Final passage remains far from guaranteed. Democrats in both chambers need to reconcile competing plans for financing the package and divisions over how to structure key components, most likely before the legislation reaches the House floor. It is possible that additional provisions will be added, including a push from some lawmakers to address the cap on the deduction for state and local taxes.
Ms. Pelosi has pledged to iron out differences with the Senate before holding a floor vote, and the drug provision remains one of the thorniest issues for leaders to resolve. While the Ways and Means Committee vote kept it in the package for now, the defections on the Energy and Commerce panel signaled that it would most likely need to change in order for the entire bill to become law.
“There is no excuse for every Democrat not supporting it,” Senator Bernie Sanders, the Vermont independent who is the chairman of the Budget Committee, said in a statement. “Now is the time for Congress to show courage and stand up to the greed of the pharmaceutical industry. The American people will not accept surrender.”
The drug pricing provision is a major policy priority for congressional leaders and the White House. High drug prices are a major consumer issue and a top voter concern. All three of the holdouts voted for nearly identical legislation when it passed the House in 2019.
“Polling consistently shows immense bipartisan support for Democrats’ drug price negotiation legislation,” Henry Connelly, a spokesman for Ms. Pelosi, said in a statement after the vote. “Delivering lower drug costs is a top priority of the American people and will remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill.”
During the hearing on Wednesday, Representative Frank Pallone Jr. of New Jersey urged his colleagues to vote to advance the bill, pledging “that your voices will be heard either with a seat at the table or through me.”
The moderates were unmoved, though they refrained from forcing a vote on their own drug pricing alternative. Mr. Schrader said he hoped “this is genuinely the beginning of a conversation on drug pricing policy that can actually be signed into law.”