There could be a special session of the Minnesota Legislature in a matter of weeks to pass an emergency insulin access law that fell victim to end-of-session chaos and politics.
On Wednesday, after an open-to-the-press meeting with activists trying to fight rapid increases in the cost of insulin, Gov. Tim Walz said he would sign what is called the Alec Smith Emergency Insulin Act if it reached his desk — and would consider calling a special session to make that happen.
But as with earlier statements about the failure of the bill in the regular session, the DFL governor places a major condition on any special session. He won’t convene a session until there is bipartisan agreement on a mechanism that makes emergency supplies available to those who can’t afford the cost or their insurance policy deductibles. And it must hold insulin makers accountable for the problems that have led to 1,200 percent increases in the product that diabetics need to survive.
The later condition has meant that the costs of the emergency program — estimated at between $2 million and $3 million a year — must be borne by the companies that make the hormone. Only three pharmaceutical companies make nearly all of the brand-name insulin sold in the United States: Eli Lilly, Novo Nordisk and Sanofi. While there are expected to be non-brand-name suppliers soon, the products known as biosimilars are not yet available in Minnesota.
Only a governor can call a special session of the Legislature.
“If the solution is out there, which I believe is, we should pursue it and we should solve it,” Walz told a group that included parents whose son died rationing insulin, parents currently helping children manage the disease, adults with Type 1 diabetes trying to afford insurance and high deductibles, as well as health professionals.
Later Walz said he will begin working with advocates and lawmakers. “We have stated very clearly that we will not call a special session unless there’s an agreement ready to go,” he said. “If they are very close, we can bring them back in for a short amount of time.” There is an ad hoc group of lawmakers from both houses and both parties talking about a bill.
From $20 to $300-$400
Quinn Nystrom, a type 1 diabetic and advocate for other patients, said insulin vials she and her brother both rely on have gone from $20 when they were first diagnosed two decades ago to between $300 and $400 now. Some use up to five vials per month. She said groups of patients have been sponsoring trips to Canada, where the cost is $30.
“This is not an optional medication,” Nystrom said, holding up a vial. “If I don’t have this, I’m dead.”
Cody Wiberg, a pharmacist who is the executive director of the Minnesota Board of Pharmacy, said the agency is creating a webpage including advice for diabetics who can’t afford their supply, including how to travel to Canada to purchase insulin.
“I just want you to be able to get it, don’t get me wrong,” Walz said of such advice. “But I’ll be damned if I want to live in a state where that’s our solution.”
Action in House and Senate, but …
While there are still different explanations as to why the bill named for Alec Smith — who died while trying to ration his insulin after being forced off his family’s health insurance — didn’t become law, the source of funding appears to be the primary reason. The House had already passed the bill when Sen. Michelle Benson, R-Ham Lake, surprised bill supporters by offering a similar amendment to her own health and human services omnibus bill.
There were some differences between Benson’s amendment and the bill sponsored by Rep. Mike Howard, DFL-Richfield. But the two versions were close enough that supporters were elated, especially because a unanimous Senate had included fees on insulin makers to pay for the program.
Yet when the health and human services omnibus bill emerged from closed-door meetings at the end of the regular session last month, the Alec Smith language was missing. After first blaming House DFL negotiators for failing to include it, Senate GOP leaders said it wasn’t ready to pass and promised it would be a topic of the 2020 session.
Moves by minority members of the Legislature — DFLers in the Senate and Republicans in the House — to amend some insulin language onto the omnibus bill during the one-day special session were rejected by the majority parties because it would have violated the no-amendments agreement made by Walz and legislative leaders.
A group of five GOP senators wrote an op-ed piece after the session saying the bill presented was too complex because it created a new supply and payment system with drugstores. But they also appeared to oppose placing fees on the brand-name manufacturers (the Benson language already exempted potential biosimilar suppliers from the fees).
“Citizens and civic groups could donate to support the program and we know they would do so. Manufacturers and distributors would likely donate product and financial support,” wrote Sens. Jim Abeler (Anoka), Scott Jensen (Chaska), Eric Pratt (Prior Lake), Karin Housley (St. Marys Point) and Paul Anderson (Plymouth). “The state would pick up the remainder, as we can tap into $3 million in the just-passed budget that is available to be used.”
On Wednesday, Walz said it fell off the table because Republicans didn’t want to use industry fees as a revenue source, instead looking to the state general fund or the Health Care Access Fund to be the source.
But he said that was unlikely to meet his approval.
“They need to be part of this,” Walz said of the manufacturers. “You can’t tell me that a $3 to $5 vial of insulin with what the prices are now, and the CEO makes $17 million plus stock options — they certainly need to be part of the solution.
“I’m not going to step in and watch people make obscene profits, shift the cost back to the taxpayers of Minnesota and then walk away with that money too,” he said. “The irony is you’d use taxpayer money to pay the very companies that aren’t helping us to get the insulin to come back.”
‘Something meaningful’ but no ‘fig leaf’
And House Speaker Melissa Hortman said earlier this month that while she was open to a special session for insulin it needed to be to pass what termed “meaningful” legislation.
“I think that there’s a lot of merit in the idea of a one-day special session to do insulin, to do something on insulin that’s not a sellout to the pharmaceutical industry,” said the DFLer from Brooklyn Park. “Because if the Senate Republicans are just looking for a fig leaf, I don’t think Gov. Walz or I are interested in giving them a fig leaf and selling out to the pharmaceutical industry.
“But if we could do something meaningful on insulin … and the bonding bill that we should have been able to do on May 25th, I think a one-day special session makes sense,” she said. The bonding bill was a $500 million package of construction spending for colleges, water projects and roads that had been agreed upon by Walz, Hortman and Senate Majority Leader Paul Gazelka in the deal that helped end the session.
Walz too said doing a bonding bill could be on any special session agenda — should he call one. But it would still be subject to a House GOP veto since selling general obligation bonds requires a 60 percent yes vote and therefore needs Republican votes. The lack of GOP votes is why it didn’t come to vote during the one-day special session that stretched from May 24 to the early hours of May 25.
Walz has called the failure to take a vote on the bonding bill “a lost opportunity.” He noted the needs of colleges, wastewater systems and some transportation infrastructure, along and low interest rates, as a good combination to have acted on his year.
“I recognize that is one of the points of leverage that a minority has and I respect that they exercised that, but I disagree strongly that it was a good move, that it was good for Minnesota.”
And what does Gazelka say about a special session? The Nisswa Republican was not available this week to talk about it, but last week he tweeted this less-than-supportive position:
I’m hearing there are calls for a special session... we agreed to compromise and everyone has something they didn’t get. I’d like to revisit adding a sunset on the sick tax too. #mnleg— Paul Gazelka (@paulgazelka) June 6, 2019
The reference to the sick tax is his agreement to cancel the sunset on the provider tax, which has paid for health insurance subsidies and other health programs for 27 years. He agreed to keep the tax without a new sunset, something that drew criticism from other Republicans, especially House Minority Leader Kurt Daudt.
Walz and Hortman would likely not agree to a new sunset, so Gazelka’s comment was either a poison pill or a statement that everyone didn’t get something in the session and a special session could reopen more conflicts than insulin.
After Walz’s roundtable on Wednesday, Gazelka issued a statement: “As I said on the last night of special session, we are going to keep working on insulin to make sure we have a solution that fits the problem. The proposed ideas need to be hammered out to earn the support of legislators, patients, advocates, doctors, and pharmacists. The legislative process worked effectively to pass regulations on Pharmaceutical Benefit Managers to lower prices on ALL prescription drugs, and we agreed that health insurance companies would not make a profit on insulin. Minnesota will get this right by working together, not by using insulin access as a divisive political tool.”
In late May, after that one-day session had adjourned, Gazelka was asked about insulin. He said it would need to wait until 2020 but pledged to make it a high priority.
“It’s sort of like hands free,” he said. “It was almost ready last year but it needed just a little more. This year it passed with flying colors. The insulin bill was first dropped last April with no discussion so this is the first year and rarely do you get something in one year, you have to build momentum.”
But Nystrom said the bill can’t wait. “As someone who gets messages every single day about people who cannot afford insulin, are going to die unless one of us around this table can get them insulin,” she said. “No. this bill cannot wait.”