Some older patients with diabetes are now getting easier access to insulin. But there is concern many younger ones are still navigating a difficult path in managing their situation, including an outspoken Wisconsin health care worker.

The average cost of insulin nearly tripled between 2002 and 2013, according to The American Diabetes Association. It prompted outrage following stories of patients being forced to ration their supply of the drug. Last year's federal Inflation Reduction Act capped monthly copays at $35 for Medicare recipients.

Saskia Hale, a registered nurse in Stevens Point, said she is relieved those individuals are less likely to need hospitalization for diabetes complications.

"Some of these complications include having limbs amputated, having sores, having chronic kidney problems, going into kidney failure," Hale said.

She said those often stem from patients not being able to cover out-of-pocket insulin costs. A new federal Health and Human Services report suggests the cap will save seniors $500 a year. But Hale, who is a diabetic herself, said non-Medicare patients still have insurance barriers, along with added expenses for supplies like needles and glucose monitors.

Hale said falling off a management plan because of skyrocketing insulin costs can result in being labeled "noncompliant" by your insurance coverage provider.

"When they're labeled that way, it makes it seem as though they are doing this simply because they don't want to take their insulin and that is usually not the case," she said. "It's usually because they cannot afford the medication."

She added being labeled noncompliant, even if it's not the patient's fault, can lead to the insurer dropping insulin coverage from the individual's plan. President Joe Biden recently called on Congress to extend the $35 cap to all Americans with diabetes. But political analysts predict it is unlikely, with a divided power structure right now. There is some bipartisan support, but some Republicans say it would be a mandate, hindering competition.

As the federal government nears a shutdown over a budget impasse in Congress, Wisconsin offices that help low-income individuals worry they'll have to stretch their programs. They hope the public sees the importance of their assistance.

Public policy analysts say safety-net aid, such as the Supplemental Nutrition Program for Women, Infants and Children (WIC) would feel the budget squeeze sooner rather than later.

Brett White is executive director of the Southwestern Wisconsin Community Action Program, which helps clients access WIC benefits. His office is nonpartisan, but he feels the work they do tends to get overlooked in public debates over government funding.

"We are the transportation program for this neck of the woods, and take people to dialysis treatments," he said. "I mean, we're big on that."

He said they've been preparing to try to keep services running, but noted that some programs would eventually have to pause in a prolonged shutdown. Hard-right House Republicans have insisted on a federal budget that includes deep cuts for social assistance. The group Opportunity Wisconsin has called out certain GOP members of the state's congressional delegation for not opposing that plan.

Freedom Caucus members have said their demands for big cuts should be considered because they didn't make it into the debt-ceiling agreement earlier this year. Meanwhile, White said that as a lot of households still struggle with higher consumer prices, these programs are increasingly becoming a lifeline for those turning to them for the first time.

"We will see spikes, we've actually already begun to see inquiries," he said. "We see spikes in our food pantry programs."

The government shutdown threat and the potential for big spending reductions follow new data from the U.S. Census Bureau showing increases in poverty rates. That includes the nation's child poverty rate more than doubling, to 12%.

New Yorkers are preparing for an impending government shutdown.

State officials are worried about how it could impact the work state agencies have been doing for migrants. Meanwhile, residents are concerned about how a shutdown could affect federal benefits they receive.

Make the Road Action held a press conference this week urging U.S. Rep. Anthony D'Esposito - R-Island Park - to stand up to hard-right Republicans taking budget negotiations hostage.

Angel Reyes Rivas, Long Island organizing coordinator with Make the Road Action, said a shutdown would be financially disruptive for New Yorkers.

"For Social Security and Medicare, the checks are sent out, but benefit verification as well as card issuance would cease," said Reyes Rivas. "Also, SNAP, that many low-income families use on Long Island also would, the ability to send out food stamp benefits could be affected by the shutdown."

The Center on Budget Policy and Priorities finds almost 3 million New Yorkers received SNAP benefits in 2022.

Earlier this week, Gov. Kathy Hochul implored members of Congress to avert a shutdown - noting that among the many other problems it would pose, New York's 51,000 federal employees would be out of work.

The Senate passed a measure to fund the government until November 17, though House Speaker Kevin McCarthy has said he will not take the measure up as it is.

Reyes Rivas said any kind of budget must be bipartisan and based on what constituents want.

"A solution would be for the people, being Democrat or being Republican, that really care about these communities and understanding the importance of these benefits to pass something, right?" said Reyes Rivas. "There's a government shutdown, it's unacceptable."

The Senate's budget bill would have provided around $6 billion for Ukraine war efforts and another $6 billion for disaster relief in the wake of recent floods, and wildfires in the U.S.

Since the passage of the American Rescue Plan Act in 2021, a number of cities and counties in Ohio and around the nation have used ARPA funding to retire medical debt.

Over the summer, Akron became the latest community in Ohio to adopt a plan to retire such debts.

The city council allocated $500,000 to purchase debts through the non-profit RIP Medical Debt. RIP in turn negotiates with hospitals and debt collectors to buy old debts for pennies on the dollar and then forgives them.

Akron Ward 1 City Council Representative Nancy Holland said these debts take a toll on the community.

"Medical debt is one of the leading causes of personal bankruptcy," said Holland. "It's also a leading cause of divorce, of job disruption, of inability to qualify for most major loans like home loans, it can also cause trouble in a rental application, just to rent an apartment. "

Akron joins Lucas County, Toledo, and Cleveland in using ARPA funds to eliminate medical debts. The anticipated value of retired debts from Akron's allocation is up to $50 million.

After entering into a contract with a local government, RIP Medical Debt reviews hospital debt portfolios to determine which ones will be retired.

Residents who qualify must earn less than 400% of the federal poverty level, and their medical debts must be at least 5% of their annual income.

Allison Sesso is the president and CEO of RIP, and says medical debt can be hard to avoid.

"I think medical debt is different than other kinds of debt, because of the fact that it's inherent in the system," said Sesso. "And it's sort of a trap, you can't avoid it. You can have insurance and yet you still have medical debt. You can do all the right things and you still have medical debt. You don't control the pricing. It is not transparent as a system and so it's really hard to avoid. "

Pre-pandemic research found that 23 million Americans have medical debt, with 3 million owing more than $10,000.

While these debts are accumulated in countless ways, and at different types of healthcare organizations, Sesso said RIP will negotiate with anyone to buy qualifying medical debt belonging to those most financially burdened.

"There's often been questions about whether or not we'll work with certain kinds of hospitals, that maybe are seen as bad actors," said Sesso. "And at the end of the day, we really focus on the patient. If you have debt at a bad actor hospital, you shouldn't be punished for that."

Sesso said to date, RIP has retired $10 billion of debt for 7 million people nationally.