Why the Insulin Price Cap for Private Insurers Won’t Be in the Reconciliation Bill

Senate Democrats’ plan to cap insulin costs at $35 a month for people with private insurance will not be in their new spending bill after Republicans killed the proposal on Sunday while citing procedural issues.

Lowering insulin prices is a priority for Democrats, who argue that the high cost of the drug in the United States warrants legislative action. Insulin prices can range from $334 to $1,000 per month in the United States, according to a 2020 report from the Kaiser Family Foundation. Americans typically pay about 10 times more than people in 32 other countries, according to a 2020 government survey.

Despite bipartisan support for lowering insulin costs, efforts to cap the price of the drug, used by millions of Americans to help manage diabetes, have stalled in the evenly divided Senate.

Hopes for Democrats to pass a cap on insulin prices for Americans with private insurance have risen in recent weeks following a deal reached between Senate Minority Leader Chuck Schumer of New York and two moderate Democrats, Senators Joe Manchin and Krysten Sinema, who represent West Virginia and Arizona. respectively.

Senate Republicans on Sunday blocked a proposal in the Cut Inflation Act to cap insulin prices at $35 a month for people with private insurance. Above, an insulin kit is seen in St. Paul, Minnesota on January 17, 2020.
KEREM YUCEL/AFP via Getty Images

The provision was to be included in the Inflation Reduction Act, which aims to fight inflation and reduce the federal deficit by generating $739 billion in new revenue, while investing more than $400 billion in the fight against climate change and in health care.

Senate Democrats pass the bill through a process known as reconciliation, which allows them to circumvent a GOP filibuster, a Senate procedure that would require 60 votes to hold a debate on the bill. However, it also narrows the scope of what they could pass, as the rules require reconciliation bills to deal directly with budget issues.

Their proposal to include the insulin price cap for private insurers ran into a problem Saturday, when the Senate Congressman, the adviser who helps interpret Senate rules, determined that the price cap violated the reconciliation rules. The congressman allowed the $35 insulin cap to apply to Medicare beneficiaries.

Democrats planned to move forward with price caps for private insurers, despite the ruling. But Sen. Lindsey Graham, a Republican from South Carolina, implemented the congressman’s decision, which means 60 senators – all Democrats and 10 Republicans – would have to vote for the price cap.

Ultimately, the proposal failed to gain enough GOP support, with 43 Republicans voting against.

Senate Minority Whip John Thune, a Republican from South Dakota, said in remarks reported by The Hill that Democrats’ efforts to overturn the congressman’s decision “undermine the entire reconciliation process.”

“They added it back in and basically, you know, they wanted to make us, I guess, vote it down,” Thune said. “I think there’s a right way and a wrong way to do it. They want to get that vote, there’s a lot of ways to get that vote, but doing it that way wasn’t the right way to go. do it.”

Still, seven Republicans voted alongside Democrats to keep the proposal in the bill:

  • Senator Susan Collins of Maine
  • Senator Josh Hawley of Missouri
  • Senator Cindy Hyde-Smith of West Virginia
  • Senator John Kennedy of Louisiana
  • Senator Bill Cassidy of Louisiana
  • Senator Lisa Murkowski of Alaska
  • Senator Dan Sullivan of Alaska

But Democrats needed three more Republicans to reach the 60-vote threshold to include the price cap for private insurers in the bill. Even though the prospect of a $35 price cap stalled in the Senate, the House passed a bill that would cap the price of the drug in March.

Republicans who voted against the price cap were criticized by fellow Democrats, including New York Senator Kirsten Gillibrand.

“Republicans just stopped us from capping the price of insulin for all Americans at $35 a month,” she tweeted. “We have already seen far too many people risk their lives and health by rationing insulin they cannot afford. It is unacceptable that we allow this tragedy to continue.”


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