The DFL majority in the Minnesota House passed a bill Wednesday night that would assess fees on drugmakers to fund an emergency insulin program, a plan that faces significant opposition in the Republican-led Senate.

Democrats have put a potential price tag of more than $38 million on the program, nearly four times the estimate from a year ago. But the final version of the measure could look significantly different — if legislators are able to reach an agreement with Senate Republicans.

For Nicole Smith-Holt, Wednesday’s vote was one she has watched before. Last year she sat in the seats above the House floor as legislators passed a bill named for her son, Alec, who died from diabetic ketoacidosis. She had been elated by that vote, believing it would help people access the drugs her son could not afford.

But the bill failed in the final days of that session.

This time around, she was warier. The real fight to reach a deal on insulin aid lies ahead. Once the Senate passes its version of the measure, the two sides must reach an elusive compromise.

“Now I know the true logistics of, OK, this is one hurdle. It’s a great hurdle and we’re making progress,” Holt-Smith said. “I’m still optimistic and I’m still hoping that we have, sooner rather than later, a bill signed into law that’s going to protect the lives of people.”

Insulin backers including Nicole Smith-Holt, center, gathered outside the House Chamber to support House members who voted to pass an emergency insulin package Wednesday night. The bill named after her son Alec who died trying to ration his insulin in 2017.

House Democrats’ bill, which passed 75-52 Wednesday night, would largely fund the program with a fee on insulin manufacturers. Legislators estimate manufacturers would have to pay a total of $38 million the first year of the program. Last year legislators said the price tag for manufacturers would be roughly $10 million.

The new number assumes 70% of diabetics who are eligible for the program would use it. That is greater than the assumption last year that just one-quarter of eligible diabetics would use the program, said bill sponsor Rep. Mike Howard, DFL-Richfield. He said the cost will likely end up being significantly less than $38 million and the state could adjust the fee for future years and repay drug companies if the state collected too much in the first year.

House Republicans raised several concerns in the whirlwind of hearings on the bill over the past couple of weeks. Some have questioned the program’s cost to insulin manufacturers, noting that many drug companies have added programs to help patients pay for insulin. Republicans have instead backed a plan proposed last year by Rep. Rod Hamilton, R-Mountain Lake, that would use state dollars to fund insulin assistance.

Some have accused Democrats of politicizing the issue at the industry’s expense. “You had victory in hand way back in April or May. And you decided to deny those that are urgently seeking this because of a decision on your part to weaponize this for a partisan objective,” said Rep. Tony Albright, R-Prior Lake.

Howard said Wednesday that the House DFL approach is not to punish drug companies but to hold them accountable for profiting from a insulin price crisis.

Sen. Scott Jensen, R-Chaska, is pushing a different approach in the Senate. His bill, like the House version, would have pharmacies give out the emergency drug supplies. But it would require manufacturers to provide insulin for distribution, as opposed to having them pay a fee.

Jensen estimates the cost to manufacturers to supply the drugs would total between $10 million and $20 million annually. He said the proposal would likely be voted on by the full Senate on March 12.

“What we need to do is: We need to focus on fixing the problem and we need to make sure there aren’t any more Alec Smiths,” Jensen said. “And if we can do that, I don’t think anyone should get too fussy about the mechanism.”