Daily Briefing

2024 SOTU: President Biden's top healthcare priorities

President Joe Biden on Thursday delivered the State of the Union address, touting a number of his administration's healthcare accomplishments and proposing more, including expanding Medicare drug price negotiations and expanding price caps on certain drugs.

The healthcare takeaways from the State of the Union

Drug prices

In the speech, Biden touted the Inflation Reduction Act (IRA), which capped insulin prices at $35 per month for Medicare beneficiaries and allowed Medicare to negotiate prices on certain drugs.

"With a law I proposed and signed and not one Republican voted for we finally beat Big Pharma," Biden said in the speech. "Instead of paying $400 a month for insulin, seniors with diabetes only have to pay $35 a month!" Biden also proposed capping "the cost of insulin at $35 a month for every American who needs it."

Biden noted that starting next year, the IRA will cap "total prescription drug costs for seniors on Medicare at $2,000 a year even for expensive cancer drugs that can cost $10,000, $12,000, $15,000 a year." Biden then proposed capping "prescription drug costs at $2,000 a year for everyone."

Biden highlighted the Medicare drug price negotiations under the IRA, saying they will save seniors money as well as cut the federal deficit by $160 billion, and proposed pushing drug price negotiations further.

"Now it's time to go further and give Medicare the power to negotiate lower prices for 500 drugs over the next decade," Biden said. "That will not only save lives it will save taxpayers another $200 billion!"

The Biden administration has also proposed measures to cap Medicare copayments at $2 for common generic drugs and to expand a provision within the IRA — requiring drugmakers to pay rebates to Medicare when drug prices increase faster than inflation — to commercial drugs as well.

In response to Biden's comments, the Council for Affordable Health Coverage issued a statement saying the proposal to increase drug price negotiations to 500 drugs over the next decade "will exacerbate the drug shortage and drastically reduce the investment into new treatments."

Advisory Board's Chloe Bakst noted that the impact of Medicare drug price negotiation "is still currently an unknown as we wait for the Medicare maximum fair prices for the 10 drugs currently on the table."

"Those drug prices are set to be announced in September," Bakst said. "Given the November presidential election, the results of this first experiment in Medicare negotiation will not only impact the potential expansion of the program that Biden proposed, but perhaps the future of the federal government's approach to drug pricing reform."

Bakst added that it's currently "unclear where Congress will go next in their efforts to manage prescription drugs," but said that drug prices "will no doubt remain a priority topic for policy leaders this election year, and we'll be watching to see what proposals gain traction."

Women's health/reproductive rights

In his speech, Biden also addressed the Supreme Court's decision in Dobbs v. Jackson to overturn Roe v. Wade, adding that he would sign legislation "that supports the right to choose" and would "restore Roe v. Wade as the law of the land again."

Since the Dobbs decision, four states have seen ballot measures approved to protect reproductive rights, while three other states have rejected limits. In this upcoming election, Florida, Maryland, and New York will be voting on codifying abortion rights.

"There are state laws banning the right to choose, criminalizing doctors, and forcing survivors of rape and incest to leave their states as well to get the care they need," Biden said. "Many of you in this chamber and my predecessor are promising to pass a national ban on reproductive freedom. My God, what freedoms will you take away next?"

Biden also mentioned the decision by the Alabama Supreme Court ruling that frozen embryos qualify as people and that a person could be held liable for destroying them. Biden pointed out Latorya Beasley, who was seated next to First Lady Jill Biden, who had to halt her in vitro fertilization (IVF) treatments following the Alabama ruling.

"What her family has gone through should never have happened," Biden said. "And unless Congress acts, it could happen again."

In the Republican response that followed the speech, Sen. Katie Britt (R-Ala.) also mentioned the Alabama ruling, saying the Republican party "want[s] 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."

Advisory Board's Rachel Woods noted that, while Biden asked Congress to protect IVF, "clinicians are unlikely to feel confident since their clinical autonomy remains in question as they navigate the aftermath of Dobbs v. Jackson, the new Alabama decision, and future rulings."

Woods also said she's "watching to see how clinical leaders combat the real and perceived risk to clinical autonomy, ensuring that boots-on-the-ground care teams have the latest information, protocols, behavioral health support and legal tools to understand how to best serve their patients under a patchwork legal system. The best leaders won't limit that support to OB/GYN or fertility care, they will ensure support for women's health across all specialties and service lines — including those likely to require secondary fertility treatment, like cancer care, and treatments for new cell and gene therapies."

Biden also proposed increasing research on women's health, noting that women "are more than half our population but research on women's health has always been underfunded."

As a result, Biden said his administration is "launching the first ever White House Initiative on women's health research. Pass my plan for $12 billion to transform women's health research and benefit millions of lives all across America."

Woods noted she's watching "to see how women's health is embedded into the development of all clinical products and for much needed emphasis on women's health in the post-reproductive years."

The Affordable Care Act

Biden also touted his administration's expansions of the Affordable Care Act (ACA), including enhanced credits enacted in the American Rescue Plan.

Those credits make zero-dollar premium plans available to anyone earning up to 150% of the federal poverty line (FPL). They also increase the generosity of credits for those earning up to 400% of the FPL and eliminate what's known as the "subsidy cliff," making it so no one buying coverage on the ACA exchange will be required to contribute more than 8.5% of their income on premiums.

However, the credits from the American Rescue Plan, which were extended in the IRA, are slated to expire at the end of 2025 unless renewed by Congress.

During the speech, Biden referenced former President Donald Trump and other congressional members' previous attempts to repeal the ACA.

"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."

Nursing homes

During the speech, Biden repeated his previous calls to strengthen home-based and community services for seniors and those living with disabilities.

"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.

Previously, Biden's administration had proposed spending $400 billion to help older Americans stay home. In the American Rescue Plan, that number was reduced to around $37 billion, and last year, Biden proposed an additional $150 billion. (Wilkerson, STAT, 3/7; Owermohle, STAT, 3/7; McAuliff, Modern Healthcare, 3/7; Lotven, Inside Health Policy [subscription required], 3/8; Constantino, CNBC, 3/6)

Bold predictions for healthcare in 2024

Healthcare is undergoing seismic shifts that will change where care is delivered, who delivers it, and how it is paid for. From the influence of ecosystem players to the role of technology on the care team, get Advisory Board's three predictions for how healthcare leaders must adapt and strategize to thrive in the evolving industry.






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