Lawmakers and experts clash over IRA drug‑pricing, Medicare Part D changes and Medicaid risks

Lawmakers and expert witnesses used a joint subcommittee hearing to assess how the Inflation Reduction Act's health provisions are affecting drug prices, Medicare Part D plans and broader coverage programs, and to consider the consequences of proposed rollbacks.

Dr. Erin Trish, co‑director of the USC Schaeffer Center for Health Policy and Economics, told the panel that the IRA's drug‑price negotiation authority and Part D redesign have created market uncertainty and higher federal spending during implementation. "We got an opaque process. We got uncertainty," Trish said, adding that an abrupt benefit redesign has contributed to insurers exiting the market.

Trish testified that the number of Part D plans fell and that taxpayers are shouldering a larger share of premiums. "There is a 35% reduction in the number of plans offered this year," she said, and taxpayers are now covering an estimated 83% of premium subsidies, a figure she said was higher than historical norms. Trish also cited a Government Accountability Office finding that the Centers for Medicare & Medicaid Services is spending about $3 billion on negotiation implementation.

Dr. Emily Gee, senior vice president for inclusive growth at the Center for American Progress, highlighted protections added by the IRA. "That $2,000 limit is estimated to save $600 on average for the 11,000,000 beneficiaries who would have otherwise had spending above that level," Gee said, referring to the new annual out‑of‑pocket cap for Medicare drug spending. She also noted a $35 cap on insulin monthly costs and expanded low‑income subsidies for Part D.

Members pressed witnesses on trade‑offs and projected impacts of proposed House legislation to rescind IRA provisions. Several Democratic members and witnesses cited nonpartisan CBO estimates and other studies predicting that rolling back marketplace subsidies and Medicaid funding in the pending House package would raise the uninsured rate and could lead to plan exits and rural hospital strain. Representative statements in the hearing pointed to CBO projections that millions could lose coverage under some rollback scenarios.

Witness testimony underscored distributional concerns and implementation effects. Trish cited evidence that plan deductibles have increased and that many beneficiaries do not reach the catastrophic cap that protects highest spending; she warned that some beneficiaries nonetheless experienced higher pharmacy out‑of‑pocket costs in the short term. "Imagine the frustration your constituents must feel when they see news headlines that CMS is lowering drug prices, and yet they find their costs are going up," Trish said.

The hearing did not produce legislation; members used the session to request documents and press witnesses for analysis. Lawmakers on both sides signaled further oversight and potential policy proposals in coming weeks.