President Biden signed the Inflation Reduction Act into law this week, but despite lowering health care costs and putting money back in the pockets of North Carolina families and seniors, every single North Carolina Republican voted against the bill.

In addition to tackling the climate crisis and reducing the deficit, the Inflation Reduction Act will cap prescription drug costs for hundreds of thousands of North Carolina Medicare beneficiaries, reduce health insurance premiums for hundreds of thousands of North Carolinians by about $760 per year on average while expanding coverage to about 135,000 North Carolinians, and cap insulin copayments for the tens of thousands of North Carolina Medicare beneficiaries that use insulin

Here’s what Republicans voted against in the Inflation Reduction Act that will cut health care costs for North Carolinians:

The Inflation Reduction Act Will Cut Prescription Drug Costs By:

• Protecting Hundreds of Thousands of North Carolinians from Catastrophic Drug Costs by Capping Medicare Beneficiary Out-of-Pocket Costs in Part D at $2,000.

  • Medicare beneficiaries with conditions such as cancer, multiple sclerosis, and lung disease can face thousands of dollars in out-of-pocket prescription drug costs, and millions of people in Medicare struggle to afford their medications. The Act will require Part D plans to offer improved financial protections that would phase in starting in 2024, with the $2,000 out-of pocket cap taking effect in 2025. Each year, that will benefit about 51,000 North Carolina Medicare beneficiaries who would otherwise have out-of-pocket costs above the cap, according to estimates from the Kaiser Family Foundation (KFF). And, for the first time, all 1.6 million North Carolinians with Medicare Part D will have the peace of mind of knowing their pharmacy costs are capped.

• Saving Billions of Dollars for Seniors and People with Disabilities and the Federal Government by Allowing Medicare to Negotiate Prices for High-Cost Drugs.

  • By bringing down the cost of these drugs, the legislation will save billions of dollars for both Medicare beneficiaries, who will see reduced out-of-pocket costs, and the federal government. Nationwide, KFF estimates suggest that some 5 to 7 million beneficiaries each year use the types of high-cost drugs that would be subject to negotiation and could see reduced cost sharing as a result.

• Addressing Rapid Prescription Drug Price Growth in Medicare. 

  • The Act requires companies to pay Medicare a rebate if they increase drug prices faster than inflation. That will achieve billions more in savings for the federal government and will further reduce out of-pocket costs for Medicare beneficiaries, starting in 2023.

• Saving North Carolina Medicare Beneficiaries Money by Capping Insulin Copays at $35 per Month.

  • Drug manufacturers have raised insulin prices so rapidly over the last few decades that some Medicare beneficiaries struggle to afford this life-saving drug that costs less than $10 a vial to manufacture. Starting in 2023, the legislation will cap the out-of pocket cost of insulin for Medicare beneficiaries at no more than $35 for a month’s supply. Some 116,000 North Carolina Medicare beneficiaries used insulin in 2020.

• Providing Extra Help Paying for Drugs for North Carolina Medicare Beneficiaries with Low Incomes.

  • The Act expands eligibility for full Part D Low-Income Subsidies – known as Extra Help – in 2024 to low-income beneficiaries with incomes up to 150% of poverty and modest assets. Currently, individuals with incomes between 135% and 150% of poverty only receive partial help, meaning that they still pay premiums and face more significant co-pays. About 23,000 North Carolina Medicare beneficiaries received partial Extra Help in 2020 and could be helped by the expansion of income eligibility for full Extra Help, KFF estimates.

• Saving Tens of Thousands of North Carolina Medicare Beneficiaries Money by Ending Cost-Sharing for Vaccines in Part D.

  • While Medicare Part B covers vaccines such as the flu vaccine at no cost-sharing, patients receiving vaccines covered under Medicare Part D, such as the vaccine for shingles, must pay for a portion of the cost out of pocket. Starting in 2023, the legislation will require $0 cost-sharing for vaccines for Medicare Part D beneficiaries. Some 141,000 North Carolina Medicare beneficiaries received a Part D vaccine in 2020, and that number is likely to rise as those vaccines become more affordable.

The Inflation Reduction Act Will Lower Health Insurance Premiums and Expanding Coverage By:

• Saving Hundreds of Thousands of North Carolinians about $760 per Year.

  • About 670,000 North Carolinians with Marketplace coverage are saving an average of about $760 annually from the ARP subsidies that the Inflation Reduction Act would continue. Those savings increase to thousands of dollars per year for some middle-income older people who would otherwise face very high premium burdens. Among those benefiting the most from these affordability improvements are:

    • North Carolina small business owners and self-employed people. ACA coverage plays a critical role in providing affordable health coverage to 106,000 small business owners and self-employed adults in North Carolina, Treasury data show. In fact, this population makes up 23 percent of ACA marketplace enrollment among working-age North Carolinians.

    • Middle-income older people who have retired or don’t have health coverage through their jobs. For example, a 60-year old North Carolinian with income of $60,000 would pay about 21 percent of income for benchmark health coverage without expanded premium tax credits, which cap premiums at 8.5 percent of income.

• Allowing Tens of Thousands of North Carolinians to Gain Coverage. About 135,000 more North Carolinians will have health insurance next year compared to without the Inflation Reduction Act, according to HHS projections. The Act’s coverage expansions will:

  • Improve health outcomes and likely save lives. Health insurance improves access to care and health, a large body of research finds. That includes a randomized trial finding that expanding Marketplace coverage saves lives: mortality fell among people who gained Marketplace coverage due to randomized outreach.

  • Improve financial security. Health insurance reduces medical debt and improves credit scores and access to credit, research finds – making it possible for people to buy a home or take out an auto loan that in turn allows them to get or keep a job. Health insurance also reduces the frequency of bankruptcies and evictions, with one study finding that access to premium tax credits significantly reduces the share of people delinquent on rent or mortgage payments.

  • Narrow disparities in health coverage and access to care. Continuing the ACA improvements will reduce uninsured rates for all demographic groups, but the uninsured rate will fall disproportionately for Black people – narrowing existing gaps in coverage, Urban Institute researchers estimate. Narrowing gaps in coverage also narrows gaps in access to care, research finds.

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