Schumer Dares Republicans to Vote Down Insulin Cap

[applegrove]

Schumer Dares Republicans to Vote Down Insulin Cap

August 6, 2022 at 3:32 pm EDT By Taegan Goddard 173 Comments

https://politicalwire.com/2022/08/06/schumer-dares-republicans-to-vote-down-insulin-cap/

"SNIP......

“Senate Majority Leader Chuck Schumer wants to dare Senate Republicans to knock out a popular $35 monthly cap on insulin prices from the party’s big bill under consideration,“ Insider reports.

“The $35 limit on insulin co-pays is one of the most popular elements of the legislation that Democrats want to pass using budget reconciliation… But the insulin cap has always been at risk of falling out of the bill since it may not comply with its strict procedural rules.”

......SNIP"

[comradebillyboy]

1. The Pukes will vote it down no matter how popular it is.

[rurallib]

2. Any word on when the vote might be?

[applegrove]

3. Don't know.

[rurallib]

4. Thanks

Prepping an LTTE on Grassley, but I want to wait until he officially votes "no"

[reACTIONary]

17. What's an LTTE?

[royable]

20. Letter to the editor. n/t

[reACTIONary]

21. Thanks. I googled it...

... and the only thing that came up was the Tamil Tigers.

[True Blue American]

8. First vote is now. They are waiting on the VP.

[airplaneman]

5. You have to have insurance to get the $35 settlement fee and the insurance companies are

free to raise the rates on everybody on everything else to make up the loss.
Only a temporary solution
-Airplane

[reACTIONary]

19. It's pretty good...

Raising the insurance rates (if it happens) socializes the costs. And insurance companies have more market clout to negotiate prices.

[airplaneman]

22. That is a good point but I feel for those without insurance until that problem is solved n/t.

[reACTIONary]

24. You are right about that. n/t

[Ms. Toad]

6. I almost hope they do

So it can be replaced by a cap which is not disease-specific.

We have to stop writing bills for diseases with the best lobbies, leaving it more likely that drug/insurance companies will shift costs to other diseases (they aren't going to cut profits), for which relief will likely never be provided.

Anyone taking biologics is billed $200,000 - $400,000/year for medication necessary to survive. If insurance is available, it covers a lot - BUT both people with diabetes and with diseases which require biologics will pay the exact same amount out of pocket - the annual out of pocket max. People with biologics may even pay more, since people with diabetes often have high costs - which still don't hit the out of pocket max.

People on Medicare who need Creon to live (e.g pancreatic cancer) hit the donut hole very early in treatment - and then pay approx $1000 / month for a drug necessary to live until they are out of the donut hole, and then pay 15% of the actual cost, without no annual cap.

Why should monthly out of pocket drug costs be capped for patients with one disease, but not another? Are we going to pass disease-specific fixed for every costly chronic disease?

We previously fixed cancer disfigurement for breast cancer by declaring bilateral breast reconstruction.medically necessary. But disfigurement for all other cancers is considered cosmetic, and must be paid for out of pocket.

When we make disease-specific fixed, it leaves those with diseases which are less common - or - which don't have fancy lobby groups left with very high medical costs AND make it far less likely that they/we will ever get relief.

(I have breast cancer and diabetes AND disfigurement from a different cancer, and a daughter who is billed $400,000/year for biologics.)

[area51]

7. +1 n/t

[Hermit-The-Prog]

9. We have so much work to do.

[Ms. Toad]

11. Yes, and my concern is that we are making it harder

By fixing things one disease, one medicine at a time.

[Novara]

10. This real-life stuff is what we should be hearing about

Most people aren't even aware there are these sorts of unbelievable discrepancies in care costs.



About getting republicans on the record turning this down? It won't matter. They have no shame and nothing seems to hurt them. Their voters are so stupid that they're happy republicans make their lives worse for them as long as they're sticking it to the Dems. It's pretty astonishing when you think about it - not even self-interest overcomes their hatred. They'd rather suffer more than see Dems have any legislative victories.

[Ms. Toad]

13. Agreed. When people, including some Dems

Were trashing the ACA as not good enough and we lobbying for it to fail because of wasn't single payer, I was terrified they would succeed. (And terrified it would be yanked out from under us with each new legal attack.)

At that time, my daughter was about to age out of my plan, and would have been unable to get insurance on her own, because before the ACA, insurance companies were allowed to reject small employers and individual policies. As it was, she was forced to be a full time student (and take medical leaves when she crashed and burned every semester), since - until the ACA fully kicked in - she had to be a full time student to stay on my insurance.

Until you have a chronic illness, which requires costly medication and or annual tests, most people don't even think about the out of pocket max, since most years they don't even come close to hitting it. When my daughter has to go on an ACA marketplace plan, we really had to struggle to get our insurance agent to understand that we're really didn't care what percent of procedures, drugs, doctor's visits were covered, since she pays the maximum by the end of the first it second month every year. All we needed to make the decision was the premium x 12 + the out of pocket max. That number is her fixed cost for the year (not some theoretical worst case scenario). Most years, it is between 10 and 15% of her very low income - and it is only that low because national employers (Starbucks and Amazon) have dirt cheap policies, because their demographic is generally young and healthy.

It definitely wasn't everything we needed but, as designed, it provided a path for every American to get health insurance. Unlike this bill, which addresses one medication for one disease.

[Novara]

14. The ACA was a godsend for families like yours

The number of insured is now at an all time high. Yet the Rs have weakened it, the bastards.

I understand about the out-of-pocket max, as I had to pay it two years in a row, once for gallbladder surgery and the next year I catastrophically broke my wrist falling on the ice and needed two surgeries. And this year I fell on the ice and injured my hip so badly I will have hip replacement surgery in a couple of months. However, that is a work-related injury and worker's comp is paying for it. The orthopedist's office is probably so sick of me asking them to triple check that my treatments so far have been approved and covered. I don't think worker's comp insurance has a choice not to cover things, but I am so worried about getting stuck with the costs. Any my issues aren't even close to what your family has had to face.

So yes, the ACA is a wonderful, wonderful thing. But the Rs have weakened it. And running on repealing it never hurt them. It never hurts them to be hateful, it seems. I mean, how can anybody be against healthcare for everyone? Right? But it doesn't seem to hurt them politically.

[Ms. Toad]

15. For many people with a chronic illness,

Your "happened twice" years are an expense that has to be budgeted for each and each and every year.

That is part of what this bill is intended to fix . . . But only for people whose chronic illness is diabetes, and only if their lifesaving drug is insulin.

It is a fix needed for all of us (at a minimum anyone with a chronic illness), regardless of disease it lifesaving drug.

[Novara]

18. Having to pay for that out-of-pocket max two years in a row ...

... I fully understand that medical debt is crippling, and I am lucky enough to be covered. That said, the out-of-pocket max keeps going up every year. It stretched me so thin I couldn't afford to replace my old, old, falling-apart car until after I finally paid off all the hospital bills years later. And I am lucky enough to have decent insurance.

At least Biden made it so that medical debt no longer will appear on your credit report. In previous years I had a hospital stay when I was uninsured. That ruined my credit for years because I simply could not pay it. I waited for the statute of limitations on medical debt in my state to run out after several years and rebuilt my credit from nothing to excellent. But it took me over a decade.

I understand medical debt and how it can ruin a person. And every little bit to ease that financial hit helps. But no, it surely isn't perfect and a lot of families are still ruined by medical debt.

[TheBeam19]

23. Absolutely.

[lostnfound]

25. It's even worse than why you describe

Insurance companies have decided that biological xyz is only viable to people over the age of X who have condition Y.

The experts in a specialty who are truly he backbone of the field, holding top positions at major facilities need doing research, concluded a few years ago that xyz is the single most effective treatment and practically could be described as the only effective treatment for condition abc.

Insurance covered 100%a few years ago but now they’ve all written policies that say too bad, so sad.

With coupons it is ~ $3600 a month, and not only is the drug not covered by insurance, but the money spent DOES NOT FULFILL the $7000 OUT OF POCKET MAXIMUM.

[Ms. Toad]

27. And the $3600 is only the drug cost.

The infusion cost, especially when the first-in-class of a biologic comes out brings the total cost of infusion in a hospital/clinic setting to $20,000.

My daughter currently takes entyvio every 4 weeks.

[cstanleytech]

12. Question is how will a law capping the price survive the courts?

[GoodRaisin]

16. I didn't know the insulin cap was even still under consideration in this bill. Thought

it had been dropped during negotiations with Manchin. Obviously great news if we can get that through.

[Saoirse9]

26. They happily obliged. Fuckers.