White House budget leans into drug pricing, ObamaCare expansion

President Biden's budget proposal focuses heavily on expanding access to health care and lowering the cost of prescription drugs.

In an effort to extend the life of Medicare's hospital trust fund, the budget proposal would increase the number of drugs that can be negotiated, and allow those negotiations to begin sooner. 

The plan builds off the Inflation Reduction Act (IRA), which granted Medicare the power to negotiate the prices of up to 20 drugs each year — though the drugs can only qualify after being on the market for at least nine years. 

The IRA passed with only Democratic votes last year, and some in the GOP have already claimed they will try to repeal it.

Another IRA provision that would get a boost in the budget is the requirement that drug companies pay rebates to Medicare when they increase prices faster than inflation. Under the White House proposal, that requirement would extend to the commercial market as well.

The budget also seeks to extend the $35 insulin cap to the private sector. Under the IRA, Medicare beneficiaries won't pay more than $35 out of pocket for insulin.

A proposal to cap the cost for all Americans was defeated by Senate Republicans.

The White House budget also includes proposals to expand ObamaCare programs. 

It calls for permanently expanding enhanced subsidies for health plans on the exchanges, which currently expire at the end of 2025. The enhanced subsidies make insurance premiums free for most Americans with incomes just above the poverty line, and they lower the cost of premiums for Americans with higher incomes.

The budget also proposes “Medicaid-like” coverage for eligible people in states that haven’t expanded Medicaid coverage yet, paired with financial incentives to ensure states maintain their existing expansions. 

Republicans began blasting elements of the budget before it was formally released, and are not likely to support the proposals. 

The White House called the budget a “blueprint” to build on progress from the first two years of the administration. It claims that Republicans “have taken a very different approach” and want to add to the nation’s debt.