President Joe Biden mostly painted in broad strokes in his State of the Union Address Thursday when it came to healthcare, touting a raft of healthcare accomplishments and proposals aimed at lowering costs for patients but perhaps raising costs for companies.
He also pointed to some new proposals, including expanding the number of drugs that can be negotiated by Medicare to 50 a year, extending a $2,000 cap on out-of-pocket drug costs to all Americans, and launching a $12 billion women's healthcare initiative.
And in a speech designed to jump-start his 2024 reelection campaign, he led off the healthcare related elements of his speech with an issue Democrats believe will boost their election prospects — reproductive healthcare.
Reproductive health
Democrats defied a predicted "red wave" during the 2022 midterm elections, in part because of voter discontent over the Supreme Court's Dobbs v. Jackson ruling that overturned Roe v. Wade and freed states to ban abortion. That political calculus intensified when the Alabama Supreme Court decreed last month that embryos frozen for in vitro fertilization are legally human and may not be destroyed, although the state's elected officials took steps this week to blunt the ruling's impact.
Biden pointed to two women sitting with First Lady Jill Biden early in the speech to make his points. Latorya Beasley had to put her hopes for a pregnancy on hold after the Alabama ruling.
"What her family has gone through should never have happened. And unless Congress acts, it could happen again," Biden said.
Nearby was Kate Cox, who had to leave her state of Texas to get care for a non-viable fetus.
"Many of you in this chamber and my predecessor are promising to pass a national ban on reproductive freedom," Biden chided Republicans. "My God, what freedoms will you take away next?"
The Republican response by Sen. Katie Britt (R-Ala.) spent little time on health issues, though she did nod at the IVF ruling in her state, saying her party still supports such medical procedures.
"We are the party of hard working parents and families and we want to give you and your children the opportunities to thrive," Britt said. "And we want families to grow. It's why we strongly support continued nationwide access to in vitro fertilization. We want to help loving moms and dads bring precious life into this world."
Prescription drugs
Biden touted what may be the chief health policy accomplishment of his presidency: lower prescription drug costs for Medicare enrollees. He called on Congress to broaden that initiative.
Democrats had advocated for Medicare to negotiate pharmaceutical prices since before President George W. Bush enacted the Part D prescription drug benefit 21 years ago. Biden and Congress achieved this long-sought goal two years ago, at least in part. The Inflation Reduction Act of 2022, which passed with only Democratic votes, allows the Centers for Medicare and Medicaid Services to negotiate prices for 20 drugs. The agency and drugmakers are in talks about the first 10 drugs. The results of that back-and-forth are expected by September, ahead of Election Day, although the prices won't take effect until 2026. Biden wants to give CMS the authority to set prices for 50 prescription drugs a year.
"It's now time to go further and get Medicare the power to negotiate lower prices for 500 different drugs over the next decade," Biden said.
The Inflation Reduction Act limits out-of-pocket drug costs under Medicare to $3,300 this year and $2,000 next year. The Health and Human Services Department estimates about 300,000 enrollees have already benefited from the cap. CMS estimates annual out-of-pocket spending on medications will fall from $51.1 billion in 2022 to $47.3 billion in 2025.
The law specifically targeted insulin prices, which are now capped at $35 per month for Medicare beneficiaries. The pharmaceutical companies Sanofi, Eli Lilly and Novo Nordisk subsequently established the same limit for all patients. Biden wants to make such expansions law.
"What to do next? I want to cap the cost of insulin $35 a month for every American — everyone," Biden said.
Health insurance exchanges
Biden oversaw a significant enhancement of the Affordable Care Act, which President Barack Obama enacted while Biden was his vice president. Health insurance premium tax credits are now more generous, which drove a surge in enrollments during the most recent sign-up period to a record 21.3 million, up from 16.4 million the year before.
Spurred by the COVID-19 pandemic and created through the American Rescue Plan Act of 2021, these enhanced subsidies were extended in the Inflation Reduction Act. But they are due to expire at the end of 2025 unless Congress renews them. If Biden doesn't win reelection, former President Donald Trump — who continues to call for full repeal of the Affordable Care Act — would have to change course and instead build on Obama's and Biden's landmark policies for the enhanced subsidies to continue.
"My predecessor and many in this chamber want to take that protection away by repealing the Affordable Care Act I won’t let that happen," Biden said. "We stopped you 50 times before. I will stop you again. In fact I am protecting it and expanding it," he said, pointing to the subsidies and saying he wants to make them permanent.
Nursing homes
One thing Biden did not address was his administration's controversial push to tighten staffing in nursing homes, though he did repeat his previous calls to strengthen home-based and community services.
"Imagine a future with home care and elder care so seniors and people living with disabilities can stay in their homes and family caregivers get paid what they deserve," Biden said without getting into specifics.
Biden had proposed spending $400 billion in his first year in office to help older Americans stay at home. He only got about $37 billion in the American Rescue Plan Act, and last year proposed finding $150 billion more.
During his address to Congress two years ago, Biden announced a slate of nursing home policies he characterized as crucial to improving safety and quality in long-term care, including minimum staffing rules for skilled nursing facilities and greater transparency of nursing home ownership.
Women's health initiative
Biden made a push for another idea from past years — ramping up research on women's health.
"Women are more than half of our population but research on women's health has always been underfunded. That's why we're launching the first ever White House Initiative on women's health research," Biden said. "Pass my plan for $12 billion to transform women's health research and benefit millions of lives all across America."
