They all love means testing shit. It seems to me that the Trump administration set some nebulous tbd “low income” standard for price relief and then Biden admin reversed that before it became effective because they claimed the administrative cost would be too “burdensome”
If any of them gave a fuck about making sure Americans could get insulin they would just nationalize production and make it available - simple answer. The end. Like everything else in this country the matter is settled by the people who have money to pay off politicians. In this case, the various pharma and medical interests make money off of insulin so that is that.