Inflation Reduction Act Delivers Academy Advocacy Wins

The bill, which was signed into law Aug. 16, carries forward several provisions from the Build Back Better Act that had drawn the Academy’s support, including

• a three-year extension of the enhanced premium tax credits for individuals and families purchasing health insurance from the Patient Protection and Affordable Care Act marketplace;
• creating parity between traditional Medicaid and Medicaid expansion programs by eliminating cost-sharing for all vaccines recommended by the Advisory Committee on Immunization Practices for adults, ensuring equitable access in the Medicaid program and thus improving vaccination rates among at-risk populations; and
• eliminating cost-sharing for ACIP-recommended immunizations covered under Medicare Part D, bringing parity with those covered under Part B.

The legislation also lowers Medicare expenditures on prescription drugs while capping Part D monthly and annual out-of-pocket costs and limits co-pays for insulin to $35 a month for beneficiaries — reforms consistent with AAFP policy. A similar limit to insulin costs for individuals on private health plans was stripped out of the legislation before passage; the Academy continues to push for insulin pricing reform for such patients.

Ahead of Senate debate on the Inflation Reduction Act of 2022, the Academy advocated for its swift passage. That July 29 letter, signed by Board Chair Ada Stewart, M.D., of Columbia, S.C., emphasized that extending the ACA premium tax credits would mark “an important step toward ensuring that millions of Americans can retain affordable, comprehensive insurance coverage.” The letter noted that the Urban Institute warned some 3 million people faced loss of health care coverage if these tax credits were allowed to expire at the end of 2022.

The Academy’s letter also strongly supported the legislation’s attention to immunization, reminding lawmakers that the United States has failed to meet its Healthy People 2020 goals for vaccinating adults, with childhood vaccination rates dipping in several regions as well. Adult immunization coverage lags federal targets for most commonly recommended vaccines; 75% of adults are missing one or more critical vaccines for flu, pneumococcal disease, shingles, tetanus, diphtheria and pertussis.

“Studies show — and family physicians know — that cost can be one of the biggest barriers to patients ultimately receiving their recommended vaccines,” the letter said. “The AAFP has endorsed the Helping Adults Protect Immunity Act to eliminate cost-sharing for ACIP-recommended immunizations for all adults enrolled in Medicaid and the Protecting Seniors Through Immunization Act to bring parity between out-of-pocket costs for immunizations covered under Medicare Part B and Medicare Part D. We are pleased that the Inflation Reduction Act includes both bills, which will eliminate financial barriers to adult vaccines in Medicare Part D and Medicaid.”

The letter stressed the ongoing need for insulin pricing reform “to ensure that all patients who need insulin can afford it.” More than 37 million Americans have diabetes, and an estimated one-quarter of people with diabetes in the United States ration their insulin due to costs. In 2021, U.S. diabetes deaths exceeded 100,000 for the second consecutive year.