H.R.2636 - Making Insulin Affordable for All Children Act (119th Congress)
Summary
H.R.2636, the "Making Insulin Affordable for All Children Act," aims to lower insulin costs for individuals aged 26 and under who are covered by private health insurance plans. The bill mandates that these plans provide coverage for selected insulin products without deductibles and with cost-sharing capped at either $35 per 30-day supply or 25% of the negotiated price, whichever is lower. This applies to plan years beginning on or after January 1, 2026.
The bill amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986 to enforce these provisions. It also clarifies that the cost-sharing limitations do not affect the actuarial value calculations for qualified health plans under the Affordable Care Act.
The legislation empowers the Secretaries of Health and Human Services, Labor, and the Treasury to implement these changes through sub-regulatory guidance.
Expected Effects
This bill, if enacted, would significantly reduce the financial burden of insulin for young adults with diabetes who rely on private health insurance. It ensures predictable and manageable out-of-pocket expenses for this essential medication.
Health insurance plans will need to adjust their coverage policies to comply with the new cost-sharing requirements. This may lead to shifts in premiums or other cost adjustments across the broader insured population.
By capping insulin costs, the bill could improve adherence to treatment plans, leading to better health outcomes for young individuals with diabetes.
Potential Benefits
- Reduced Financial Burden: Lowers out-of-pocket insulin costs for individuals 26 and under.
- Improved Healthcare Access: Makes insulin more accessible, potentially improving health outcomes.
- Predictable Costs: Caps cost-sharing, allowing for better financial planning.
- Broader Coverage: Ensures coverage without deductibles for selected insulin products.
- Alignment with ACA: Integrates with the Affordable Care Act to maintain actuarial value standards.
Potential Disadvantages
- Potential Premium Increases: Health plans may raise premiums to offset the cost of capped insulin prices.
- Limited Scope: Only applies to individuals 26 and under, excluding older adults with diabetes.
- Definition of 'Selected Insulin Products': The selection process by health plans could limit choices for patients.
- Administrative Burden: Health plans will incur costs to implement and administer the new requirements.
- Potential for Cost Shifting: Costs could be shifted to other areas of healthcare or to other insured individuals.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution (Preamble), as it aims to improve public health by making insulin more affordable. Congress has the power to regulate interstate commerce (Article I, Section 8), which includes health insurance and the pharmaceutical industry. The bill amends existing laws, such as the Public Health Service Act and ERISA, which are within the scope of congressional authority.
However, some might argue that mandating specific coverage requirements for private health plans could be seen as an overreach of federal power. The Tenth Amendment reserves powers not delegated to the federal government to the states or the people, and healthcare regulation has traditionally been an area of state authority.
Overall, the bill's alignment with the Constitution is reasonable, given the federal government's role in regulating interstate commerce and promoting public health.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).