The House last week passed a bill to cap the price of insulin for people with insurance at $35 a month. That was part of President Biden’s larger social investment plan that has hit the hopes and dreams shredder of Democratic Sens. Joe Manchin and Kyrsten Sinema in the Senate. Because this single issue is so critical the White House and Democratic leadership blessed efforts to pass this bill as a stand alone piece of legislation, rather than as part of that large reconciliation bill.
Despite the fact that this price cap bill did nothing to hurt one of the Republicans’ favorite industries, Big Pharma, 193 Republicans in the House opposed the bill. Republican spokesmember Rep. Matt Gaetz (R-FL), as Republican an everyman as you’re going to find these days, explained his vote. It’s the fat people, you see. If they’re going to be fat and have diabetes, they should have to pay through the nose to be alive. They should be rewarded for being fat. That’s really his argument. “[L]ifestyle changes en masse would expeditiously lower demand and the subsequent prices of insulin,” he wrote.
We can thank him for putting the Republican position out there so clearly when Senate Republicans also refuse to support the bill, even though one of their own is working on an alternative. To be honest, the bill that Sens. Susan Collins (R-ME) and Jeanne Shaheen (D-NH) are crafting together has the potential to be a much better bill. If Republicans would allow it.
RELATED STORY: House Democrats vote to make insulin affordable for people with insurance, 193 Republicans oppose it
What the House bill does is cap how much people with health insurance have to pay a month for insulin at $35—nothing else changes. One House Democrat, who voted for it nonetheless, had a problem with that. “This bill does not lower the price of insulin by one penny,” said Rep. Lloyd Doggett (D-TX). “It just shifts the burden of paying for the insulin off of the shoulders of insured insulin users, and shifts it on to the rest of all of us who are paying insurance premiums.”
The approach Collins and Shaheen are taking is more effective, fairer, and importantly, helps uninsured people who have diabetes as well. Their bill would instead bring the prices pharmaceutical companies charge. “It tackles the broader issue of the high list price for insulin, and the conflicts of interests that occur in the chain from manufacturer to the consumer buying it at the pharmacy counter,” Collins said.
It would be based on a bill the two worked on in 2019, and would roll insulin costs back to what they were in 2006, before the great surge in the cost of the drug. They would achieve that by barring pharmacy benefit managers (PBMs) from getting rebate payments on the drug.
Those are the intermediaries who act as sort of brokers for insurance companies, negotiating prices with pharmaceuticals and other medical device manufacturers. The PBMs generally determine which drugs the insurance companies will cover. The PBMs are in a position to jack up prices, because they are in a position to pick higher-priced drugs—that gives them a larger rebate, really a kick-back, and that in turn gives drugmakers an incentive to raise the prices of their drugs.
“There’s a very complex system which essentially encourages high list prices because the pharmacy benefit managers frequently receive a percentage of the list price,” Collins said. “So their incentive is to choose one that is higher cost. And so we are trying to address that broader issue, as well as looking at the out-of-pocket costs.” She’s not wrong, which is not something one can say about her that often.
Majority Leader Chuck Schumer has blessed this effort, but that doesn’t necessarily mean the House bill, which Sen. Raphael Warnock has sponsored in the Senate, isn’t also a possibility. Because at this point Collins only has a discussion draft and she’s not going to be in any hurry to make her Republican colleagues have to take a vote on something that will both help people and also help President Joe Biden and congressional Democrats.
Either would take 60 votes in the Senate. That would mean 10 Republicans who gave a damn about people's lives. Which is why Schumer should put one of them on the floor, even if it’s not the better bill—the one from Collins that might or might not ever be introduced.
“If 10 Republicans stand between Americans being able to get access to insulin or not, that’s a good question for 10 Republican [senators] to have to answer when they go back home,” Rep. Dan Kildee (D-MI) said ahead of the House vote. “So we’re gonna pass this bill, and this will put the pressure on the Senate to act.”