You do know, magic isn’t real, right?

I’ll admit to scrutinizing magic acts on TV, trying to unearth their tricks. But we know a magician’s job is to fool us.

Politicians, on the other hand, aren’t supposed to trick us. Yet watching the Democrats since January vow to fix the insulin crisis and then do nothing is the worst type of sleight of hand. They’ve done it not behind the curtain, but in the spotlight, using patients as props. So, advocates were forced to remind them who they work for — the people, not lobby groups. And their advocacy paid off.

I’ve chastised Democrats before. You may recall me condemning Democrats for mischaracterizing their Affordable Insulin Now Act as “lowering the price” of insulin (it didn’t; it was a copay cap). I was also critical of Republican Sen. Susan Collins after she released priorities for a stand-alone insulin bill with Sen. Jeanne Shaheen. Though I was panned as playing both sides, my criticism was justified. No one was doing what they claimed they would: lower the price of insulin.

And while I wasn’t holding my breath for lawmakers to come through for advocates, I never dreamed Democrats would leave millions entirely in the lurch. But it was happening.

A few weeks ago, Democrats made headlines with their plan to pass a bill through the reconciliation process, thereby bypassing the 60-vote filibuster. It would authorize Medicare to negotiate pricing for many expensive drugs. Except … after months and months of speeches, social media posts, and videos promising to lower the price of insulin, even showcasing a child with type 1 diabetes at the State of Union, Democrats removed insulin from Medicare negotiations.

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It made no sense. Sen. Manchin wanted to use the Collins-Shaheen bill to show bipartisanship. But that’s all the bill was — a show. Bipartisan it may be, but otherwise, it’s a bad bill. It doesn’t address the root problem: affordability among the uninsured and underinsured. It also doesn’t tackle Pharma’s price-gouging. Finally, a report from the Congressional Budget Office estimates the bill will increase Pharma’s profits, raise premiums for commercial insurance and Medicare Part D subscribers, and increase federal spending.

Additionally, the Collins-Shaheen bill requires 60 votes to pass. Rumor is, they don’t have the votes. So why would Manchin favor it? More perplexing, why would Sen. Schumer and the rest of the Democrats rally behind a bill that’s essentially DOA?

A letter to Schumer asking for insulin to be added back into the legislation was sent by advocates and organizations like Public Citizen, The Insulin Initiative, T1International, Social Security Works, and Doctors for America. T1International organized a protest outside Schumer’s office. Advocates chanted, “Patients over profits!” It wasn’t too late for Schumer to change course. Who would he choose? Patients or Pharma?

Would Democrats invest so much time and money and not act? Would the president invite one of my friends to the Oval Office, make a video with her for social media, promise action, and then lose her number? Had patients been used? Were they pawns?

Yes, they were!

The legislative text for the Inflation Reduction Act of 2022 was released Thursday night. It is long. It’s 725 pages. There is a lot in it. You know what isn’t? Insulin.

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Why does it matter? More than 37 million Americans have diabetes, including 1.9 million with type 1 diabetes — meaning they will die within days without insulin. One in 4 Americans can’t afford insulin and ration it. Think about it. People die because they can’t afford what most of our bodies make for free. And Democrats were abandoning patients.

So, why was insulin really removed? My cynic alter ego reminded me what nonprofits like JDRF, the ADA, and Beyond Type 1 have been saying for weeks … nothing. Eureka! The pharmaceutical lobby has deep pockets, and it needed to protect the billions they make off insulin. Those three organizations receive money from insulin manufacturers and often become tight-lipped around insulin affordability. And lawmakers? I looked again at their contributions from Pharma. Sens. Schumer, Menendez, Cortez Masto, and Sinema all make the top 15.

But wait! The story doesn’t end there. Just as I had completed this column, Schumer announced Democrats would indeed add insulin back in the Medicare portion of the bill!

What did I feel? Relief? A bit. Also, anger that Democrats almost left so many Americans behind. And still, encouraged that advocacy and organizing works. I’m convinced that Democrats had a change of heart because advocates were relentless.

So, yes, I’m relieved, but frustrated. No one should have to fight this hard to stay alive in America.

The details of how insulin fits in are unclear (and I have a deadline). Will it be a copay cap? Price negotiations? It won’t be a price cap necessary to make insulin truly affordable. And I now hear the Collins-Shaheen bill won’t make it to a vote at all. So, patients, advocates, and allies. Buckle up! There’s more work to do!

Hilary Koch lives in Waterville. She can be reached at: hilarykoch@pm.me


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