Since agreeing to voluntarily reduce drug prices by “as much as $80 billion worth of discounts,” Big Pharma has embarked on a campaign to prevent moderate House Democrats from supporting a measure that would ensure that savings are actually realized. The POLITICO’s David Rogers has the scoop here, but suffice it to say, this rather public intimidation effort casts serious doubt over whether the industry ever plans to realize its voluntary pledge.

The background is rather straightforward. Back in 2003, the Medicare part D legislation moved the six million Americans who were eligible for both Medicare and Medicaid into the Medicare part D program. This created a windfall for the industry. Whereas Medicaid obtained an average discount of about 34 percent from pharmaceutical companies that chose to participate in the Medicaid program, “the average discount obtained by the Part D plans was 14 percent,” according to a report issued by Rep. Henry Waxman (D-CA).

“Under Medicare Part D, the six million dual eligible beneficiaries can take the same drugs they got under Medicaid. The only difference is that the federal taxpayer is now paying 30% more. Add it up, and it amounts to a drug manufacturer windfall worth at least $3.7 billion dollars in just the first two years of the Part D program” Waxman explained:

The drug companies are making the same drugs. They are being used by the same beneficiaries. Yet because the drugs are being bought through Medicare Part D instead of Medicaid, the prices paid by the taxpayers have ballooned by billions of dollars.

Now, if drug manufacturers provided the Medicare Part D program with the same prices that Medicaid receives, “these drug costs could be reduced by as much as $86 billion” over 10 years. Waxman’s legislation would effectively reinstate the rebate for the 6 million who were moved out of Medicaid and, in the process, save taxpayers billions of dollars. And for the industry, that’s precisely the problem. Rogers explains that “PhRMA sees any rebates as a big step backward. In making its deal with Baucus, the industry believes it won a commitment from the senator that he won’t sign a final House-Senate conference report that includes what Waxman wants.”

In other words, PhRMA is only comfortable embracing imaginary voluntary savings. Their agreement with Baucus encourages them to issue coupons or rebates to seniors for “unspacified discounts.” The savings “would benefit Medicare beneficiaries directly” and it’s unclear “what portion would accrue to the federal treasury.” Waxman’s bill would generate guaranteed savings that could help finance health care reform.

The two agreements have different winners and losers to be sure, but any health reform legislation should hold the industry to its word. One option is to design a policy that would trigger Waxman’s rebate proposal if the industry fails to produce the $80 billion it has pledged. After all, these days, triggers seem to be all the rage in health care policy.

Republicans argue that greater government involvement in health care will lead to rationing of care and denial of coverage. A government run health care would place a bureaucrat between “you and your doctor,” Sen. Orrin Hatch (R-UT), a member of the Senate Finance Committee, repeated at least four times during a recent interview on Fox News.

And according to some reports, Hatch is working hard to translate his criticism into reality. Hatch and his Republican colleagues on the Senate Finance Committee are pushing legislation that would require insurers operating within the new Exchange to to deny coverage for abortion services. From Raising Women’s Voices:

The Senate Finance Committee has been writing a health care reform bill and struggling to create legislation that will have bipartisan support. Chairman Max Baucus (pictured left) considered several compromises to win Republican support, so they can claim it is bipartisan legislation. One of these potential compromises comes in the form of an abortion exclusion, which would prevent abortion services from being covered by some or all insurance plans in the Health Insurance Exchange. We fear that members of the Senate Finance Committee are considering such a compromise.

Nineteen House members have also sent a letter to House Speaker Nancy Pelosi (D-CA) stating that they will not vote for health care reform legislation “unless it explicitly excludes abortion funding from the scope of any government-defined or subsidized health insurance plan.” “Furthermore, we want to ensure that the Health Benefits Advisory Committee cannot recommend abortion services be included under covered benefits or as part of a benefits package,” the members wrote.

The available legislation from the Health, Education, Labor and Pensions (HELP) Senate Committee and the House’s Tri Committee leaves the coverage decisions — the design of the so-called essential benefit packages — to the Secretary of Health and Human Services or a committee of experts. The Chairman’s mark of the HELP bill sates that “the Secretary shall ensure that the scope of the essential health benefits under paragraph (1)(A) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary.” The Tri Committee legislation establishes a “private-public advisory committee which shall be a panel of medical and experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and an essential benefits package.”

Should it pass, the Senate Finance version would be the only bill that specifically prohibits — takes away, rations, if you will — a medical service. Approximately one in three American women will have an abortion by age 45 and private insurers typically cover the procedure. In 2002, The Guttmacher Institute found that 86.9 percent of “typical” employment-based health plans “routinely cover” surgical abortion and 86.5 percent “routinely cover” medical abortion. The language under consideration would take away this benefit from women receiving coverage through the Exchange, eliminating the service for millions of American women.

As Republicans often argue, Congress should leave benefits decisions to the medical professionals. After all, if denying abortion services to women is the price of bipartisanship, then perhaps winning those one or two Republican votes isn’t worth the price of jeopardizing women’s health and well-being. In fact, according to a new national opinion survey conducted for the National Women’s Law Center (NWLC), 71 percent of Americans overwhelmingly support requiring health plans in the Exchange to cover women’s reproductive health services. Even 78 percent of Republicans prefer an independent commission of citizens and medical professionals make decisions about what should be covered under reform rather than the President and Congress. Allowing an independent commission of medical professionals to make coverage decisions is the real face of bipartisanship.