Senate must use reconciliation to bring down drug costs, invest in home care

Rebekah isn’t someone who typically comes to mind when thinking about the importance of affordable prescription medication and access to home care-based services — especially for people who are elderly. Instead, Rebekah is a 32-year-old millennial who works full-time and is also a caregiver for her mother who suffered a stroke. Rebekah and her new husband moved back in with her mother in her childhood home in Queens, N.Y., to help her with day-to-day tasks — such as cooking and eating, managing medications and paying bills. Rebekah and her husband are among the 53 million people in the U.S. who are caregivers for family who are elderly or disabled — a number that increased by nearly 10 million from 2015 to 2020.

In addition to needing assistance at home, Rebekah’s mother needs at least eight different medications, including a recently prescribed injectable medication which may not be covered by her mother’s insurance. “Every time another medication is added we hold our breath”, said Rebekah. “My generation is already coping with multiple financial pressures of our own. We need lower drug prices and a better support system of affordable and high quality care when our loved ones need it.” 

Seniors’ living costs have been escalating — especially for medical and long-term care. The prices of prescription drugs have skyrocketed to the point where many seniors are forced to cut pills in half or skip vital medications altogether.

The lack of access to affordable home care and prescription medications creates a difficult burden for workers who are also trying to meet family caregiving needs. With a national average wage of less than $60,000 per year, everyday working Americans are faced with impossible choices like staying in their jobs to pay for necessary prescription medications or staying home to provide the care that their loved ones need but can’t afford. This decision forces many out of the workforce and worsens the economic outlook for their own future.   

The Senate can — and must — do something about this, now.

Every American deserves access to prescription drugs at the lowest, negotiated price. The House-passed Elijah Cummings Lower Drug Costs Now Act (H.R.3) would save Medicare some $450 billion over ten years, mainly by allowing the program to negotiate prices directly with Big Pharma. Or, in the House-passed Build Back Better Act, Medicare would be able to negotiate the prices of up to 10 drugs per year starting in 2023, with that number eventually rising to up to 20 drugs per year. The Congressional Budget Office estimates federal budget savings from the drug pricing provisions would be $297 billion over ten years.

Either way it gets done, the prohibition on allowing Medicare to negotiate drug prices must be lifted.

Through a legislative mechanism called budget reconciliation, with 50 votes, the Senate can enact vital investments of federal funding in the public interest. Older people and their families need affordable in-home care, so that family members aren’t forced to leave the workforce to step into caregiving roles. Professional caregivers — 86 percent of whom are women, and a majority women of color — need family-supporting wages. Increasing the wages of care workers in the Medicaid Home and Community Based services program, will expand the job market and strengthen this workforce, according to Moody’s Analytics.

Any reconciliation agreement that comes across Congress must include these vital investments to lower costs for caregiving families, strengthen the workforce, and lower prescription drug prices. A majority of Americans agree: recent polling shows 87 percent of respondents support policies to provide “affordable long-term care for seniors and people with disabilities”, and 81% of Republicans support allowing Medicare to negotiate lower prices for prescription drugs. 

We can afford to make these investments, but we can’t afford to wait. People like Rebekah, her husband, and her mother, all of us, need the Senate to act now.

Ai-jen Poo is president of National Domestic Workers Alliance. Max Richtman is president and CEO of the nonprofit National Committee to Preserve Social Security and Medicare. He is former staff director at the Senate Special Committee on Aging.