MACON, Ga. — The runoff election for Senate in Georgia has not lacked for drama, with a fresh round of attack ads, a fevered get-out-the-vote effort and both sides casting the outcome as pivotal for the nation’s future even though control of the chamber is no longer at stake.
But one campaign issue relevant to many voters has little to do with the highly partisan horse race. Rather, it involves one of the most common chronic diseases in America, diabetes, and the soaring cost of the medicine used to treat it, insulin. In both the general and runoff campaigns, Senator Raphael Warnock, the Democratic incumbent, has made much of his efforts in Congress to cap the price of insulin at $35 a month, talking them up in ads, debates and speeches.
“It has resonated with just about everyone,” said Dr. Kris Ellis, a physician who also owns the Bearfoot Tavern in Macon, where Mr. Warnock made a recent campaign stop. “If you don’t have diabetes, you know someone with diabetes.”
He was describing an unsettling reality in Georgia, as in much of the South, where diabetes rates are staggeringly high and the escalating cost of insulin over the years has led to painful choices and, for some, catastrophic consequences.
“I have someone in my family with diabetes who couldn’t afford insulin,” Tony Brown, 57, said on a recent afternoon as he walked into a building in downtown Macon where he works as an engineer. For that reason, he said, he would turn out one more time to vote for Mr. Warnock in Tuesday’s runoff.
As campaign issues go, the price of insulin is nowhere near as contentious as just about everything else raised in the four-week runoff between Mr. Warnock and Herschel Walker, the former football star who is his Republican challenger. Even so, interviews with Dr. Ellis and a number of other voters suggested it had broken through the noise of the high-decibel contest, which Georgia requires because neither candidate won a majority of the vote in the general election.
Mr. Warnock has focused on lowering insulin prices since arriving in the Senate nearly two years ago, motivated in part by hundreds of letters that have poured into his office, pleading with him to do something. He has also described seeing the ravaging impacts of diabetes, including losing limbs and eyesight, on congregants at Ebenezer Baptist Church in Atlanta, where he is the senior pastor.
“This isn’t an ideological matter, it’s a practical one — and it has broad support across the political spectrum,” Mr. Warnock wrote last spring in an opinion essay published in The Atlanta Journal-Constitution.
Earlier this year, he introduced legislation that would require both Medicare and private insurers to cap out-of-pocket costs for insulin at $35 a month. The average out-of-pocket cost per prescription reached $54 in 2020, according to an analysis by the Kaiser Family Foundation, which also found that many patients pay significantly more for diabetes care.
What to Know About Georgia’s Senate Runoff
Another runoff in Georgia. The contest between Senator Raphael Warnock, a Democrat, and his Republican opponent, Herschel Walker, will be decided in a Dec. 6 runoff. It will be the state’s third Senate runoff in two years. Here’s a look at the race:
What is a runoff election? A runoff is essentially a rematch, held when none of the original candidates meet the criteria for winning. Under Georgia law, candidates must receive a majority of the vote to win an election, but Mr. Warnock and Mr. Walker both failed to clear the 50 percent threshold in the Nov. 8 election.
How long will the process take? Two years ago, Georgia was the site of two Senate runoffs that weren’t decided until January 2021, but a new election law shortened the runoff period from nine weeks to four. This year’s runoff will be on Dec. 6, with early voting beginning on Nov. 28, the Monday after Thanksgiving.
Why does Georgia have a runoff law? Georgia’s runoff law was created in the 1960s as a way to preserve white political power in a majority-white state and diminish the influence of Black politicians who could more easily win in a multicandidate race with a plurality of the vote, according to a report by the U.S. Interior Department.
What are the stakes? Even though Democratic victories in Arizona and Nevada ensured that the party would hold the Senate, a victory by Mr. Warnock would give Democrats an important 51st seat ahead of a highly challenging Senate map in 2024.
Where does the race stand now? Both sides are pouring money into ads and courting national allies for visits. But the outcome will probably come down to one big factor: turnout. With the shortened window for runoffs, the parties are investing heavily to mobilize voters during the early voting period.
The proposal gained bipartisan support, including from Republican senators representing Mississippi and Louisiana, states where diabetes rates are even higher than Georgia’s.
The price cap for Medicare recipients was folded into the Inflation Reduction Act, the sprawling $370 billion spending package signed by President Biden in August. But the cap for privately insured Americans was stripped out, even though seven Republicans joined all 50 members of the Democratic caucus in an effort to preserve it. Mr. Warnock continues to push for it.
Mr. Walker has said that he, too, supports lowering insulin costs, and has noted that his mother takes insulin. But his campaign has dismissed the $35 cap as insufficient and suggested that people struggling with diabetes are victims of a failure by the Biden administration and Democrats to rein in inflation.
“I believe in reducing insulin, but at the same time, you have to eat right,” Mr. Walker said in a televised debate with Mr. Warnock in October. “Unless you are eating right, insulin is doing you no good. So you have to get food prices down and you got to get gas prices down so they can go and get insulin.”
Renee Rayles, who has Type 1 diabetes, said Mr. Walker’s comment suggested he did not understand how necessary accessing insulin is for patients like her, whose diabetes cannot be managed with diet. “Without insulin, we will die, and we will die quickly,” said Ms. Rayles, an actress in Atlanta and advocate for diabetes patients who runs the website Diabettie.com.Just over 12 percent of adults in Georgia have diabetes, according to the American Diabetes Association, a rate that is among the worst in the country.
Some patients have reported rationing their prescriptions or forgoing them altogether as the prices of diabetes medications have exploded. The cost of the four most popular kinds of insulin have tripled over roughly the past decade.
“I’ve seen it over and over and over again: People will go without their medicine,” said LaTosha Brown, a co-founder of Black Voters Matter, a civic engagement organization based in Atlanta. “They will cut back. I know people who have split pills. It really is that chronic. And so it becomes more pronounced when there is an economic crunch.”
The contest, which will be decided on Tuesday, has not crackled with the same intensity as the runoffs in Georgia two years ago when Mr. Warnock and Jon Ossoff, then Democratic challengers, forced the Republican incumbents into showdowns that swung the balance of power in the Senate.
Still, the stakes remain high; a win by Mr. Warnock would pad the Democrats’ narrow majority, and the outcome will provide an early measure of the impact of Donald J. Trump’s nascent 2024 presidential campaign on other Republican candidates.
Anger over insulin prices fits into a wider discontent among voters about the nation’s health care system that Mr. Warnock has brought up often on the campaign trail. Polls have shown that many are concerned about the prices of prescription drugs overall, as well as the Supreme Court ruling that overturned Roe v. Wade, which led to Georgia severely restricting abortion access.
Ms. Brown is a leader of the Southern Black Girls and Women’s Consortium, a group that has held listening sessions with young women ages 12 to 22 in a dozen states across the region. She has been struck, she said, by how often participants share concerns about diabetes and the cost of insulin, raising them alongside concerns about education and economic opportunity.
“It wasn’t their own health,” Ms. Brown said of the participants. “They were talking about their families.”
Shannon Bjorneby, an elementary schoolteacher whose teenage son was diagnosed with Type 1 diabetes after a routine physical, said her medical benefits help make the cost of his care reasonable. But he is 18, and, eventually, will no longer be on the family’s insurance plan. That is what worries her the most.
“Insulin should be a basic human right,” she said.
Ms. Bjorneby described herself as a moderate voter who does not stick to a single party, but she shared her family’s experience with Mr. Warnock at a recent round-table event and was convinced to vote for him because of his persistence on insulin prices.
“I really respect that about him,” Ms. Bjorneby said. “He’s kept pushing it and pushing it and pushing it.”
The pressure from Mr. Warnock and other elected officials may have had an impact: Sanofi, one of the largest producers of insulin, said in June that it would cap the cost of its insulin for uninsured patients in the United States at $35; previously, it had been $99. Some insurance providers, including Ms. Bjorneby’s, have announced in recent months that they would implement a similar cap. For the last two months, her son’s insulin has cost $35.
Ms. Rayles, who supports Mr. Warnock, said that more needs to be done to help with the enormous expense of treating diabetes. Just one of her insulin prescriptions costs $546 per month, she said. She also has to pay for a continuous glucose monitor.
“We are getting completely and totally raked over the coals,” she said. “At what point do you say that is enough, we stand with you? It is serious. It’s literally life and death.”