system we need, do we?” she said. “Maybe it’s time to try something new.”
While progressives have been more willing to attack Primus as a member/staffer interfering with their priorities, they haven’t extended that critique to the woman empowering him: Pelosi. “The speaker respects members. This is separate from her,” DeSaulnier said. Jayapal added, “She has always been respectful of members.” But without a go-sign from the speaker, Primus wouldn’t have any weight to throw around. While the House Democratic caucus has unified in opposition to Trump, there are key splits on core values and ideals. It’s a bit easier to blame the split on a staffer, but the root cause has yet to be resolved.