[Congressional Record Volume 169, Number 188 (Tuesday, November 14, 2023)]
[Senate]
[Pages S5498-S5500]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           WORLD DIABETES DAY

  Mr. WARNOCK. Mr. President, there are several important domestic and 
international matters before us that require our urgent attention, not 
least of which is the need to find a bipartisan path to keep the 
Federal Government open and fund it within the next 3 days to prevent a 
national economic calamity.
  We have a lot of work to do. A lot of priorities vie for our 
attention. But today, on World Diabetes Day, I rise to address another 
pressing issue that I believe also requires our timely action.
  I want to uplift the findings of my new bipartisan white paper, 
released today on this World Diabetes Day. It shines a light on the 
urgent need for Congress to finally address the high costs of insulin 
and pass Federal legislation to cap the costs of insulin for every 
American who needs it.
  This report is issued jointly today from my office in collaboration 
with my partner in this work, my friend the Republican Senator from 
Louisiana, John Kennedy. Senator Kennedy and I have been working to 
address the high costs of insulin because this is a problem that is 
particularly acute in our States.
  Over 12 percent of adults in my home State of Georgia--12 percent--
are diabetic, but in Louisiana, that number climbs to over 14 percent, 
and many of these are people who cannot afford access to this 
lifesaving drug.
  This is what we hear from the people in our States, but this new 
report, for the first time, takes a comprehensive look to learn more 
about who and where these people are. And what we found in our original 
analysis is that there are more than 800 counties across the country 
where you see the tragic convergence of high rates of diabetics coupled 
with high rates of uninsured people--high levels of diabetes, high 
levels of uninsured people. And we call these insulin deserts. These 
insulin deserts--some 813 counties across our country--are in the top 
half of counties across the country for both their percentage of 
individuals who are uninsured and who have diabetes--over 800 counties. 
And over 100 of these insulin desert counties are in my home State of 
Georgia.

  Over 75 million nonelderly people live in insulin deserts. That 
includes more than 12 million Americans who are uninsured. In fact, 
among nonelderly individuals, insulin deserts have nearly double the 
percentage of uninsured residents as those who live in nondeserts.
  So our analysis shows these insulin deserts are concentrated in the 
South and the Southeast. But it also shows that there are insulin 
deserts all over the country, concentrated in the South and in the 
Southeast, but you see them from Washington State to Texas, to North 
Dakota, to Florida, to New Jersey. In other words, this is a national 
problem.
  And who are the people in these insulin deserts? Well, as compared to 
uninsured folks in other parts of the country, uninsured Americans who 
live in these places are, one, more likely to fall under the Federal 
poverty line than their counterparts. They are less likely to be 
college graduates than uninsured Americans in nondeserts. They are more 
likely to be people of color than uninsured Americans in nondeserts. In 
fact, in 2019, Black Americans were twice as likely as non-Hispanic 
White Americans to die from diabetes.
  And uninsured Americans in insulin deserts are less likely to have 
access to sufficient internet service than uninsured Americans. And why 
does this matter? One of the reasons it matters is because it means 
that they have less access to patient assistance programs offered 
online by insulin manufacturers, and we know the challenges that 
uninsured people experience when it comes to accessing healthcare.
  This report deals with the uninsured people who are diabetics and the 
convergence of those two things.
  So what does all of this mean? What this report illustrates is that 
even with the steps private industry has taken to lower insulin costs--
steps that are good, that many of us in Congress pressed them to do. 
But it is still voluntary, and, by the way, they could be rescinded at 
any time.
  And even with the steps more than 20 States have taken to institute 
State-level insulin copay caps and even with our success in lowering 
out-of-pocket insulin costs for Medicaid beneficiaries, there are still 
millions of Americans and communities across our country that are being 
left behind. They live in these insulin deserts concentrated in the 
South and the Southeast, but you see them all over the country. They 
are being left behind.
  According to the Department of Health and Human Services, in 2019, 
uninsured people with diabetes spent close to $1,000 on insulin alone. 
If you are poor and you are uninsured, that number is unaffordable. We 
know that number includes the 246,000 insured Americans who use insulin 
every year, and we know that number rises to more than 540,000 
Americans when we include those who experience a lapse in coverage.
  But even when we look past the uninsured, we know that when we 
include those Americans with private insurance, the total number of 
Americans who are left vulnerable to potential spikes in insulin prices 
jumps to some 2.75 million Americans.
  Here is the thing: Insulin should not be expensive. It is a 100-year-
old drug. When it was invented, the patent was sold for $1. It 
certainly shouldn't be unaffordable.
  For the first time, this analysis, which my office releases today, 
paints a clear picture of who is needlessly suffering and whom we will 
leave behind if we do not pass my $35 cap for the insured and the 
uninsured.
  We already know what happens when people can't afford their insulin. 
We know that one in four diabetics--listen--ration their insulin. In 
the United States of America, people are rationing insulin, getting 
insulin from friends who have relatives who have passed away. I spent 
time with a young woman in my State named Lacey, who is a graduate 
student, was meeting people on Facebook meetup groups and then meeting 
them in dimly lit parking lots at the local Chick-fil-A to get insulin 
in the United States of America, a drug, invented 100 years ago, sold 
for $1.
  That is not right. But not only is it not right, it is not smart. It 
is bad fiscal policy. We know that every year Federal and State 
government spending on hospitalizations related to complications from 
diabetes totals more than $11 billion. That is more money

[[Page S5499]]

than it would cost to cap the cost of insulin for everybody who needs 
it.
  And, so, yes, I am a pastor; I am going to make the moral argument, 
but I am saying to you that it is not right, and it is not smart.
  And perhaps that is why there are many of my colleagues on both sides 
of the aisle who care about this issue and have long been working to 
make insulin more affordable for diabetics.
  I want to commend my colleagues, Senator Jean Shaheen and Susan 
Collins, for their leadership over the years that has helped keep this 
issue on Washington's front burner. I look forward to our continued 
partnership in the coming months on this issue.
  I was proud that last year this Chamber passed a provision from my 
legislation, the Affordable Insulin Now Act, that was signed into law 
as part of the Inflation Reduction Act. Since January 1, that provision 
has been saving our seniors money by capping out-of-pocket insulin 
costs at no more than $35 a month for Medicare patients. And my 
original Affordable Insulin Now Act included a 35-dollar-a-month 
insulin copay cap for patients on private insurance as well, and it 
almost passed this Chamber.
  We got close. Now it is time to get it done. We weren't successful in 
getting that provision over the finish line. But I was proud that 
earlier this year, I got together with my friend John Kennedy, and we 
introduced a new bipartisan version of the Affordable Insulin Now Act 
that would finish the work we started by capping insulin costs at $35 a 
month for insured Americans and uninsured Americans.
  Since then, Senator Kennedy and I have been working to build support 
for our legislation, which we have committed will be--listen--
completely paid for. And I am proud that support for our plan has 
continued to grow. I am proud our bipartisan bill has the support now 
of a broad coalition of Senators from both sides of the aisle, from 
Senators Fetterman to Peters, to Hawley, to Vance, to Warren, to Casey, 
to Britt, to Tuberville, to Braun, to Rosen--Senators who don't agree 
on a whole range of things, but we all know this makes sense.
  Our bipartisan plan to lower insulin costs for the insured and 
uninsured also has the support of organizations like the American 
Diabetes Association, the American College of Physicians, Protect Our 
Care, and First Focus Campaign for Children.
  So on World Diabetes Day, I encourage all of my colleagues to read 
this report, which we released today, because it drives home the work 
we should be focused on for the more than 7 million Americans with 
diabetes who use insulin, and it reminds us of whom we leave behind 
when we fail to act.
  Dr. King said: Of all the injustices, inequality in healthcare is the 
most shocking and the most inhumane.
  Shame on us if we can't get this done.
  And so in closing--and nobody believes a Baptist preacher when he 
says ``in closing''--I think that this report is summed up by the story 
of a woman in the State of Georgia.
  She said:

       I have suffered with [diabetes] since the age of 11. [The] 
     type of insulin that costs me hundreds of dollars every month 
     at the pharmacy was released to market the year before I was 
     diagnosed. I bought a vial in 1997 without insurance and it 
     cost me $18.
  In 1997.

       This insulin has not changed since then--

  The drug hasn't changed--

     but now costs hundreds of dollars. Something needs to be done 
     to ensure we who depend on this life sustaining medicine can 
     continue to afford it. We will literally die in a matter of 
     days without it. It is not a matter of choice.

  I agree with her, something must be done. And so let me just thank 
folks in my office, dedicated public servants who have been working on 
this issue, especially Gabi Vesey, Annie Wang, and Harper Melnick, for 
their work on this report. Thank you. People who need insulin really 
need it. It is not a matter of choice, and Congress can make a 
difference by passing this bipartisan legislation.
  I urge my colleagues, with all that we have to do, to prioritize this 
work as we handle the host of other vital issues that require this 
body's attention.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. KENNEDY. Mr. President, I don't intend to try to match the 
eloquence of Senator Warnock, and I am certainly not going to repeat 
what he just said.
  Senator Warnock and I have introduced--as he said--the Affordable 
Insulin Now Act of 2023. It would cap the price of insulin for people 
with private insurance and people who don't have any insurance at all 
at $35 for a 30-day supply.
  I have noticed that nobody in Washington ever stands up and says: I 
have got a lousy idea, and I need money for it.
  It is always: I have got an extraordinary idea and an important idea 
and an effective idea, and we need to do this. We need to spend money.
  And in almost all the cases, the people making that assertion are in 
good faith. They really believe that. And in many cases, it is true. 
They have a great idea. And a lot of what we do, as you know, is we 
make decisions, but we really--that means we balance interests. We have 
got a finite amount of money. We can't keep borrowing at the rate we 
have been borrowing. We have got a finite amount of money, and we have 
got to make hard decisions on what to spend that money on.
  And the traditional dichotomy is, well, guns versus butter, domestic 
needs versus defense needs. But it is more complicated than that. 
Sometimes it is butter versus butter. And those are hard decisions to 
make, and I realize that.
  The second point, I guess, I would make is that we deal with so many 
problems in the U.S. Congress that, frankly, we don't know how to 
solve. We are doing the best that we can, but we are really nibbling at 
around the edges. I don't know how to make a parent love their child.
  We all know that if a parent doesn't show the parent's love for a 
child, the child is not going to stop loving the parent; the child is 
going to stop loving himself. And we know what that leads to.
  And I don't know how. I don't know anybody who really knows how to 
make a parent love a child and support their children. That is one of 
those problems we deal with all the time. It is hard to solve. We don't 
really completely understand how to successfully help an addict stop 
being an addict. I wish we did. And there are things we can do to help 
the addict, but we don't really have the answer.
  Sometimes we pretend we do, but we don't. We don't have the answer. I 
don't have the answer to stop people from hurting other people, from 
taking their stuff and doing it repeatedly.
  And I could continue. All the easy problems are solved. And I make 
these two points that we have a lot of competing interests for the way 
we spend money and the point that there are some problems we really 
don't know how to solve. To assert--and you can believe me or not 
believe me, but if you will read the report that Senator Warnock talked 
about, you will see that he and I, I believe, are correct. This is a 
problem we can solve.
  If I had to pick one health problem that affects the quality of life 
and costs our country and our system the most money, it would be 
diabetes. I don't know if you have ever known somebody with diabetes. 
It is a horrible disease, and it can't be cured. But we know how to 
treat it.
  It is very pervasive. In my State, 44 percent of my people are 
affected by diabetes directly. Fourteen percent are diabetic. Another 
30 percent are prediabetic. And Louisiana is not the only State with 
those kind of numbers.
  Diabetics account for $1 of every $4 spent, $1 out of every $4 spent 
on healthcare in the United States of America. Think about that. The 
average cost of hospitalization for a diabetic--which if they can't pay 
for it, ultimately we all pay. The average cost of hospitalization for 
diabetic patients is from $8,400 to $23,000 a year.
  And medical costs, if you look beyond the quality-of-life issue and 
the moral issue of just helping people who are sick, if you look at it 
in terms of dollars and cents, diabetes costs America $327 billion a 
year. That is in medical costs and lost work and wages and lost 
productivity.
  So we know the problem, and we know the costs. And we have a 
solution: Insulin. It works. It works. So why don't we make insulin 
available to everybody who needs it, whether they

[[Page S5500]]

can afford it or not? And that is what our bill does. It is not going 
to be free. Insulin doesn't cost that much to make, and I don't 
begrudge the companies who sell insulin. I don't begrudge them making a 
profit.
  But it is bone-deep, down-to-the-marrow stupid for us to allow 
someone whose diabetes can be managed by taking insulin not to take 
that insulin because they can't afford it. That is immoral, and that 
makes no sense in terms of dollars-and-cents cost to the rest of the 
American people. And Senator Warnock and I's bill would address that. 
It would say: If you have private insurance, great. But if you don't 
have any insurance at all, if you are uninsured--and a lot of Americans 
become uninsured every year; maybe they don't stay uninsured, but they 
become uninsured--and you are diabetic, we are going to cap your out-
of-pocket cost at $35 for a 30-day supply. So you have no excuse not to 
take your insulin to address your diabetes.

  It is the right thing to do. It is the smart thing to do. And Senator 
Warnock and I's bill is paid for. We are not suggesting we go out and 
just borrow more money. This bill, our bill, is paid for. It is going 
to be paid for by finding other moneys in the budget.
  Now, Senator Warnock has worked extremely hard. He is the lead author 
on this bill, and I thank him for his big mind and his good heart and 
soul on this issue.
  Others have worked hard too; Senator Collins and Senator Shaheen have 
a bill, and we are working to try to marry our two bills, the four of 
us. But, ultimately, what it is going to come down to, in my opinion, 
is that, Senators being Senators, Senator Schumer is the floor leader. 
He is going to have to force a shotgun marriage here. He is going to 
have to take the good work of Senator Shaheen and Senator Collins, 
Senator Warnock and my work--whether you want to call it good or not--
and say: I am going to take their efforts and put them in one bill. And 
Senator Schumer's bill will be paid for; otherwise, I am not going to 
vote for it, but it will be paid for.
  And his bill--I will wrap it up real fast--and his bill will be paid 
for, and it will lower the cost of insulin for insured and uninsured.
  I yield to the Senator from Kansas.
  The PRESIDING OFFICER. The Senator from Kansas.

                          ____________________