SOTU 2024: Biden calls for drug negotiation expansions, promises reproductive health protections

President Joe Biden promised the country further action on prescription drug prices, insurance coverage and reproductive care access during a State of the Union Address that doubled as an early campaign speech.

With a presidential election months away, the White House hasn’t held back from promoting its recent efforts on issues at the front of voters’ minds such as the cost of American healthcare and abortion. Though Biden's address included several calls for policy support from Congress, he wasn't shy about making his pitch directly to watching voters who could tip the scales in his office's favor. 

"When reproductive freedom was on the ballot, we won in 2022 and 2020—and we'll win again in 2024," the president said near the top of his address. "If you, the American people, send me a Congress that supports the right to choose, I will restore Roe v. Wade as the law of the land again." 

As previewed in fact sheets and other communications released in the run-up to Thursday night, Biden asked Congress to build upon the Inflation Reduction Act (IRA) to increase the number of products subject to Medicare drug price negotiations.

Rather than the current 20-drug-per-year limit, Biden asked lawmakers for the authority to negotiate prices for 50 drugs a year, or "500 different drugs over the next decade," he said.

Additionally, the president called to extend the $2,000 out-of-pocket cap on prescription Medicare drugs (set to go into effect in 2025) to all private insurance.

Per the fact sheets, he is also pushing for a similar expansion of another IRA requirement—that drug manufacturers pay rebates to Medicare for certain drug price increases that exceed inflation—to the commercial market. He illustrated that goal during the address by calling for Medicare's $35-per-month cap on insulin to apply "to every American."

"They're making a lot of money guys, and they'll still be extremely profitable," the president said of the pharmaceutical industry. The price restrictions, he said, "will not only save lives, that'll save taxpayers another $200 billion."

Beyond the IRA, Biden pointed to his political opponents' ongoing attempts to under the Affordable Care Act and its provisions protecting care for those with pre-existing conditions. The president stressed that "the ol' Obamacare is still a very big deal," and that his administration hopes to not just protect the landmark healthcare law, but to expand it by extending its $600 per person, per year Premium Tax Credit set to expire next year. 

Though not mentioned explicitly during the address, Biden is also asking Congress to provide “Medicaid-like coverage” to those living in states that haven’t adopted Medicaid expansion, per his office. He’s also looking for support on mental health care access, where his administration is currently finalizing a rule to ensure parity within health plan coverage; improving the availability of home care for Medicaid enrollees and bringing out-of-network billing restrictions ushered by the No Surprises Act to ground ambulance providers, which are currently exempt.

Access to reproductive health services was a cornerstone of the night's speech. Within minutes of beginning his address, Biden told the stories of individual guests in attendance who had been personally impacted by state restrictions on abortion and in vitro fertilization. On the latter, he urged Republican lawmakers not to "keep families waiting any longer—guarantee the right to IVF nationwide."

The president also noted the proliferation of "state laws banning the right to choose, criminalizing doctors and forcing the survivors of rape and incest to leave their states as well to get the care they need." He stared down Supreme Court justices in attendance when discussing their ruling to overturn Roe v. Wade, and suggested conservative efforts to pass a "national ban on reproductive freedom" would be a slippery slope toward stripping other individual freedoms.

During the run up to the address, Biden's White House had highlighted its efforts to preserve regulatory approvals and access to medication abortion, affirm that Emergency Medical Treatment and Labor Act protections extend to emergency abortion care and protect the privacy of those seeking or providing reproductive care.

In broader strokes throughout the night, the president painted his administration as an advocate for American consumers and an opponent of “corporate rip-offs.” 

He extended that framing to drug manufacturers impacted by the IRA during the speech, but has previously touted his agencies’ work investigating the role “middlemen” such as pharmacy benefit managers, group purchasing organizations and drug wholesalers may have on prices and product shortages. His office's fact sheets also highlighted antitrust wins within healthcare and the ongoing work of his administration to clamp down on anticompetitive mergers and acquisitions.