BISMARCK — Twelve-year-old Nina Kritzberger was preparing to share with North Dakota lawmakers her experience of going to school, playing sports and doing everything kids her age do while living with Type I diabetes.

However, because the North Dakota Senate killed a bill to make insulin more affordable in a 26-21 vote on Monday, Feb. 22, she will no longer have that chance.

During an extensive discussion about Senate Bill 2183, senators weighed the pros and cons behind making insulin more affordable for diabetic North Dakotans who need the medication to survive. Ultimately, lawmakers decided the cons and prices insurance companies would need to pay to make insulin more affordable outweighed the benefits.

Senators on Monday voted down a scaled-back, more conservative version of the bill that would have capped the price of a 30-day supply of insulin at $25 in copays and coinsurances for residents enrolled in the North Dakota Public Employees Retirement System (NDPERS). After two years of piloting this effort, legislators would have analyzed the costs incurred by the plan and then decided whether to apply it to other insurance plans.

The original version of the bill would have capped the price residents paid up front for insulin at the pharmacy or distributor at $25 for anyone insured by a North Dakota provider. Senators earlier this month amended the bill to only apply to members of NDPERS.

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Many senators testified on the Senate floor before the bill came to a vote, with multiple lawmakers expressing their concerns that the bill would not affect many North Dakotans because the state's largest providers, the Sanford Health Plan and Blue Cross Blue Shield, have implemented $25 or lower copays.

"I would argue that this bill doesn't actually change the prices in that ... all of the major health insurers who this would affect have already changed this, so the bill actually ends up affecting virtually no one," said Sen. Kristin Roers, R-Fargo.

However, the Sanford Health Plan and Blue Cross Blue Shield of North Dakota do not offer a $25 or lower copay or coinsurance for all of their plans.

"I'm sorry if this would cause a problem for private insurance companies, but I would think the life or death of one of our citizens would be worth a little inconvenience in their having to figure out how to make this work," said Sen. JoNell Bakke, D-Grand Forks.

Senators also expressed concerns that the cost would shift from the consumer to the provider, and this could be a "slippery slope" for mandating coverage for other medications.

"The insurance company lobbyists got their day," Sen. Tim Mathern, D-Fargo, said. "I just feel so much for these families." Mathern drafted the original version of the bill.

Lobbyists influenced at least three senators' votes, Mathern said, as he did not know they were going to vote "no" on the bill until their votes were cast.

Sen. Diane Larson, R-Bismarck, told senators on Monday that "people talked to me about this bill," which is why she decided to vote "no." Larson said on the Senate floor that her daughter is living with Type I diabetes and is insulin-dependent.

"Legislatively picking and choosing which maintenance drugs will receive mandated coverage is a slippery slope that prioritizes one person’s condition over another’s," said Andrea Dinneen, spokeswoman for Blue Cross Blue Shield of North Dakota, in a statement. She said Blue Cross Blue Shield of North Dakota prioritizes finding solutions to the rising cost of insulin and believes "addressing the issue at the plan level with a benefit that supports a broad spectrum of chronic disease is the best approach."

Angela Kritzberger, Nina Kritzberger's mother, said she has empathy for all people who are living with or have family members living with diabetes, and it is unfortunate that the cost of insulin is something many will have to continue worrying about since this bill failed.

Even though North Dakota senators killed the bill, Danelle Johnson, a local diabetes advocate whose daughter lives with Type I diabetes, said she is glad awareness was brought to this issue. She encourages people to keep fighting to make insulin more affordable.

"I hope that everyone that utilizes insulin to sustain their life becomes more engaged in the process of making changes at the federal and state level," Johnson said.

Angela Kritzberger said she does not yet know how she is going to tell her 12-year-old daughter that lawmakers rejected the bill.

"How do you tell a young child who's diabetic that they killed the bill and they don't want them to have access to affordable insulin?" Kritzberger questioned.

Readers can reach Forum reporter Michelle Griffith, a Report for America corps member, at mgriffith@forumcomm.com.