Health Care — Democrats advance health measures in sweeping bill
A pulled pork BBQ sandwich stuffed with Reese’s Peanut Butter Cups, Fluffer Nutter sweet potato fries and deep-fried pickles smothered in gravy are all dishes you can find at an MLB stadium this season, if you weren’t already excited about baseball.
It was a long weekend on Capitol Hill, where Democrats got a big win on Sunday by passing their sweeping health care and climate package. We’ll dive into what it means and how it happened.
Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Peter Sullivan, Nathaniel Weixel and Joseph Choi.
Want a copy of this in your inbox each day? Subscribe here.
Health provisions in Dems’ big bill
It was a huge weekend for Democrats, as the Senate passed the long-delayed health care, climate and tax bill. Here’s a look at the key health provisions:
Medicare can negotiate lower prices
The bill would allow Medicare to negotiate prices for some drugs for the first time, a policy Democrats have been trying to enact for years over the fierce objections of the pharmaceutical industry. The provisions save more than $200 billion over 10 years.
- It would allow Medicare to negotiate lower prices for 10 high-cost drugs beginning in 2026, ramping up to 20 drugs by 2029. There is a steep penalty if a drug company doesn’t come to the table: a tax of up to 95 percent of the sales of the drug. There is also a ceiling that the negotiated price cannot rise above.
- In a deal with moderates including Sen. Kyrsten Sinema (D-Ariz.), only older drugs are subject to negotiation after a period of nine years for most drugs and 13 years for more complex “biologic” drugs. That means the negotiations are more limited than many Democrats wanted.
Drug costs can be capped but largely only for Medicare
The bill includes other measures to cap drug costs. The provisions still largely apply only to seniors on Medicare, not the millions of people who get health insurance through their jobs, in part because complex Senate rules limited how expansive the provisions would be.
- If drug companies raise prices in Medicare faster than the rate of inflation, they must pay rebates back to the government for the difference.
- In one of the most tangible provisions for patients, the bill caps out-of-pocket drug costs at $2,000 a year for seniors on Medicare, starting in 2025.
People enrolled in ACA plans get an extension on premium assistance
The measure also builds on the Affordable Care Act (ACA) by extending enhanced financial assistance to help people enrolled in ACA plans afford premiums for three years.
White House pushed behind scenes for Senate win
President Biden is closing in on a legacy-defining win in Congress with the passage of a climate and health care bill in the Senate, a process officials say was not just months, but years in the making.
While hopes of passing Biden’s agenda appeared dead just a few weeks ago, the president and White House officials quietly worked behind the scenes to help revive talks and ultimately get negotiations in the Senate over the finish line, an administration official said.
Biden’s activity: Over the weekend, while the Senate was working through a very long series of votes to approve the package, Biden called roughly a dozen senators and called the cloak room, an administration source told The Hill. The White House legislative team also delivered White House cookies to members on Sunday.
That followed several months of engagement between senior White House aides and Capitol Hill to get the reconciliation deal passed.
Quieter approach: Rather than going on offense against Sen. Joe Manchin (D-W.Va.) appearing to reject much of the package last month, the White House opted for a quieter approach. Officials did not offer any rebuttal to Manchin, nor would they confirm any communications between the president and members of the Senate about the status of Biden’s agenda.
GOP PHYSICIANS: DRUG PRICE CONTROL WILL IMPACT PATIENT CARE
A group of Republican physicians in Congress are voicing their “strong opposition” to the prescription drug pricing control policies that were included in Democrats’ massive reconciliation package that cleared the Senate over the weekend.
“We write to express our strong opposition to the government drug price control policies in your reconciliation package,” the lawmakers wrote in their letter to Senate Majority Leader Charles Schumer (D-N.Y.) and Speaker Nancy Pelosi (D-Calif.).
The letter, which was written Friday, was shared on Monday by Rep. Scott DesJarlais (R-Tenn.).
“As medical providers and Members of Congress, we are deeply concerned with the harm these provisions will cause to patients across the country,” the lawmakers wrote.
The members of the GOP Doctors Caucus cited concerns from health care providers that the policies would result in limited access to care as well as a drastic drop in provider reimbursement.
The legislative package that addressed tax, health care and climate change issues was passed by the Senate on Sunday along 50-50 party lines, with Vice President Harris breaking the tie. The Democratic-controlled House is expected to take it up later this week.
WHY LOWERING THE COST OF INSULIN IS SO HARD IN THE US
Over the weekend, the Senate tried to rein in the skyrocketing price of insulin for millions of diabetic Americans but ultimately couldn’t garner enough support. The failure reflects the complexity in regulating insulin and the stronghold pharmaceutical companies have on the drug.
Most of the world’s insulin is produced by just three companies: Eli Lilly, Novo Nordisk and Sanofi. The drug itself has not changed since it was first discovered about 100 years ago.
Senate Democrats tried to rally support for a proposal that would have capped out-of-pocket insulin costs at $35 a month for people not covered by Medicare — but fell just three votes short.
However, they were able to secure the $35 insulin price cap for Medicare beneficiaries.
Most diabetic Americans, however, will still face steep insulin costs, as 2020 Census Bureau data shows about 54 percent of Americans were in employment-based health insurance plans while about 18 percent were enrolled in Medicare. There were also about 28 million people who did not have any health insurance in 2020.
At the same time there are more than 34 million people of all ages that have diabetes in the U.S. It’s considered the most expensive chronic illness in the country, with $1 out of every $4 in health care costs spent on caring for people with the condition.
Health officials walk fine line as monkeypox swells
State and city governments are walking a fine line as they move to confront the monkeypox outbreak, trying to spread awareness of the disease — which has thus far predominantly affected men who have sex with men — while avoiding stigmas.
“The tightrope you’re trying to walk is making sure that people don’t see it as just a gay men’s illness, but not alarming people so that they use up resources that need to go to the people who need the most right now,” Will Goedel, a professor at the Brown University School of Public Health, told The Hill.
- The first American cases of monkeypox were detected in Massachusetts nearly three months ago, and, on Thursday, Health and Human Services Secretary Xavier Becerra officially declared monkeypox to be a public health emergency in the U.S.
- The number of total monkeypox cases in the U.S. has reached more than 7,000, with concentrations in the states of New York, California and Illinois. Each of these states has issued their own emergency orders to distribute resources such as vaccines and testing more efficiently amid growing demand.
San Francisco public health officer Susan Philip told The Hill in an interview that it is crucial to bring awareness and education to vulnerable communities most at risk.
“It’s really important for us not to stigmatize any groups so that they feel comfortable getting information from us or from community partners, that they understand how they can access services, including vaccine and treatment and testing.”
WHAT WE’RE READING
- Why generic drugmakers oppose Dems’ drug pricing bill (Axios)
- COVID sewage surveillance labs join the hunt for monkeypox (NPR)
- There’s just one drug to treat monkeypox. Good luck getting it. (New York Times)
- Phones know who went to an abortion clinic. Whom will they tell? (Wall Street Journal)
STATE BY STATE
- Illinois day-care worker tests positive for monkeypox, officials say, but no cases reported in children (CNN)
- Abortion bans complicate access to drugs for cancer, arthritis, even ulcers (Washington Post)
- Mobile medical, dental care clinics expand in Oregon and Washington (Oregon Public Broadcasting)
OP-EDS IN THE HILL
- The medical, financial and social realities of post-Roe America
- Women suffer as American progressives struggle for global ideological hegemony
That’s it for today, thanks for reading. Check out The Hill’s Health Care page for the latest news and coverage. See you tomorrow.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
