The closed-door negotiations “reveal a familiar dynamic in Washington, where political parties don’t debate each other on policy as much as they mediate fights between corporate interests.”

Progressive activists and lawmakers criticized House Democratic leadership last week for their non-transparent approach to crafting drug price legislation. Progressives fear they are being shut out of a decision making process that will lead to a weak bill incapable of addressing skyrocketing prescription drug costs.

Rep. Alexandria Ocasio-Cortez (D-NY) and Rep. Lloyd Doggett (D-TX) were among the House Democrats who felt their leadership’s non-inclusive approach to crafting legislation is part of a bigger problem.

“That’s a problem and it’s part of a pattern, I think, where we don’t know things until 48 hours before. And then it’s like, ‘You’re either with us or you’re against us,'” said Rep. Alexandria Ocasio-Cortez.

Rep. Doggett is the sponsor of a bill that would allow Medicare to directly negotiate drug prices with pharmaceutical companies. Doggett’s bill would also diminish the monopoly power of drug corporations by permitting the government to authorize low-cost generics in the event of a stalled negotiation. Although Doggett’s bill has 125 co-sponsors and the endorsement of the Congressional Progressive Caucus (CPC), House Speaker Pelosi and other establishment Democrats have ignored the Texas Representative’s ambitious proposal.

“We have a great history with Republicans where they locked up their healthcare plan so that even Rand Paul couldn’t see it, and they held their tax plan to the last minute,” Doggett told reporters, “so if there is to be good collaboration here there needs to be more openness.”

House Speaker Pelosi’s tentative proposal would allow the Department of Health and Human Services to negotiate at least 25 of the most egregiously priced drugs per year and give the Government Accountability Office more power to arbitrate disputes. Supporters of Pelosi’s plan argue its details have yet to be finalized and believe its more moderate approach could gain support from the Trump administration.

“Congress should focus on price negotiations on key drugs for the same reason that bank robbers rob banks: Because that’s where all the money is,” Ben Wakana, executive director for Patients for Affordable Drugs, told Politico. “It is really a handful of two dozen drugs that are driving the majority of the spending in Medicare.”

Critics of the House leadership’s plan believe its 25-drug limit, as well as its failure to use the government’s huge purchasing power as negotiation leverage, would fail to tackle the most serious abuses of the pharmaceutical industry. Rep. Pramila Jayapal (D-Wash.) told Politico she “sent Democratic leadership staff a list of questions about their drug pricing work, demanding details after the latest plan raised ‘lots of concerns’ about whether it would make a significant dent in the prices Americans pay for their prescription drugs.”

The Intercept’s David Dayen notes that a lobbyist for the health insurance industry is one of the few experts advising Speaker Pelosi’s secretive bill, and argues the House Democrats are negotiating on behalf of pharmacy benefit managers while the Trump administration vouches for drug companies. Dayen says the closed-door negotiations “reveal a familiar dynamic in Washington, where political parties don’t debate each other on policy as much as they mediate fights between corporate interests.”

Other critics argue Democratic leadership’s attempt to negotiate with the Trump administration, while shutting out the progressive wing of their own party, is a misguided pursuit. Critics challenge the president’s longstanding commitment to lowering drug costs by pointing to his administration’s deep ties to the pharmaceutical industry, as numerous lobbyists and former employees hold positions in the cabinet.

Alex Azar, who became the Trump administration’s Secretary of Health and Human Services after former secretary Tom Price resigned amid ethics scandals, represents one of the clearest examples. Azar previously served as CEO of the drug company Eli Lilly during a period when the company more than doubled the cost of its version of insulin.

“The price of insulin has tripled in the last decade,” said Senator Amy Klobuchar. “If you want to bring down drug prices, you don’t put a former pharmaceutical company executive in charge of health care policy for our country.”

“It’s no surprise that drug prices continue to skyrocket on the Trump administration’s watch,” said Restore Public Trust spokeswoman Lizzy Price. “Trump and Secretary Azar have talked a big game about lowering drug prices, but they simply haven’t delivered. Trump’s pharma hires into key positions are one reason why.”

With both Republican and Democratic voters citing drug prices among their top concerns, the final bill could have tremendous consequences for the 2020 election.