The Biden administration made prescription drug costs its signature healthcare issue, signing into law the first-ever authority for Medicare to negotiate drug prices directly with pharmaceutical companies. That single provision, part of the Inflation Reduction Act of 2022, anchored a broader set of changes spanning insurance affordability, consumer protections, and access to mental health and reproductive care. Here’s what actually changed and where things stand.
Medicare Drug Price Negotiation
For decades, Medicare was prohibited by law from negotiating the prices it paid for prescription drugs. The Inflation Reduction Act removed that restriction. The Centers for Medicare and Medicaid Services selected ten high-cost drugs covered under Medicare Part D for the first round of negotiations, reaching agreements with the manufacturers. Those negotiated prices take effect January 1, 2026.
The selected drugs treat common conditions among seniors, including blood thinners, diabetes medications, and treatments for heart failure and blood cancers. A second round of negotiations covering additional drugs is set to follow in subsequent years. The program’s long-term impact depends on how many drugs eventually come under negotiation and whether the law survives legal challenges from the pharmaceutical industry.
Insulin and Out-of-Pocket Caps
Starting in 2023, Medicare beneficiaries saw their insulin costs capped at $35 for a month’s supply per product, covering both Part D (pharmacy) and Part B (doctor-administered) insulin. Before this cap, some seniors paid hundreds of dollars a month for insulin they needed to survive.
The Inflation Reduction Act also introduced a hard ceiling on total out-of-pocket prescription drug spending for Medicare enrollees. In 2025, no Medicare Part D beneficiary pays more than $2,000 per year in out-of-pocket drug costs. Previously, patients with expensive medications for conditions like cancer or autoimmune diseases could face annual drug bills well into the thousands with no upper limit. This cap effectively eliminates the catastrophic spending that forced some seniors to skip doses or choose between medications and other necessities.
ACA Premium Subsidies
The American Rescue Plan in 2021 temporarily expanded premium subsidies for Affordable Care Act marketplace plans, making monthly premiums significantly cheaper for people buying their own insurance. These enhanced subsidies removed the income ceiling that previously cut off help for middle-income households and lowered costs for those already receiving assistance. The Inflation Reduction Act extended these enhanced subsidies, keeping premiums lower for millions of marketplace enrollees. The subsidies are set to expire, and whether Congress renews them will determine whether premiums jump for people who buy coverage through healthcare.gov and state exchanges.
Protection From Surprise Medical Bills
The No Surprises Act, signed in late 2020 and implemented under the Biden administration starting in 2022, protects patients from unexpected bills when they receive care from out-of-network providers at in-network facilities. This commonly happened in emergency rooms or during surgeries when an anesthesiologist or specialist who wasn’t in the patient’s insurance network treated them without their knowledge.
Under the law, patients pay only their in-network cost-sharing amount, and the provider and insurer settle the difference through a dispute resolution process. Both providers and insurers have reported that one of the law’s core objectives has been achieved: patients are no longer caught in the middle of payment disputes over out-of-network charges. The practical effect is that a trip to the ER or a scheduled surgery no longer carries the risk of a surprise bill for thousands of dollars from a doctor you never chose.
Over-the-Counter Hearing Aids
In 2022, the FDA finalized a rule allowing hearing aids for mild to moderate hearing loss to be sold over the counter without a prescription, medical exam, or audiologist fitting. Before this change, hearing aids typically cost $1,000 to $6,000 per pair and required professional visits that added time and expense. The FDA estimated the rule would generate tens of millions of dollars in annual consumer savings by opening the market to competition from consumer electronics companies. Major retailers and tech companies began selling devices for a few hundred dollars within months of the rule taking effect.
Mental Health Parity Enforcement
The administration finalized updated rules in 2024 strengthening the Mental Health Parity and Addiction Equity Act, which requires insurers to cover mental health and substance use treatment on equal terms with physical health care. In practice, insurers had long used indirect methods to restrict mental health access, such as requiring more prior authorizations, limiting provider networks, or imposing stricter visit caps compared to medical care.
The updated rules require health plans to collect data measuring whether their policies create harder access to mental health care than to medical care. If the data shows meaningful disparities, plans must take corrective action. This shifts the burden from patients proving they were denied fair coverage to insurers demonstrating they’re providing it.
Postpartum Medicaid Coverage
The American Rescue Plan gave states the option to extend Medicaid coverage for new mothers from 60 days after delivery to a full 12 months. Maternal mortality is disproportionately high in the United States compared to peer nations, and a significant share of pregnancy-related deaths occur in the weeks and months after birth, often after Medicaid coverage had already lapsed. As of 2025, 49 states and Washington, D.C., have implemented the 12-month extension, with one state still pursuing federal approval. This represents near-universal adoption of a policy that keeps new mothers insured through the highest-risk postpartum period.
Reproductive Health and Contraception
Following the Supreme Court’s reversal of Roe v. Wade in 2022, the administration issued a series of executive orders focused on preserving access to reproductive health care within federal authority. On contraception specifically, actions included clarifying coverage requirements under the ACA, expanding walk-in contraceptive care for military service members and their families, proposing rules to improve access for veterans’ dependents, and increasing funding and telehealth capacity for Title X family planning clinics. The administration also worked to strengthen the inclusion of family planning providers in marketplace insurance networks.
These actions were largely executive in nature, meaning they relied on agency authority rather than new legislation. That makes them more vulnerable to reversal under future administrations than the statutory changes in the Inflation Reduction Act.
Rural Hospital Stability
A new Rural Emergency Hospital designation, established by Congress in late 2020 and launched under the Biden administration, allows struggling rural hospitals to convert to a streamlined facility focused on emergency and outpatient care. Hospitals that convert receive enhanced Medicare payment rates (5% above standard outpatient rates) plus a monthly facility payment of roughly $285,600 in 2025, adjusted upward each year.
The program is designed to prevent rural hospital closures by removing the financial requirement to maintain inpatient beds that many small facilities can no longer sustain. Converting hospitals can use the additional revenue to maintain or even expand core services like emergency care, imaging, and preventive screenings. For rural communities where the nearest alternative hospital may be an hour or more away, the designation offers a financial lifeline that keeps basic care accessible locally.
Medical Debt and Credit Reports
The Consumer Financial Protection Bureau finalized a rule that would have removed medical debt from consumer credit reports, potentially affecting tens of millions of Americans whose credit scores are dragged down by medical bills. However, a federal court in Texas vacated the rule in July 2025, agreeing with challengers that the CFPB had exceeded its legal authority under existing law. The court found that the Fair Credit Reporting Act permits the inclusion of medical debt information on credit reports as long as it doesn’t identify specific providers or the nature of medical services. As a result, medical debt continues to appear on credit reports and affect borrowing ability.