Medicare caps insulin costs to $35 per month. Can Biden get that award for all Americans?

“Biden’s Promise to Cap Insulin Costs to $35 Per Month: Can He Deliver for All Americans?”

President Biden Tuesday night will ask Congress to extend a monthly cost cap on insulin to all Americans.

Insulin costs are now capped at $35 per month for people on Medicare, but that cap doesn’t apply to younger Americans who buy their own health insurance directly or get coverage from an employer.

All people with type 1 diabetes and some with type 2 diabetes need the drug, but a study last year found more than 1.3 million American adults missed, delayed or missed insulin doses because of the cost of the life-saving drug bought rationed.

During his State of the Union address, Biden is also expected to ask Congress to expand Medicaid for low-income residents in 11 states who have refused to do so under the Affordable Care Act.

Here’s what we know.

Why are Americans struggling to afford insulin?

The price of the life-saving drug nearly tripled from 2002 to 2013, costing 10 times more in the United States than anywhere else in the world, according to the American Diabetes Association.

A 2022 study found that 11% of Medicare-age adults age 65 and older were on rationed insulin, compared with more than 20% of younger adults.

How Has Congress Addressed Insulin Costs?

Under last year’s climate and health bill called the Inflation Reduction Act, insulin costs for Medicare beneficiaries are capped at $35 per month. That cap doesn’t apply to Americans covered by private insurance plans after Republicans removed that provision from the final bill.

White House officials did not immediately say how Biden’s proposed cap on out-of-pocket insulin would extend to the uninsured, veterans, or those covered by military health insurance.

Some analysts doubt that Biden’s proposal to extend the cap to include working-age adults will gain traction in the Republican-controlled House of Representatives.

Still, patient advocacy groups promised to push for more affordable insulin prices.

Chuck Henderson, CEO of the American Diabetes Association, said the cost of insulin was prohibitive for too many of the more than 8 million US citizens who depend on the drugs.

“While Medicare’s co-payment cap was a significant step in the right direction and a potentially life-saving policy change for seniors, the ADA will continue to fight to extend this benefit to all people with diabetes who depend on insulin to survive.” said Henderson.

Southern states resist Medicaid expansion

The Affordable Care Act, passed in 2010 when Biden was vice president, pays the bulk of the costs for states that choose to expand Medicaid eligibility. Last November, South Dakota voters approved a constitutional amendment to expand Medicaid.

States that have resisted Medicaid expansion include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

Biden is also expected to announce the Inflation Reduction Act provision Tuesday, which negotiates some Medicare drug prices, registration for the Affordable Care Act this year, and an uninsured rate that has dropped to 8%, in part due to pandemic guidelines . Millions of Americans could lose Medicaid coverage this year as states resume Medicaid eligibility reviews that were halted during the COVID-19 public health emergency.