Will Republicans really stop Democrats from lowering insulin prices?

Will Republicans really stop Democrats from lowering insulin prices?

A woman with Type 2 diabetes prepares to inject herself with insulin at her home in Las Vegas in April 2017. (John Locher/AP)

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By Paul Waldman

Columnist

Today at 4:13 p.m. EST

Republicans and Democrats have in recent years agreed on at least one thing: It’s important to tell voters you are very concerned about the ever-increasing price of prescription drugs. But now, with the Build Back Better bill, Democrats are actually proposing to do something about it — and Republicans might stand in the way.

While a proposal to allow Medicare to negotiate the price of prescription drugs was drastically watered down (in its current form, Medicare will negotiate prices for a small number of drugs, though any resulting savings will not take effect until 2025), the bill limits the amount anyone on government or private insurance will pay for insulin to $35 a month.

Because millions of Americans use insulin for diabetes, and the drug can cost as much as $1,000 a month, that represents enormous progress in improving people’s lives. Though this particular provision isn’t slated to take effect until 2023, it’s still something Democrats can brag about to voters.

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Which is why, as The Post’s Dan Diamond reports, Republicans are considering mounting a procedural challenge to the bill aimed at the insulin measure and others on health care:

Meanwhile, Republicans have been meeting with the Senate parliamentarian to determine whether the bill’s health provisions would technically qualify under budget reconciliation, a legislative maneuver that allows Democrats to avoid a GOP filibuster and enact policy changes with a simple majority, so long as the legislation is linked to the federal budget. Under the Byrd rule, lawmakers can challenge individual provisions in the bill.

If Senate Republicans challenge the insulin provision, some policy experts say they expect the parliamentarian will determine that the plan to cap insulin costs for privately insured Americans is “merely incidental” to the federal budget. In that case, Republicans could call a point of order to strip the provision from the bill.

It’s possible that the insulin provision could fall to a Byrd Rule challenge — but only if Republicans bring that challenge. And would they? It seems they haven’t yet decided, but the more popular the insulin provision seems, the more likely they may be to go after it.

Because, after all, Republicans don’t want to object to most of what’s in the bill while favoring a few things, such as bringing down insulin costs. Instead, they want to say, “This bill is a steaming pile of freedom-destroying socialism that will melt the face of anyone who gazes upon its horror.”

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But it isn’t enough to oppose the whole bill. If they can torpedo one of its most popular provisions — even one many of them have supported before — they may do it.

In short, Republicans can’t let Democrats do something popular, no matter how many people it might help, if it would mean the public might appreciate it.

Which is why Democrats should be prepared to make Republicans pay a price if they kill this provision. Just the threat of a hundred ads saying “Senator So-and-So killed a proposal to bring down the price of insulin” might make them back off.

Unlike many legislative proposals, this one is fairly easy to understand. And Democrats wouldn’t have to work too hard to convince voters that Republicans are in the pocket of big corporations.

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This period in our history shows the complex nature of the pharmaceutical industry, which simultaneously produces some of the most remarkable scientific advancements humanity could hope for and some of the most rapacious behavior you could imagine.

The mRNA coronavirus vaccines are an absolute marvel that have likely saved millions of lives. Yet they also made billions of dollars for the companies that produce them. And we regularly hear about drug company greed resulting in products that date back years or decades suddenly shooting up in price. (One vivid example involves Heather Bresch, the chief executive of Mylan, who also happens to be the daughter of Sen. Joe Manchin III, the West Virginia Democrat, exploding the price of EpiPens.)

Stories such as those — and the skyrocketing price of insulin — are part of why Americans dislike and distrust drug companies. In fact, allowing Medicare to negotiate drug prices has consistently been one of the most popular proposals in the Build Back Better framework.

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There are questions remaining about this aspect of the bill. For instance, progressive Democrats want the $35 provision to take effect next year and apply to people who lack medical insurance. Which are also good ideas.

But if Democrats are thwarted in trying to do something so simple to help so many people who right now are being preyed on by drug companies, people who depend on insulin should be enraged. And they ought to know whom to take their anger out on.