据知情人士透露，参议院民主党人已就修订后的国内政策法案的关键部分达成一致，该法案曾被称为“重建得更好”，将允许医疗保险公司谈判处方药价格。

民主党人多年来一直致力于赋予医疗保险这一权力，但面对共和党的反对，他们总是功亏一篑，但这一次他们希望将其作为一个更广泛的、尚未完成的经济一揽子计划的一部分，急于为选民提供救济，以应对高通胀和可能的衰退。

自从西弗吉尼亚州的中间派民主党人乔·曼钦(Joe Manchin)去年12月因担心通货膨胀加剧而突然破坏了总统乔·拜登(Joe Biden)的签名国内议程提案(宣布他对福克斯新闻频道的决定令白宫和他的政党感到惊讶)以来，他一直在幕后与参议院多数党领袖查克·舒默(Chuck Schumer)密切合作，制定一项较小的法案，该法案仍将根据特殊规则推进，只需简单多数票——或者在这种情况下，只需民主党投票——即可最终通过，副总统卡玛拉·哈里斯打破了预期的平局。

“参议员曼钦长期以来一直倡导降低老年人处方药费用的提案，他对这一提案的支持从未受到质疑。他很高兴所有50名民主党人都同意，”曼钦的发言人萨曼莎·鲁尼恩告诉美国广播公司新闻，这项交易首先由华盛顿邮报报道。

共和党人一直保持反对该立法的统一战线，称其为民主社会主义，并声称更广泛的立法——最初的价格为2.2万亿美元，但预计在修订版中将大幅减少——只会加剧通货膨胀。

据两名民主党助手称，更广泛的经济法案仍有很长的路要走，预计几周内不会最终确定，但据知情人士透露，周三宣布的这项协议已提交给参议院的规则守护者议员，让她开始漫长而详细的过程，以确保该措施符合民主党打算采用的快速程序的限制，即“和解”。

消息人士对美国广播公司新闻(ABC News)表示，舒默参议员的举动“表明了重大进展，并显示了领导层试图最早在下个月推动一项法案的承诺”。

根据ABC新闻获得的条款摘要，目前的协议将允许医疗保险从明年开始谈判某些处方药的费用;第一次将医疗保险受益人的自付费用限制在每年2000美元，同时向更多低收入老年人提供保费援助;惩罚那些把药品价格提高到高于通货膨胀的制药商，要求制药公司为老年人支付更高价格的回扣。

根据该计划，所有的疫苗都将免费提供给老年人。

也是第一次，民主党人-担心共和党政府不执行这项政策-计划填补他们所谓的“流氓HHS秘书漏洞”根据这份摘要，该条款的目的是要求部长“每年谈判药品的最大数量，以符合谈判条件的药品数量为限。”

民主党人还打算向制药公司施压，让它们将更多的仿制药推向市场。“如果一家制药公司继续阻止仿制药竞争，新的谈判框架会积极地协商越来越低的价格，”该摘要指出。

周三，医疗保险药物谈判协议遭到了在华盛顿拥有巨大影响力的制药行业强大游说机构的严厉批评。

“今天公布的处方药法案对患者来说越来越糟糕。民主党人削弱了以前版本中对患者费用的保护，同时加倍强调将威胁患者获得和未来创新的全面政府定价政策。事实上，他们正在提议废除一项政策，该政策将直接降低数百万老年人在药店的费用，支持新的价格制定计划。该法案还忽略了中间商和保险公司在确定患者自付费用方面的作用，”PhRMA公共事务执行副总裁Debra DeShong在一份声明中说，并补充说，“患者应该得到更好的待遇。”

舒默和曼钦仍在就更广泛的经济一揽子计划中剩下的两个主要项目——能源和气候条款，以及税收改革——进行谈判。

最初的1.75万亿美元立法于11月在众议院获得通过，但曼钦表达了对通胀上升的担忧，突然退出了与拜登总统和政府官员的谈判，令所有相关人士感到震惊。

这位中间派民主党人在12月的“福克斯新闻频道周日”上宣布反对。

仅仅几天后，拜登在接受美国广播公司“今晚世界新闻”主持人大卫·穆尔的独家采访时说，他仍然认为他可以挽救他的议程。

“嗯，听着，我希望尽可能多地完成工作，尽可能多地完成我们可能完成的工作，我仍然认为我们能够完成我们需要完成的大量工作，”拜登告诉穆尔。“特别是当美国人民弄清楚这项立法的内容时。这是极其重要的。”

7个月后，民主党人大幅缩减了最初的一揽子计划，其中包括普及学前教育以及为儿童保育、带薪探亲假、教育、医疗保健和应对气候变化提供大量资金。

到2028年，该法案中的医疗保险处方药谈判部分将包括多达20种名牌药物。目前还不清楚在目前的交易中这种情况是否依然存在。

参与此事的民主党人回避了关于通过任何最终协议的时间表的问题，他们认识到，对错过最后期限的强烈关注困扰着立法的第一次迭代。

但毫无疑问的是，为期一个月的8月休会将变得日益重要，之后的重点是在10月1日之前为政府提供资金，以及很可能改变国会权力结构的关键中期选举。民主党人也非常担心用任何压力吓跑反复无常的曼钦，尽管他们知道重大的经济一揽子计划可能会大大增加他们的政治机会。

Democrats Schumer and Manchin strike deal to cut costs for seniors

Senate Democrats have reached agreement on a key portion of a revised domestic policy bill, once known as Build Back Better, which would allow Medicare to negotiate prescription drug prices, according to a source familiar with the matter.

Democrats have worked for years to give Medicare this power, always falling short in the face of GOP opposition, but this time they hope to move it forward as part of a broader, as-yet-unfinished economic package, anxious to provide relief to voters buffeted to tackle sky-high inflation and a possible recession.

Since centrist Democrat Joe Manchin of West Virginia abruptly scuttled President Joe Biden's signature domestic agenda proposal last December over fears of rising inflation -- surprising the White House and his party by announcing his decision on Fox News -- he has been working intensely behind the scenes with Senate Majority Leader Chuck Schumer on a smaller bill that would still advance under special rules that require a mere simple majority -- or in this case just Democratic votes -- for final passage, with Vice President Kamala Harris breaking an expected tie.

"Senator Manchin has long advocated for proposals that would lower prescription drug costs for seniors and his support for this proposal has never been in question. He's glad that all 50 democrats agree," Manchin spokeswoman Samantha Runyon told ABC News of the deal, first reported by the Washington Post.

Republicans have kept up a united front against the legislation, branding it Democratic socialism and claiming the broader legislation -- originally carrying a $2.2 trillion price tag but is expected to be dramatically reduced in the revised version -- would only exacerbate inflation.

The broader economic bill still has a long way to go and is not expected to be finalized for weeks, according to two Democratic aides, but this deal announced Wednesday was submitted to the Senate's rules-keeper, the parliamentarian, for her to begin the lengthy and detailed process of ensuring the measure fits within the strictures of the expedited process Democrats intend to employ, called "reconciliation," according to a source familiar with the matter.

The move by Sen. Schumer "demonstrates major progress and shows leadership's commitment to trying to move forward with a bill on the floor as early as next month," the source told ABC News.

The current deal, according to a summary of the provisions obtained by ABC News, would allow Medicare to begin negotiating the cost of certain prescription drugs next year; for the first time cap Medicare recipients' out of pocket costs at $2,000 annually while offering premium assistance to more low income seniors; and penalize drug manufacturers that raise the cost of drugs higher than inflation by requiring companies pay a rebate back to seniors for those higher prices.

All vaccines would be available for free to seniors under the plan.

Also for the first time, Democrats -- wary of a GOP administration not implementing this policy -- plan to close what they call the "rogue HHS secretary loophole." The aim of the provision, according to the summary, would be to require the secretary "to negotiate the maximum number of drugs each year, to the extent that number of drugs qualify for negotiation."

Democrats also intend to pressure drug companies to bring more generics to market. "The new negotiation framework aggressively negotiates lower and lower prices if a drug company continues to block generic competition," the summary states.

The Medicare drug negotiation deal was lambasted Wednesday by the drug industry's powerful lobbying arm that holds tremendous sway in Washington.

"The prescription drug bill released today went from bad to worse for patients. Democrats weakened protections for patient costs included in previous versions, while doubling down on sweeping government price-setting policies that will threaten patient access and future innovations. In fact, they are proposing to repeal a policy that would have directly lowered costs at the pharmacy for millions of seniors in favor of a new price-setting scheme. The bill also ignores the role of middlemen and insurers in determining patient out-of-pocket costs," said Debra DeShong, PhRMA's Executive Vice President of Public Affairs, in a statement, adding, "Patients deserve better."

The two major remaining items expected to be in the broader economic package -- energy and climate provisions, along with tax reforms -- are still being negotiated by Schumer and Manchin.

The original $1.75 trillion legislation passed the House in November, but Manchin - expressing fears of rising inflation, abruptly bowed out of negotiations with President Biden and administration officials, shocking all concerned.

The centrist Democrat took to "Fox News Sunday" in December to announce his opposition.

Just days later, Biden, in an exclusive interview with ABC "World News Tonight" anchor David Muir, said he still thought he could salvage his agenda.

"Well, look, I want to get as much as I can possibly get done, as much as we can possibly get done, and I still think we'll be able to get a significant amount of what we need to get done, done," Biden told Muir. "Particularly as the American people figure out what is in this legislation. It's extremely consequential."

Seven months later, Democrats have dramatically scaled back the original package which contained universal pre-kindergarten and significant funding for child care, paid family leave, education, health care and combating climate change.

The Medicare prescription drug negotiation component in that bill would have included up to 20 name-brand drugs by 2028. It is unclear if that would still be the case in the current deal.

Democrats involved in the matter dodged questions about timetables for passage of any final deal, cognizant of the fact that an intense focus on missed deadlines plagued the first iteration of the legislation.

But there is little doubt that the month-long August recess looms large with the focus afterward on funding the government by Oct. 1 and the crucial midterms that may very well alter the power structure in Congress. Democrats are also very wary of scaring off the mercurial Manchin with any pressure, despite knowing that a major economic package could potentially boost their political chances significantly.