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Biden to renew calls to lower health costs at SOTU

Drug pricing, reproductive rights among topics Biden is expected to address on Thursday night

President Joe Biden, pictured here at the South Lawn of the White House on Feb. 20, will deliver his State of the Union address on Thursday night.
President Joe Biden, pictured here at the South Lawn of the White House on Feb. 20, will deliver his State of the Union address on Thursday night. (Tom Williams/CQ Roll Call)

President Joe Biden will call on Congress to allow Medicare to increase its ability to negotiate drug prices and to expand caps on consumer prescription drug costs during his State of the Union address Thursday.

White House Domestic Policy Advisor Neera Tanden told reporters Wednesday that the president will ask Congress to build on work from the 2022 health care and climate law that granted federal authority to negotiate the price of some drugs in Medicare, place caps on out-of-pocket prescription drug costs for seniors and charge drug companies if they raise prices at a rate higher than inflation. 

“The president’s work on health care is a signature issue for us,” said Tanden.

Biden will specifically request Congress to allow Medicare to negotiate at least 50 drugs annually, up from the up to 20 allowed per year under current law. The president will also point to the $2,000 out-of-pocket cap that will apply to Medicare Part D beneficiaries in 2025 as a model cap for private insurers. Congress abandoned a provision expanding the cap to the private market during debate before the law’s passage.

A senior administration official said the president feels confident in scaling up the model used for the 10 drugs currently negotiating with the administration. The number of drugs subject to negotiation will ultimately increase to 20 per year in future years, according to current law.

Biden will also ask Congress to expand the inflation-related drug rebates under the 2022 law to include commercial drug sales.   

He’ll also preview that the White House budget expected Monday will ask Congress to cap cost-sharing for what are called high-value generic drugs at $2 under all Medicare plans. The Department of Health and Human Services listed some of these drugs as part of a new drug pricing model on Wednesday.

The actions follow a White House roundtable held Monday to discuss the role of pharmacy benefit managers, drug prices and the formation of a new task force.

Biden will also press Congress to extend premium tax credits last renewed under the 2022 law before they expire in 2025. The credits help low-income individuals in non-Medicaid expansion states who earn too much to qualify for traditional Medicaid.

“We know that the promise and benefits of the federal Affordable Care Act are really at stake and the president will continue to deliver on the ACA as he has done through this term,” said Tanden, referring to the 2010 health care law.

Biden will also preview upcoming regulatory action, as the administration is working to finalize a mental health parity rule and to finalize a proposed rule to restrict health plans that don’t meet the 2010 health care law’s guardrails.

Senate Majority Leader Charles E. Schumer, D-N.Y., speaking on the Senate floor Wednesday, praised health actions taken following Biden’s previous addresses to Congress. He pointed to efforts to cap insulin costs for some individuals and the coming Medicare spending cap that will take effect in 2025.  

“Sometimes it can take a while for the effects of an ambitious agenda to take root. We saw this happen with the ACA,” said Schumer.

Other health priorities

Biden is also expected to make reproductive freedom a key component of his remarks Thursday, according to a second senior administration official who would not elaborate on specific calls to action.

Democrats in Congress are using this year’s address as a way to message on access to the realm of reproductive health care, including in vitro fertilization, abortion and maternal health. More than two dozen lawmakers have announced guests with connections to these issues.

Piggybacking on increased attention to IVF following a recent Alabama Supreme Court decision, Sens. Tim Kaine, D-Va., and Tammy Duckworth, D-Ill., and Reps. Gerald E. Connolly, D-Va., and Lori Trahan, D-Mass., announced their guests which include Elizabeth Carr, the first person in the U.S. born through IVF, two reproductive endocrinologists and the president of RESOLVE: The National Infertility Association.

House Minority Leader Hakeem Jeffries, D-N.Y. invited Reproductive Freedom for All President Mini Timmaraju, and House Minority Whip Katherine M. Clark, D-Mass., Rep. Joyce Beatty, D-Ohio, and Sen. Patty Murray, D-Wash., will be bringing women affected by state abortion bans, according to their offices.

Biden is expected to use the address to ask Congress to increase investments in women’s health research more broadly.   

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