Lawmakers explain support, opposition to Alec Smith Emergency Insulin Act

The legislation received widespread bipartisan — and, in the case of the Minnesota Senate unanimous — support, but there remained some dissenting votes in the House who decried the act as a bad precedent for government overreach into the free market.

Insulin Vials File Photo.jpg
A collection of insulin vials. Insulin is an enzymatic injection that Type 1 and some Type 2 diabetics require on a daily basis to live. Between 1996-2018, insulin prices rose by 1,200%, while production costs remained static, according to a study by the Harvard Medical Review. The same study noted prices doubled between 2012 and 2016 alone. Gabriel Lagarde / Brainerd Dispatch file photo

After roughly a year of debate, negotiations, fiery statements and public input — to say little of unexpected legislative hiccups at the end of last session — the Alec Smith Emergency Insulin Act passed the Minnesota Legislature and has been signed into law.

The bill passed Tuesday, April 14, in the Minnesota Senate with a unanimous 67-0 vote and garnered widespread bipartisan support in the House with a 111-22 vote. Gov. Tim Walz signed the legislation into law on April 15. Lawmakers told the Dispatch they were thrilled with the passage of bipartisan legislation that should satisfactorily conclude another chapter in an issue that’s taken on a life of its own.

The Alec Smith Emergency Insulin Act provides eligible Minnesotans with diabetes up to three months' supply of emergency insulin, as well as assistance to help them secure a long-term supply of the drug. The legislation stipulates copays for regulated health plans meanwhile would be called at $30 per month, with pharmacies required to take part in the insulin program in order to do business in the state. This would be funded, in part, by a fee levied on drug companies behind the skyrocketing cost of insulin, which has tripled in the last 10 years.

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The bill owes its name to a 26-year-old Minneapolis man who lost his health insurance and succumbed to his condition in 2017 when he tried to ration the life-sustaining medication. Smith’s parents, Nicole Smith-Holt and James Holt, have been a constant supportive presence in St. Paul during the bill’s animated, and sometimes heated, passage through the Minnesota Legislature the last few months.

Another prominent advocate for the bill and a voice for diabetic issues at a national scale is Quinn Nystrom — a former Baxter City Council member and a current DFL candidate for the 8th Congressional District. Nystrom lauded the passage of the Alec Smith Emergency Act and thanked activists and lawmakers on both sides of the aisle for stepping up.


“So many people know what a long road this has been for us with a lot of pushback,” Nystrom said during a phone interview Friday, April 17. “I've gotten more calls and been more busy the last couple weeks than I have in the last six months in regards to people not affording insulin or struggling to afford health insurance. I think now more than ever we needed this bill signed into law.”

But, Nystrom also noted the act is mainly a last-resort resource or emergency fallback, not a comprehensive solution for myriad obstacles facing diabetics, as well as a litany of other problems in the United States’ health care system that stems from corporate pharmaceutical companies and their moneyed interests.

“I'm thrilled this passed because ultimately it will save lives and it does show that we can work on a bipartisan basis to get work done, but ultimately the goal is to never have to have an emergency program,” Nystrom said. “The ultimate goal is, how can everybody — without a special coupon, or a special law — just know that the future of them living with a chronic illness and rely on list-sustaining medication, know that they can continue to afford it on a regular basis. The goal is so that we can have laws passed on a state level, but especially on a federal level.”

The Dispatch spoke with local state lawmakers, including Minnesota Senate Majority Leader Paul Gazelka, R-Nisswa, as well as state Sen. Carrie Ruud, R-Breezy Point, and state Reps. Dale Lueck, R-Aitkin; Josh Heintzeman, R-Nisswa; Ron Kresha, R-Little Falls; and John Poston, R-Lake Shore.

All of them — with the exception of Heintzeman — voted in favor of the act. Heintzeman has repeatedly declined to comment other than by email, citing a discomfort with face-to-face or phone interviews and expressed sensitivity with how prior statements were presented in the Dispatch.

In an email, Heintzeman said he voted against the Alec Smith Emergency Insulin Act because he was not in favor of the industrywide precedent it may set.

“I fully supported the programs that (we've) offered previous to this legislation but have serious concerns that the statutory requirement could be extended to other business models around the state,” Heintzeman’s email stated. “The precedent created was a deal-breaker for me. If you apply the same logic to other products, what life-sustaining service, drug, or medical device couldn't you require be provided at low or no cost?”

On the other hand, other members of his caucus, including Lueck, Poston and Kresha, all praised the bill as a proactive step forward to addressing the issue.


“The bill actually went from $30 million to $35 million in taxpayer money down to, I think, in 2024, it's projected to be just a little over $100,000,” said Poston, an insulin-dependent Type 2 diabetic who lauded the cost-effectiveness of the bill in its final form. “The insulin advocates did a great job. They went out and fought very hard to get the attention of the Legislature. They fought very hard to get the attention of the media. They got the attention of these health care systems. And these health care systems responded.”

Lueck said the bill was the product of a thorough process in St. Paul, but also noted some stated opposition in his caucus — and non-affiliated members of the House — stemmed from concerns the state would face lawsuits from the pharmaceutical industry on the grounds it was an unconstitutional seizure of funds from corporations. Those considerations weren't enough to sway Lueck’s support for a measure for the greater good, he said.

“You’re always at a risk of being sued,” Lueck said. “That's just a fact of life.”

Kresha also noted it was a thoroughly crafted and negotiated deal by lawmakers that garnered a lot of productive input from citizens, the industry, and advocates — which stands in contrast to some bills being rushed through the House amid the coronavirus pandemic, even if they are ultimately well-intentioned laws.

“I wasn’t really looking at it as a party-line vote or who’s advocating for who,” Kresha said. “I was really looking for a bill that was fair to folks and one we could afford, and I think we struck that balance.”

As for the Minnesota Senate, Gazelka said the bill was an example of effective pressure on corporations to provide a business framework that works for both the industry, the government, and its constituents. This stood in contrast to the DFL-led House proposal, he said, which would have entailed more government programs and dependency.

“It’s good news,” Gazelka said. “The solution basically was to work with the pharmaceutical industry to provide products directly to the pharmacies and so it didn't require more for government employees to operate them.”

State Sen. Carrie Ruud spoke favorably of the bill and apologized that it took so long for this legislation to finally be enacted after months of debate, haggling and bureaucratic missteps — such as the unexpected absence of the legislation from a final omnibus last session — despite being widely supported by lawmakers like Ruud from the start.


“I'm sorry that it took so long to get it done. It's been almost a year and I think it just got into this political wash machine that it couldn't couldn't get out of the spin cycle,” Ruud said. “I think it's a good bill and I think it really had really broad support when we got it done.”

GABRIEL LAGARDE may be reached at or 218-855-5859. Follow at .

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