In 2017, Alec Smith turned 26, aging out of the Obamacare rule that he could get his health insurance through his parents' policy.
He had Type 1 diabetes and needed insulin to manage it. But he didn’t have the money for a high deductible plan. He also didn’t have the $1,300 he needed each month to pay for insulin out of pocket. So he tried to ration it until his next paycheck. He would end up dying a month later.
This session, the Minnesota House passed the Alec Smith Emergency Insulin Act, which would levy a fee on pharmaceutical manufacturers to pay for emergency supplies of insulin for people who couldn't afford it. Its success was short-lived. It died in the final moments courtesy of the Republican-controlled Senate, with 33 senators voting in favor and 34 against.
It was a surprising demise for a bill that originally had bipartisan support. Some lawmakers have been calling it a mere omission or oversight in the eleventh hour of the special session. In a debrief last week, Sen. Karin Housley (R-St. Mary’s Point) called the incident a “debacle” and “disappointing.”
“No one should die in the state of Minnesota because they don't have access to insulin,” she said. But she went on to explain that Minnesota already has “a program in place” right “at your pharmacy.”
“He didn’t need to die, this Alec Smith,” she said. “He could have called his doctor and if there was a program in place, then he could have gotten the insulin for free… they would be able to get insulin, it would just be billing it by another code.”
Though Housley didn’t respond to interview requests, she’s referring to a hypothetical alternative to the Smith bill proposed by fellow Republican Senators Jim Abeler (Anoka), Paul Anderson (Plymouth), Scott Jensen (Chaska), and Eric Pratt (Prior Lake) in an opinion piece in the Star Tribune. It ran the day before Housley’s post-session interview.
Smith’s story was tragic, yes, but the authors found his posthumous bill “extremely complicated,” “unworkable,” and bait for lawsuits. Instead, they suggested Minnesota could make use of its “fee for service” network already in place in “hundreds” of Minnesota’s pharmacies.
Citizens and civic groups could donate to it, and so could manufacturers and distributors – rather than using manufacturer fees to pay for it all. The state, as the op-ed put it, “would pick up the remainder.”
Just like that, everyone would have access to free insulin without forcing manufacturers to pay a dime. Presto – problem solved, lives saved. “And as a pleasant side effect: The political partisanship blame game would stop, and we can move on to solving other important issues that matter to all of us,” the piece concluded.
But some are unimpressed by the idea, including Nicole Smith-Holt, the late Alec Smith’s mother. Since the death of her son, she has been a dogged champion for getting people better access to their life-saving medications. The day after Housley and her colleagues published their piece, she co-authored her own, entitled, “If Republicans want to support insulin program, they should talk to us.”
“We never heard from these senators about their new plan,” she wrote. “Each of them voted against Alec’s bill during a near party-line vote in the middle of the night during the special session.” (Here’s the final tally.)
After Democrats released the audio from Housley’s post-session interview, Smith-Holt tweeted directly at the senator to explain why her son didn’t save his own life by calling his doctor and taking advantage of some existing program.
“[Alec] did not qualify,” she wrote. He “made too much money” to make the eligibility cut. And Smith did have a “relationship” with his doctor. Even so, that didn’t mean his doctor had access to free insulin.
“Few dr. receive samples from PHARMA because the product is so expensive,” she said. “They don’t just give it away.”
She posted a second tweet driving her point home. It’s time, she said, for elected officials to “stop placing blame” on victims like her son and “start working for the people to help create solutions.” Her son – her “heart” – did not die because he wasn’t close enough with a doctor. He died because of “PHARMA greed.”
Plenty of Twitter users – including fellow legislators – have used Housley's interview as a chance to jump on her and her co-authors. They blamed them for not providing the single vote that would have made the Smith bill a reality.
It’s not enough, they say, to sustain an emergency network of extremely expensive medicine on free-will donations. The price of insulin has more than doubled in recent years for reasons Big Pharma can't seem to explain. But with the legislative session over, any remedy will have to wait until next year.