Nicole Smith-Holt spoke at a news conference with Minnesota Attorney General Ellison in February as he announced a settlement with Eli Lilly in his litigation against the three largest insulin manufacturers. (Glen Stubbe/The Minnesota Star Tribune)

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Who deserves credit for lowering senior citizens’ insulin costs is a matter of some dispute in the 2024 presidential campaign.

Former President Donald Trump and his running mate JD Vance have said that he alone is responsible. Democrats contend that the cost-saving measures passed as part of the 2022 Inflation Reduction Act, which was signed by President Joe Biden, will help more people.

With debate over this still simmering on social media, I asked a Minnesota mom and insulin affordability expert to weigh in on the competing claims. Nicole Smith-Holt has become a nationally known advocate because of a family tragedy. Her 26-year-old son Alec, a Minneapolis restaurant manager who had Type 1 diabetes, died in 2017 after rationing insulin. He couldn’t afford a medication refill.

A grieving Smith-Holt shared her story repeatedly with media across the United States and became a fierce force at the Minnesota State Capitol to pass the state’s pioneering insulin safety net program in 2020. In her view, the real game changer has been the insulin cost relief community that has become a potent political force in years since her son’s death.

“I would give the majority of the credit to the insulin-for-all advocates who have not stopped screaming for affordable insulin,” Smith-Holt said in a recent interview.

And as for politicians claiming credit for lower prices, she had this to say: “We’ve come so far but we still have a long way to go.”

Smith-Holt is right. The insulin affordability measures championed by Trump and the Biden administration have mostly helped seniors on Medicare, the federal government’s popular health insurance program that covers Americans age 65 and up. Those who rely on commercial insurance (such as those who get coverage through employers) may still struggle with this medication’s price.

Greater assistance is also needed for those without insurance, such as Smith-Holt’s deceased son. Currently, there’s no national version of the Minnesota’s 2020 emergency insulin program that helps people who are running low on funds to quickly get a 30-day supply with a $35 copay from a local pharmacy. A bill to enact a federal version of this, introduced by Sen. Tina Smith, a Minnesota Democrat, regrettably has yet to gain sufficient traction in Congress.

All that said, it’s worth noting the remarkable progress spurred by Smith-Holt and her passionate fellow advocates. A movement with clear Minnesota roots has brought us to the present, where there’s a high-profile tussle in the 2024 presidential campaign over who did more to lower insulin costs. That alone is a significant accomplishment.

There certainly is still work to do, as Smith-Holt notes, but the presidential campaign spotlight inspires hope for more progress. The drug’s cost should also galvanize policymakers. “Across all insulin types, the price of a 30-day supply of insulin increased from $271 in 2012 to $499 in 2021, a 184% increase,” reports the Health Care Cost Institute.

With the election just weeks away, the solutions for which Republicans and Democrats are claiming credit merit scrutiny. The reality: Both Trump and the Biden administration have taken beneficial steps, according to recent analysis by KFF, a respected nonpartisan health policy organization.

As KFF notes, the Trump administration “established a voluntary, time-limited model under the Center for Medicare and Medicaid Innovation known as the Part D Senior Savings Model. Under this model, participating Medicare Part D prescription drug plans covered at least one of each dosage form and type of insulin product at no more than $35 per month. The model was in effect from 2021 through 2023, and less than half of all Part D plans chose to participate in each year.”

During the Biden presidency, insulin cost relief was one of the Inflation Reduction Act’s components. The sprawling legislation capped “out-of-pocket costs of insulin for Medicare patients at $35 a month. But whereas the Trump program applied only to certain Medicare Part D plans, the IRA mandated that all Medicare drug programs cap out-of-pocket insulin costs — including those in what’s known as Medicare Part B, which pays for medical equipment such as insulin pumps.”

In addition, the Inflation Reduction Act “mandated that the out-of-pocket price cap apply to all insulin products a given Medicare plan covers, not just a subset,” KFF notes.

Bottom line: Claims that the Inflation Reduction Act’s cost-relief measures benefited more insulin users appear accurate.

Insulin affordability advocates deserve credit as well for pressuring action from the drug industry. In early 2023, three insulin manufacturers — Eli Lilly, Novo Nordisk and Sanofi — announced that they’d lower prices and cap out-of-pocket costs.

Smith-Holt welcomes the industry initiatives but remains wary. “Without federal policy in place to cap the price of insulin, there’s nothing to stop Eli Lilly, for example, from turning around come January 3 and going back to their old practices,” she said.

About 8.4 million Americans rely on insulin. Politicians claiming credit for insulin cost relief should understand that the work isn’t done. They should also face this question: What’s next?