Senate Republicans stripped a $35 insulin cap for those with private insurance from the climate and health bill.
Seven Republicans joined 50 Democrats in seeking to keep the provision in the bill, falling short by three votes.
The vote was held as part of a "vote-a-rama" as the reconciliation bill makes its way through the Senate.
Senate Republicans on Sunday successfully removed a $35 monthly price cap on insulin for many patients as part of the Democratic-led climate, health, and tax reconciliation bill making its way through the upper chamber.
The insulin cap had been a much-desired policy goal for Democrats, who aimed to have the provision apply to Medicare beneficiaries along with Americans carrying private health insurance.
While GOP lawmakers didn't challenge the portion applying to Medicare patients, they were able to strip the cap for those using private insurance, after talks regarding a potential bipartisan agreement fizzled earlier this year.
The Senate parliamentarian — who is tasked with analyzing reconciliation bills to ensure that they meet strict procedural rules — ruled that the cap wasn't in accordance with what is permissible under the guidelines.
Republican Sen. Lindsey Graham of South Carolina, the ranking member on the Budget committee, raised a point of order on the insulin cap, arguing that it was in violation the Congressional Budget Act — and therefore would need at least 60 votes in order to stay in the larger bill.
In a 57-43 vote, seven Republicans joined all 50 Democrats in seeking to keep the provision in the larger bill, falling short by three votes.
Republican lawmakers who voted to keep the specific provision in the legislation included Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Josh Hawley of Missouri, Cindy Hyde-Smith of Mississippi, John Kennedy of Louisiana, and Lisa Murkowski and Dan Sullivan of Alaska.
Democrats were quick to blast the move. Sen. Ron Wyden of Oregon, the chairman of the Finance committee, sharply criticized Republican resistance to capping insuling costs.
"Republicans have just gone on the record in favor of expensive insulin," he said in a statement shortly after the vote. "After years of tough talk about taking on insulin makers, Republicans have once against wilted in the face of heat from Big Pharma."
"I think it's shameful," Sen. Tammy Duckworth of Illinois said in an interview. "I have folks who are literally choosing between whether they can afford insulin or food."
He continued: "Fortunately, the $35 insulin copay cap for insulin in Medicare remains in the bill, so seniors will get relief from high insulin costs. I will continue working to deliver lower insulin costs to all Americans."
Democrats, who control the evenly-divided Senate as a result of Vice President Kamala Harris' tiebreaking vote, are pursuing the party-line legislation through the reconciliation process, which would permit them to overcome a 60-vote filibuster for the larger bill.
The tax and climate bill — officially called the Inflation Reduction Act of 2022 — would allow a three-year extension of subsidies for individuals to buy health insurance through the Affordable Care Act, while also providing nearly $370 billion for climate and energy programs and $300 billion to reduce the federal budget deficit.
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