It was predictable, but still notable, that Senate Democrats could not keep a provision capping insulin prices at $35 a month in their Inflation Reduction Act, the groundbreaking climate, tax, and health-care bill they drove through the chamber this past weekend. Democrats had to pursue reconciliation because they have only a 50-member majority and Republicans will cynically invoke the filibuster to block almost anything they try to do in Congress. (A normal legislative process wouldn’t require a once-a-year mishmash of legislating to make government work, but that’s the broken system modern America inherited from its Founders.) The insulin cap for all private insurance would have run afoul of the arcane budgetary rules that govern reconciliation, but Democrats put it in anyway, daring any Republican to strip it out. Most did.
Combating rising insulin costs, in any sane political environment, would be the ultimate bipartisan cause. But in their quest for zero-sum victories — and Democratic defeats — Republicans are now incapable of tackling a basic and very popular issue. More than one in five insulin users on private insurance pay more than $35 a month, according to a recent analysis from the Kaiser Family Foundation. One Yale University study found that 14 percent of those on insulin are spending more than 40 percent of their income on the medicine.
The insulin fight illuminates growing fissures in the Republican Party between its most venal, corporate wing and the legislators who are coming to understand that they may have a winning issue to wrest from Democrats. While much of the media hand-wringing these days is over Democrats who can’t appeal to the median voter — this is certainly a problem — there are many Republicans in Congress who hold increasingly alienating views. The GOP’s absolutist opposition to abortion and celebration of Roe’s demise, for example, may limit what would have been massive electoral gains in the fall. In conservative Kansas, abortion rights overwhelmingly won at the polls, proving definitively that the Republican approach to banning abortion is anathema to Americans in almost every part of the country.
There were seven Republican senators who voted with Democrats to keep the insulin cap for private insurance. Two of them are the well-known centrists: Lisa Murkowski of Alaska and Susan Collins of Maine. Another, rightfully derided for his January 6 insanity, was Missouri’s Josh Hawley, who has been attempting, in his own way, to chart a more economically populist course for the Republican Party. Hawley and a few other Republicans understand there is a way, with their natural geographical advantages in the Senate, to triangulate Democrats to death by embracing certain popular causes on health care and the economy. Even the most conservative voters don’t want to see cuts to Medicare and Social Security — it was something Donald Trump, of all people, intuited in 2016 — and the Republican Party could probably build a durable majority abandoning its obsession with slashing the welfare state at all costs.
Sunday’s vote on insulin demonstrated, however, that the party is nowhere close to existing, and if a working-class voter wants a mainstream political party to care remotely about their well-being, the Democrats remain the only option, as flawed as they are. Had three more Republicans joined with Democrats to vote for the insulin cap, the filibuster would have been overcome and it would have been up to an unelected Senate parliamentarian to shut down the proposal. Democrats could then dismiss the parliamentarian — Republicans in the Senate did the same in 2001 — and institute the cap anyway.
The bill will still be able to deliver the $35 cap on insulin for Medicare patients and allow Medicare to negotiate drug prices. And Democrats will be able to go out and say, without any hesitation, that it was Republicans in Congress who didn’t care that insulin prices are predatory for working- and middle-class people. The insulin vote should be a reminder to liberals to stop valorizing a certain kind of Republican who appears courageous when denouncing Trump but utterly fails to deliver on policy that saves lives. Voting against the insulin cap were Mitt Romney and Ben Sasse, so-called resistance champions of the Trump era. In the House, Democrats shouldn’t expect allies out of heroes of the hour like Liz Cheney, either. Making greater changes to the health-care system — a public option or even something resembling Medicare for All — will take many more Democratic votes. The immediate good news, at least, was that the Democrats got much done this summer operating without any margin for error.