A proposal to cap insulin costs for people with private insurance will not be part of the sweep climate and healthcare legislation that Senate Democrats are about to pass after Republicans decided to remove it from the bill on Sunday.
The Democratic proposal needed 60 votes to survive, but only seven Republicans joined the chamber’s 50 Democrats by voting “yes.”
The high price of insulin is one of the best known, most extreme examples caused by high drug costs hardship for Americans. Insulin costs five to ten times as much in the US as in other economically developed countries, according to research by the RAND Corporationand in a recent study of people with diabetes who use insulin, almost 80% said it caused them financial problems.
Among them are people who have private insurance, but end up paying much of the cost directly because of: high personal contributions in their drug coverage. Democrats had hoped to address that by capping those out-of-pocket contributions to $35 a month, and the version of the “Inflation Reduction Act” they brought up on Saturday included such a provision.
“This will not only save money, it will save lives. This shouldn’t be a difficult vote to cast,” said Senator Patty Murray (D-Wash.)
But to pass legislation by a simple majority, rather than the usual 60 it takes to overcome a filibuster, Democrats use the “budget reconciliation” process. The reconciliation rules state that any legal provision must have a direct, significant impact on the federal budget. The senate MP, who advises the chamber on procedural issues, ruled that the insulin cap on private insurance did not meet that requirement.
Democrats went ahead and included the provision in their bill anyway, effectively challenging Republicans to scrap it — a challenge 43 Republicans accepted when they objected to its inclusion on procedural grounds. Under Senate procedural rules, that was enough to win.
The effort to limit insulin costs was not a total wash. The IRA law contains a similar provision that limits insulin to $35 per month for Medicare beneficiaries. The Republicans have not challenged that measure because the MP ruled that it meets the reconciliation requirements.
And the insulin cap is just one of many IRA provisions designed to cut prescription costs that remain in the legislation. Others include the power for the federal government to negotiate the price of certain drugs in Medicare and a $2,000 annual cap on out-of-pocket drug spending in the program.
But the insulin supply was one of the few that would directly affect people with private insurance. Another proposal designed to help those with private coverage, limits to annual drug price increases in commercial plans, also got a negative ruling from the MP — and the Democrats didn’t even try to include it afterwards.
The insulin cap is popular, with 61% of likely voters strongly supporting it according to polls by Data for progressand Democratic leaders wasted no time on Sunday attacking Republicans for their vote.
“After years of hard talk about hiring insulin makers, Republicans have been wilted again by the heat of Big Pharma,” said Senator Ron Wyden (D-Ore.).
Republicans tried to prevent Democratic attacks on the insulin supply by proposing their own amendment that aimed to make insulin available in federal health centers, paid for by drawing funds from Obamacare. But the Democrats blocked that measure, arguing it was insufficient.
This probably won’t be the last time the Senate will address the high cost of insulin. Democratic leaders have vowed to hold a vote on bipartisan legislation drafted by Sens. Jeanne Shaheen (DN.H.) and Susan Collins (R-Maine), who would also limit the cost of insulin. Collins was one of the 7 Republican Senators who voted with the Democrats to keep the insulin cap in the IRA.
But the Collins-Shaheen bill is also unlikely to get 60 votes if Sunday’s skirmish over amendments is any indication.
Democrats are on track to pass the bill on Sunday, and their counterparts in the House are expected to approve it Friday and send it to President Joe Biden’s desk. It includes historic investments to combat climate change and other measures to reduce health care costs.
As for insulin, a new possibility is the kind of state action that: California pioneer. Last month, Democratic Governor Gavin Newsom announced that the state is using $100 million of its budget to manufacture and distribute low-cost insulin to residents.
Such measures could even help people without insurance, which the IRA private insurance insulin proposal would not have.
This is a story in development. Come back for updates.