The Shot 10/16/20
Judge Coney Barrett and the ACA, Pharma bucks to state legislatures, and more.
Welcome to the Shot Issue #3, written by Emily Pisacreta, a 5’7” pancreas. Have feedback? Got a tip? Email theshotnewsletter@gmail.com.
What Does It Mean For Insulin if the ACA is Overturned?
After this week’s hearing, there’s little doubt that Judge Amy Coney Barrett, President Trump’s nominee to replace Ruth Bader Ginsburg on the Supreme Court, will be confirmed by the majority Republican Senate. Her confirmation will mean many things. Judge Barrett is just 48 years old, meaning she’ll be on the bench for the next 40 years if she lives to be as old as Ginsburg. At stake for many people is what her confirmation means for things like abortion rights, equal marriage, and climate change — her socially conservative background and recent rulings the only clues she had to offer in a hearing full of evasive answers. But it’s her impact on health policy that is likely to be felt the soonest. The Supreme Court is due to hear the latest challenge to the Affordable Care Act in less than a month, on November 10th.
The Affordable Care Act is many things. In the broadest terms, it’s a package of reforms and regulations that has altered how various parts of the health care system have been allowed to operate. For people with diabetes, the most impactful elements of the law are the ones that have increased our access to health insurance — by expanding Medicaid, allowing young adults to stay on their parents’ insurance plans until age 26, and forbidding commercial health insurance companies from denying coverage to those with so-called “pre-existing conditions.” Before the ACA, people with diabetes were regularly denied the ability to purchase health insurance privately or through their employer.
In an effort to shore up their base in these last weeks of the election, Democrats have been framing their opposition to Barrett’s nomination as a battle to save the ACA — and have been including the voices of #insulin4all advocates in their messaging. In a press release opposing Barrett’s nomination this week, Senator Kirsten Gillibrand quoted NY-based #insulin4all activist Allie Marotta:
It was already so difficult for me to get access to health care and I am concerned the additional barrier of being denied coverage due to my preexisting condition if the ACA is overturned will actually kill me. Although New York is working to provide relief specifically for insulin dependent people, I’m worried it won’t be enough. If we lose access to health care those who need life sustaining medications will be particularly vulnerable. Everyone needs access to affordable health care, and a health care system that only works for the healthy isn’t a health care system at all.
People with diabetes are likely to once again be on the frontlines fighting to preserve what parts of the ACA they can. Between the cost of insulin and other supplies, our need to access specialists like endocrinologists and nutritionists, our susceptibility to things like staph infections and diabetic ketoacidosis, to our simple existence in a naturally precarious world, people with diabetes have relied on health insurance to keep us alive.
However, the ACA is not everything. For some diabetics, it has been precious nothing. Since the ACA passed in 2010, the list price for insulin has continued to skyrocket. While having the doors to commercial health insurance yanked open did provide financial salvation for some, for others, it remains out of reach. In 2019, nearly 28 million Americans were without any health insurance at all, a number that the pandemic has swelled to a yet to be determined number. Many of the commercial plans with the lowest premiums have deductibles in the four digit range, leaving people on their own to pay for insulin for months at a time. Even those with solid employer-based plans suffer punishing copays and a maze of referrals and preferred providers and formulary changes that lead them to keep their plan’s customer service number saved on their phone with the devil emoji in the contact name. (OK, is that just me?) Between these two camps — those whose insurance will cover most of the cost of their insulin, and those who have been left to pay for it on their own — exists a robust mutual aid network keeping many in the latter group alive.
In 2017, Alec Smith died from diabetic ketoacidosis when he couldn’t afford the premiums for the plans available through the ACA marketplace, and was forced to pay out of pocket for insulin. For many fighting for insulin for all, it’s become routine to ask whether a given reform would’ve helped Alec. When it comes to the ACA, tragically we know that the answer was no.
No matter what decision a Supreme Court with a brand new Justice Amy Coney Barrett makes on the ACA in November, people with diabetes will have to continue fighting for insulin for all. What changes is how many more of us will be fighting for insulin to give ourselves.
Stat: Pharma Money Floods State Legislatures
On Thursday, Stat published a not-to-miss analysis of recent pharmaceutical industry donations to state legislators. No wonder pharma-friendly co-pay caps make it through, while things like the Alec Smith Emergency Insulin Act, which makes pharmaceutical companies cover some of the cost, require such a fight.
Stat: First-of-its-kind examination shows how widely pharma showers campaign cash at the state level
Small Doses
Open enrollment for Medicare started yesterday, which means people can start enrolling in the much-lauded Part D plans with $35 insulin copays. The Miami Herald has a good breakdown.
Speaking of the $35 copay cap, it hasn’t gone into effect yet. But that hasn’t stopped people from claiming it has. Since one woman’s viral Facebook post a month ago claimed that Trump’s “prescription bill” (not what the Medicare Part D copay cap is) dramatically reduced the cost of her insulin and test strips at Walmart, Trump supporters have kept insisting online the President has solved the issue of high prescription drug costs once and for all.
There’s the Trump supporter approach of pretending a problem has been solved when it hasn’t, and there’s the Senator Tom Cotton approach: pretending a thing that hasn’t yet solved the problem will one day do so. Folks, we’re talking about the market.
New Hampshire Democrats tried to barter water for insulin with Republicans after Trump debate.
Eli Lilly CEO David Ricks says COVID-19 will continue to be ‘endemic’ for years to come. Lucky for them, they’re cooking up something for everyone.
That’s all for this week. May the wind be always at your back, may your blood sugar stay a cool 100 all weekend long.