A proposal to cap insulin costs for people with private insurance won’t be part of the sweeping climate and health care legislation that Senate Democrats are about to pass after Republicans moved to strip it out of 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 among the best-known, most extreme examples of high drug costs causing hardship for Americans. Insulin in the U.S. costs five to 10 times what it does in other economically developed countries, according to research by the RAND Corporation. In one recent survey of people with diabetes who take insulin, nearly 80% said it caused them financial difficulty.
Among them are people who have private insurance, but end up shouldering a large share of the cost directly because of high co-payments in their drug coverage. Democrats had hoped to address that by limiting those co-payments to $35 a month, and the version of the “Inflation Reduction Act” they brought to the floor on Saturday included such a provision.
“This won’t just save money, it will save lives,” Sen. Patty Murray (D-Wash.) said. “This should not be a hard vote to cast.”
But in order to pass legislation through a simple majority vote, rather than the customary 60 it takes to overcome a filibuster, Democrats are using the “budget reconciliation” process. The rules of reconciliation stipulate that every legislative provision must have a direct, significant impact on the federal budget. The Senate parliamentarian, who advises the chamber on procedural questions, ruled that the insulin cap for private insurance did not satisfy that requirement.
Democrats went ahead and included the provision in their bill anyway, effectively daring Republicans to strip it out ― a dare that 43 Republicans accepted when they objected to its inclusion on procedural grounds. Under the rules of Senate procedure, that was enough to prevail.
The effort to cap insulin costs was not a total wash. The IRA legislation includes a similar provision limiting insulin to $35 a month for Medicare beneficiaries. Republicans did not challenge that measure because the parliamentarian ruled it satisfies reconciliation requirements.
And the insulin cap is just one of several IRA provisions designed to lower prescription costs that remain in the legislation. Others include authority for the federal government to negotiate the price of certain drugs in Medicare and a $2,000 annual cap on out-of-pocket drug expenses in the program.
But the 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 year-to-year drug price increases in commercial plans, also got a negative ruling from the parliamentarian ― and Democrats didn’t even try to include it afterwards.
The insulin cap is popular, with 61% of likely voters supporting it strongly according to polling by Data for Progress, and Democratic leaders on Sunday wasted no time in attacking Republicans for their vote.
“After years of tough talk about taking on insulin makers, Republicans have once again wilted in the face of heat from Big Pharma,” said Sen. Ron Wyden (D-Ore.).
Republicans sought to preempt Democratic attacks over the insulin provision by proposing their own amendment aimed at making insulin available at federal community health centers, to be paid for by drawing funds from Obamacare. But Democrats blocked that measure, arguing it was insufficient.
This likely isn’t the last time the Senate will address the high cost of insulin. Democratic leaders have vowed to hold a vote on bipartisan legislation authored by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) that would also cap the cost of insulin.
Collins was one of the seven Republican senators who voted with Democrats to keep the insulin cap in the IRA. The others were Sens. Bill Cassidy and John Kennedy (La.), Josh Hawley (Mo.), Cindy Hyde-Smith (Miss.), and Lisa Murkowski and Dan Sullivan (Alaska).
But the bipartisan Collins-Shaheen bill would have to pass through regular order, meaning it would need 60 votes ― and even with those seven Republicans on board, it would still be three short of the threshold.
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 lower the cost of health care.
As for insulin, one new possibility is the kind of state action that California is pioneering. Last month, its Democratic governor, Gavin Newsom, announced the state was using $100 million of its budget to manufacture and distribute low-cost insulin to residents.
Such measures could help even people with no insurance, which the IRA insulin proposal for private insurance would not have.
This is a developing story. Please check back for updates.