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LOUISVILLE, KY - JUNE 5: James "Big Ken" Manuel, 66, a heart patient with many co-morbidities, goes through his evening medicine ritual at his home on the West End of Louisville on June 5, 2023, in Louisville, KY. After retiring a year ago as a union electrician for 45 years, Manuel said, "I want to be able to enjoy my pension." All his cardiometabolic diseases call for a lot of medicines. Hydralazine. Torsemide. Atorvastatin. Metformin. Carbetol. Benzonatate. Prednisone. "It's a lot of medicine. And it's expensive. Eatin' up my pension," Manuel said.Manuel spends, by his estimate, at least $800 a month on medicine.(Photo by Jahi Chikwendiu/The Washington Post via Getty Images)