Key health care takeaways from President Biden’s State of the Union speech

In what likely is a preview of a key theme for his general election campaign, President Joe Biden made health care affordability a centerpiece of Thursday evening’s State of the Union address. A White House fact sheet touted the administration’s accomplishments during its first three years in office.

“The president continues to build on, strengthen and protect Medicare, Medicaid and the Affordable Care Act, signing laws such as the American Rescue Plan Act and the Inflation Reduction Act to lower prescription drug costs and health insurance premiums,” it said. “Thanks to the president’s efforts, more Americans have health insurance than under any other president and are better protected against surprise medical bills and junk fees.”

Many of the initiatives target the high cost of health care.

“Seniors are already seeing lower prescription drug prices with insulin capped at $35, free vaccines and out-of-pocket costs for prescription drugs capped at $2,000 starting in 2025,” it said. “And the administration is well on its way to lowering the cost of range of drugs as Medicare negotiates over the prices of prescription drugs for the first time ever.”

Many of the proposals outlined during the speech seek to extend and expand these programs:

1. Expand Medicare price negotiations. Last month for the first time in history, Medicare made offers on fair prices for 10 of the most widely used and expensive drugs. This week the Centers for Medicare & Medicaid Serviced announced that manufacturers of all 10 selected drugs are participating in drug price negotiation, with all of them submitting counteroffers. Later this year, negotiated prices for the first 10 prescription drugs will be announced. Biden said he wants to increase the annual number of drugs under negotiation to 50.
2. Expand the cap on out-of-pocket prescription drug costs. When the $2,000 out-of-pocket cap on prescription drugs in Medicare begins in 2025, nearly 19 million seniors and other beneficiaries are projected to save $400 per year on prescription drugs, the White House said. The president called on Congress to expand the cap to all private insurance so Americans have the peace of mind that comes with knowing that they won’t have to choose between filling their prescription or putting food on the table.
3. Cap Medicare cost sharing at $2 for common generic drugs. Medicare will launch a new model to limit Medicare Part D cost sharing for certain generic drugs to $2. The Department of Health and Human Services will publish a list of dozens of generic drugs for the model, including such drugs as statins to treat high cholesterol, beta-blockers for high blood pressure and platelet inhibitors to prevent blood clots. Biden asked Congress to limit Medicare cost-sharing to $2 for high-value generic drugs for all Medicare plans.
4. Require rebates. Drug manufacturers now must pay rebates to Medicare if their price increases for certain drugs exceed inflation. Biden asked Congress to require those rebates for commercial drug sales as well as sales to Medicare. This will save the federal government billions of dollars, further curb prescription drug price inflation and reduce health insurance premiums for people with private health insurance coverage, he said.
5. Close the coverage gap. Biden will make another push to close the coverage gap in the 10 states that haven’t expanded Medicaid; extend a $35 monthly cost limit for insulin to the commercial market; and make the ACA’s enhanced premium tax credits permanent before they expire in fall 2025.

Related: Biden launches health care task force to ease patient costs, fight ‘corporate greed’

Biden also cited his efforts to bring about mental health parity; his proposed nursing-home staffing mandate; and the PACT Act he signed, which expands benefits for veterans exposed to toxins. “We truly believe the president’s work on health is a signature issue for us,” White House domestic policy adviser Neera Tanden said.

However, Biden’s proposals will require substantial congressional action at a time when Congress struggles with passing an annual budget. Congress also remains closely divided, and while the president is expected to call for bipartisanship to expand these health-care savings, he repeatedly has noted that no Republican voted for the IRA. When asked about the likelihood of Congress taking up the reforms, a senior administration official told reporters that there’s “little value in prognosticating about what Congress is and isn’t going to do.”

In the wake of both Super Tuesday and the State of the Union address, health-care reform will play out against the backdrop of election year politics.

Joe Grogan, former director of Donald Trump’s Domestic Policy Council, countered that despite Biden’s claims, Americans are generally unhappy with the state of health care. “The Democrats have dominated policymaking, and Biden wants to go out there and say, `This is so great?’” he told Axios. “I think Republicans have to push back.”