Health Care Reform
How will the newly enacted Patient Protection and Affordable Care Act change the way that you get health care coverage? The bill that President Barack Obama signed on March 23 seeks among other things to fix the problems that many people with diabetes have in securing quality care. The law is certainly complex, but given how essential quality health insurance is when you have diabetes, it’s important to know what is changing, and when (timeline begins on next page). Here’s an overview of the law’s initiatives that most pertain to people with diabetes.
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A prime example of a problem with the current system is the concept of “preexisting conditions.” Many people with diabetes get their health insurance through their or their spouse’s (or parent’s) employer. Others try to buy it on their own. But since many health insurance plans impose restrictions if you already have diabetes (a preexisting condition), switching jobs or getting laid off could mean losing health coverage. Beginning this year, insurers can no longer deny coverage to children because of preexisting conditions; starting in 2014, the same will be true of adults, too (until then, high-risk insurance pools will offer coverage to people who can’t get insurance otherwise).
Today, if you have diabetes and don’t have Medicare, Medicaid, or an employer-provided plan, buying your own insurance can be either financially prohibitive or pretty much impossible. Under the new law, coverage will be as available to people with diabetes as it is to everyone else, through the new American Health Benefit Exchanges that begin operating in 2014. These marketplaces will allow people (and businesses with fewer than 100 employees) to purchase insurance from both private insurers and nonprofit groups. “It’s likely that people purchasing coverage on their own will eventually move to the exchanges,” says Jennifer Tolbert of the nonpartisan Kaiser Family Foundation. Health plans in the exchanges must offer a minimum set of benefits, and states may drop plans that make unjustified premium increases.
One of the goals of health care reform is to prevent both chronic diseases and their complications. “We had a system in which insurance companies would pay for an amputation caused by diabetes, but all too often would not pay for the care that would have prevented an amputation in the first place,” says George Huntley, former chair of the board of the American Diabetes Association.
Before the new law, insurance companies could drop people when they were diagnosed with a condition like diabetes, or its complications. Another provision going into effect in 2010 prohibits that practice. Plans will also be required to cover policyholders’ adult children up to age 26. Lifetime and annual limits on policy benefits will eventually be banned. Seniors with Medicare Part D will see the “doughnut hole” gap in prescription drug coverage gradually disappear.
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The law also recognizes the nationwide impact of diabetes. For example, the Cures Acceleration Network, which will start receiving funding this year, will finance research into cures for diseases. A new National Diabetes Prevention Program will fund grants for community-level efforts to help people lower their risk for type 2. Additional initiatives boost the number of health care workers and increase the availability of medical services in areas hardest hit by diabetes and other chronic diseases. Other provisions—like requiring restaurant chains to post calorie counts on menus—attempt to create a healthier environment in order to stem the exponential growth of type 2 diabetes nationwide.
The law expands the ability of employers to use workplace wellness programs to reward employees based on certain health measures. The intent is to encourage people to engage in activities that both improve their health and reduce the cost of care. However, diabetes advocates are working to ensure that employers won’t use the provision to keep people with diabetes from getting affordable coverage because, say, their blood glucose exceeds a certain level.
Throughout the legislative process, the American Diabetes Association worked with members of Congress to represent the interests of people with diabetes. “We heard from so many people who couldn’t get insurance or had their claims denied because of their diabetes,” says Huntley. “Eliminating preexisting condition exclusions and establishing the high-risk pools lessened the fear of losing coverage, or having such financial strain that people have to cut back on essential medications like insulin.”
How some components of the law will play out remains to be seen. “The final bill was not perfect by anyone’s estimation,” says Huntley, “but it was a major step forward for access to care for people with diabetes.” When it comes to diabetes, good, affordable health care will remain a priority long after the words health care reform have left the headlines.
Glossary of Terms | ||
| Children’s Health Insurance Program (CHIP): insures children and teens whose families can’t afford health insurance but make too much to qualify for Medicaid. | Co-pay: a payment that an insured person must make for a medical service, such as a doctor’s visit or prescription medicine (for example, $20 per office visit, or $5 per prescription). The amount is set by the insurance policy and varies by type of service. | Deductible: the amount that must be paid out of pocket for health care expenses in a given year before an insurer starts paying for medical claims under a policy. Not all health plans have a deductible. |
| Doughnut hole: in Medicare Part D prescription drug coverage, a gap between the initial coverage limit and the minimum threshold for catastrophic coverage. A Medicare beneficiary who has spent enough on prescription drugs to exceed the coverage limit in a given year falls into the doughnut hole and is responsible for the total cost of all prescriptions filled until spending enough to qualify for catastrophic coverage. | Exchanges: state-level marketplaces through which individuals, families, and small businesses will be able to purchase insurance. The exchanges are intended to help small businesses and people without employer coverage compare plans and band together to get better prices. | Grandfathered plans: Health insurance plans that existed prior to health care reform being signed into law on March 23. Grandfathered plans do not have to comply with some provisions of the new law. However, these plans maintain their grandfathered status only if certain elements of coverage do not change. |
| Preexisting condition: a medical condition that was diagnosed before beginning coverage with a new health plan. Currently, many insurers deny coverage based on such conditions, and large plans may impose a waiting period before coverage begins. | Premium: the amount of money a person, family, or business pays for insurance coverage. | Subsidy: monetary assistance from the government to help pay for insurance premiums, often to people with low incomes. |
Comments
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Like everything else in this country, it's easier to put band aids out there than actually addressing the root cause. Health insurance costs continue to rise due to corporate greed and a self fulfilling prophecy of the medias constantly reporting the rise in costs. People have become accustomed to it so get used to it. Diseases like type 2 diabetes are preventable, but rather than change lifestyles, let's pump a boatload of money into researching rather than addressing the root cause. Type 1 diabetes is a death sentence that takes ones life piece by piece. Thank you Government and FDA for putting church and political agenda above everything else. Let's still support HIV like we do so people can continue to act irresponsible.
Have a great day! And no worries, a cure is close..... Lol. Lol. Lol. Lol
Preexisting
Preexisting is a word I hate and is a huge problem in health care.
My husband is 32 Has type 2 diabetes, can not get it under control, spends alot of time in the ER but due to the fact he has a job and he cant get state help. And due to his preexisting disability his insurence will not cover him. We are a family of 7 cant afford a specialist, cant not work due to needing food and shelter. We feel like its hopeless if he dont get help he wont live to see are kids grow up.
Coverage denied for a lot of us that fall thru the gap
These plans are all fine and dandy but what about the unemployed person who is on cobra now and cant get insurance after it ends because of diabetes. The premiums are so expensive and you cant afford to go without insurance the 6 months required before you qualify. There is a big gap in the health plan and it effects lots of unemployed since Cobra is running out for a lot of us.
RETIREMENT/Health Plan
As an early retiree(not by choice)who carried my retired husband when I was working, how do I get my healthcare to work best for us? Especially for me, since I am a diabetic.My husband has picked up TRS-CARE1 under the notion that we would be covered in a significant way. However, we have found that we can't afford to make the high cost of office visits. We were told that we could change if this packet wasn't appropriate. When we attempted to change we were told we couldn't until my husband turn 65 which is 4 years away. In the mean time I am not able to have my blood work, cataracts, blood pressure,blood cholestral,and see cardio Doctor.For a family that is between poverty and middle class there is no help. I have gone to public hospital ER but that only creates an additional bill. We are not considered poverty level.However, we have had to deal with the economy like everyone one else. What type of sudsidy will help support us, temporaily? Take into account $4000 deductible, plus meds and not having the funds.This is a hard pill to swallow. I have not seen a doctor since March.With diabetes I should see my Doc every three months. This is not a pity party but a reaching out for resources.Looking for TEMPORARY HELP. I can't wait until 2014.
Help
Under the circumstances you may, unfortunately have to get on the welfare rolls. Social Security seems to have a problem with those of us with diabetes.
Side Effects: The Obamacare Threat to Your Liberty
http://blog.heritage.org/2010/09/22/the-right-way-to-limit-pre-existing-...
The inability of some Americans to obtain health insurance for pre-existing medical conditions continues to be used by Obamacare supporters as justification for the mammoth legislation. The truth, however, is that the problem was nowhere near as big as portrayed, and the solution doesn’t require 2700 pages of legislation or $1 trillion in new government spending.
Over 90 percent of Americans with private health insurance are covered by employer group plans where existing rules governing the application of pre-existing condition exclusions are not an issue. Before passage of Obamacare, the law specified that individuals with employer-sponsored insurance cannot not be denied new coverage, be subjected to pre-existing-condition exclusions, or be charged higher premiums because of their health status, when switching to different coverage. Thus, group market, pre-existing-condition exclusions only apply to those without prior coverage, or to those who wait until they need medical care to enroll in their employer’s plan.
These existing rules represent a fair approach: Individuals who do the right thing (getting and keeping coverage) are rewarded; individuals who do the wrong thing (waiting until they are sick to buy coverage) are penalized.
The problem is that the same kind of rules did not apply to the “individual” (non-group) market—about 9.4 percent of the total market for private health insurance. Thus, an individual can have purchased non-group health insurance for many years, and still be denied coverage or face pre-existing condition exclusions when he or she needs or wants to pick a different plan.
The obvious, modest and sensible reform is to simply apply to the individual health insurance market a set of rules similar to the ones that already govern the employer group market.
How to apply for insurance
Hello,
First off, thank you very much for the Health Care Reform information. I have a quick question about something described in this article. I have been a type 1 diabetic for over 45 years, but have been without health insurance for the past 3 years. How do I apply for the high-risk pool coverage?
Thank you kindly,
Wayne Duffey
Insurance
I fell and broke my ankle in three places last month and I have been forced to see if the state of Washington will pick up my medical.
I had Premeria blue Cross at work and I was asked for two months I can pay 121.00 dollars to keep my insurance active for two months.
I am no longer working and I am not receiving a pay check and I do not have the money to pay the money for the insurance.
I have put in for Social Security Disability and state disability. in the mean time I have no prescription coverage or hospital coverage.
I did manage to put down money for Direct Care from the medical clinic I receive my care from. It only covers the medical clinic and my labs if needed.
I am a Type 2 diabetic. I do take onglyza and only have to pay a 10.00 dollar co-pay for the med.
atbowen@centurylink.net
Health Care Reform
I am one of the many advocats for Health Care Reform. It is such a wonderful feeling to learn that we have made positive changes in Health Care such as this latest one, in a move forward for helping those with diabetes in medical and insurance reform/repair.
Health Ins
I want to know this! If a child became a diabetic at the age of 8 and the parents split up and the mother doesn't know the child's fathers insurance. Can she get on medicaid or something to help her with the medical bills? He kicked the child out at the age of 17. I need some information on this if I could. The FDS wont even give her a medicaid card, because what she makes from SS from her dad and my job of part time would put me in the high bracket for her to get on this. He is on SS and a VA, plus he works at Wal-Mart. I have to come up with all the deductables which is over $2,000 every time she goes into the hospital. They told me when she was 8, she is what they call Fragile Juvinille Diabetic.
Please help me.
Thank you
Corinna Lundblade
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