When Representative Kathleen Rice was running for reelection from New York last year, the centrist Democrat’s campaign ads announced that “in times of crisis, you see what really drives someone.” What drove Rice, the ads declared, was a recognition of the necessity of “taking on drug and insurance giants to lower costs.”

So when Rice secured a coveted spot this year on the House Energy and Commerce Committee—which has a big say on how Washington can take on the pharmaceutical industry—it was reasonable to assume she would vote for legislation authorizing Medicare to use its immense buying power to negotiate lower prescription drug prices. Right?

Wrong.

Rice, a member of the Wall Street–aligned New Democratic Coalition, has over the course of her congressional career raised more than $8.4 million —much of it from the finance and insurance industries, but also with a considerable $386,436 from health care business PACs and individuals associated with the industry. She’s generally recognized as one of the more “corporate” Democrats in Congress, and when it came time this week to choose between patient need and industry greed, the New Yorker sided with the corporations that have been lobbying against the critical component of the Democratic program for cutting drug prices.

Rice joined two other centrist Democrats, Scott Peters of California and Kurt Schrader of Oregon, in voting against advancing the plan to authorize direct government negotiation of drug prices. On a committee that is split 32-26, the decision of Rice and the two other Democrats to align with the Republicans blocked approval of the price-negotiation proposal, in a blow to the agenda laid out by President Biden and Democratic leaders in the House and Senate. The Washington Post wrote that they were putting a “roadblock” in the way of the Democratic program; Politico observed that the trio “threw their party’s health care agenda into disarray.”

It’s not just that Rice, Peters, and Schrader set back the historic fight to address the excesses and abuses of Big Pharma. They also undermined efforts to enact the “go big” agenda that Biden and Senate Budget Committee chair Bernie Sanders are seeking to advance with a $3.5 trillion reconciliation bill. The estimated $456 billion that could be saved over the coming decade by negotiating lower drug prices is essential, as it helps to fund the budget plan’s expansion of Medicare coverage, home- and community-based caregiving, and paid family and medical leave.

While Peters and Schrader have always been closely tied to Big Pharma—collecting $860,465 and $614,830, respectively, from the industry over the course of their congressional careers—Rice’s take has been more modest. In recent cycles, she’s accepted between $15,000 and $25,000 from pharmaceutical interests. Yet those contributions have come in the context of an overall profile of heavy fundraising with corporate interests—especially in the financial services sector.

Among the centrists on the committee, Rice’s vote was always going to be the defining one. So when she cast it on the side of the drug companies, the outcry was intense. “Kathleen Rice’s vote against lower drug prices is an affront to the working New Yorkers who expect their representatives to have their best interests at heart,” announced Sochie Nnaemeka, the director of the New York Working Families Party. “Her vote undermines President Biden’s Build Back Better agenda by siding with corporate CEOs over struggling seniors.”

Expressing his deep disappointment with the 29-29 vote on the House Energy and Commerce Committee, Sanders said, “I understand that the pharmaceutical industry owns the Republican Party and that no Republican voted for this bill, but there is no excuse for every Democrat not supporting it.”

He’s right. But blame for this fiasco does not merely rest with Rice, Peters, and Schrader.

After the 2020 election, when it was clear that the House as a whole and key committees in particular would be narrowly divided between Democrats and Republicans, House Democratic leaders were in a position to fill openings on committees with reliable progressives who could be counted on to embrace the bold agenda that the president and key senators such as Sanders were advancing. With the defeat in 2020 of New York Democrat Eliot Engel, a veteran member of the Energy and Commerce member, there was an opening for a representative from New York on the committee.

New York Representative Alexandria Ocasio-Cortez stepped up. As one of the party’s most prominent advocates for taking on Big Pharma, and a leading advocate for addressing the climate crisis—another focus of the committee—she was a natural choice. And AOC had the support of House Judiciary Committee chair Jerry Nadler, the senior member of New York’s Democratic delegation, as well as other key Democrats from the state.

But the House Democratic Steering and Policy Committee, the body that oversees committee assignments, passed over Ocasio-Cortez and chose Rice. The surprise move was pushed by Texas Democrat Henry Cuellar, the most conservative member of the caucus, who objected to the willingness of AOC and other progressives to support primary challenges to corporate-tied incumbents. In 2020, AOC endorsed Jessica Cisneros, a human rights lawyer who earned 48 percent of the vote in her challenge to Cuellar.

The steering committee overwhelmingly backed Rice, despite the fact that she had tangled with House Speaker Nancy Pelosi (D-Calif.) and objected to progressive initiatives.

It was a fateful decision.

Had AOC been placed on the Energy and Commerce Committee, the vote for permitting negotiations to lower drug prices would almost certainly have been 30-28. This mess may yet be cleaned up with a manager’s amendment on the House Budget Committee, or by a decision to err on the side of the version of the broader bill approved by the Ways and Means Committee. But there are no guarantees, especially in a moment when pharmaceutical industry lobbyists are pulling out all the stops. One of the most popular pieces of Democratic agenda remains under serious threat.

“There is no good reason, none, for any member of Congress to block pricing reform. There is especially no good reason for any Democrat, since voters elected Democrats specifically to deliver on promises to bring down medicine prices,” said Robert Weissman, the president of Public Citizen. “There are, however, many very identifiable, bad reasons for members to side with Big Pharma and against their constituents.”

Sanders summed up the bad reasons when he said Wednesday, “The pharmaceutical industry has spent over $4.5 billion on lobbying and campaign contributions over the past 20 years and has hired some 1,200 lobbyists to get Congress to do its bidding. They are the most powerful industry on Capitol Hill. Nonetheless, the American people are demanding that Congress stand up to them and finally lower the outrageous price of prescription drugs by requiring Medicare to negotiate with the pharmaceutical industry. 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 combative language is appropriate. This is going to be a battle.

What’s frustrating is that the House Democrats on the steering and planning committee sent a compromising centrist into the fight when they could have chosen AOC and the path of bold progressive resistance to Big Pharma greed.