A few weeks ago, the U.S. House of Representatives passed House Bill 6833, legislation which limits the out-of-pocket costs of insulin to no more than $35 per month for patients with diabetes. The bill had bipartisan support — 12 Republicans crossed party lines to vote with their Democratic colleagues. Rep. Matt Gaetz of Florida was one of the 193 Republicans who opposed the bill. After the vote, he tweeted “arbitrary price controls are no substitute for individual weight control.” Essentially, Gaetz blamed high insulin prices on the “expanding waistlines” of Americans instead of the price-gouging of the pharmaceutical industry.
The outlandish assertion is not only stupid, it’s incorrect. And this time, a senseless statement from a politician hits close to home.
I am one of the 37 million Americans suffering from diabetes. I have had Type 2 diabetes — a condition where the body cannot keep blood sugar under control without either insulin or oral medication — for the past 5 years. I am the third generation in my family to live with this chronic condition, beginning with my mother’s father, a family practice physician, who was diagnosed with it in the mid-1960s and treated with insulin for the remainder of his life.
After I stopped nursing my youngest son at the age of 41, I applied for additional life insurance coverage. It was during that evaluation where blood testing revealed my blood sugar was slightly higher than it should have been. Over the next 6 weeks, I restricted my sugar and fat intake significantly. Up to that point, I ate a balanced diet, enjoying healthy foods while savoring an occasional treat from time to time. I was reticent to restrict my intake after conquering an eating disorder during college, something I did not want to face again. Nevertheless, those restrictive dietary changes didn’t solve my problem. A repeat test, known as a hemoglobin a1c, kept climbing after ingesting little to no sugar a few months later. I needed medication to treat my condition.
There are two types of diabetes. Type 1 diabetes is an autoimmune condition, usually triggered by a viral infection, which destroys the cells of the pancreas, the organ which regulates the release of insulin, a hormone which controls the level of sugar in the bloodstream. Type 1 diabetics are unable to produce insulin and require insulin injections for the rest of their lives, through no fault of their own.
In Type 2 diabetes, the pancreas does not function well enough on its own to control blood sugar levels. Some with Type 2 diabetes can take oral medication only, which improves the effectiveness of the body’s own insulin to regulate blood sugar. Others with Type 2 require oral medication and insulin as their condition progresses.
The risk of developing Type 1 diabetes is relatively unpredictable; the risk of Type 2 diabetes is usually the result of genetic predisposition combined with obesity, poor diet, and sedentary lifestyle. But not every person with Type 2 diabetes is obese. I am just over five feet tall and weigh 110 pounds. I am active, walking at least 10,000 steps every day, but also playing tennis, running, or chasing my children on their various adventures. Genetically, my pancreas simply drew a short stick. And I am not alone.
Diabetes is the most expensive chronic condition in the United States, costing $237 billion annually. Nearly $1 out of ever $4 in U.S. healthcare costs are spent on caring for those with diabetes. Over the past decade, insulin costs have tripled. While a single vial of insulin costs just $2-$6 to produce, patients pay between $50 and $1,000 for a single vial. Studies reveal that one in four patients ration insulin because they cannot afford the increasing out-of-pocket costs.
Implementing national legislation for regulating drug prices could stabilize or potentially decrease insulin costs for consumers in the United States. An analysis by the Kaiser Family Foundation found that a $35-a-month cap on out-of-pocket costs could benefit more than 1 in 4 Americans on the individual and small group markets and 1 in 5 in large employer-sponsored plans.
Why is there so much opposition to this kind of common-sense legislation in the first place? It seems that too many legislators, like Gaetz, are simply out-of-touch with average Americans. In April 2021, the House Ethics Committee announced it had opened an inquiry in the wake of news reports that Gaetz was under investigation by the Department of Justice for his relationship to a 17-year-old girl and payments he may have made to other women for sex. In fact, the only drug legislation supported by Gaetz has involved loosening regulations on marijuana, an effort unlikely to make Americans healthier.
Too many Americans rely on insulin for survival to leave such important decisions up to legislators unable to comprehend basic science. As the Insulin Act moves on to the Senate, let’s hope that the majority of Senators grasp the fact that insulin treatment is not just for fat people. Diabetes is a disease, not everyone has a choice.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular column for the Kitsap Sun. Contact her at email@example.com.