That Reconciliation Bill The House Is Passing Today Could Have Been Transformative

This week, Noah Smith wrote that "After some scary June numbers, disinflation finally looks like it has kicked in. Consumer prices as a whole increased 0% from June to July— nada, zilch, nothing— whereas before they had been increasing at an almost 16% annualized rate… The most obvious story here— and the one that we all want to be true— is the “soft landing” scenario, where the Fed has increased rates just enough to restrain price increases without causing noticeable damage to the real economy.”

In a few hours, House members will return from their late summer break to pass H.R. 5376, the Inflation Reduction Act of 2022-- a snappy little title for what could have been called Build Back Worse-- which will do almost nothing whatsoever to take on inflation in 2022. One part of the bill that could have, was Prescription Drug Pricing Reform. This is one of the only parts of the massive package that could have actually touched people in a real way— and is gigantically popular, far more popular than the Democratic Party or the Republican Party has ever been. But Congress has even managed to screw this up. They will pass the bill today. But we won’t get fairly priced drugs on Monday… nor before the midterms... nor before the next presidential election, not even close. This is what’s wrong with the compromised and corrupted Democrats in the House. Even when they mean well— which, unlike the GOP, is often— they can never do well. Too much corruption... way too much. The party is now almost as useless as a vehicle to working families as the GOP is.

Part 1-- Lowering Prices Through Drug Price Negotiation

The bill requires the Centers for Medicare & Medicaid Services (CMS) to negotiate the prices of certain prescription drugs under Medicare beginning in 2026.

Specifically, the CMS must negotiate maximum prices for brand-name drugs that do not have other generic equivalents and that account for the greatest Medicare spending. The CMS must negotiate the prices of 10 drugs in 2026, 15 drugs in 2027 and 2028, and 20 drugs in 2029 and each year thereafter. Drug manufacturers that fail to comply with negotiation requirements are subject to civil penalties and excise taxes.

The bill provides funds for FY2022 for the CMS to implement this program.

Part 2-- Prescription Drug Inflation Rebates

In addition, the bill requires drug manufacturers to issue rebates to the CMS for brand-name drugs without generic equivalents under Medicare that cost $100 or more per year per individual and for which prices increase faster than inflation. Manufacturers that fail to comply are subject to civil penalties.

The bill provides funds through FY2031 for the CMS to implement the rebate programs.

Part 3-- Part D Improvements and Maximum Out-of-Pocket Cap for Medicare Beneficiaries

The bill eliminates beneficiary cost-sharing above the annual out-of-pocket spending threshold under the Medicare prescription drug benefit beginning in 2024 and caps annual out-of-pocket spending at $2,000 in 2025 (with annual adjustments thereafter). It also establishes a program under which drug manufacturers provide discounts to beneficiaries who have incurred costs above the annual deductible beginning in 2025.

The bill provides funds through FY2031 for the CMS to implement these changes and requirements.

The bill also establishes a process through which certain beneficiaries may have their monthly out-of-pocket costs capped and paid in monthly installments beginning in 2025; it provides funds for FY2023 for the CMS to implement this process.

Part 4--Continued Delay of Implementation of Prescription Drug Rebate Rule

The bill further delays until 2032 implementation of a Department of Health and Human Services rule relating to the treatment of certain Medicare prescription drug benefit rebates from drug manufacturers for purposes of federal anti-kickback laws.

The Axios report by Victoria Knight this morning emphasizes that “Vulnerable Democrats believe finally passing a law to let Medicare negotiate the prices it pays for some prescription drugs will give them a much-needed lifeline in what's otherwise been shaping up as a brutal midterm cycle.” Bad word: “some.” Why “some?” Too many members of Congress have taken far too much money from PhRMA and are far too under the tombs of K Street. That’s why “some” and that’s why no one will feel anything in 2022, 2023, 2024 or 2025.

Delusional Democrats tell themselves that “A relentless focus on health care helped propel Democrats to seize control of the House in 2018, and they're hoping that delivering on this decades-long campaign promise will help them keep their congressional majorities now.” Delivering? Wake up, you assholes!

Knight quotes some of the worst conservative crooks on the Democratic side of the aisle, Abigail Spanberger (VA), Maggie “no minimum wage increase for you” Hassan (NH) and Michael Bennet (CO) celebrating the lowering of drug prices. Do they think they can fool people who actually go to the pharmacy to buy drugs? 10 shitty drugs— 4 years from now!

You know what will keep the voters from turning on the Democrats? The alternative: “Republicans’ votes against the drug pricing provisions— particularly opposition to a cap on what patients pay for insulin— will likely be a centerpiece of Democratic campaign messaging and paid advertising, said a national Democratic official working with Senate campaigns.” Reporting for The Guardian this morning, Michael Sainato wrote that “The prices of insulin has soared in the US in recent decades and is more than eight times higher in the US than in 32 comparable, high-income nations… With an average list price of $98.70 per unit in the US, compared with $7.52 in the UK, US insulin sales account for nearly half the pharmaceutical industry’s insulin revenue, though the US makes up only about 15% of the global market… As part of the Inflation Reduction Act passed in the Senate this week, the Biden administration proposed a $35 monthly cap on the cost of insulin in the private market. But the proposal was blocked by Republicans.”

The vote incited criticism against Republicans from diabetes advocates who have been pushing for legislation to cap the cost of insulin in the US.

But even a cap on private insurance co-pays wouldn’t have affected the real price of insulin in the US. The proposal would merely have limited the co-pay for the price of insulin to $35 for those with private insurance, with insurance expected to cover the difference. It would also probably have resulted in increases for insurance premiums. Those without insurance would still have been expected to pay exorbitant prices for insulin.

“The co-pay caps aren’t price caps. All they effectively do is if you have insurance or Medicare, the $35 is your maximum co-pay,” said Laura Marston, co-founder of the advocacy group the Insulin Initiative and a type one diabetic. “That doesn’t change the underlying price of what someone without insurance pays for insulin, which in and of itself is concerning and scary from a patient’s point of view because I know first-hand how hard it can be as a type 1 diabetic in this country to get and keep health insurance.”

…More than 100,000 Americans died in 2021 from diabetes. More than 30 million Americans are diagnosed with type 1 or type 2 diabetes and over 7 million require daily insulin– all type 1 diabetics and many type 2 diabetics.

For now diabetics and their families who were hoping for some relief are back where they started– paying exorbitant fees for a life-saving medicine.

Which of these have the Democrats accomplished for Americans-- any of which would have handed them back control of Congress in November? Look closely: