Over the weekend, the Senate passed the Democrats’ climate change and health care bill by the narrowest of margins. One provision in the original bill that was stripped out was a federally mandated $35 cap on the price of insulin. The exclusion of the mandate made headlines as reporters, lawmakers and activists pointed out that the cost of the medication millions of diabetics use to regulate their blood glucose levels has been going up for years.

Nearly 38 million Americans currently have diabetes, the Associated Press said, and of those, some 8.4 million use insulin, according to the American Diabetes Association. At least 7.5 million of those require insulin daily.

Over the last two decades, the price of insulin has more than tripled, and America’s diabetics have shelled out thousands of dollars annually, the AP reported. And the prices stateside are significantly more than in dozens of other countries.

One study from Rand Health Care compared the price of insulin in the U.S. to the price in 32 countries of the Organization for Economic Co-operation and Development. The study found that the average manufacturer price for a standard unit of insulin in the U.S. was about $100. This was more than 10 times the average price of about $9 in the 32 OECD countries.

According to a CharityRX survey, 79% of Americans who have diabetes or take care of someone with diabetes say the price of insulin has been a financial difficulty for them or the person they provide care for. Four out of five people surveyed said they have taken on credit card debt to afford insulin, with the average amount of additional debt being $9,000.

Though lawmakers and politicos have been outraged by the rising price of insulin, there’s another factor to consider. Officials say there needs to be a comprehensive approach to dealing with diabetes that includes prevention and treatment. According to the National Clinical Care Commission, if current health trends continue, one in three Americans will develop diabetes in their lifetime.