A proposal to limit the cost of insulin for people with private insurance will not be part of the scan climate and health care legislation that Senate Democrats are set to approve after Republicans moved 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 in voting yes.
The high price of insulin is one of the most well-known, most extreme examples high cost drugs that cause suffering for Americans. Insulin costs five to 10 times more in the US than in other economically developed countries, according to research by RAND Corporationand in a recent study of people with diabetes taking insulin, almost 80% said it caused them financial hardship.
Among them are people who have private insurance but end up shouldering a large share of the costs directly because high stakes in their drug coverage. Democrats had hoped to counter that by capping those co-payments at $35 a month, and the version of the “Cut Inflation Act” they introduced Saturday included such a provision.
“This will not only save money, it will save lives. That shouldn’t be hard to give,” said Sen. Patty Murray (D-Wash.).
But to pass legislation through a simple majority, instead of the usual 60 needed to overcome a filibuster, Democrats are using the “budget reconciliation” process. The reconciliation rules state that any legislative provision must have a direct, significant impact on the federal budget. The Senate lawmaker, who advises the chamber on procedural matters, ruled that the insulin cap for private insurance did not meet that requirement.
Democrats went ahead and included the provision in their bill anyway, effectively daring Republicans to remove it — a dare 43 Republicans accepted when they opposed its inclusion on procedural grounds. Under the rules of Senate procedure, that was enough to prevail.
The effort to contain insulin costs was not a total wash. The IRA legislation includes a similar provision that caps insulin at $35 a month for Medicare beneficiaries. Republicans did not challenge the measure because the congressman ruled it met reconciliation requirements.
And the insulin cap is just one of several IRA provisions designed to lower prescription costs that remain in the law. Others include the power for the federal government to negotiate the price of certain Medicare drugs and a $2,000 annual cap on the program’s out-of-pocket drug costs.
But insulin provision was one of the few that would directly affect people with private insurance. Another proposal designed to help people with private coverage, limits on annual drug price increases in commercial plans, was also voted down by the congressman — and Democrats didn’t even try to include it afterward.
The insulin cap is popular, with 61% of likely voters strongly supporting it, according to a poll Progress dataand Democratic leaders on Sunday wasted no time attacking Republicans for their vote.
“After years of tough talk about taking insulin shots, Republicans have once again wilted in the heat from Big Pharma,” said Sen. Ron Wyden (D-Ore.).
Republicans have tried to preempt Democrats’ attacks on insulin delivery by proposing their own amendment aimed at making insulin available at federal community health centers, which would be paid for by siphoning funds from Obamacare. But Democrats blocked that measure, arguing it was insufficient.
This likely isn’t the last time the Senate will consider the high cost of insulin. Democratic leaders have vowed to hold a vote on bipartisan legislation authored by Sens. Jeanne Shaheen (DN.H.) and Susan Collins (R-Maine) that would also cap the cost of insulin. Collins was among them 7 Republican senators who voted with the Democrats to keep the insulin cap on the IRA.
But the Collins-Shaheen bill isn’t likely to get 60 votes, if Sunday’s skirmish over the 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 on Friday, sending it to President Joe Biden’s desk. It includes historic investments to fight climate change and other measures to reduce health care costs.
As for insulin, a new possibility is the kind of government action that California is leading the way. Last month, its Democratic governor, Gavin Newsom, announced that the state is using $100 million of its budget to produce and distribute low-cost insulin to residents.
Such measures could help even the uninsured, which the insulin IRA proposal for private insurance would not.
This is a developing story. Check back for updates.