Why Does Elizabeth Warren Hate the 21st Century Cures Act?

A quick primer on the bill drawing Warren’s opposition.

Sen. Elizabeth Warren, D-Mass., asks a question of Janet L. Yellen, of California, Presidential nominee for Chairman of the Board of Governors of the Federal Reserve System, at a hearing of the Senate Banking, Housing and Urban Affairs committee examining Yellen's nomination, on Capitol Hill in Washington, Thursday Nov. 14, 2013. (AP Photo/Jacquelyn Martin)

Photo via AP

UPDATED, December 7, 3:30 p.m.: Despite Senator Warren’s best efforts, the 21st Century Cures Act passed the Senate Wednesday by a near-unanimous vote of 95 to 4. It will go next to President Obama, who is expected to sign it into law.

Original story:

You may not know much about the 21st Century Cures Act, but you’ve likely heard that Elizabeth Warren is fighting it, tooth and nail.

Why is this bill drawing the Massachusetts senator’s ire? Here’s a quick primer.

What is the 21st Century Cures Act, in a nutshell?

The wide-ranging piece of legislation would do a number of things. It would earmark billions of dollars for public health initiatives and medical research, including Vice President Biden’s Cancer Moonshot, President Obama’s Precision Medicine Initiative, the BRAIN Initiative, fighting the opioid crisis, and reforming mental health care. Funding would also be given to the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). The bill would also speed up the prescription drug and medical device approval process, helping new products reach FDA approval faster.

Why should I care?

If passed, the 21st Century Cures Act would shape the direction of medical research in this country, from national efforts to close-to-home causes such as the opioid epidemic. Changing the process by which drugs and devices are approved could also affect the therapies available to patients, and likely the costs associated with them. Making drug approval easier could potentially also endanger patient safety, according to some critics.

Since Massachusetts is a hub of pharmaceutical companies, hospitals, and medical research, these changes could directly affect some of our local institutions. The Cancer Moonshot and Precision Medicine Initiatives also have strong Boston representations.

Medicine aside, the bill represents a rare example of bipartisan support in the government. It’s been years in the making, championed by Michigan Republican Fred Upton and Colorado Democrat Diana DeGette.

Why does Senator Warren oppose it?

Warren feels that the bill has been “hijacked” by the pharmaceutical industry. In an impassioned speech on the Senate floor Tuesday, Warren criticized the bill’s friendliness to the pharmaceutical industry and major donors. While the senator has long called for more funding for medical research, she claims the bill is meant to extort Democrats into voting for the legislation, sweetening “a lot of bad stuff” with “good, bipartisan proposals”—including mental health reform, privacy protections, and funding—that make it hard to say no.

“I cannot vote for this bill,’’ Warren said in the speech. “I will fight it because I know the difference between compromise and extortion.”

Among other things, Warren has taken issue with provisions that would allow doctors to use drugs for non-FDA-approved purposes; shield drug companies from disclosing financial incentives given to hospitals and doctors; and hasten the development of stem cell therapies, which she says would directly benefit an unnamed Republican “megadonor.”

Nonetheless, the bill has garnered support from many of Warren’s fellow senators, and some were displeased by her Tuesday speech. John Cornyn, of Texas, “called for more civility” after she finished speaking, STAT reports.

The Pharmaceutical Research and Manufacturers of America’s president also praised the bill’s “pro-patient, science-based reforms which enhance the competitive market for biopharmaceuticals and drive greater efficiency in drug development.”

Does Warren have any big allies?

Yes. Senator Bernie Sanders is standing with her. In a statement released Tuesday, Sanders said the bill “provides absolutely no relief for soaring drug prices” and “includes numerous corporate giveaways that will make drug companies even richer.”

Several other senators, including Dick Durbin of Illinois and Jeff Merkley of Oregon, have come out against the legislation.

What’s the status of the bill?

The 21st Century Cures Act passed the House with flying colors, by a margin of 392 to 26. It heads to the Senate next week, where it is expected to pass, though Senate Minority Leader Harry Reid admitted there is “angst” among his colleagues about what to do.

While the act looks likely to pass, and has support from the Obama Administration, Warren sent a last-minute fundraising request to her donor base, in an email with the simple subject line, “Hijacked.”

Haven’t I heard of this before?

Possibly. The House approved an earlier version of the bill in 2015. The latest iteration incorporates tweaks made since then, including more funding for medical research and the expansion of mental health services.

Where can I find out more?

Right here.