Affordable Insulin Now Act

Floor Speech

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Mr. SMITH of Nebraska. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, this issue is so important I don't think we should automatically accept a partisan proposal that doesn't even get to the heart of the problem.

Today we actually could be voting on H.R. 19, the Lower Costs, More Cures Act, a bipartisan bill that would not only address the root causes of the high insulin prices, but lower costs for all patients.

Instead, and I might say, very sadly, we are voting on a partisan messaging bill to give Washington a greater say in Americans' medical decisions while raising premiums on seniors and the millions of Americans with private health insurance.

This is nothing more than an attempt by my colleagues on the other side to pass just piece by piece their cures-killing Socialist takeover of the entire innovation sector. And worse, despite the misleading title of this current bill, it does nothing to lower the actual price of insulin. Instead, it uses budget games and regulations to disguise the actual cost of insulin for all consumers.

This is just another instance of misguided health and economic policies coming at a time when more than half of Americans are worried about rising prices and the economy. And, of course, like the President's budget released this week, this bill, too, is only ``paid for'' with gimmicks, adding to our deficit and the core causes of inflation.

We can and should do more for the American people who are struggling. The American people expect us to work together. We could be doing that.

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Mr. SMITH of Nebraska. Madam Speaker, I reserve the balance of my time.

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Mr. SMITH of Nebraska. Madam Speaker, I include in the Record letters from numerous groups representing and reflecting the views of millions of Americans. AMAC Action, Leesburg, FL, March 30, 2022. Hon. Steve Scalise, House Republican Whip, Washington, DC.

Dear Whip Scalise: On behalf of the 2.3 million members of AMAC--Association of Mature American Citizens, I write to express our concern with H.R. 6833, the Affordable Insulin Now Act.

Not too long ago, former President Trump made significant gains in lowering insulin costs for Americans. He initiated the Part D Senior Savings Model a voluntary program which allows beneficiaries to choose enhanced Part D plan options that offer lower out-of-pocket costs for insulin. He also signed an Executive Order that delivered inexpensive insulin and epinephrine to lower income patients. Unfortunately, President Biden delayed this Executive Order the day after he took office in 2021 before rescinding it later that year.

Now, the Democrats are considering H.R. 6833 which is an unserious attempt to lower the price of insulin. This bill would exert price controls on private market insulin to cap the costs paid by patients. H.R. 6833 takes us closer to further pharmaceutical price-fixing, a policy contained the Build Back Better plan. Price-fixing drugs leads to rationing and shortages as evidenced in other countries who have employed this policy. The Democrats' bill is estimated to increase spending by about $11 billion, and the bill is paid for by delaying the rebate rule for one year. This Trump-era rule compels pharmacy benefit managers to share the rebates they receive from drug manufacturers with Part D beneficiaries to lower their out-of-pocket expenses.

The Affordable Insulin Now Act is an election year messaging act on the part of Democrats. If they were serious about lowering the cost of insulin, they would work with Republicans on innovative programs like the Part D Senior Savings Model, a program that is expanding with robust participation by plan sponsors and offers predictable insulin costs that do not exceed $35/month.

As an organization comprised of Americans who are age 55- plus, controlling drug costs, especially insulin costs, is paramount to maintaining a good quality of life for AMAC members. H.R. 6833 is a step in the wrong direction for lowering insulin prices and opens the door for further government price-fixing and regulation. Sincerely, Bob Carlstrom, President, AMAC Action, ____ Council for Citizens Against Government Waste, March 30, 2022, House of Representatives, Washington, DC.

Dear Representative: You will soon be considering H.R. 6833, the Affordable Insulin Now Act. On behalf of the more than one million members and supporters of the Council for Citizens Against Government Waste (CCAGW), I urge you to oppose H.R. 6833 and any other measure to institute price controls in the medical marketplace.

In addition to imposing price controls, H.R. 6833 also increases funding for the Medicare Improvement Fund by $9 billion and adds $1.5 million to the budget for the Centers for Medicare and Medicaid Services to carry out the provisions of the bill.

Historically, price controls like those contained in the Affordable Insulin Now Act increase costs and lead to shortages and rationing. H.R. 6833 will lead to increased premiums for seniors and the 217 million Americans who rely on private health insurance. The government has no business setting prices on any good or service, especially not healthcare. Price controls inherently distort the medical marketplace and leave Americans worse off by significantly decreasing future research and development.

Americans are already suffering under the highest inflation in 40 years, and H.R. 6833 will increase this financial hardship. The cost of medicines should be address without instituting price controls or threatening future innovation. I again urge you to oppose this legislation. All votes on H.R. 6833 may be among those considered in CCAGW's 2022 Congressional Ratings. Sincerely, Tom Schatz. ____ NFIB, Washington, DC, March 30, 2022. Hon. Nancy Pelosi, Speaker, House of Representatives, Washington, DC. Hon. Kevin McCarthy, Republican Leader, House of Representatives, Washington, DC.

Dear Speaker Pelosi and Leader McCarthy: On behalf of NFIB, the nation's leading small business advocacy organization, I write to express concern regarding H.R. 6833, the Affordable Insulin Now Act.

This legislation has a laudable goal of attempting to make insulin more affordable and accessible to Americans on private and public health plans. Unfortunately, it will have unintended consequences for small businesses and employees by necessitating increased premiums while failing to address the underlying issues that make insulin unaffordable in the first place.

As studies have shown, a limited number of manufacturers, patent evergreening, practices of pharmacy benefit managers (PBMs), and other issues contribute to the high price of insulin. H.R. 6833 does not address any of these problems and instead seeks to solve consumer affordability by pushing significant, additional costs onto employers and health plans by limiting participant cost sharing.

For over 30 years, NFIB members have identified the cost of health insurance as the number one small business problem with 50 percent ranking it as a critical problem. Rising health insurance premiums result in fewer small businesses offering health insurance benefits. Since 2000, the average costs of an employer-sponsored single coverage plan and an employer-sponsored family plan have increased 149 percent and 18 percent, respectively. Unsurprisingly, facing these cost pressures, the number of small businesses with fewer than 50 employees offering coverage has declined from 47.2 percent in 2000 to 31 percent in 2020. Many small employers that are providing insurance have been forced to increase participant cost-sharing and deductibles as the only means to counter unsustainable premium increases and continue to offer coverage. To that end, solutions to affordability that limit cost-sharing without corresponding reforms will only serve to increase premiums and further exacerbate the small business affordability problem.

NFIB continues to advocate for affordable health insurance for small businesses and all Americans. However, if the system of employer sponsored health insurance is to endure in the long-term, Congress must work together to address the underlying cost drivers of the American healthcare system, rather than shift additional cost burdens onto employers seeking to offer health insurance to their employees. Sincerely, Kevin Kuhlman, Vice President, Federal Government Relations. ____ Partnership for Employer-Sponsored Coverage, March 30, 2022. Hon. Nancy Pelosi, Speaker, House of Representatives, Washington, DC. Hon. Kevin McCarthy, Minority Leader, House of Representatives, Washington, DC.

Dear Speaker Pelosi and Leader McCarthy: The Partnership for Employer-Sponsored coverage (P4ESC) writes to share our strong concerns regarding H.R. 6833 the ``Affordable Insulin Now Act.'' Although P4ESC shares the goal of lowering the cost of insulin, we believe this bill will simply shift costs back to employers and employees, including those who are insulin dependent. A better and more direct solution that addresses excessive profit taking by pharmaceutical manufacturers and others, including pharmacy benefit managers, in the pharmaceutical supply chain would be preferable.

The Congressional Budget Office (CBO) recently found that H.R. 6833 would increase the federal deficit by as much as $11 billion over ten years and increase health insurance premiums for all Americans. Indeed, there will not be any curb on future insulin price increases paid by employers and insurers. Every dollar of cost increase will be reflected in ever higher health insurance premiums paid by all Americans, whether privately insured or covered through Medicare. Better approaches that increase competition among insulin manufacturers, address regulatory problems and streamline the supply chain will help reduce the cost of all prescription drugs, including insulin.

The Partnership for Employer-Sponsored Coverage is an advocacy alliance of employment-based organizations and trade associations representing businesses of all sizes and the more than 181 million American employees and their families who rely on employer-sponsored coverage every day. We are committed to working to ensure that employer-sponsored coverage is strengthened and remains a viable, affordable option for decades to come. We look forward to working with you to ensure employer-sponsored coverage continues to thrive.

We would welcome the opportunity to discuss these issues with you or your staffs. Sincerely, Partnership for Employer-Sponsored Coverage (P4ESC). ____ The ERISA Industry Committee, Washington, DC, March 29, 2022.

Dear Member of Congress: As the House prepares to vote on the ``Affordable Insulin Now Act'' (H.R. 6833), The ERISA Industry Committee (ERIC) writes to share opposition to this legislation and urges members to vote ``NO'' when the bill is called for a vote.

ERIC is a national nonprofit organization exclusively representing the largest employers in the United States in their capacity as sponsors of employee benefit plans for their nationwide workforces. With member companies that are leaders in every economic sector, ERIC is the voice of large employer plan sponsors on federal, state, and local public policies impacting their ability to sponsor benefit plans and to lawfully operate under ERISA's protection from a patchwork of different and conflicting state and local laws, in addition to federal law.

ERIC member companies voluntarily offer comprehensive health benefits to millions of active and retired workers and their families across the country. Our members offer great health benefits to attract and retain employees, be competitive for human capital, and improve health and provide peace of mind. On average, large employers pay around 75 percent of health care costs on behalf of 181 million beneficiaries. As such, ERIC member companies have a significant stake in, and deep commitment to, efforts to curb unsustainable rising costs in the health care system.

Employers oppose H.R. 6833 because the bill imposes government-mandated prices, shifts costs to patients, and will not lower drug costs. The bill may in fact increase the costs of insulin by creating a perverse incentive wherein insulin manufacturers know that no matter how much they increase prices, their customers will pay government-set prices. This action will cause employers, insurers, and other health insurance enrollees to pay more to offset these high costs. This view is supported by the Congressional Budget Office (CBO), which recently found that this policy would increase the federal deficit by around $11 billion and increase health insurance premiums for all Americans.

ERIC and our member companies support legislation that would actually lower prescription drug costs, including for insulin, rather than shift costs to employers and other patients. Congress could achieve this by enacting policies to:

Increase competition among insulin manufacturers;

Fix the regulatory problems that misclassify insulin and fail to properly align market exclusivity and patent protections to the drug; and

Address supply chain issues like rebates and bona fide service fees that lead to formularies that do not reflect value for patients.

Many of these proposals are already included in bipartisan legislation that could be quickly passed and sent to the President for his signature. They have been scored by CBO to lower drug costs and health insurance premiums for all Americans.

Because the ``Affordable Insulin Now Act'' fails to reduce drug prices and raises health insurance costs for all, ERIC urges members to vote NO, and oppose the passage of H.R. 6833. We look forward to working with Congress on productive, effective, value-driven solutions to make prescription drugs--including insulin--affordable for all Americans. Sincerely, James P. Gelfand. ____ FreedomWorks, March 30, 2022. Key Vote NO on the Affordable Insulin Now Act, H.R. 6833

On behalf of FreedomWorks' activist community, I urge you to contact your representative and ask him or her to vote NO on the Affordable Insulin Now Act, H.R. 6833, introduced by Rep. Angie Craig (D-Minn.). This legislation would impose socialist price controls to cap the price of insulin at $35.

Currently, Americans are grappling with the harsh reality of increased prices on everything from gas to groceries. We see firsthand the consequences of modem monetary theory and the devastation it brings. Unfortunately, the many Americans that struggle with diabetes are no stranger to increased prices. The cost of insulin has been steadily rising for decades.

While progressives are all too eager to blame high prices on ``corporate greed,'' the reality is that this is an issue created by the federal government. Heavy-handed price controls are a deeply flawed solution that misses the mark when identifying the problem.

Pharmacy benefit managers (PBMs) play a significant role in the dramatic rise in the cost of prescription drugs. PBMs are third-party administrators determining which drugs go on formularies (a list of approved prescription drugs that hospitals can prescribe and are covered under an insurance policy). Ostensibly, PBMs negotiate to obtain the best price. However, these ``savings'' are often pocketed by PBMs themselves and aren't passed onto patients. Since they are reimbursed based on the markdown from the original list price, PBMs are incentivized to prioritize drugs with higher list prices, so they can receive a larger markdown.

There are free-market alternatives to lower the cost of insulin and healthcare in general. For example, it was reported in an article in The Federalist, ``A consortium of hospitals recently announced plans to build a factory that can manufacture insulin within two years. Once their plant gets up and running, the non-profit consortium said it would sell the insulin at a cost of $30 a vial--a fraction of what pharmaceutical companies currently charge.''

This legislation is a simplistic proposal to address a highly complex problem. We cannot afford half-hearted proposals based on unsound economics like this one for an issue that impacts so many.

FreedomWorks will count the vote for H.R. 6833 on our 2022 Congressional Scorecard and reserves the right to score any amendments, motions, or other related votes. The scorecard is used to determine eligibility for the FreedomFighter Award, which recognizes Members of the House and Senate who consistently vote to support economic freedom and individual liberty. Sincerely, Adam Brandon, President, FreedomWorks. ____ National Taxpayers Union

As the calendar turns to April, the U.S. House of Representatives is planning to vote on legislation that would cap insulin costs for all Americans who are privately insured or on Medicare Part D at no more than $35 per month in out- of-pocket payments. While the bill's sponsors may have good intentions, and while Congress can certainly act to provide support for Americans facing high prescription drug costs, NTU has several concerns about the impact the ``Affordable Insulin Now Act'' will have on America's taxpayers and broader health care system.

The legislation would impose new cost-sharing limits on insulin for almost all privately insured Americans, and would extend these limitations to the tens of millions of Americans on Medicare Part D. According to a Congressional Budget Office (CBO) cost estimate, the bill's requirements would cost federal taxpayers around $11 billion ($6.6 billion in higher spending and $4.8 billion in reduced revenues). It is likely this cost estimate is due to anticipated higher premiums in both Medicare Part D and the Affordable Care Act individual marketplace. In these programs, higher premiums usually mean higher federal subsidies for health coverage that are paid for by taxpayers.

Indeed, proponents of the legislation have not properly addressed the impact this legislation would have on premiums in both Part D and the private marketplace. The Affordable Insulin Now Act puts a cap on the out-of-pocket costs owed by insured enrollees for insulin products, but it does not ultimately change the price of insulin paid for by health insurers. If insurers face higher costs for covering these drugs, they will likely be forced to pass those costs on to customers in the form of higher premiums or higher cost- sharing on other health products and services. And, as noted above, some higher premiums will result in higher costs for taxpayers, who bear some of the burden for covering seniors under Part D and low- and middle-income Americans on the ACA marketplace.

Perhaps the most troubling part of the legislation, though, is the proposed offset for the cost of the legislation. House Democratic leadership is proposing to `pay for' the legislation's $11 billion cost with a shameless budget gimmick that NTU and NTU Foundation have called out before: delaying a Trump administration ``rebate'' regulation that was projected to raise federal government costs but was never likely to be implemented in the first place.

As NTU wrote in July of last year, when a bipartisan group of lawmakers proposed using rebate rule delay as a pay-for in the major infrastructure bill:

``This phantom $49 billion ``pay for'' was called ``Washington at its worst'' by one health industry lobbyist speaking to The Washington Post. In short, the Biden administration has delayed until 2023 a Trump administration regulation that would change how prescription drug discounts are handled by insurers and pharmacy benefit managers (PBMs). Because the Congressional Budget Office projected that the so-called rebate rule would increase federal spending in Medicare and Medicaid by about $177 billion over a decade, due to a rise in Medicare premiums (and therefore, taxpayer-funded subsidies for Medicare premiums), lawmakers get to count a further delay in the rule (beyond the Biden administration's one-year delay) as ``savings'' for the federal government. Reports indicate Congressional Democrats may use additional phantom ``savings'' from the rebate rule in their larger reconciliation bill by repealing the rebate rule entirely.

. . . This rule has never been implemented, and there's no clear indication that the Biden administration would have followed through on implementing the regulation even after their one-year delay. And even if the Biden administration had implemented the rule, there's little clarity as to whether the rebate rule would have actually cost federal taxpayers over $177 billion over the decade. In short, delaying the rebate rule does not present real, tangible savings to taxpayers, like a reduction in federal spending would.''

Unfortunately, it seems like the rebate rule is becoming yet another tried-and-true budget gimmick that Congress dips into again and again, in order to appear as if they are paying for new spending. And according to the CBO estimate cited above, because the rebate rule is projected to offer $20 billion in phantom savings--not just the $11 billion needed to cover the insulin bill's costs--the revised insulin legislation proposes spending another $9 billion on a broad- based Medicare Improvement Fund. That means $9 billion more will ultimately be spent without real offsets and, in our view, be paid for by taxpayers in the long run with higher debt and deficits.

To be clear, high out-of-pocket costs for insulin are a real issue for many Americans. NTU continues to support several bipartisan and meaningful proposals that would provide relief for many Americans, including:

An out-of-pocket cap in Medicare Part D, along with Part D benefit redesign that would actually save taxpayers money in the long run;

An ongoing Medicare insulin model that represents a public- private partnership between the federal government, insurers, and drug manufacturers that has the potential to meaningfully reduce out-of-pocket insulin costs for up to millions of seniors on Part D; and

Allowing Part D enrollees to spread their out-of-pocket burdens over the 12 months of a plan year, rather than having to owe major bills in the first or second months of a new plan year.

This legislation could undermine the ongoing Medicare insulin model, Part D redesign efforts, and reported bipartisan work in the Senate to provide insulin cost relief for American patients who are struggling. The House should go back to the drawing board and focus on more bipartisan opportunities.

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Mr. SMITH of Nebraska. Madam Speaker, I yield such time as he may consume to the gentleman from Arizona (Mr. Schweikert), who is an expert in health policy.

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Mr. SMITH of Nebraska. Madam Speaker, it is interesting listening to the debate here. Certainly my colleague, Mr. Doggett, I think very appropriately pointed out:

This bill does not lower the price of insulin by one penny. It just simply shifts around who pays for what.

We have seen that pattern in healthcare across America for some time now, and I would hope that we could learn from that.

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Mr. SMITH of Nebraska. Madam Speaker, I yield myself the balance of my time to close.

Madam Speaker, I think that this discussion that we are having here today is important. I also believe that we need to work together on solutions to actually reduce the cost of insulin, again, not just shifting around who pays for what. But certainly I am willing to give my colleague on the other side more information about the information Mr. Schweikert was sharing. He is very knowledgeable on the subject. He certainly works with his constituents a lot, constituents in need. And we know that literally millions of people across America are in need for lower-cost insulin. We owe them, I think, a much better approach than just simple government intrusion and more government involvement shifting around the cost.

I was a bit alarmed earlier when I heard that we should maybe make Medicare prescription coverage more like the VA. We need to remember that the VA offers roughly 50 percent of the options for participants compared to Medicare. I don't think we want to reduce the choices that seniors would have with their formularies within Medicare part D. If anything, we should make sure they have more choices. We know that more choices in the marketplace bring down the price, and we need to focus in that direction.

Madam Speaker, I urge a ``no'' vote on this bill. We owe the American people a diligent effort, working together to truly reduce the cost of insulin.

I yield back the balance of my time.

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