In the aftermath of Sen. Joe Manchin (D-WV) voting to confirm Sen. Jeff Sessions (AL) as Attorney-General, liberals on Twitter have been going nuts and demanding that Manchin be primaried for proving he’s insufficiently liberal. None other than Sally Kohn has threatened to relocate to West Virginia to take Manchin down.

To any rational and vaguely well-informed observer of politics, it’s obvious that Manchin has never been anywhere close to in-line with someone like Sen. Elizabeth Warren (MA) philosophically. So, Manchin’s Sessions vote isn’t indicative of some newfound “conservadem” instincts. For anyone who’s ever been to West Virginia, it’s also pretty funny that liberal Twitter thinks it could get a Democrat like Warren elected in the state. But liberals, and conservatives for that matter, wanting to take down Manchin might still have a viable line of attack against him: Votes and positioning that look partially-geared towards helping his daughter, beleaguered Mylan CEO Heather Bresch.

As RedState has previously covered, Manchin was not merely in the “yea” column for Sessions. He also aggressively championed confirming Sessions well ahead of President Trump even being inaugurated. Manchin critics point to cable news appearances, and this quote he gave to Politico:

Informed that Democrats might hold up Sessions and other nominations past Jan. 20, Sen. Joe Manchin of West Virginia responded: “That’s just bull****.”

“My God, I think we should have an attorney general in place on Jan. 20. I sure do believe that,” added Manchin, one of five Democratic senators up for reelection in 2018 in states that overwhelmingly supported Trump.

This was read by most as an effort by a vulnerable red-state Democrat to insulate himself heading into what could be a tough re-election fight. But as has been noted here, with President Trump continuing to make reining in high drug prices a high priority, and Mylan remaining in the spotlight over its EpiPen pricing—and the DOJ having huge jurisdiction there, there was another major reason why Manchin might have wanted to play nice with the administration and Sessions. That is, as we noted, even more the case given that Sen. Chuck Grassley (IA), who was responsible for getting Sessions confirmed, is the main senator leading a charge against Mylan, again regarding drug pricing. Manchin got his daughter her first job at Mylan. It seems likely, at least, that he saw playing nice with Sessions and Grassley as political “gravy” making something that was politically rational for him to do anyway even more appealing. That’s an issue that liberals could plausibly raise if they really wanted to oust Manchin, though admittedly, it would be harder for conservatives to do so.

Where conservatives might stand a chance of pinning Manchin regarding votes benefiting his daughter comes with his vote against Rep. Tom Price (GA)’s nomination as HHS Secretary, which from a straight political calculus standpoint kind of makes sense and kind of doesn’t.

On the one hand, West Virginia isn’t exactly Silicon Valley in terms of its population’s health or wealth. Some of the provisions of Obamacare—which Price has long been intent on dismantling, a charge he’ll be leading for Trump—probably do disproportionately benefit West Virginia’s poorer population. The state simply has a higher incidence of things like diabetes and obesity, and presumably also respiratory illness and drug addiction, than do lots of more affluent, white collar areas of the country.

On the other hand, as noted (though not by the liberal Twitterati), Manchin represents a red state where anything with the name “Obama” in it (as in Obamacare) is, shall we say, less popular than in, well, probably most states. Don’t forget, in a Democratic presidential primary, 41 percent of West Virginia voters supported Keith Judd, a prison inmate, over Obama. Manchin’s constituents undoubtedly like certain components of Obamacare, but votes to save it—or against a guy who would dismantle it— don’t look like a clear political win for Manchin, at least not in the era of Trump.

But as with Manchin’s vote for Sessions, there may have been some “gravy” to be had in voting against Price that again ties in with his daughter. Price is known in health care circles to be an ardent defender of the 340B drug discount program, which at no taxpayer cost essentially gets poor, rural patients drugs for cheap in exchange for pharmaceutical companies getting access to entitlement monies. The pharmaceutical industry has come to hate the program, which they see as constraining its ability to maximize profits.

Manchin has supported 340B, albeit perhaps the most notable example of that came before the industry started waging an all-out war on the program during the last 18 months or so. Notably, 340B is one thing that has blocked Mylan making even more out of its EpiPen price hikes, because the program does cover EpiPens. No Price, more likelihood of rolling back an initiative that Manchin’s daughter’s company wants cut? Maybe.

Also worth noting is that while Manchin has supported Medicare directly negotiating drug prices with pharmaceutical companies—as Trump has consistently advocated, and Price will presumably be tasked with helping with as HHS Secretary, whether he likes it or not—it seems he has done it more as an alternative to supporting straight-up cuts in Medicare’s payment for drugs. The latter thing would be bad for Mylan, whereas Medicare negotiating drug prices with pharmaceutical companies including Mylan could potentially be just fine for the drug-maker.

Why? As the LA Times’ Michael Hiltzik recently noted, this policy—favored by Trump and lots of Democrats, including apparently Manchin— “may simply not be as effective as people expect. ‘The reason is that any attempt to get a better price means the paying party needs to have a quasi-credible threat to say no and walk away,’ observes Richard Mayhew, the ace health insurance expert at balloon-juice.com… The Part D companies don’t always have that threat at hand.” In short, that’s because it’s politically untenable to say “fine, then seniors will just go without drugs” and walk away from the negotiating table altogether if pharmaceutical companies won’t agree to bring drug prices down.

It’d be pretty tricky, politically, for any Democrat in a primary with Manchin to invoke either of these arguments, or be seen to be attacking Manchin for voting against Price, as the entire Democratic establishment wanted him to. But it might be tenable for a conservative Republican opponent to make them in a match-up against Manchin.

Depending on what kind of candidate(s) challenge Manchin, his record as governor with regard to pharmaceutical matters might also present a viable target. Back in the day, West Virginia Democrats took issue with Manchin’s apparent lack of enthusiasm for a mechanism to rein in drug prices, and it’s the kind of thing you could potentially see a populist conservative candidate also making an issue of. In January 2011, the Charleston Gazette reported:

“In 2004, West Virginia hoped to lead the nation in efforts to contain soaring prescription drug costs — not just for public benefit programs, but for all consumers. The Legislature passed the landmark Pharmaceutical Availability and Affordability Act, signed by former Gov. Bob Wise in the last year of his administration.

The 2004 legislation created the Pharmaceutical Cost Management Council and an appointed state pharmaceutical advocate. Neither exists now.

A key component would have made drug makers disclose spending on marketing to doctors — in the form of gifts, trips, speaking fees and other compensation — and direct-to-consumer advertising.

The legislation’s advocates wanted to use that spending data to help the state negotiate prices with drug makers.

Eventually, drug makers only had to report aggregate data, meaning individual doctors – and how many payments they received — could not be identified in the disclosure figures.

Opposition from the pharmaceutical industry and a lack of political will hampered the efforts, say those involved in the original legislation. At the time, critics also questioned then-Gov. Joe Manchin’s dedication to the initiative.”

That article goes on to note that as of the time of publication, according to the Kaiser Family Foundation, West Virginia had the highest use of prescription drugs of any state in the country. So, in any event, it looks like whoever runs against Manchin—Democrat or Republican, liberal or conservative—will probably see political incentive to invoke his daughter’s heading of Mylan, and potential pro-Mylan moves Manchin has made. The question is, how much will stick, and how much of Manchin’s behavior really is about helping Mylan, or his daughter out—and how much more is to do with his actual political beliefs, political realities, and much more obvious considerations.