Collins faces uphill battle to win GOP support for insulin cost bill

Sen. Susan Collins (R-Maine) is facing an uphill climb as she seeks to win over GOP colleagues for a bipartisan insulin bill ahead of a vote expected next month.   

Senate Majority Leader Charles Schumer on Wednesday said the bill from Collins and Sen. Jeanne Shaheen (D-N.H.) to lower insulin costs would come to the floor “very soon.”  

Backers say the bill, which would cap out-of-pocket insulin costs at $35 per month and seeks to lower the overall cost of the drug, is sorely needed given that as many as 1 in 4 patients with diabetes ration their insulin due to cost.   

But the measure faces headwinds due to election year politics as well as concerns from some Republicans that it interferes in the free market or costs too much money.   

Collins will need to win over nine other Republicans for the measure to get the 60 votes needed to clear the Senate.   

In her bid to do so, she has been holding one-on-one meetings with her GOP colleagues, including Senate Minority Leader Mitch McConnell (R-Ky.).   

“I have briefed Sen. McConnell about the bill and I’ve also been setting up individual meetings with many of my colleagues,” she told reporters. “Many of them have heard similarly from constituents who are having a difficult time affording their insulin.”  

Asked how many other Republicans are supporting the legislation, Collins said: “I can’t give you a count, which you’re obviously looking for, because those briefings are ongoing.”  

Adding a political hurdle, Sen. Raphael Warnock (D-Ga.), who faces a tough reelection race this year, has touted action on insulin as a key part of his message. The opposing party tends to be hesitant to pass legislation that a vulnerable lawmaker could claim as a victory.   

Schumer is also billing the measure as addressing rising costs. Republicans have consistently hammered Democrats over soaring inflation on a number of products.   

“Senators Shaheen and Collins’ bipartisan legislation deserves the support of anyone who claims they want to lower costs for the American people,” Schumer said in a statement on Wednesday, putting pressure on Republicans to support it.   

Some Republicans are concerned that the measure veers too close to “price controls” with its cap on out-of-pocket insulin costs.  

“I’ve never been in favor of capping costs,” Sen. Richard Burr (N.C.), the top Republican on the Senate Health Committee, said when asked about the Shaheen-Collins bill.   

Sen. Mike Crapo (Idaho), the top Republican on the Senate Finance Committee, said that he liked “some pieces” of the bill but that he doesn’t “think they exactly have the correct answer yet.”  

A McConnell spokesman declined to comment on the leader’s position on the measure.   

A Senate GOP aide said that “GOP staff seem mostly skeptical” of the bill but that some offices are waiting to see a Congressional Budget Office estimate of the cost of the measure and the extent to which premiums would increase if more costs are shifted onto insurers.  

“Seems like 60-vote potential is an open question at this point,” the aide said, referring to the threshold needed to overcome a filibuster.

A related House insulin bill costs roughly $20 billion. Shaheen said Wednesday that she and Collins are working to find offsets to pay for any cost.  

At least some Republicans are more open to the measure, though.   

Sen. Chuck Grassley (R-Iowa), who has often been willing to go farther than the average Republican lawmaker on drug pricing issues, called the bill “very enticing” and said he had met with Collins about it for half an hour.   

In addition to capping insulin costs for patients at $35 per month, the measure also seeks to reduce the overall cost of the drug. It would provide an incentive for drugmakers to lower the cost of insulin by eliminating the rebates they pay to negotiators called pharmacy benefit managers if they kept the price below a certain level.   

However, some drug pricing advocates are concerned the bill does not guarantee that drugmakers will lower their prices, only providing voluntary incentives — concerns that Grassley has echoed.   

Grassley said there is “a question if it will accomplish what they want, from the standpoint of it being voluntary.”  

“But on the other hand, for a small government person like me, maybe that’s something that ought to entice me,” he added.   

Sen. Roger Marshall (R-Kan.) said the measure has “steps in the right direction,” though he still has some concerns.   

“We both agree that there’s a significant problem there and we’d love to solve it,” he said, saying he had talked to Collins.   

Asked how she would respond to GOP concerns about giving President Biden or Warnock a victory, Collins pointed to efforts during the Trump administration to lower drug costs and reform the drug rebate system, including for insulin.   

“I would point out that it was the Trump administration that initially proposed going after this kind of pricing,” she said. But more broadly, she said, the issue of affording insulin “transcends partisan lines.”  

She said at this point she is not formally asking for co-sponsors and is still working to explain the complex measure.   

“We’re going to have to do work, as you do with any major piece of legislation,” she said.