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A bill that would ensure nobody with health insurance pays more than $35 a month out of pocket for insulin passed the U.S. House this week, but with no support from Minnesota's Republican Congressional Delegation.

The Affordable Insulin Now Act, authored by Minnesota DFL Rep. Angie Craig, passed Thursday by a vote of 232-193. It caps the copay for certain insulin products at $35 a month or 25% of a plan's negotiated price (whichever is lower). If it were to become law, it would take effect in 2023. 

“No American should have to choose between paying for lifesaving insulin and other basic necessities like food and rent," Craig said in a statement. "And yet, today, all across the country, patients are risking their own lives by rationing doses or skipping treatments entirely due to the skyrocketing cost of their medications,."

About 390,000 Minnesotans (8.8% of the state's adults) have diabetes, according to the Minnesota Department of Health. Many of them rely on insulin to keep them alive.

Yet in recent years, the cost of the drug has skyrocketed, a rise the Mayo Clinic described as "inexplicable." Insulin costs ten times more in the U.S. than it does in any other developed country, with one version (Humalog) going from $21 a vial in 1999 to $332 in 2019 — all while the price hasn't changed elsewhere, including Canada, Mayo said.

An affordable insulin bill became law in Minnesota nearly two years ago, requiring top insulin manufacturers to reimburse pharmacies for the drug, helping patients receive it at a more affordable cost. The law is named after Alec Smith, a 26-year-old Minnesotan who died rationing his $1,300-a-month insulin.

Craig's bill passed the U.S. House on a near party line vote, with only 12 Republicans voting in support of the proposal. 

All three of Minnesota's Republicans in the U.S. House — Reps.  Tom Emmer, Michelle Fischbach, and Pete Stauber — voted against Craig's bill.

Bring Me The News reached out to all three, with only Fischbach's office responding. They pointed to the Fischbach's comments on the House floor Thursday.

"This bill is just a partisan exercise that will only reshuffle the decks for how patients pay for insulin. It is not a serious attempt to address ... rising prices," she said. "The price controls in this legislation would be an expansive intervention into the free market and will most likely lead to an increase in premiums for everyone."

The opposition from Republicans drew rebuke from Minnesota's 5th District Democratic Rep. Ilhan Omar, who tweeted: 

Craig argued on the floor the bill is being "mischaracterized," saying the price of insulin is "unsustainable."

But the concern raised by the likes of Fischbach has been brought up by others, including some Democrats who still ended up voting in favor of the bill. 

Journalist Emily Pisacreta explains the price of insulin itself is unchanged — only the copay for people with commercial insurance or on Medicare Part D is reduced. This means insurance companies could simply push these costs to insurance plans themselves, raising premiums. (Pisacreta points out a few other potential issues particularly for the uninsured and people with high-deductible plans.)

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Rep. Susan Wild, a Democrat from Pennsylvania who voted for the bill, acknowledged to Politico the act's flaws, as it doesn't address the root issue: Decisions by pharmacy benefit managers and pharma manufacturers.

But ultimately, Wild said, “It’s a matter of do we help people who are literally dying or rationing their insulin? … I have a greater concern for patients and for people in that position.”

All of the celebrations and vocal concerns about the Affordable Insulin Now Act might not ultimately matter. It has to get 60 votes in the U.S. Senate to pass, and that appears unlikely. The Hill notes Georgia Sen. Raphael Warnock has discussed a bill to cap insulin costs by addressing the "underlying" issue "through a yet-to-be-defined process."

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