On Wednesday afternoon in Winona’s city council chambers, U.S. Sen. Amy Klobuchar greeted a small group of community members and stakeholders gathered to share concerns about the rising cost of prescription drugs and its effect on Minnesotans.

The greeting was electronic and prerecorded, of course, as the senator is in the midst of a busy week. Klobuchar attended President Donald Trump’s State of the Union address Tuesday night with the mother of a young Minnesota man who died after being unable to afford his insulin prescription, and she’ll be making a much-anticipated announcement on Sunday in Minneapolis about a possible presidential run.

But amid speculation about her 2020 plans, Klobuchar’s staff is visiting several southern Minnesota cities to hear from residents about their struggles to afford costly prescription drugs. In Winona, members of the community were joined by representatives from Winona Health, the Mayo Clinic and Minnesota’s chapter of AARP.

“Our ability to control any of this — we don’t have any,” said Winona Health CEO Rachelle Schultz.

Rural hospitals have especially tight margins, Schultz explained, and pharmaceutical costs have begun to outweigh everything else, putting patients at risk. She said she’d observed every example that Klobuchar mentioned in her greeting — like patients not filling prescriptions or cutting pills in half — in Winona.

The price gap between older and newer medicines is startling, sometimes more than a thousand-dollar difference, added internal medicine physician Dan Parker. Patients opt for the cheaper drug that they can afford, he said, even if it’s not as safe.

Elizabeth Ebot, who works in Klobuchar’s office, told the group that it’s reassuring to see the conversation shifting from “Is this a problem?” to “How do we address it?” The senator has already introduced three bills aimed at helping Medicare negotiate directly with pharmaceutical companies, bringing in safe and affordable drugs from Canada and eliminating the “pay-for-delay” process, which allows large drug companies to strike deals to prevent or slow the entrance of the generic version of their drug to the market.

Later this session, she’ll introduce additional bills attacking high drug costs with bipartisan support from U.S. Sen. Chuck Grassley of Iowa, Ebot said. And as the president mentioned lowering prescription drug costs in his State of the Union address Tuesday, it does appear to be an issue that could move legislation forward quickly.

But even these measures aren’t enough to fix all of what’s broken, said Andrea Frank, a Winona resident who along with her husband faces a $5,000 deductible and pays more than $800 a month for a health insurance plan.

“This is a bandaid over a system that is sick,” Frank said. “The sicker you are, the more you’re held hostage.”

Frank, who received a diagnosis a few years back of Lupus-like symptoms, said she quit a prescription for eye drops to treat her dry eyes because it would have cost at least $550 per month. The same drug would have cost a third less in Canada, she told staffers Wednesday, and had it been a comparable medicine through a veterinarian for her dog, it would have been less than $100 per month.

Legislation to reign in big pharma is a good start, she said, but moving toward single-payer health care would fix other, even larger system flaws.

Schultz said she recently spoke with a Winona Health pharmacist who told her they had just filled the most expensive prescription for a drug they’d ever seen: It cost the patient $30,000. Although a community health care provider would certainly do everything it could to help a patient finance a needed drug if the patient could not themselves, she worried that price tags that high could wipe out an entire hospital.

“I don’t know that we see a light at the end of the tunnel,” Schultz said.