The Waiting Room

Chapter 3 of The Briefing: Tom Emmer (R-MN-06), Part One — The Cost.

Minnesota’s Sixth Congressional District has 94,278 residents over 65. More than 126,000 are enrolled in Medicare. An estimated 15,000 to 18,000 use insulin. The national average family health insurance premium is $26,993 a year. Approximately 28,600 people in the district have no coverage at all.

87% of Americans support capping insulin at $35 a month. 85% support letting Medicare negotiate drug prices. Among Republican voters, 75%. Among Trump voters, 70%.

The community’s representative has introduced no drug pricing legislation. He has cosponsored none. Across six Congresses, his legislative record on insulin is blank.

The cost to produce a vial of insulin is less than seven dollars. The pharmacy price reaches $315. Insulin list prices tripled in the decade before 2017. Three manufacturers — Eli Lilly, Novo Nordisk, Sanofi — control more than 90% of the market. Insulin was discovered in 1921.

Three pharmacy benefit managers — OptumRx, Caremark, Express Scripts — control 80% of the pharmacy benefit market. The Federal Trade Commission found they systematically excluded lower-priced insulins in favor of high-list-price, heavily rebated products. The rebate savings go to the PBM, not the patient. UnitedHealth owns both the insurer and the PBM. The company raising the premium and the company inflating the drug price are the same company.

A conservative who opposes government price caps has a point: price controls can distort markets, reduce supply signals, and shift costs in ways that are difficult to predict. The free-market answer to a $315 vial that costs seven dollars to produce is to break the monopoly — patent reform, PBM transparency, generic competition, antitrust enforcement against vertically integrated insurers.

Emmer introduced none of those bills. He cosponsored none. He opposed the price cap and offered no market-based alternative. The pharmaceutical industry spent $384.5 million on lobbying in 2024 alone. The insulin market remained exactly as it was.

In March 2022, the Affordable Insulin Now Act came to the House floor. It would have capped out-of-pocket insulin costs at $35 a month for people with private insurance. Tom Emmer voted NAY. The vote fell along party lines — all but 12 Republicans voted no. All four Minnesota Democrats voted yes. All three Minnesota Republicans voted no. The UnitedHealth Group political action committee — the political arm of the company that owns both the insurer and the PBM — contributed to Emmer’s campaign in every cycle he has served.

The provision to extend the cap to private insurance went to the Senate. It received 57 votes — a majority, but short of the 60 needed. 43 Republicans voted against it. The private-market cap died. Medicare beneficiaries got the $35 cap through the Inflation Reduction Act. The privately insured did not.

Emmer voted NAY on the Inflation Reduction Act — a spending bill he opposed on broader fiscal grounds that also contained the only federal insulin price protection to become law.

A review of his official press releases, floor statements, and media coverage yielded no public statement on insulin pricing. No bill introduced, none cosponsored.

His campaign website describes him as “lowering costs for 100% of American families.”

The pharmaceutical industry has been the top lobbying spender in America for 25 consecutive years. $4.7 billion in federal lobbying since 1999.

In 2003, a provision banning Medicare from negotiating drug prices was written into the Medicare Part D prescription drug benefit. The government’s largest drug purchaser was prohibited by law from negotiating. The congressman who authored the provision, Billy Tauzin, left office and became president of PhRMA, the pharmaceutical lobby. The ban he wrote is the ban that held for nineteen years. Every time a bill to lift it reached the House floor, Emmer voted to keep it in place.

Congress tried at least six times between 2003 and 2022. Each time, it failed.

85% of the country wanted this. For nineteen years, the industry outspent every effort to pass it.

In 2022, the Inflation Reduction Act finally cracked the ban — for a limited set of Medicare drugs. Emmer called it a “prescription drug price fixing scheme.”

Between 1999 and 2018, the pharmaceutical industry spent $1.4 trillion on research and development and $2.2 trillion on marketing and administration. After the IRA passed, drug R&D spending increased.

The No Surprises Act prohibited surprise medical billing — the practice of charging patients out-of-network rates for care they received at in-network facilities. It passed with bipartisan support. Emmer voted YEA. Across six Congresses, he voted YEA on every bill to cut or repeal healthcare coverage — five ACA repeal votes, the 2017 healthcare overhaul, the 2025 reconciliation bill that included Medicaid reductions. He voted NAY on every bill to expand it — the 2021 social spending bill, the Inflation Reduction Act, the Affordable Insulin Now Act. One exception: the No Surprises Act, which passed as part of a larger spending package.

Some of those NAY votes had legitimate conservative rationale — large spending bills bundled healthcare provisions with policies that a limited-government Republican would reject on principle. Six Congresses. Zero bills addressing the cost of insulin, the cost of prescription drugs, or the structure of the PBM monopoly. The conservative case against the Democratic bills may be sound. The legislative record that followed is empty.

Alec Smith was 26 years old. He earned approximately $35,000 a year as a restaurant manager. When he turned 26, he lost his parents’ health insurance. His insulin and supplies cost approximately $1,300 a month without coverage. The best plan available to him: $450 a month in premiums with a $7,600 deductible. Too much income for Medicaid. Too little for the insurance.

On June 22, 2017, he went to the pharmacy to refill his insulin. He could not afford it. He left without the medication.

On June 27, his girlfriend found him on the floor of his apartment in Richfield, Minnesota. An empty insulin pen lay beside him. Cause of death: diabetic ketoacidosis. He died 27 days after losing coverage. Three days before payday.

He lived in Minnesota’s Fifth Congressional District — not MN-06. He was not Emmer’s constituent. The pricing structure that led to his death runs through the same committees, the same floor votes, the same chamber.

Jesimya David Scherer-Radcliff was 21. He died in Minnesota in June 2019 — rationing insulin because he could not afford the full dose. He was at least the second Minnesotan to die this way.

The state acted. In 2020, the governor signed the Alec Smith Insulin Affordability Act — a 30-day emergency supply for $35, ongoing coverage at $50 per 90-day supply. Over 1,100 Minnesotans used the program in its first full year. In 2025, the attorney general reached settlements with all three manufacturers, capping insulin at $35 a month regardless of insurance. Effective January 1, 2025, state law caps monthly insulin cost at $25 for state-regulated plans.

Since becoming Majority Whip, he has introduced no insulin pricing legislation, no drug pricing reform, and no PBM transparency bill. He has the leadership position and the vote count. The community’s healthcare needs remain where they have been for six Congresses.

In December 2025, the House passed the Lower Health Care Premiums for All Americans Act, which included PBM transparency provisions. Emmer voted yes. In media appearances, he described PBMs as “the middleman” and said the bill would “give you transparency so the consumer knows if they’re being ripped off.” He did not introduce the bill. He did not cosponsor it. The Senate has not scheduled it for a vote.

His district has 15,000 to 18,000 insulin users.

Sources

FEC Schedule A (UnitedHealth Group PAC contributions); House roll calls (H.R. 6833, H.R. 5376/IRA), via clerk.house.gov; KFF Health Tracking Polls (2024–2026); Gallup healthcare polling (2025); FTC PBM interim report; Census ACS 2019–2023; CMS Medicare enrollment; CDC PLACES 2023; Annals of Internal Medicine (insulin rationing, 2022); BMJ Global Health, Gotham et al. (2018, insulin production cost); Minnesota Legislature (Alec Smith Insulin Affordability Act, 2020); MN Attorney General (manufacturer settlements, 2024–2025); AP News, Star Tribune, KFF Health News; PhRMA lobbying data (OpenSecrets).