S. 4189 explained  ·  119th Congress  ·  Pending in Congress

INSULIN Act of 2026

Create a free account or sign in to follow S. 4189 and get alerts. Policy area: Health Create a free account or sign in to follow the Health policy area and get alerts. ▲ 73 days since action Sponsor: Jeanne Shaheen, NH-Senate, D → Congress.gov

Cosponsors: 28 (13 D, 14 R, 1 other) · per Congress.gov, 2026-10-14

Introduced: 2026-03-25

Latest action (2026-08-07): Placed on Senate Legislative Calendar under General Orders. Calendar No. 552.

What S. 4189 does, in plain terms

The Congressional Research Service has not published a summary of S. 4189 yet. Its official title: “INSULIN Act of 2026”.

Constitution Index

“VFA Constitution grade”

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S. 4189 has not been graded yet. New measures with an official summary are graded daily under the published rubric.

The Framers

“Founders’ Verdict”

CONDITIONAL

Confidence 0.75

Archived SI output (machine-generated)

No editorial review recorded. This historical SI verdict was machine-generated by software and predates the review desk; check it against the official bill text.

Synthesis

The INSULIN Act of 2026 is constitutional only if its provisions are confined to regulating interstate commerce in insulin and do not commandeer states or regulate purely intrastate transactions. The Commerce Clause (Article I, Section 8, Clause 3) and Necessary and Proper Clause (Article I, Section 8, Clause 18) authorize federal action on interstate insulin pricing, but the Tenth Amendment reserves to states the power over local health affairs and intrastate commerce not substantially affecting interstate commerce.

Hamilton CONDITIONAL

The power to regulate commerce among the several states is expressly vested in Congress by Article I, Section 8, Clause 3. So long as the INSULIN Act of 2026 operates directly upon the interstate sale, distribution, or pricing of insulin—a good that moves in interstate commerce—it falls within the legitimate scope of that authority. The Necessary and Proper Clause (Article I, Section 8, Clause 18) further empowers Congress to enact all laws which shall be necessary and proper for carrying into execution the foregoing powers. However, if the Act attempts to command the States to regulate intras…

Article I, Section 8, Clause 3 Article I, Section 8, Clause 18 Tenth Amendment Federalist No. 23 Federalist No. 33
Jefferson NO

This bill, by directing the federal hand to regulate the price of insulin, exceeds the enumerated powers delegated to Congress. The Constitution grants no authority to fix the price of medicines, which is a matter of police power reserved to the states and the people. The general welfare clause is not a blank check for any measure Congress deems beneficial; it is limited to the enumerated objects of federal power. To permit such legislation would be to sanction an unbounded construction of federal authority, eroding the very foundations of our compact. The Tenth Amendment stands as a bulwark a…

Amendment X Article I, Section 8
Madison CONDITIONAL

The INSULIN Act of 2026, as a federal regulation of insulin pricing and access, may be constitutional only if it falls within the enumerated powers of Congress, particularly the power to regulate interstate commerce. Insulin is a commodity that moves in interstate commerce, and Congress may legitimately address price distortions that burden such commerce. However, the Constitution reserves to the states all powers not delegated to the United States (Tenth Amendment). If the Act extends to purely intrastate transactions or imposes price controls without a clear connection to an interstate comme…

Article I, Section 8, Clause 3 (Commerce Clause) Tenth Amendment Federalist No. 45
Marshall YES

The INSULIN Act of 2026 is a constitutional exercise of the power of Congress to regulate commerce among the several states. Under the Commerce Clause, Congress may regulate all commercial intercourse that concerns more than one state, and the pricing of insulin—a drug widely distributed and sold in interstate markets—falls squarely within that authority. The means chosen by Congress, whether by direct price controls or other mechanisms, are appropriate and plainly adapted to the legitimate end of regulating interstate commerce in pharmaceuticals, as affirmed by the doctrine of implied powers.…

Article I, Section 8, Clause 3 (Commerce Clause) Gibbons v. Ogden (1824) (commerce includes all commercial intercourse; Congress's power over interstate commerce is plenary) McCulloch v. Maryland (1819) (Congress may choose any means not prohibited by the Constitution that are appropriate and plainly adapted to a legitimate end)
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What should pass

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Archived SI output (machine-generated) · No editorial review recorded

This historical draft has no editorial review time on record. Check its claims against the original bill and current law.

INSULIN Fair Pricing Act of 2026

Generated by VFA SI Solutions

To reduce the out-of-pocket cost of insulin for consumers by capping prices or otherwise regulating the pricing of insulin products.

Bipartisan rationale: Democratic priorities honored: The bill caps insulin prices for consumers in interstate commerce, directly addressing affordability and access. Republican priorities honored: The bill is narrowly tailored to interstate commerce, avoids commandeering states, uses market-based penalties rather than price controls on intrastate sales, includes a sunset for periodic review, and funds enforcement via a manufacturer fee rather than general taxation.

Funding: Per-unit fee on insulin manufacturers, col Up to $50 million annually, su Sunset 5y Oversight: HHS Office of Inspector Genera Enforcement: Civil penalties (10% of excess reven
→ Article I, Section 8, Clause 3 (Commerce Clause) → Article I, Section 8, Clause 18 (Necessary and Proper Clause) → Tenth Amendment (reserving powers to states) → Fifth Amendment Due Process Clause (penalties subject to fair notice and hearing)

Article I, Section 8, Clause 3 Article I, Section 8, Clause 18 Amendment X Amendment V

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