WASHINGTON — The Senate is poised to vote Thursday on the most significant healthcare legislation in more than a decade, a sweeping bill that would allow Medicare to negotiate prices for hundreds of prescription drugs and create new federal subsidies for Americans purchasing insurance on the individual market.
The Healthcare Affordability and Access Act, which passed the House last month on a largely party-line vote, faces an uncertain path in the evenly divided Senate, where at least two moderate Democrats have expressed reservations about provisions that critics say could stifle pharmaceutical innovation.
"This bill represents a once-in-a-generation opportunity to make healthcare more affordable for working families," said Senate Majority Leader Chuck Schumer on the chamber floor Monday. "The pharmaceutical industry has profited for too long while Americans ration insulin and skip medications they cannot afford."
The legislation would require Medicare to negotiate prices for the 250 highest-spending drugs, a dramatic expansion from the 20 drugs currently subject to negotiation under the Inflation Reduction Act of 2022. Administration officials estimate the change could save the federal government $300 billion over ten years while reducing out-of-pocket costs for seniors.
The bill also addresses the so-called "family glitch" in the Affordable Care Act, which currently prevents family members of workers with employer-sponsored coverage from qualifying for marketplace subsidies, even when family premiums are unaffordable. An estimated 5.1 million Americans would become eligible for assistance under the proposed fix.
Opponents, led by Republicans and some pharmaceutical industry allies, argue that aggressive price controls will discourage investment in new treatments and ultimately harm patients. A study commissioned by the Pharmaceutical Research and Manufacturers of America projected that the bill could result in 100 fewer new drugs reaching the market over the next two decades.
"We all want affordable healthcare, but we shouldn't achieve it by killing the golden goose of American innovation," said Senator John Cornyn (R-TX). "This bill is a wolf in sheep's clothing — it promises lower prices today at the cost of cures tomorrow."
Vice President Kamala Harris has cleared her schedule for Thursday, signaling the administration's expectation that her tie-breaking vote may be needed if all Democrats support the bill and all Republicans oppose it.