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Even before President Trump鈥檚 victory in the 2024 election, he had his eyes on the Inflation Reduction Act. In September 2023, Trump stated his desire to 鈥渞escind all unspent funds鈥� for the ambitious law passed under President Biden in 2022 and best known for its climate policies. Then, on Jan. 20, 2025鈥擨nauguration Day鈥擳rump wasted no time issuing an to pause IRA funding. (Confusingly, this action is referred to as 鈥渢erminating the Green New Deal,鈥� which was a .)听

, in practice, it will be much harder for the Trump administration to actually pull back funding. But the IRA doesn鈥檛 just tackle climate; it represents a addressing everything from carbon emissions and health care to tax codes and the economy. (It鈥檚 worth noting that the link to the comprehensive overview of the IRA that I used for my reporting back in December has since been removed from whitehouse.gov.)

Often considered a landmark achievement of the Biden administration, the IRA includes, among other policies, an ambitious set of initiatives for clean energy jobs, funding for climate resiliency infrastructure and disaster relief, and more aggressive taxation for large corporations. But perhaps one of the most important, if under discussed, aspects of the IRA is its impact on prescription medication costs.

At a time when due to the expense, the IRA gave the government the ability to curb rising drug costs through a variety of strategies. Most notably, the law gave Medicare the power to negotiate prescription prices directly with drug companies for the first time, which could have a cumulative, long-term impact on drug prices. 

鈥淸The IRA] has given the government for the first time the ability and also the tools through which it can negotiate drug prices鈥� says , director of the , a nonpartisan research organization. This ability ramps up over time, allowing a set number of additional drugs to be negotiated each year. 鈥淭hat really changes the ball game in an important way鈥攏ot so much today or even tomorrow, but over time, you鈥檝e equipped the government with a whole bunch of new opportunities to keep prices in check.鈥� 

As far as immediate price reductions, the IRA also guarantees that many Medicare beneficiaries will pay no more than . This price cap is not only a practical win for people on Medicare, but a symbolic victory for many activists who have long lobbied to make predatory insulin and .

In recent years, insulin has become a poster child for the broken health care system. By , a mere three pharmaceutical companies control 鈥攁nd this monopoly has given them free reign to .

A recent found that from 2012 to 2021, the price of a 30-day supply of insulin nearly doubled from $271 to $499. The estimated , meanwhile, is only $2 to $4. When compared to international prices, insulin in the United States is eight times more expensive, per a . For many, these discrepancies are particularly outrageous; without insulin, .

It鈥檚 unclear exactly how Trump鈥檚 executive order will affect the IRA鈥檚 climate initiatives, let alone how or if it could have any effect on other aspects of the law, such as insulin price caps. But just a few years after Biden signed the IRA into law, it is clear that its benefits are under threat. Project 2025鈥攁 harrowing, authoritarian 鈥渨ish list鈥� published by the Heritage Foundation and meant to guide the next Republican presidency鈥攃alls for the repeal of the IRA. Republicans, too, are already pushing for and its so-called 鈥渨oke agenda,鈥� including its climate provisions and tax increases for corporations. (Republicans鈥� continued distaste for the IRA is not surprising, however, as every single Republican in Congress . But that partisanship does not extend beyond the halls of Congress: The majority of Americans, regardless of political affiliation, .) 

The main goal of Project 2025鈥檚 repeal is to strip Medicare of its power to negotiate with corporations, according to , vice president of health policy at the Center for American Progress, a nonpartisan policy institute. 鈥淭o achieve that goal they鈥檙e willing to undo progress and throw prescription drug affordability into jeopardy for everyone in Medicare,鈥� Ducas says. 鈥淏y and large [Project 2025], this mandate for leadership, is grounded in a worldview that prioritizes profits, corporations, and business over people鈥攆ull stop.鈥�

In short, Project 2025鈥檚 IRA repeal would throw the baby out with the bathwater. In order to maintain corporate monopolies and profits, Americans would lose out on insulin price caps, health care savings, climate initiatives, clean energy jobs, and a whole lot more.

Yet even with the IRA currently in place鈥攁nd a that health care and are simply overwhelming for most Americans鈥攑eople with diabetes still struggle to afford their insulin on a day-to-day basis. In 2021 alone, more than , with Black Americans, the uninsured, and those too young to qualify for Medicare being the most vulnerable to rationing. 

Clearly, the IRA represents only one step on a much longer journey toward equitable health care access. But health advocates, grassroots organizers, and people living with diabetes continue to lead the way in advocating for a future where accessible insulin is a reality for all.

Insulin Policies for All

While the IRA is an achievement, it鈥檚 important to understand its limits. The IRA grants a co-pay price cap for certain Medicare beneficiaries鈥�not a holistic price cap. This difference is an important one, according to Shaina Kasper, executive director of , a grassroots nonprofit run for and by people with diabetes. 

The $35 co-pay limits monthly out-of-pocket expenses for certain people with Medicare, but it does nothing to regulate the actual list price of insulin, the initial price of a drug set by pharmaceutical manufacturers before any rebates, discounts, negotiations, or insurance kicks in. As a result, Kasper says , premium insurance plans, or any health care coverage are still left in the lurch. (It should be noted that the IRA initially did include a $35 co-pay cap for those with private insurance, not just Medicare recipients, but it was .)

鈥淥ur goal is an absolute price cap [and] lowering that list price of insulin to make sure that it鈥檚 affordable and accessible to all,鈥� says Kasper. Together, Kasper says, lowered list prices and co-pay caps would impact the full spectrum of people in need, including those with private insurance, those without insurance, and those with Medicare benefits. (Even without a full price cap, however, the IRA did play an important role in pressuring all three insulin giants to or reduced list prices for some insulin products鈥攁n important, if incomplete, step toward affordability.)

But affordability and accessibility aren鈥檛 always the same thing when it comes to medications. The fact that insulin and diabetes supplies need to be prescribed also means added barriers. Tracy Ramey, leader of the Ohio Insulin for All chapter and T1 International organizer, has recently helped pass an in her state, which grants pharmacists the ability to dispense an emergency supply of a chronic maintenance drug without a prescription. The law was named after 36-year-old after being turned away from a pharmacy and unable to contact his doctor for an insulin refill.

The impact of Kevin鈥檚 Law is immediate鈥攅ven for Ramey鈥檚 own daughter, who has Type 1 diabetes. While Ramey was between jobs and waiting for Medicaid to kick in, her daughter was still able to get her supplies, even after a prescription had run out. 鈥淚鈥檓 very proud that my daughter was able to benefit from that as well,鈥� Ramey adds. 

Since 2016, 26 states have passed some version of Kevin鈥檚 Law, but Kasper says expanding the law is an important way to ensure equitable access to health care across the country. Taken together, these policies鈥攗niversal price caps, lower list prices, and an expanded scope of practice for pharmacists鈥攚ould add much-needed guardrails for people struggling to afford and access their medications.

Insulin Access on the Ground

However well crafted or impactful a potential policy may be, people urgently need insulin access here and now. To fill in the gaps, communities across the country are creating their own mutual aid networks.

鈥淲e can鈥檛 sit and wait forever for someone else to save us. It鈥檚 just not going to happen,鈥� says Brandon Lopez, founder of , a nonprofit, volunteer-run organization in Arizona that sends free diabetic supplies to people who need it. 鈥淲ho knows, maybe a policy will pass or something will change where health care will be free, but until then it鈥檚 our job as a community to take care of each other.鈥� 

The Embrace Foundation has its roots in Lopez鈥檚 own health care experiences. In 2017, Lopez was working full time, living without health insurance, and struggling to afford his insulin. 

鈥淲ith bills, rent, cost of living, I had no money for diabetic supplies, [which] added up to almost $1,000 a month. I simply couldn鈥檛 afford it,鈥� says Lopez, who has Type 1 diabetes. 鈥淔or months I didn鈥檛 test my blood sugar once. I couldn鈥檛 afford the strips. I took insulin when I felt high and ate something when I felt low, completely in the dark. I spread out what insulin I had, skipped meals, took half doses, and reused the same bag of dull pen needles I had over and over, completely unsanitary and unsafe.鈥�

To get by, Lopez described how he sold whatever possessions he could and spent days going from hospital to hospital, 鈥�.鈥� Eventually, Lopez landed a better job that provided health insurance. But he continued building an ad-hoc insulin-supply-sharing network on social media, where he connected people experiencing insulin insecurity to a growing inventory of donated supplies.

In 2018, Lopez formally launched the Embrace Foundation, and nearly seven years later, says it has expanded to 19 volunteers, three storage units of supplies, and more than 2,500 people served across the country. According to Lopez, the majority of supply requests come from people who don鈥檛 qualify for insurance, college students who may have aged out of their parents鈥� insurance, and people who are out of work. But plenty of people with insurance still can鈥檛 afford their supplies.

鈥淚t鈥檚 either have insurance [with] a co-pay or pay [more than] $600 to live,鈥� says Lopez. 鈥淭his month we had a woman reach out that was a single mother with three children and was rationing her supplies so she could keep the power on and feed her family. We鈥檝e set her up to where she will receive a package from us every month so that she can [have] one less thing to worry about.鈥�

Lopez says the Embrace Foundation is meant to continue , the Canadian researcher and doctor who discovered insulin in the early 1920s. 鈥淏anting sold the patent for insulin for $1 … saying, 鈥�,鈥� Lopez says. 鈥淲e will always stay true to that.鈥�