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ashoup
In Research, Fact Sheet

FACT SHEET: Trump Vows to “Never Give Up” MAGA-Republican Efforts to Repeal the Affordable Care Act, Ripping Health Care Away From Millions

Over the weekend, Donald Trump renewed calls to “terminate” the Affordable Care Act (ACA), claiming his administration’s failure to repeal the ACA was “a low point for the Republican party.” Repealing the ACA would rip coverage from 20 million Americans and raise premiums for nearly 15 million more. The GOP repeal scheme would also rip away protections for the over 135 million Americans with pre-existing conditions and put insurance companies back in charge, allowing them to deny basic care like hospital visits and prescription drugs. Despite overwhelming support for the ACA from the American people, including record enrollment and consistent support across parties, MAGA-Republican lawmakers can’t quit their “repeal” agenda. 

If the Affordable Care Act is repealed:

  • GONE: Protections for 135 million Americans with pre-existing conditions, including 54 million people with a pre-existing condition that would make them completely uninsurable.
  • GONE: Medicaid expansion, which covers more than 21 million people. 
  • GONE: 49 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women more than men.
  • GONE: Premium tax credits that help 80 percent of people who purchase health care on the marketplace.
  • GONE: Key support for rural hospitals. 
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.
  • GONE: 61.5 million Medicare beneficiaries will face higher costs and disruptions to their medical care. 

Republican Threats Could Lead To More Than 35 Million People Losing Their Coverage

  • 35 Million People Would Lose Coverage. If Republicans succeed in repealing the ACA, 35 million people will lose coverage obtained through the marketplaces. This would raise the uninsured rate to nearly 19 percent.
  • The Uninsured Rate Would Increase By 69 Percent. Repealing the ACA would increase the number of uninsured Americans from 26.6 million to 61.6 million, according to 2020 data. Americans of all ages would be impacted by coverage losses:
  • 1.7 million children would become uninsured, an increase of 48 percent.
  • 4.9 million young adults aged 19 to 26 would become uninsured, an increase of 76 percent. 
  • 8.8 million adults aged 27 to 49 would become uninsured, an increase of 60 percent.  
  • 5.6 million million older adults aged 50 to 64 would become uninsured, an increase of 95 percent. 

Overturning The ACA Would Exacerbate Racial Disparities In Coverage

The uninsured rate for Black Americans would spike to 20 percent, 32 percent for American Indian/Alaska Natives, 17 percent for Asian/Pacific Islanders, and 33 percent for Hispanics — compared to 13 percent for white Americans. 

  • 3.1 Million Black Americans Would Lose Coverage. The Urban Institute estimates that 3.1 million Black Americans would become uninsured if the ACA were overturned. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one-third between 2013 and 2016 from 18.9 percent to 11.7 percent. 
  • 5.4 Million Latinos Would Lose Coverage. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if Republicans repeal the ACA.
  • 1.3 Million Asian/Pacific Islanders Would Lose Coverage. 1.3 million Asian/Pacific islanders would become uninsured if the ACA were overturned, according to estimates from the Urban Institute. Research shows the ACA cut uninsurance rates among Asian Americans by more than half–from nearly 20 percent to just under 8 percent — eliminating coverage disparities with white Americans.
  • 488,000 American Indians And Alaska Natives Would Lose Coverage. According to the Urban Institute, the uninsurance rate for American Indians and Alaska Natives would more than double in 10 states if the ACA is overturned. Nationwide, 488,000 would lose coverage. 

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders
  • More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies could have the license to do this again. 

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three-year period. 
  • A 2009 congressional report found that some of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five-year period.
  • The Kaiser Family Foundation estimates that 54 million people, or 27% of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. 

Coronavirus Could Be Considered A Pre-Existing Condition. Without the ACA, millions of Americans who have contracted the coronavirus would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care.

Source: Kaiser Family Foundation, 2016; 2019

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

  • Premium Surcharges Could Once Again Be In The Six Figures. Republican threats to repeal the ACA could mean insurance companies once again could charge people more because of a pre-existing condition. The 2017 House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Could Be Charged More Than Men For The Same Coverage. Prior to the ACA, women were often charged higher premiums on the nongroup market than men were charged for the same coverage. 
  • People Over The Age of 50 Would Face A $4,000 “Age Tax.” Without the ACA, insurance companies could charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the 2017 Republican repeal bill, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to AARP.
  • 80 Percent of People With Marketplace Coverage Would Pay More. If the ACA is repealed, consumers would no longer have access to tax credits that help them pay their marketplace premiums, meaning 80 percent of people who have marketplace coverage would see price increases.
  • Seniors Would Have To Pay More For Prescription Drugs. Republicans’ plan to repeal the ACA, would make 49 million seniors pay more for prescription drugs because the Medicare “donut” hole would be reopened. 
  • 60 Million Medicare Beneficiaries Could Face Higher Costs. In addition to paying more for preventive care and prescription drugs, Medicare beneficiaries could face higher premiums without the cost-saving measures implemented under the ACA. If Republicans are successful, seniors would also face less coordinated care. 
  • Insurance Companies Would Not Have To Provide The Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care, and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Insurers Could Reinstate Lifetime And Annual Limits On 179 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market. In 2009, nearly 6 in 10 (59%) covered workers’ employer-sponsored health plans had a lifetime limit, according to the Kaiser Family Foundation. 
  • Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers.
  • Employers Could Eliminate Out-Of-Pocket Caps, Forcing Employees To Pay More For Care. Under the ACA, health insurers and employer group plans must cap the amount enrollees pay for health care each year. If the law is overturned, these cost-sharing protections would be eliminated. The ACA also barred employer plans from imposing waiting periods for benefits that last longer than three months.

Republicans Want To End Medicaid Expansion

  • More Than 21 Million People Enrolled Through Medicaid Expansion Would Lose Coverage. As of 2022, more than 21 million people were enrolled in Medicaid in over 40 states and territories.
  • Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in 10, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
  • Key Support For Rural Hospitals Would Disappear. States that haven’t expanded Medicaid have poorer financial performance than states that have expanded Medicaid. If Medicaid provisions in the ACA were to be stripped, all rural hospitals would face this financial cliff.

Republicans Are Willing To Sacrifice Your Care For More Tax Cuts For The Wealthy

  • The Richest Americans Would See Tax Cuts Averaging $200,000. Overturning the ACA would cut taxes for the top 0.1 percent of earners by an average of $198,000.
  • Drug Companies Would Save Billions. If the ACA is struck down, pharmaceutical companies would pay $2.8 billion less in taxes each year.
  • Repeal Would Weaken The Medicare Trust Fund. A significant portion of the tax cuts resulting from ACA repeal would come “at the direct expense of the Medicare Trust Fund,” according to the Center on Budget and Policy priorities.
ashoup
In News, Report, Research

NEW REPORT: Big Drug Companies Continue To Bring In Hundreds of Billions While Americans Struggle To Afford Skyrocketing Prices

Read the Full Report Here.

Washington, DC — Protect Our Care is releasing a new report detailing pharmaceutical companies’ sky-high revenues as they continue charging unaffordable prices to patients. In total, the 16 top companies reported $176.7 billion in total global revenue for the third quarter, and have rewarded shareholders by announcing dividend payments and stock buybacks totalling $26.8 billion. According to the report, the same big drug companies that are trying to block Medicare negotiation in court had more than $100 billion in revenue in Q3 alone.

Passed last year by President Biden and Democrats in Congress, the Inflation Reduction Act’s Medicare Drug Price Negotiation Program will finally give Medicare the authority to negotiate lower prices, making prescription drugs more affordable for millions of seniors. Big drug companies are talking in court about all the harm they will suffer from negotiations, but they’re telling investors the opposite and spending billions on rewarding their investors through stock buybacks and dividends, paying their executives millions, and spending millions lobbying to keep their prices high. 

Key Points:

  • We followed the Q3 2023 earnings reports of 16 drug companies.
  • These 16 companies reported $176.7 billion in total global revenue for the third quarter, and have announced dividend payments and stock buybacks totalling $26.8 billion. 
  • The eight publicly traded drug makers of the first ten drugs selected for negotiation under the Inflation Reduction Act brought in more than $100 billion in the third quarter alone, and a total of $285 billion in the first nine months of 2023.
  • These eight drug companies have rewarded shareholders with nearly $20 billion in stock buybacks to date in 2023.
  • Contrary to their fearmongering to lawmakers and patients about diminished incentives to invest in innovation,  top drug companies bragged to Wall Street about their investment in new, innovative drugs.

“Drug companies’ greed knows no bounds,” said Protect Our Care Chair Leslie Dach. “Our nation’s seniors depend on the savings from the Inflation Reduction Act so they don’t have to choose between filling their prescription and filling their refrigerator. Make no mistake: big drug companies are only trying to roll back the law to protect their outrageous profits.”

ashoup
In News, Report, Research

NEW REPORT: Reps. Castro and Gallego, UnidosUS Action Fund, and Protect Our Care Discuss Report on the Impact of the Inflation Reduction Act for Latino Families

Watch the Full Event Here.

Read the Full Report in English Here. 

Read the Full Report in Spanish Here.

Washington, DC – Today, U.S. Representatives Joaquin Castro (D-TX-20) and Ruben Gallego (D-AZ-03) joined UnidosUS Action Fund and Protect Our Care for a press call discussing the importance of accessing lower healthcare costs through the ongoing Medicare and Affordable Care Act open enrollment periods, and how the Inflation Reduction Act is lowering health care costs for Latino families. During the call, UnidosUS Action Fund and Protect Our Care released a report detailing how the Inflation Reduction Act is benefiting Latinos nationwide.

According to the report, Latinos face disproportionately high adverse health outcomes with Latino seniors being the most likely to experience affordability challenges of any racial/ethnic group in America. The Inflation Reduction Act addresses this challenge by lowering the out-of-pocket cost of health coverage and prescription drugs, which will especially help Latinos who face barriers to care due to unaffordable costs.

The report also spotlights the states with the highest Latino populations, including Arizona, California, Florida, Nevada, New Mexico, and Texas. The report also details how half of the first ten drugs selected to have lower prices negotiated by Medicare are disproportionately taken by Latino Medicare enrollees. 

“Last year, Congressman Gallego and I worked with our Democratic colleagues in the House and Senate to pass the Inflation Reduction Act, a historic investment in good jobs, affordable health care, and better lives for America’s families and seniors. More than a year later, the Inflation Reduction Act is capping prescription drug costs and lowering health care premiums for millions of Americans, especially in Latino communities that have disproportionately struggled with access to care,” said Representative Joaquin Castro (D-TX-20). “As we approach the final weeks of open enrollment, I strongly urge all Americans to visit Healthcare.gov and Medicare.gov and check out their coverage options today.”

“The report from Protect Our Care and UnidosUS underscores what we have long known: that the Inflation Reduction Act is saving Latinos in Arizona hundreds of dollars on health care,” said Representative Ruben Gallego (D-AZ-03). “Insulin is now capped at $35 a month, drug companies are finally being held accountable for their price gouging tactics, and even more savings are coming. I look forward to continuing my work to build on these improvements and lower prescription drug and health care costs for all Arizonans.”

“Increasing engagement between the Latino community and the benefits offered by programs like Medicare and the Inflation Reduction Act is imperative, not only to ensure the health of our communities but to our financial health and economic prosperity as a nation,” said Rafael Collazo, Executive Director of the UnidosUS Action Fund.

“I have lived with Type One Diabetes now for almost 28 years, so I have been through not having insurance, having to insulin ration – I understand those struggles,” said Yamelisa Taveras, founder of The Unidos Foundation. “I understand what our community needs, which is why I founded The Unidos Foundation. So seeing the huge changes, especially the insulin cap, I know that is something that benefits me personally, but it definitely benefits a great number of individuals who live within my community. These changes are necessary and we need to support them. ” 

“The Inflation Reduction Act is a game-changer, especially for Latino families,” said Leslie Dach, Chair of Protect Our Care. “Between lowering premium costs for families, capping insulin costs and drug costs for seniors, penalizing drug companies for egregious price hikes, and giving Medicare the power to negotiate lower drug prices, the benefits of this historic legislation are already being seen across the nation. Thanks to President Biden and Democrats in Congress, not only will Latino seniors and families save thousands of dollars a year, but they will also be able to access the health care they need and deserve.”

“I was paying $780 in insurance, but that doesn’t include all my medicines for my asthma and I was not yet old enough to be on Medicare,” said Ana Valenzuela, Deputy Director of the Arizona LULAC. “Luckily, I was on Medicare when I was diagnosed with cancer. And eventually, the Inflation Reduction Act will limit my out-of-pocket spending to $2,000. The Inflation Reduction Act is really working for a lot of us. We need these programs that are really going to help our health care. Like President Biden said, ‘We are stronger as a Nation when we work together to lift everyone’s well-being.’”

ashoup
In Fact Sheet, Research

“Medicare Autumn” Fact Sheet: Protecting Seniors From Prescription Cost Price Hikes

Thanks to the Inflation Reduction Act, championed by President Biden and Democrats in Congress, Medicare is better than ever and seniors are protected from outrageous price increases by big drug companies as a result of the law’s penalties on price increases greater than inflation. Hundreds of drugs have seen their list prices grow faster than inflation, forcing seniors to make tough decisions between needed medication and basic necessities — all while big drug companies bring in tens of billions in revenue and spend lavishly to reward shareholders. The Inflation Reduction Act has also brought down the cost of prescription medications for seniors on Medicare by capping insulin costs at $35 per month, providing free vaccines, and allowing Medicare to negotiate drug prices directly with pharmaceutical companies.

This is just the beginning: In 2025, seniors’ total drug costs will be capped at $2,000 per year and, in 2026, new savings from Medicare’s drug price negotiation will take effect. Together, these provisions will save seniors thousands of dollars on prescription drugs. These policies lower costs and improve access to care, which are essential for improving the health and well-being of millions of Americans nationwide.

BY THE NUMBERS

  • Medicare beneficiaries save as much as $600 per dose thanks to the Inflation Reduction Act’s inflation-pegged price hike rebates.
  • Medicare beneficiaries only pay 20 percent of the inflation-adjusted amount in copays for drugs with prices that have increased faster than the rate of inflation, 
  • 34 drugs will have reduced copays until the end of the year thanks to the Inflation Reduction Act. 

Seniors Will Continue To Save Hundreds On Prescription Costs Through Rebates For Drug Prices That Increase More Than Inflation. Thanks to the Inflation Reduction Act, Medicare beneficiaries save as much as $600 per dose. The new law requires drug companies to pay Medicare rebates if their drug prices rise faster than inflation, and those rebates are passed on as savings to seniors. For decades, big drug companies have been launching new drugs at sky-high prices and continuously raising prices faster than inflation, hurting the individuals reliant on them all while making record profits.

Drug Prices Have More Than Tripled Since Launch For The Top 25 Drugs By Medicare Spending. According to an analysis by the AARP, drug prices have more than tripled – an average increase of 226 percent – for the 25 drugs with the highest aggregate Medicare spending since launch. All but one of the top 25 drugs’ lifetime price hikes exceeded the lifetime average rate of inflation as well, with some increasing prices as much as nine times higher than inflation.

Over 100 Drugs Hiked Prices Above Inflation This Year. According to an analysis by the Center for American Progress, 112 drugs saw their list prices hiked above the annual inflation rate in July 2023, with an average rate increase of 30 percent.

1 In 3 American Adults Report Being Unable To Take Their Medications As Prescribed Due To High Costs. According to KFF, 1 in 3 American adults report being unable to take their medication as prescribed, demonstrating how high and rising drug prices are negatively impacting health outcomes for Americans struggling with affordability challenges. Existing racial and ethnic economic disparities place additional pressures on racial and ethnic minorities and make it even more challenging to keep up with drug prices rising faster than inflation.

…All While Big Drug Companies Bring In Record Profits and Reward Shareholders With Lucrative Stock Buybacks. As hundreds of drug prices rise faster than inflation, their manufacturers are bringing in record profits. Drugmakers of the first ten drugs eligible for Medicare price negotiation under the Inflation Reduction Act have made tens of billions in revenue from Medicare and other sources while spending billions of dollars on stock buybacks and lobbying. For example, Eliquis, a drug used to treat blood clots manufactured by Bristol Myers Squibb and Pfizer, has cost Medicare over $41 billion through 2021. Meanwhile, the two companies have executed more than $97 billion in stock buybacks while bringing in nearly $91 billion in global sales and spending over $172 million on lobbying since launch.

ashoup
In News, Report, Research

NEW REPORT: Protect Our Care Unveils New Report During Press Call with Rep. Pallone On “The Endless War: The MAGA Republican War on American Health Care”

Under Speaker Johnson’s Leadership, Republicans Will Continue Their Agenda of Hiking Drug and Health Insurance Costs, and Eliminating Crucial Protections for the American People

Watch the Event Here.

Read the Full Report Here.

Washington, D.C. — Today, Protect Our Care is releasing a new national report holding Republicans accountable for putting profits over people in their ongoing war on health care during a press call headlined by U.S. Representative Frank Pallone, Jr. (D-NJ-06). Geoff Garin, president of Hart Research, also joined the call and presented recent polling showing how unpopular the Republican war on health care is with the American people.

In Washington and across the country, Republican legislators and Republican-leaning Courts are continuing to attack essential health care, disproportionately targeting people of color, seniors, rural populations, people with disabilities, and the LGBTQI+ community. Right now, Republicans are pushing health care plans that hike costs and trying to repeal the Inflation Reduction Act that lowered care and prescription drug costs for millions of Americans — all to put drug companies back in charge at the expense of seniors across the nation. Republicans rallied behind Rep. Mike Johnson, who has a long history of fighting to raise health care costs and rip away critical protections from the American people, as the newest Speaker of the House. 

On the other hand, President Biden and Democrats in Congress continue to fight for the American people by working to build upon the Inflation Reduction Act and Affordable Care Act. Representative Pallone, joined by Representatives Neal, and Scott, has helped lead the way and introduced the Lowering Drug Costs for American Families Act which seeks to reduce prescription drug costs further for all Americans by expanding the drug price provisions to apply to private insurance, including price negotiation and inflation rebates. 

Report Key Points:

  • Every Republican in the House and Senate voted against the Inflation Reduction Act which lowers health care costs for millions of Americans and has vast support from voters of all parties. 
  • Big drug companies spent over $100 million trying to kill the Inflation Reduction Act, and they are spending even more to undermine the Medicare Drug Negotiation Program.
  • Republicans have released budget proposals that seek to repeal the Inflation Reduction Act’s Medicare negotiation program, hike premium costs, and impose deep cuts to Medicaid.
  • Republican-led states are moving far too quickly to throw people off of Medicaid without taking advantage of all the available tools to minimize coverage losses.
  • Republicans in Congress are pushing for bills that all promote insurance plans that eliminate protections for people with pre-existing conditions and do not include coverage of essential services like hospital visits and prescription drugs.
  • Republicans are leveraging their influence in a number of health care-related court cases such as Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, and Braidwood Management v. Becerra, as well as lawsuits filed by Merck, Bristol Myers Squibb, Johnson & Johnson-owned Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, Novartis, and Novo Nordisk as well as mega lobbying groups The Pharmaceutical Research and Manufacturers of America (PhRMA) and the US Chamber of Commerce.

“We may have a new House Speaker, but Republicans are still trying to take away health care,” said U.S. Representative Frank Pallone, Jr. (D-NJ-06). “As today’s new report from Protect Our Care says, ‘Republicans’ position on health care is slash, sabotage, and repeal.’ Last night’s election results once again prove that Republicans are extremely out of touch. Democrats are unified in opposing Republicans’ extreme health care agenda and are focused on fighting to further lower health care and prescription drug costs for the American people.” 

“Looking towards 2024, health care can play a very decisive role in how voters vote,” said President of Hart Research Geoff Garin. “A large majority of voters say health care will play a large role in deciding their vote and Democrats and President Biden have powerful accomplishments that are broadly supported by diverse groups of voters, including many Republicans. Republicans are in a world of hurt on this issue. The rejection of their policies on health care has deepened when you talk about not just the policies themselves, but the real-world impacts of those policies – how they affect people’s health and their ability to afford the drugs they need to stay healthy.”

“Republicans are pushing their radical MAGA health care plans that harm the American people,” said Protect Our Care Executive Director Brad Woodhouse. “The GOP will stop at nothing to raise health costs, eliminate critical protections just so the rich can get richer, even if it means leaving their own constituents behind. They want to go back to the status quo of Americans struggling to make ends meet due to outrageous health costs just to line the pockets of drug company CEOs and other billionaires. Some things never change: Republicans want a health care plan that would be disastrous for the well-being of hardworking people across our country.”

ashoup
In Fact Sheet, Research

“Medicare Autumn” Fact Sheet: Shingles Vaccines Are Now Free For American Seniors

Thanks to the Inflation Reduction Act, Medicare is better than ever and seniors can get their shingles shots and all other vaccines recommended by the CDC’s Advisory Committee on Immunization Practices, such as COVID-19, RSV, and the flu, for free. Prior to the Inflation Reduction Act, seniors could be forced to spend hundreds of dollars out of pocket for these vaccines, contributing to particularly low vaccination rates for low-income seniors, seniors of color, and rural seniors. The Inflation Reduction Act also brought down the cost of prescription medications for seniors on Medicare by capping insulin costs at $35 per month, limiting outrageous price hikes, and allowing Medicare to negotiate drug prices directly with pharmaceutical companies.

This is just the beginning: In 2025, seniors’ total drug costs will be capped at $2,000 per year and, in 2026, new savings from Medicare’s drug price negotiation will take effect. Together, these provisions will save seniors thousands of dollars on prescription drugs.

BY THE NUMBERS

  • 50.5 million American seniors can get their shingles vaccine free of cost, including over 9 million Medicare beneficiaries under 65 with disabilities, 15 million beneficiaries of color, and millions of rural beneficiaries.
  • Seniors will save up to $424 on their two-part shingles shots.
  • 84.5 million Medicaid recipients will also benefit from increased access to vaccinations.

Seniors Will Continue To Save Hundreds On Their Shingles Vaccine. Thanks to the Inflation Reduction Act, 50.5 million seniors are saving up to hundreds of dollars when getting vaccinated against shingles. With a single shot of Shingrix costing $212, seniors on Medicare Part D are saving over $400 on average on vaccinations. The cost of the shingles vaccine has been a driving factor in keeping vaccination rates especially low for the Black and Latino communities. This will level the playing field for seniors on Medicare, given that Americans on private insurance typically can get their shingles vaccines at no cost. 

33 Percent of Americans Will Develop Shingles In Their Lifetime. Shingles is a reactivation of the chicken pox virus, typically occurring in adults older than 50 years old. Symptoms include a painful rash, itching, fever, headache, chills, and nausea. The risk of shingles increases with age, making it paramount for vaccinations to be available and accessible. While complications or death from shingles is not common, seniors with weakened immune systems are particularly vulnerable, with 30 percent of shingles hospitalizations occurring within this population.

Required Vaccine Coverage For Medicaid Recipients Will Benefit Nearly 85 Million Americans. The Inflation Reduction Act also required state Medicaid and CHIP programs to cover vaccines recommended by the CDC’s Advisory Committee on Immunization Practices for no out-of-pocket costs. This allowed an estimated 4 million adults to gain access to shingles vaccines that didn’t previously have access before. Accessible vaccinations will particularly help low-income families on Medicaid, many of whom are people of color and people with disabilities, to help prevent illness and related work absences.

ashoup
In Report, Research, News

NEW REPORT: Leading Civil Rights Organizations Call on State Leaders to Address History’s Deepest Medicaid Losses by Halting Medicaid Terminations for People Who May Still Be Eligible

New Report Finds That If All States Achieved Results Like Those in the 10 Best States, 4.5 Million People Would Not Have Been Disenrolled from Medicaid for Paperwork Reasons

Watch the Full Event Here.

Read the Full Report Here. 

Washington, DC – Today, U.S. Representative and Congressional Black Caucus Chair Steven Horsford and U.S Representative and Congressional Asian Pacific American Caucus Member Jill Tokuda joined leaders of civil rights and health equity organizations including Protect Our Care for a press call releasing a new report detailing how six months after Medicaid’s pandemic-era continuous coverage requirement ended, millions of people in America are being needlessly disenrolled from critical health care coverage because of missed paperwork, creating an avoidable civil rights and health equity disaster. 

According to the report, more people and more children have lost Medicaid in just six months of unwinding than during any two-year period in American history. The report estimates that more than half of families terminated from Medicaid come from communities of color, including 2.3 million Latinos, 1.8 million African Americans, 400,000 Asian Americans, Native Hawaiians and Pacific Islanders, and more than 400,000 Native Americans,  During the call, speakers called on state leaders to halt procedural disenrollments until they make major reforms that cut such disenrollments to the lowest achievable level.

The report finds that 10 million people have been disenrolled from Medicaid – more than 70% of whom were terminated for nothing more than missing paperwork. If all states performed as well as the states with the lowest rates of procedural disenrollment, two-thirds of procedural terminations would have been prevented, and 4.5 million people would not have been terminated because of missing paperwork. 

Last month, the Biden administration took an important step to address this crisis by requiring states to restore Medicaid to 500,000 people – mostly children – known to have been wrongly terminated. However, state leaders must make further major reforms to ensure that only people known to be ineligible are terminated from Medicaid.

The report is co-authored by the Asian and Pacific Islander American Health Forum, the Leadership Conference on Civil and Human Rights, NAACP, the National Council of Negro Women, the National Council of Urban Indian Health, the National Urban League, the Southern Poverty Law Center Action Fund, UnidosUS, the Coalition on Human Needs, and Protect Our Care. 

“We cannot afford to roll back the hard-fought progress we have made on Medicaid, which has helped to narrow racial disparities in health coverage and provide much-needed access to life-saving care in communities of color,” said U.S. Representative Steven Horsford (D-NV-04), Chair of the Congressional Black Caucus. “As a result of Medicaid “unwinding”, nearly 1.8 million Black Americans’ Medicaid coverage has been terminated in the last six months because of missing paperwork, which will only exacerbate existing disparities in access to health care for communities that we serve. The CBC joins our Tri-Caucus colleagues in calling for states to significantly cut rates of procedural terminations by renewing eligible families’ coverage and placing terminations on hold where possible, and by ensuring that beneficiaries have the necessary tools to complete their paperwork needed to determine their eligibility.”

“This report shows what we feared: since the end of the Medicaid continuous coverage requirement, we’ve seen one of the largest losses of health insurance coverage in American history,” said U.S. Representative Nanette Barragán (D-CA-44), ​​Chair of the Congressional Hispanic Caucus. “Millions of Americans, including almost 5 million Latinos, were able to access life-saving health insurance coverage because of the continuous coverage requirement. Now that the requirement has ended, millions of people and especially communities of color, are at risk of losing their health coverage. It’s critical that state leaders take all possible steps to minimize loss of coverage, including by pausing procedural disenrollments as soon as possible. We cannot allow more low-income communities to be left behind. While the Biden Administration has provided states guidance and flexibilities to address this crisis, states must do more to protect families from wrongfully losing Medicaid coverage.”

“As an executive board member of the Congressional Asian Pacific American Caucus and the co-chair of the bipartisan Rural Health Caucus, I know that access to health care is a matter of life and death for our communities of color across the country,” said U.S. Representative Jill Tokuda (D-HI-02), Member of the Congressional Asian Pacific American Caucus. “For too long, black and brown people have been disproportionally represented when it comes both to loss of Medicaid and negative health outcomes due to lack of health access. A majority of Hawaiʻi residents are AANHPI, and I have been particularly concerned about Medicaid redeterminations for our AANHPI communities. There is an ongoing need for in-language materials, community navigators, and outreach from trusted messengers to ensure AANHPI individuals can get the health services and resources they need and in a culturally competent manner. We need to meet patients where they are at. And in doing so, we can improve health outcomes and lower healthcare costs.”

“Advocates and lawmakers alike have been sounding the alarm about Medicaid Unwinding for over a year, urging states to lead and act promptly to preserve health coverage for millions of vulnerable families and children,” said Juliet K. Choi, President and CEO of the Asian & Pacific Islander American Health Forum. “Communities of color, including Asian Americans, Native Hawaiians and Pacific Islanders, are losing life-saving care due to administrative blunders and bureaucracy. We continue to call upon the Biden-Harris administration to act, and on states to mobilize the resources necessary to make sure no family or child is left behind.”

“It is a sad reality that it took a global pandemic for our nation’s elected leadership to expand life-saving healthcare services to hardworking Americans,” said Derrick Johnson, NAACP President & CEO. “The fact of the matter is, our healthcare system has long failed our most vulnerable. This data is further proof that the procedural disenrollment process is steeped in racism. We will not stand by while millions within our community are once again left without a lifeline. The NAACP stands with UnidosUS and other leading civil rights organizations to call for an immediate pause on all procedural Medicaid disenrollments. Our state leaders must make every effort to re-enroll those who have lost coverage, leveraging available data to verify eligibility or providing readily accessible support to complete the paperwork needed to confirm eligibility.”

“The COVID-19 pandemic laid bare inequities in our healthcare system that have plagued the nation, particularly communities of color, for decades,” said Shavon Arline-Bradley, President and CEO of the National Council of Negro Women. “The termination of Medicaid benefitting our children, seniors, and qualified individuals prioritizes procedure over progress. While some states have gotten it right, we call on those states and their lawmakers that have allowed wrongful Medicaid disenrollment to not sit idly by while the constituents that elected them to office go without the critical care they need and deserve. As this comprehensive report shows, the state of health care is in crisis, and this must be reversed immediately.”

“The Medicaid redetermination is proving to be perilous for communities of color, who are disproportionately losing coverage for red tape reasons,” said Marc H. Morial, President and CEO of the National Urban League. “We support the Biden-Harris administration’s actions to enforce the law and call on states to do more to protect their people from becoming uninsured.” 

“We are witnessing the deepest and steepest losses in Medicaid insurance coverage in our nation’s history,” said Eric Rodriguez, Senior Vice President, Policy and Advocacy at UnidosUS. “Many have been dropped from Medicaid due to nothing more than missing paperwork and red tape.  Communities of color — including 2.3 million Latinos — are bearing the brunt of those losses, making health care unaffordable for them and deepening already serious health inequities across the country. The report finds that most of those that have lost Medicaid health insurance coverage may have still been eligible and that despite having the funds, state leaders did not invest the money needed to protect families from being unjustly dropped from the program.”

“It is unacceptable that millions of Americans are losing life-saving health care because of preventable paperwork issues,” said Leslie Dach, Founder and Chair of Protect Our Care. “Many of the states that are failing to keep people covered, like Texas, Georgia, and Florida, are the same ones that have rejected Medicaid expansion, leaving families with no place to turn for basic health care. If those states continue on the path of refusing to protect families who rely on Medicaid coverage, the consequences will be devastating, particularly for communities of color and children. Losing access to health care means people won’t get the care they need to stay healthy and thrive, often having to make difficult choices between visiting the doctor or keeping a roof over their heads. While the Biden administration has taken a number of important steps to address this crisis, these states must do more to protect families and stop inappropriately kicking people off Medicaid.”

“The nation’s Medicaid program is vital to the health and well-being of individuals and communities,” said Margaret Huang, president and CEO of the Southern Poverty Law Center and the SPLC Action Fund. “It is incredibly alarming that nearly 10 million people — including millions of children — have been terminated from this program largely because of unnecessary red tape. These ‘procedural’ terminations cause harm, especially to communities of color and children. They also deepen the current healthcare crisis in our Deep South states that have not yet expanded the program. Driving hundreds of thousands of people into not having health coverage is unacceptable and states must do more.”

“It is extremely troubling that some states are dropping huge numbers of people from their Medicaid programs because of bureaucratic hurdles, without even knowing whether they remain eligible,” said Deborah Weinstein, Executive Director of the Coalition on Human Needs.  “States with records so much worse than better-performing states should be required to pause terminations while they improve their systems.”

“The report highlights the disproportionate impact Medicaid unwinding is having on Native communities,” said Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health. “Medicaid and CHIP coverage are critical to fulfilling the United States’ trust responsibility to maintain and improve Native health, as inadequate insurance coverage is a significant barrier to healthcare access for Native people. Eligible Native children and families are losing coverage for administrative reasons and the federal government has a trust obligation and must do more to protect them.”

“Medicaid pandemic coverage protections were a lifeline for people who struggled to pay all their bills, helping them to see a doctor if they were sick, or get other vitally necessary health care,” said Maya Wiley, president and CEO of The Leadership Conference on Civil and Human Rights. “Since pandemic coverage expired six months ago, we’ve seen the steepest Medicaid coverage losses in history. Make no mistake. Losing Medicaid coverage is losing that lifeline. Those losses have been disproportionately borne by the communities our coalition represents, including people of color, people with disabilities, children, older adults, low-wage workers, and so many others. This deepens and compounds unfair differences in who can and who can’t get the medical care they need. We urge state leaders to do everything in their power to keep eligible folks covered and prevent further catastrophe that is a deep problem for a country that once made great strides on civil rights.”

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In Fact Sheet, Research

“Medicare Autumn” Fact Sheet: The Inflation Reduction Act Has Lowered the Cost of Insulin for Millions of Seniors

Thanks to the Inflation Reduction Act, Medicare is better than ever and seniors will pay no more than $35 per month on insulin. President Biden and Democrats in Congress worked tirelessly to lower health care costs for seniors who have worked hard their whole lives. Too many seniors on fixed incomes have been kept at night worried about paying the bills — gas, groceries, medicines and more. This $35 cap helps millions of insulin users on Medicare afford the medicines they need to stay alive. Before the passage of the Inflation Reduction Act, too many diabetic seniors had to skip doses because of the high costs. Now thousands more seniors are able to fill their prescriptions for insulin each month. While taking insulin as prescribed reduces the likelihood of costly complications such as vision loss, heart disease, and kidney disease. 

This is just the beginning: In 2025, seniors’ total drug costs will be capped at $2,000 per year and, in 2026, new savings from Medicare’s drug price negotiation will take effect. Together, these provisions will save seniors thousands of dollars on prescription drugs. And while the Inflation Reduction Act addressed the insulin affordability crisis for seniors, Democrats in Congress are also working to extend that cap so no American will pay more than $35/month for their insulin.

WHAT THE INFLATION REDUCTION ACT’S $35 INSULIN CAP DOES FOR SENIORS WITH DIABETES

Makes Insulin Accessible and Affordable For Seniors. In 2020, there were more than 3.2 million insulin users on Medicare Part D, with nearly 1.7 million purchasing their insulin without low-income subsidies. On average, seniors with Medicare Part D who are not receiving subsidies pay an average of $572 every year for this life saving medication — an unthinkable sum for many on fixed incomes. Under the Inflation Reduction Act, insulin copays for seniors on Medicare are now capped at $35 each month.

Thousands More Seniors Are Filling Their Insulin Prescriptions. The Inflation Reduction Act’s cap on insulin copays has led to increases in the total number of insulin prescriptions filled for Medicare beneficiaries. A study from the USC Schaeffer Center for Health Policy & Economics and University of Wisconsin–Madison found that following the cap’s enactment in January 2023, the number of insulin fills among Medicare Part D enrollees increased from 519,588 to 523,564 per month.

Rural Seniors Are Able to Access Affordable and Quality Care. According to a 2018 study, rural Americans are 17 percent more likely to suffer from diabetes than urban Americans. Diabetes risk factors are higher in rural areas than their urban and suburban counterparts as they have limited access to health care providers, fewer transportation options to receive care, and higher rates of being uninsured. These seniors are forced to stop taking their medication or cut doses in half. Diabetics suffer severe effects such as numbness in feet and nerve damage in the eyes when they stop taking doses as prescribed. Patients who suffer chronic complications can expect to pay upwards of an additional $650 per year. The insulin cap provision in the Inflation Reduction Act vastly improves the lives of millions of these vulnerable insulin users.

Americans Of Color Are Disproportionately Affected By Diabetes. Deaths related to diabetes are three times more likely among people of color than their white counterparts. Over 12 percent of Americans of color experience diabetes due to a combination of genetic, socioeconomic, and environmental risk factors.  11.8 percent of Hispanic adults have diabetes and are 50 percent more likely to develop type 2 diabetes over the course of their lifetime than their white counterparts. Racial and ethnic minority populations are also at a higher burden of diabetes-related complications, such as kidney disease, blindness, and worse glycemic control. Despite the higher risk of complications, Americans of color are less likely to receive recommended preventive care and annual screenings, largely as a result of systemic access barriers to this care. Americans of color spend upwards of $10,000 a year on diabetes-related costs. 

Americans Of Color Skip, Ration, Or Delay Insulin Doses At Higher Rates Than Their White Counterparts. With rates of uninsurance also being highest among people of color, these insulin users are at a higher risk of skipping, rationing, or delaying insulin doses. Nearly 24 percent of Black Americans ration insulin compared to 16 percent of their white and Hispanic counterparts. Black adults also continue to be the hardest hit when it comes to affording their prescription drugs and paying medical bills. The Inflation Reduction Act’s insulin cap is promoting health equity by expanding access and increasing affordability for diabetic seniors of color so much so that the prevalence of skipping doses is already beginning to fall. 

REPUBLICANS ARE FIGHTING TO KEEP INSULIN PRICES HIGH

Republicans Blocked Insulin Cap for Millions of Americans. As the final negotiations were being made on the Inflation Reduction Act, Republicans in the Senate unified together to make sure that the $35 insulin cap was not universal. In a country where 80 percent of diabetics have had to go into debt in order to pay for insulin, this type of action by Republicans reeks of the influence of Big Pharma. An additional 21 million insulin users of all ages would have benefited from this universal program, including the nearly 300,000 young people under 20 who are diagnosed with diabetes. 1 in 5 people with private insurance pays more than $35 per month and, for people who are uninsured or have poor coverage, insulin can cost up to $1,000 per month. A striking 14 percent of insulin users spend catastrophic amounts, or at least 40 percent of their income, on insulin. The Affordable Insulin Now Act, which will build upon the gains of the Inflation Reduction Act, is supported widely by Democrats but has been continually shot down by Republican legislators.

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In Fact Sheet, Research

“Medicare Autumn” Fact Sheet: American Seniors Will Save As Medicare Negotiates Lower Drug Costs

Protect Our Care launched a new campaign, “Medicare Autumn,” to educate seniors on how Medicare is better than ever. Thanks to the Medicare Drug Price Negotiation Program included in the Inflation Reduction Act, Medicare now has the ability to negotiate drug prices to lower costs for seniors on Medicare. The Biden administration recently announced the first round of high-cost drugs whose prices will come down from negotiation. This includes some of the highest-priced prescription drugs used to treat conditions like diabetes, heart disease, cancer, arthritis, chronic kidney disease, psoriasis, Crohn’s disease, and ulcerative colitis – many of which disproportionately impact women, communities of color, and people in rural areas. 

For too long, Americans have been paying three to four times more than people in other countries for the prescription drugs they depend on, forcing people to choose between filling a prescription or filling their refrigerator. Giving Medicare the power to negotiate with drug companies will help bring the price of medicines in the U.S. more in line with what other countries pay.

The impact of lower prescription drug costs thanks to the Inflation Reduction Act will be felt by people across the country. Negotiating lower prices on certain popular high-cost drugs will help:

  • 3,505,000 Americans who pay an average of $441 out-of-pocket per year for Eliquis, sold by Bristol Myers Squibb, to treat blood clots.
  • 47,000 Americans who pay an average of $921 out-of-pocket per year for Enbrel, sold by Amgen, to treat arthritis and psoriasis. 
  • 521,000 Americans who pay an average of $357 out-of-pocket per year for Entresto, sold by Novartis, to treat heart failure. 
  • 639,000 Americans who pay an average of $260 out-of-pocket per year for Farxiga, sold by AstraZeneca to treat diabetes.
  • 763,000 Americans who pay an average of $121 out-of-pocket per year for Fiasp/NovoLog, sold by Novo Nordisk, to treat diabetes. 
  • 22,000 Americans who pay an average of $5,247 out-of-pocket per year for Imbruvica, sold by AbbVie, to treat blood cancers. 
  • 885,000 Americans who pay an average of $270 out-of-pocket per year for Januvia, sold by Merck, to treat diabetes. 
  • 1,321,000 Americans who pay an average of $290 out-of-pocket per year for Jardiance, sold by Boehringer Ingelheim, to treat diabetes. 
  • 20,000 Americans who pay an average of $2,058 out-of-pocket per year for Stelara, sold by Johnson & Johnson, to treat psoriasis and Crohn’s disease.
  • 1,311,000 Americans who pay an average of $451 out-of-pocket per year for Xarelto, sold by Johnson & Johnson, to treat blood clots.

Drug Price Negotiation Improves Other Medicare Benefits. As a result of Medicare negotiation negotiations, Americans with Medicare will have access to innovative, life-saving treatments at lower prices, translating into lower premiums and out-of-pocket costs for older Americans and producing savings that are being used to improve benefits, including: 

  • a new $35 cap on monthly insulin prescriptions; 
  • free recommended vaccines;
  • a $2,000 annual cap on prescription drug costs taking effect in 2025.

The First 10 Drugs Are Just The Beginning. Negotiations will occur over the coming year and new, lower prices will be announced by September 1, 2024, and take effect in 2026. The first ten drugs that will see lower prices are responsible for about 20% of total Medicare Part D prescription drug costs every year. The companies that market them have made more than $493 billion in revenue from these drugs. Medicare will negotiate lower prices for an additional 15 drugs for prices effective in 2027, and by 2029, Medicare will negotiate lower prices for 20 drugs per year. And President Biden and Democrats in Congress are already working to expand these cost savings to more Americans, no matter what age they are or how they get their health coverage. 

Medicare Drug Price Negotiation Is Overwhelmingly Popular. Negotiating lower prices is overwhelmingly popular across the country, yet big drug companies are suing the federal government to protect their massive profits by halting the program. A recent Hart Research poll shows that 96 percent of Americans agree that lowering drug prices “is an important way to help people afford the cost of living,” and nearly three-quarters of Americans favor Medicare negotiation. Meanwhile, pharmaceutical companies’ arguments against negotiation are overwhelmingly rejected by the American people.

Big Drug Companies Are Threatening To Keep Drug Prices High Through The Courts. Drug company giants including Merck, Bristol Myers Squibb, Johnson & Johnson-owned Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, and Novartis, as well as mega lobbying groups PhRMA and the US Chamber of Commerce, have sued the federal government in an effort to stop Medicare from negotiating for lower prescription drug prices for Medicare beneficiaries. If the big drug companies get their way patients will pay more so the drug companies can make more money:

  • GONE: Medicare’s power to negotiate lower prices for the most popular and expensive prescription drugs. Under the Inflation Reduction Act, Medicare is set to begin negotiating prices for 10 of the top 50 most expensive Part D drugs in 2026, adding another 15 drugs in 2027 and 2028, and another 20 in 2029 and subsequent years.
  • GONE: $98.6 billion in Medicare savings over the next decade from the drug negotiation program, which translates into savings for patients and taxpayers.
  • GONE: Lower Part D premiums and lower out-of-pocket drug costs for certain Medicare beneficiaries who rely on qualifying drugs.

The plaintiffs assert several sweeping claims, including under the First Amendment, the Fifth Amendment, and the Eighth Amendment across the lawsuits, but experts agree that these meritless arguments are merely an attempt to maintain the status quo where drug companies can protect their massive profits by charging whatever they want at the expense of patients and taxpayers.

ashoup
In Fact Sheet, Research

FACT SHEET: Medicare Open Enrollment Brings New Benefits and Savings for Millions of Seniors

Seniors Will Save in 2024 Thanks to the Inflation Reduction Act: Lower Drug Costs, Monthly Insulin Cost Cap, and Free Vaccines 

Medicare open enrollment began on October 15 and runs through December 7. Millions of seniors will begin selecting their coverage for 2024. It is important that seniors understand the savings available to them as they make decisions about enrolling in a Medicare plan.

As Medicare beneficiaries review plans for 2024, seniors will see new benefits thanks to the Inflation Reduction Act’s measures to drive down drug costs. As they did during the 2023 Medicare open enrollment, seniors will see lower premiums for prescription drug coverage. As of January 1, 2023, critical vaccines are now free, monthly insulin costs are capped at $35 per prescription, and drug companies cannot take advantage of seniors by raising drug prices faster than the rate of inflation. Additionally, in the years ahead, Medicare beneficiaries will see lower drug prices across the board thanks to the Inflation Reduction Act’s provisions to give Medicare the power to negotiate and cap out-of-pocket drug costs at $2,000 a year. This translates to thousands of dollars in savings for millions of seniors and people with disabilities nationwide. 

BY THE NUMBERS: Seniors Will Pay Less for Health Care

The Inflation Reduction Act is drastically reducing the cost of prescription drugs for the more than 50 million Americans enrolled in Medicare’s Part D drug benefit, reducing racial, income, and geographic disparities in health care, and saving lives. Seniors will no longer have to choose between paying for the drugs they need and other essentials like food and housing.

By the Numbers:

  • Over 50 million Medicare beneficiaries no longer face big drug companies’ outrageous price hikes that exceed inflation. 
  • All Medicare Part D beneficiaries have access to covered vaccines, such as shingles and pneumonia, at no cost.
  • No Medicare beneficiary pays more than $35 a month for an insulin copay.
  • Over 50 million Medicare Part D beneficiaries will have out-of-pocket costs for prescription drugs capped at $2,000 per year beginning in 2025. 
  • Lower prices are being negotiated for the first 10 drugs selected for the Negotiation Program, with more drugs to be named each year. The first ten drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog.
  • Premiums for the average Medicare Part D plan are decreasing by 1.8 percent in 2024.

The Inflation Reduction Act Lowers Prescription Drug Prices

Medicare Negotiation For Lower Drug Prices. The Biden administration is implementing the Medicare Drug Price Negotiation Program which is supported by over 80 percent of Americans — the most popular provision in the Inflation Reduction Act. In August, the first round of high-cost drugs that will be negotiated was announced: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/ NovoLog. These high-cost drugs treat conditions like cancer, diabetes, and blood clots. The first ten drugs selected for negotiation are taken by nearly 9 million people on Medicare, who spent $3.4 billion in out-of-pocket costs last year alone.  The negotiated prices will be effective starting in 2026. 

Game-Changer For Insulin-Dependent Seniors. In 2020, there were more than 3.2 million insulin users with Medicare, with nearly 1.7 million purchasing their insulin without low-income subsidies. On average, seniors with Medicare Part D or B who are not receiving subsidies pay an average of $572 every year for this life-saving medication — an unthinkable sum for many on fixed incomes. Patients who suffer chronic complications can expect to pay upwards of an additional $650 per year. Under the Inflation Reduction Act, insulin copays for people on Medicare are capped at $35 per prescription each month. A recent study showed that 1.5 million people on Medicare would have saved an average of $500 in 2020 from the $35 insulin copay cap.

Ends Outrageous Price Increases For Seniors. The Inflation Reduction Act penalized drug companies for raising drug prices faster than the rate of inflation starting at the beginning of 2023. An analysis by KFF showed that half of all drugs covered by Medicare had list price increases exceeding the rate of inflation in 2020. For example, Humira, a medication commonly used to treat rheumatoid arthritis, is one of the nation’s highest revenue-generating drugs, raking in $21 billion in sales in 2019. AbbVie, Humira’s manufacturer, has hiked the price of Humira 27 times, including in January 2021 when it raised its cost by 7.4 percent. Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation. 

Free Shingles Vaccinations. Thanks to the Inflation Reduction Act, 50.5 million seniors are eligible for no-cost shingles vaccinations. In 2020, nearly 4 million Medicare beneficiaries received the two-part shingles vaccination. With a single shot of Shingrix costing $212, seniors on Medicare Part D are saving over $400 on average on vaccinations in 2023. The high out-of-pocket cost of the shingles vaccine has been a key factor in low vaccination rates, especially among Black and Latino communities. This extends an important affordable preventive service to seniors on Medicare; Americans with private insurance could already typically receive shingles vaccinations at no cost.

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