It is an open question whether Democrats will pass their Build Back Better bill this year, or ever — Sen. Joe Manchin (D-W.Va.) reiterated his ambivalence on Monday, even as he and President Biden spoke about the bill on the phone. But the version of the legislation that passed the House and is working its way through the Senate would cap insulin costs at $35 a month for people with insurance, either private or through Medicaid. Biden touted this provision of the bill last week. 

“But it’s a pledge Democrats may be unable to keep” to struggling diabetics, even if Manchin signs off, The Washington Post reports. “Senate Republicans are eyeing a procedural move to prevent the insulin cap from applying to privately insured Americans, seeking to deny Democrats a talking point heading into next year’s midterm elections — even if it means that some patients will go without relief.”

Facing lockstep GOP opposition to the expansive legislation, Senate Democrats plan to pass the bill through the budget reconciliation process. “Senate Republicans repeatedly declined to comment on whether they would use the 
‘Byrd rule’ — which governs legislation enacted through the budget process — to knock out part of Biden’s insulin plan,” the Post reports. “Republicans have been meeting with the Senate parliamentarian to determine whether the bill’s health provisions would technically qualify under budget reconciliation,” and “if Senate Republicans challenge the insulin provision,” and the parliamentarian sides with them, they “could call a point of order to strip the provision from the bill.”

Senate Republicans, and former President Donald Trump, supported lowering insulin prices that have shot up in recent years, for no discernable reason. They could decide not to challenge the plan in the Build Back Better legislation. Some progressive Democrats, on the other hand, are urging Senate Democrats to expand the plan to include the uninsured. 

“As I researched this topic, I found that 25 to 30 percent of Americans ration their insulin because of high cost,” S. Vincent Rajkumar, Mayo Clinic physician, tells the Post. “The ability to keep increasing the price every year on the same product happens only when there is no market force” to keep drugmakers in check. Read more at The Washington Post.