> The law could also use indirect leverage to gradually separate students' medical monitoring from the smartphone. For example, they could begin a multi-year transition period after which NY-regulated health insurance plans could only cover these types of smartphone-linked medical monitoring devices if they also cover a version with equivalent functionality in a non-smartphone version (at no greater out-of-pocket cost to the patient) unless no comparable non-smartphone product is on the market from any manufacturer. Then they could eventually require the non-smartphone version in class once it exists, with a fully insurance-paid (no cost-sharing) transition available to existing users of the smartphone monitoring system.

I think there are a few issues here.

T1D is already incredibly intrusive in the daily lives of children. Continuous glucose monitors (device 1, on body with bluetooth connection to a smartphone, device 2) track one's blood sugar every 5 minutes or so and gives the child, the parent, and the school nurse the information they need to jointly replace the functionality of the child's pancreas. This might be dosing with insulin through a pump (device 3, sometimes managed via smartphone) to lower blood glucose or cover carbohydrate consumption. Or it might be eating to raise blood glucose.

If the student's blood glucose gets either too high or too low (which can happen in a matter of minutes) the consequences can be fatal or lead to lifelong complications like nerve damage in the extremities or eyes. High stakes stuff.

If I understand correctly, your proposal would introduce a fourth device to separately monitor blood glucose and, I assume, manage the process of uploading this data and sharing it with all parties. This fourth device would mean a few things:

- Yet another piece of expensive, and durable medical equipment you are required to pay for, that insurance rarely fully covers.

- The child would have to tote around now four devices daily to manage a chronic condition.

- Another device to manage and maintain (batteries need to be charged, etc).

- Paying for another 5g plan to ensure that the monitoring device can share information with parents etc.

Despite some of the cons to these systems being integrated into your smartphone, there are considerable advantages to using the networked compute you always have in your pocket. Not to mention that these devices suffer from painfully slow development and approval cycles. Durable medical goods often have to go through federal approval and even small changes to firmware can take years.

Also, just some quick figures. The school age population in NY state as of 2021 was 2,622,879. About 1/400 children ages 0-18 have type 1. So around 6.5k students. This is neither the extreme edge case that others have described (and just one of many chronic diseases that are managed via smartphones) nor is it likely a large enough segment to change product development at these large health tech companies.

I don't think the solution is to try to engineer incentives and overhaul the entire health insurance coverage of durable medical goods. Nor do I think the solution is to require children with T1D to carry around and pay for yet another expensive device.

I think we just need to be careful in the design of legislation like this, as you suggest, especially when it comes to ubiquitous devices that have been integrated into so many facets of people's lives. There is no such thing as a 'trivial exception' to a state law (responding to a commenter further down).