Cozen Currents: How Far Can Progressives Progress?

“The soul of the Democratic Party is up for grabs. Progressives are seeing momentum at the local level, but it’s not clear how far they can leverage that to transition from playing the role of party insurgents to becoming the establishment.” — Howard Schweitzer, CEO, Cozen O’Connor Public Strategies

The Cozen Lens

• Progressives are gaining electoral momentum and shifting the Democratic Party to the left, though their success may have limits on the national stage.
• From the impact of GLP-1 medications to how the Food and Drug Administration approves drugs, much of the policy debate around pharmaceuticals centers on one number: a pill’s list price.
• A growing gap between the White House’s China diplomacy and Congress’s hawkish legislative agenda is emerging, with the FY27 National Defense Authorization Act likely to be where the two approaches collide.

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What ‘Progressivism’ Means Today

To the Left, to the Left. The left flank of the Democratic Party is gaining momentum.

• Progressives have delivered strong performances in primaries recently, especially in big cities. Last year, democratic socialists Zohran Mamdani and Katie Wilson defeated more moderate incumbents and were elected mayors of New York City and Seattle, respectively. DC Council Member Janeese Lewis George won the Democratic mayoral primary, teeing her up to become the first democratic socialist mayor of the nation’s capital, while Los Angeles City Council Member Nithya Raman forced Mayor Karen Bass (D) into a runoff, the first time an incumbent LA mayor failed to crack 50 percent in the first round since 2005 and only the second time since 1973.
• On the federal level, the insurgent candidate Graham Platner recently won the Democratic Senate nomination in Maine. Meanwhile, Abdul El-Sayed, endorsed by Senator Bernie Sanders (I-VT), is polling competitively with two more traditional candidates in the Democratic Senate primary in Michigan.
• Democrats’ views of capitalism are souring. Gallup polling last fall found that the percentage of Democrats who had a positive image of capitalism fell from 51 percent in 2010 to 42 percent. By contrast, the percentage of Democrats who had a positive image of socialism rose from 50 percent to 66 percent during this period.
• Hailing from outside the party establishment, democratic socialist and progressive candidates are tapping into voter anger over affordability and discontent with politics as usual. The electoral success of these insurgents in primaries is shifting the Democratic Party’s center of gravity and challenging previous party orthodoxies.

Sanders’ Succession. Sanders is the dean of the progressive movement but it’s unclear who will follow him as the standard-bearer.

• Sanders’ two presidential campaigns paved the way for progressives to expand their influence in the party and brought policy positions such as Medicare for All and the Green New Deal to the Democratic mainstream, but he will be nearing 90 when his current Senate term ends.
• Representative Alexandria Ocasio-Cortez (D-NY) has positioned herself as Sanders’ heir, joining him for the Fighting Oligarchy tour, and is flexing her own political muscles as a kingmaker in Democratic primaries. While Sanders has offered his endorsement widely, Ocasio-Cortez has endorsed in a more limited set of races and racked up a winning streak in congressional primaries, including recent races in California, Montana, New Jersey, and Pennsylvania.
• Ocasio-Cortez isn’t the only high-profile progressive on the political stage, however. An adept communicator on social media, Mamdani has dominated left-leaning politics since winning Gracie Mansion and has rapidly become a highly recognizable face of democratic socialism. Representative Ro Khanna (D-CA) is thought to be a potential contender for the 2028 Democratic presidential nomination and his role in advocating for the release of the Jeffrey Epstein files expanded his national profile. Other progressives in Congress such as Representative Maxwell Frost (D-FL) are building their own political brands.

The Bigger Picture. While progressive insurgents are harnessing the energy of the Democratic base, they may face political headwinds outside of deep-blue areas.

• Some of the progressive or democratic socialist candidates endorsed by Ocasio-Cortez won primaries in heavily Democratic districts, for example, and won’t face competitive general elections. This is the case for Pennsylvania state Representative Chris Rabb (D) and New Jersey congressional candidate Adam Hamawy.
• More left-leaning candidates may energize the Democratic base, but they risk not appealing to wider swaths of the electorate in general elections. In an analysis published in April, centrist think tank Third Way argued that moderate Democrats won 50 Republican-held congressional seats since the beginning of President Trump’s first term while “far-left” ones didn’t flip any seats.
• The left flank of the Democratic Party is just a small slice of the wider electorate and doesn’t account for a majority of the party. The two major parties don’t fully account for the full spectrum of voters’ opinions. The Pew Research Center recently classified voters into nine subgroups on the basis of political and cultural views. The most ideological groups on the left, “Leftward Progressives” and “Loyal Liberals,” accounted for only 17 percent of all voters surveyed. These two typologies amounted to only 35 percent of the Democratic Party’s coalition. While this may be enough to win a primary, it’s far from an ironclad majority.

The Public Cost of Longevity

The Skinny on Weight-Loss Drugs. Starting this year, the government will begin covering GLP-1 medications for weight loss.

• Weight-loss drugs are expected to become “the best-selling medication in history” and rocket fuel for the apparel These drugs are also challenging restaurant and other food-related revenue while single-handedly wrestling the obesity rate down. But in a country where more than one-third of people (which amounts to over 115 million people) primarily get their healthcare through government programs like Medicare and Medicaid — and where the vast majority of employer-sponsored and marketplace insurers do not cover anti-obesity medications — the fate of these drugs was and is always inextricably linked to policy.
• Since 2003, Medicare has been statutorily banned from covering drugs for weight loss, but that hasn’t stopped the federal government from paying billions of dollars for GLP-1 agonists. In 2024, Medicare spent $15.2 billion on semaglutides for 2.3 million patients, up from a mere $57 million in 2018 — on the order of about 10 percent of Medicare Part D net benefit spending. Outpatient prescriptions under Medicaid increased from 755,000 to 3.8 million, with spending rising from $597 million to $3.9 billion from 2019 to 2023. This is because Medicare is required to cover these same drugs for other indications, primarily diabetes, which is both common and comorbid with obesity. GLP-1 agonists have expanded to include approvals for cardiovascular health and sleep apnea in recent years, with numerous other studies underway examining how these drugs may meaningfully treat a suite of additional conditions. This has expanded access to anti-obesity medications, but the dam still hasn’t broken.
• The Treat and Reduce Obesity Act (TROA) would permit Medicare to cover weight-loss drugs for the very first time. Under the last modified proposal, individuals who had been taking such drugs for a year or more under insurance before joining Medicare would be eligible to continue starting in 2027. It’s got bipartisan support. However, it’s also got a price tag.
• GLP-1 drugs are expensive, but perhaps doing nothing would cost even more. The counterargument is that the chronic diseases associated with obesity are costly themselves. The range of uncertainty around estimates is wide, as the long-term effects of medications and how long people continue treatment become better known, but the estimates thus far all have more costs than savings. An informal estimate puts TROA at $1.7 billion over the next decade; full coverage under Medicare Part D would cost $25–$35 billion more than it would save over the same period.
• The executive branch is doing what it can to lower prices and expand access to GLP-1s. Medicare will begin covering anti-obesity medications for weight loss next month as part of a deal with pharmaceutical manufacturers, with a copay of just $50 for eligible patients. Plans to have private Medicare insurers cover the drugs for three years under a voluntary program (BALANCE) have been indefinitely delayed due to low uptake, leaving the government to pick up the tab through the end of the year. The Medicare Drug Price Negotiation program bartered the compound behind Ozempic from a $959 list price to $274, starting next year.

Not Worth Paying For. While some parts of the Trump administration are trying nothing more than to lower drug prices, other parts of the Republican coalition are questioning whether some medications are worth paying for at all.

• In addition to the Negotiation program, the White House has worked to establish most-favored-nation (MFN) drug pricing. A deal with Regeneron last month marks the completion of talks with 17 pharmaceutical manufacturers to provide discounts or face tariffs. Other terms of the deals include offering certain medicines at a discount off the list price directly to consumers on gov. Within the year, the Centers for Medicare and Medicaid Innovation plans to launch the GLOBE and GUARD models, which would implement mandatory MFN pricing for covered drugs under Medicare Parts B and D (those that have signed voluntary agreements would be exempt).
• Whether it be programs that explicitly require drug companies to offer lower prices for their products or a less strenuous development cycle, the Food and Drug Administration (FDA) has been coordinating with the White House to keep medication costs down. One of the agency’s biggest initiatives thus far has been the establishment of the Commissioner’s National Priority Voucher program, which can “reduce drug and biological product application or efficacy supplement review times from 10-12 months to just 1-2 months.” In theory, a side effect of reducing regulation and shortening review timelines should be cheaper drugs. But what’s interesting is that “increasing affordability” by “lower[ing] the US price of a drug” is itself one of the criteria that could qualify a firm for this program. Along with “onshoring drug development and manufacturing,” this is an unprecedented step in which the FDA is explicitly considering economic criteria to hasten drug approvals.
• But this reveals fractures within the Republican Party. While MAGA and the traditional GOP both favor deregulation, MAHA — the Make America Healthy Again movement — thinks the industry has been treated far too lightly. At the core of this schism are differing burdens of proof companies need to establish to prove their treatments are both safe and effective, or are effective enough to be FDA-approved and covered by Medicare. In all, the FDA has denied or discouraged applications for at least eight drugs in the last year, in each case contradicting earlier statements it had made to the companies in question (by another count, “about 20”). In one example, Sarepta was ordered to pause all shipments of a Duchenne muscular dystrophy treatment last year following reports of patient deaths, igniting a firestorm of controversy within the right. The president has long been a supporter of ‘right to try’ initiatives, the very opposite of restricting access to medications due to dubious efficacy or serious safety concerns.

The China Divide Within the US Government

Trump’s China Strategy Shift. Under the banner of “constructive strategic stability,” the White House is pursuing a more cautious China strategy, focusing on shoring up US weaknesses rather than picking fights.

• Since the initial trade war with China, the Trump administration has largely adopted a more conciliatory approach to the rivalry, pursuing a strategy now described as “constructive strategic stability.” While the White House remains intent on outcompeting China, it now favors a less confrontational and more indirect approach. In practice, this means focusing on shoring up US strategic vulnerabilities where China has leverage, such as critical minerals.
• Another aspect of this shift has been a less aggressive approach to semiconductor export controls, with the Trump administration favoring a strategy to make China “addicted” to the US tech stack by allowing purchases of more advanced chips. So far, this strategy has yielded few results, as the Chinese government has sought to limit purchases of these semiconductors, pushing instead for greater reliance on domestic companies. Still, it does not appear that the White House intends to abandon this philosophy for a more hawkish approach, though approving sales of more advanced devices remains a bridge too far in the near term.
• This changed approach is also reflected in how the Trump administration frames these actions, choosing not to highlight anything that could be construed as more aggressive, such as the recent release of the Department of Defense’s list of Chinese military companies. This year’s revision was initially delayed to minimize any risk of disrupting President Trump’s visit to China. Then it was ultimately released with minimal fanfare earlier this month, even though the list is largely a name-and-shame tool. Other more hawkish actions, like potential updates to the Commerce Department’s Entity List, appear off the table for now, likely out of a concern that Beijing would perceive those steps as a violation of the trade truce agreed to last October.

Hawks on the Hill. Bipartisan China competition legislation is gaining momentum on the Hill, but the Trump administration’s blessing remains the critical unknown.

• In contrast to the White House’s strategy, a more traditional China-hawk philosophy remains widely popular across both parties in Congress. As part of this, lawmakers are seeking to pass several bills this year to target US-China competition across sectors such as semiconductors, connected vehicles, and biotech. The most likely path to passage for these bills will be as part of the annual defense policy bill, which has increasingly become a catch-all for such measures.
• Currently, more progress has been made in the House to advance these measures, with several having advanced out of their respective committees of jurisdiction. Now, sponsors will look to attach the bills to the chamber’s draft of the FY27 National Defense Authorization Act (NDAA), which could be marked up before the end of this month. Similar progress has yet to be made in the Senate. Still, there is growing interest, with sponsors aiming to channel momentum from a recent Senate Banking Committee hearing that addressed semiconductor export controls against China into a markup.
• While these bills may have relatively strong bipartisan, bicameral support, it is unclear to what extent they have the White House’s blessing, which should be key for any of the measures to become law. Although the Trump administration has offered few public comments on these proposals, it has previously opposed similar efforts to pass more hawkish legislation that it feels could jeopardize its careful management of the US-China relationship. This input may not come until the fall, when the NDAA is closer to completion. However, the Trump administration’s stance will remain a key factor to watch, as it will likely prove decisive.

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