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House passes insulin bill over insurers' opposition

Despite concerns about the bill’s policy and strategy from both sides of the aisle, nearly all House Democrats as well as a dozen Republicans voted for it Thursday.

By ALICE MIRANDA OLLSTEIN and MEGAN WILSON

The House voted Thursday in favor of a bill to cap out-of-pocket costs on insulin at $35 a month, a policy Democrats hope will give them a concrete win to campaign on when they face voters in November as the rest of their health care agenda remains stalled.

“At the end of the day, I hope that we can still bring forward a reconciliation bill with additional reforms this year. I know we need to do Medicare drug price negotiation,” Rep. Angie Craig (D-Minn.), the lead sponsor of the insulin bill, told POLITICO. “But we can’t wait any longer to act on insulin.”

Despite concerns about the bill’s policy and strategy from both sides of the aisle, nearly all House Democrats as well as a dozen Republicans voted for it Thursday. Yet it faces slim odds in the Senate, where Democratic leaders are combining an out-of-pocket cap on insulin — led by vulnerable Sen. Raphael Warnock (D-Ga.) — with a still-in-the-works bipartisan bill from Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) to cut the drug’s cost.

The insurance industry tried to persuade lawmakers to oppose the measure, arguing it does not lower the actual price of insulin and could lead to higher premiums.

One insurance industry source close to the negotiations told POLITICO they’ve stressed that the bill “lets pharma off the hook,” calling it a “giveaway” to the drug industry.

“The premium impact is going to be substantial, and this isn’t the way to address the high cost of insulin,” said the lobbyist, who was granted anonymity to speak candidly about the process. “But all these Democrats want this win.”

America’s Health Insurance Plans, the trade association for insurers, wants Congress to target the pharmaceutical industry’s price-setting power instead of simply shielding patients from it. While the Shaheen-Collins bill in the Senate aims to do so, its details haven’t yet been released.

“Insulin prices are too high because Big Pharma alone sets and controls the price,” AHIP spokesperson David Allen said in a statement to POLITICO. “This legislation continues to empower Big Pharma to raise insulin prices with impunity leaving patients, businesses, and hardworking taxpayers paying even more for health care.”

Brian Newell, a spokesperson for PhRMA, drugmakers’ leading lobbying group, told POLITICO that, while they aren’t officially taking a position on the bill, they see it as “one way to help patients at the pharmacy counter” but believe that a more “holistic solution” that also reforms the drug rebate system is also needed.

“No amount of spin by the insurance industry changes the fact that they determine what patients pay at the pharmacy,” he added. “It’s outrageous that insurance companies are forcing patients to pay more for medicines than what insurance companies pay.”

More than a half-dozen pharmaceutical lobbyists told POLITICO that the industry has not been lobbying on the bill, saying the insurance industry is doing more to oppose the bill than drugmakers are doing to support it.

While some Democrats don’t view the insurance industry’s complaints about the bill as credible given their financial stake in the matter, others say they understand the concerns, though they ultimately voted for the measure.

“We aren’t putting that burden on Big Pharma, and I don’t blame [the insurers] for being upset about that,” Rep. Susan Wild (D-Pa.) told POLITICO, adding that she talked “at length” with insurance companies and agreed that the bill’s “big flaw”is how it changes who pays for insulin but doesn’t lower its cost.

Still, she countered, “It’s a matter of do we help people who are literally dying or rationing their insulin? … I have a greater concern for patients and for people in that position.”

Republicans largely lined up against the insulin bill during Wednesday’s House Rules Committee hearing. Some GOP members compared the price cap to President Jimmy Carter’s cap on the price of gasoline and claimed it would trigger similar shortages and long lines for the drug. Other Republicans said the policy would encourage U.S. pharmaceutical companies to relocate to China.

Rep. Michael Burgess (R-Texas) criticized Democrats for using the repeal of the Trump administration’s drug rebate rule —which was never implemented — as a funding mechanism.

“Those are made-up dollars. Those are not real dollars,” he said, calling it a “budgetary gimmick.”

Other GOP members on the panel pointed to a Congressional Budget Office analysis released Wednesday that appeared to back up insurers’ arguments. The CBO predicts the measure would cost the federal government more than $6 billion over a decade because it would likely force insurers to raise premiums. That would increase government subsidies paid through the Affordable Care Act and decrease income tax revenue because workers would spend more of their wages on their employers’ health plans.

Eli Lilly, one of the country’s leading insulin makers, “has long advocated for solutions to limit out-of-pocket costs on insulin,” said Shawn O’Neail, the vice president of their global government affairs division. But the company notes it hasn’t endorsed the bill.

Though the legislation easily passed the House on Thursday, it will be a much heavier lift in the Senate, where it needs support from at least 10 Republicans and all 50 Democrats. Though Warnock told POLITICO on Wednesday that he’s hearing “bipartisan interest in capping the cost of insulin,” no Republicans other than Collins have signed onto the effort, and multiple lobbyists said they don’t think it will garner enough Republican support to reach the 60-vote threshold in the upper chamber.

Still, Democrats believe those who oppose it will pay a political price in November.

“If my Republican colleagues don’t support it, I hope my voters back home see right through that,” Craig said. “You can make the case for voting against a big reconciliation bill, that you opposed this or that individual provision, but when it’s a standalone bill like this, there’s nowhere to hide.”