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Health Care Reform: How Does it Affect People with Diabetes?

I can haz a question?The health care reform bill "doesn't fix everything that's wrong with our health care system, but it moves us decisively forward," said the President yesterday.  Insurance companies will be under government regulations, coverage can't be denied based on pre-existing conditions, and the bill should be signed as early as this Tuesday.

Wait ... coverage can't be denied based on pre-existing conditions?  

According to this New York Times editorial, "The biggest difference for Americans who have employer-based insurance is the security of knowing that, starting in 2014, if they lose their job and have to buy their own policy, they cannot be denied coverage or charged high rates because of pre-existing conditions. Before then, the chronically ill could gain temporary coverage from enhanced high-risk pools and chronically ill children are guaranteed coverage."  

I've always wanted to take that leap and run my own business.  I enjoy working in new media and health care, I like working hard, but what kept me from making a bold move was pure and unadulterated fear.  It was the same fear that caused me to immediately grab my diploma after college and start working at a crappy job two days after graduation, simply so I wouldn't lose my medical insurance coverage.  (I was a bank teller.  I have no math skill to speak of.  Tell me how that career choice was safe for anyone.)  As a type 1 diabetic, medical coverage takes precedence over a paycheck, seeing as how I have never had the option of purchasing a private policy.   (Something about that whole "taking insulin" thing makes insurers squeamish.  What, like taking injections ever kept me from becoming a productive member of the work force?  Yet I'm allowed to pay my taxes.) 

Sometimes, it takes a bold move to force a bolder one.  I left my job last October in pursuit of one thing:  a healthy pregnancy.  The fear that once held me back was replaced by the overwhelming desire for a healthy pregnancy, and Chris and I moved forward without hesitation.  But, of course, we had to make sure there wasn't a lapse in my insurance coverage, and with pregnancy being considered another pre-existing condition, I remained insured by COBRA.  Thankfully, once BSparl is born, we have another plan in place.  But the details of my insurance coverage aren't the focus here.  Nor will they be.

The point is now there are options for people with diabetes.  Or at least that's what I'm hoping.  I've been pouring through the newswires and seeing, over and over again, how pre-existing conditions can't be denied.  Reuters reports that  "Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014."  This is in addition to insurers being "barred from excluding children for coverage because of pre-existing conditions."  And I remember when I was a kid and my parents dealt with that very issue after my diabetes diagnosis.) 

Newsweek sheds a little more light on this, stating, "Insurers who offer plans on an insurance exchange will be prohibited from rejecting customers with preexisting conditions or charging them higher rates. But the exchanges won't be mandatory until 2014. In the meantime, people with preexisting conditions will be permitted to enter a 'high-risk pool,' which offers caps on premiums and out-of-pocket spending. Still, there's a catch: only people who have been without coverage for six months are eligible. The rule is designed to stop people from arbitrarily switching from their private insurance plans to the cheaper—but taxpayer subsidized—pools. But it means that people who lose their jobs can remain uninsured for a full six months." 

I don't know enough about the health care reform bill to speak eloquently about the details.  I am only exposed to what the media shows me, and what my research procures, and what pages of the bill I'm actually able to pour through and understand.  And I know that talking politics on the blog (just like talking religion) can be a very tough topic, because PWD have so many varying opinions and stances on these issues.  But I'm a person with diabetes.  And I'm hopeful.  I'm hopeful that this could be the beginning of diabetes not dictating my insurability.  I'm hopeful that people with diabetes will have the option to work in fields that inspire them, not just ones that insure them.  Diabetes has a hold on so much of what we do throughout the day and so many of our choices, and I'm hopeful that the passage of this bill will give back some options.

(Just a quick note:  I posted something on Facebook and the comments are impassioned, but respectful.  So far.  :)  If you are going to leave a comment on this post, you definitely don't have to agree with me or anyone else, just please be respectful.  Or I'll send Siah after you.)  

Comments

Since my daughter's diagnosis a bit over two years ago, insurance coverage has been my constant, recurring nightmare -- even moreso than the lurking spectres of related medical issues, because without insurance, those future medical issues would be EVEN WORSE.

I have some issues with this health care reform bill, but it's a step in the right direction. And the impact on my daughter and others with pre-existing conditions fills me with nothing but relief.

my husband's job is literally killing him, but because he's the one with good health insurance, he can't look for another. the thought of losing insurance for our CWD scares the ever-living shit out of us. this will at least provide a safety net.

Wow. You hit the nail on the head. My hope for Sam (now in college) - and for all PWD - is that they can work in jobs that inspire them... not that simply insure them. I, for one, am glad that you are a blogger... and not a bank teller. :)

Kerri, I think this is a wonderful post. As a person with type 1, these same thoughts about how much of our health is tied to the whims of insurance companies and employers have also had me feeling nervous, anxious, scared, and frustrated. The new law isn't perfect, but it's still a mighty good thing.

I feel cautious hope that things will truly change. The President seems to really 'get it' about the whole preexisting condition thing. And I'm grateful that younger kids may get the chance to really follow their passions without the constant fear of losing coverage.

Like you, I've rarely had the chance to do what I really liked at work--I always had to take the job that provided benefits. Is it fair to ask anyone to defer their dreams or sell their abilities short, just because they're terrified of ending up without health insurance? I have no idea what my true potential is, or ever was, because like it or not I've always had to serve my diabetes first.

This doesn't affect just me, either. My husband badly wants to quit his job and start his own business, but I am terrified we'll end up without his health insurance plan to fall back on, should I get laid off from my current job. Is it fair to ask him to defer his dreams and cut short his own ambition and ability, just to provide me with security? Somehow that just doesn't seem fair--or American. I thought we were all supposed to have an even chance to make it here.

I'm in the same boat. Husband carries insurance for me (self employed with Type 1 diabetes, perfectly controlled but they don't care about that) and we are going through a divorce. Very sketchy for me regarding insurance coverage opportunities. It's illegal in all other 1st world countries to deny coverage due to pre-existing conditions. Illegal.

I don't know what to think about this bill. Truthfully, I am a little worried about all of the new costs the insurance companies are going to have to cover. I know raising premiums is going to become more difficult, but the money has to come from somewhere.... does this mean that durable medical equipment coverage will suddenly be cut to practically nothing?? How is it sustainable for an insurance company to provide the amount of coverage that is required but at the same time pay around $20,000/year for my diabetes treatment when they are bringing in only $6,000 in my/employers' premiums. I see a massive crisis occurring in about 10 years due to all their news costs/taxes. I am more nervous now than I was last year.

Good thoughtful post Kerri. I want my 7 year old daughter with Type 1 to be a productive, tax-paying, insurance-getting young woman when she grows up. I want her to be able to get her own health insurance, at a price that is comparable to the market. I want her to have her health.

I think the fear that people have and are displaying, is about 10 years too late. Where were all these people when the ERs of this nation were filled with un-insured people? Where were they when people were being denied coverage because of their Type 1? That to me is fearful. There had to be something done. I am glad that something is done now. Maybe it's not the best, but you know the whole journey of a thousand miles thing, well, that applies here. Someone has taken the first step.

While I'm may not be in favor of all that's in the bill, the idea of covering pre-existing conditions is an absolute blessing to us diabetics. Diabetes is treatable and today's technology is truely wonderful. My hope is that everyone who can use one can have a pump and CGMS. It's made my living with this disease so much easier.

To me, this is one of the most important aspects of the legislation.

I'm happy and hopeful.

I believe that there are a few things in the bill that are good for diabetics and other people with chronic diseases, but there are many other things in the bill that will hurt everybody in the wallet.

So much of this has been drowning in politics and fear about uncertainty. But like you, Kerri, I have hope for the same reasons you do. While I do have many concerns about overall impact on businesses and taxes in general, to me it comes down to motivating the current insurance industry to do something and change - to make it more about healthy lives than about the cost and bottom line. Yes, we can. And here's hoping for that effective change.

Thanks for this post Kerri. I'm not too great about following politics and this put it in a way that I can understand.

How awesome would that be, to not have to fret about insurance or being denied coverage?? I tried to switch to another insurance carrier last year through my work (it was 100 dollars cheaper a paycheck than the one I have now)and was denied because of Diabetes.

I am now staying at my job which is becoming more and more frustrating, because I can't loose my insurance.

I also have a lot of hope for this, but then again I don't know all the details.

Thanks again for the post!!

I know how you feel. Half of the reason I went to grad school was because I knew it would be another 5 years where I was assured insurance. When I've considered quitting grad school, the prospect of losing my insurance keeps me here in lab.

This bill finally makes me feel like I can have the freedom to really decide what I want to do with my life based on my abilities and desires and not on my diabetes. (Ignoring the fact that I'll be done with school before 2014.) I'm just glad that we are finally on par with the rest of the world as far as providing EVERYONE with an EQUAL chance at affordable healthcare.

Late to the party, but thanks for the post, Kerri. I try to stay away from politics, bills, legislation, etc., mostly because I truly hate politics & politicians the way they are today (totally on a personal level.) BUT, I am thrilled at the thought that the future is brighter for us in terms of not being denied coverage. But, there's a lot in the bill that scares me...but I'm not educated on it enough to make a fool of myself on a public blog, so that's where my comment will end! :)

Kerri, I have been following your blog for quite some time and I have also been active on the JDRF social networking site Juvenation. One thing that has completely overwhelmed me by your posts and Juvenation member discussions is insurance and health care costs.

Living in Ontario, Canada, the cost of my diabetes care is almost entirely covered by OHIP (Ontario Health Insurance Program) and a federal iniative called the Assisted Devices Program (ADP). I am also lucky to be covered by a pretty good benefits program. Here's my reality:

1. The ADP program purchased my Animas Ping directly from Animas. I applied, got my pump, my diabetes education centre (covered by OHIP) coordinated the paperwork and the federal government paid for my Ping. Additionally, the ADP program provides me with $2400 a year for pump supplied (this doesn't quite cover everything, but about 80% of it)

2. OHIP pays for almost all my insulin, lancet and other prescription costs.

3. My husband's benefits pay for 85% of my glucose strips (surprisingly these are not covered under OHIP.)

I have never had to argue with anyone about getting care or getting my expenses paid. I don't even have to pay out of pocket to be later reimbursed.

I can only imagine the added stress of arguing with insurers, figuring out how to pay for supplies or being denied top-quality treatment.

While I don't know enough about the health care reforms in the USA, I can tell you that I feel incredibly lucky to live somewhere that provides high-quality universal health care.

At the very least, I am glad to see legislation that will prevent companies from discriminating against people with pre-existing conditions. We cannot help the genes we are born with and to deny people insurance simply because they were born with a faulty gene is just horrible. For me, exclusions based on pre-existing conditions has meant that I often don't fully disclose all medical information to a physician, for fear of it coming back to bite me in the event I need future insurance through a private policy. Withholding this information cannot lead to good medical care!

In MA, you can't be denied health care due to pre-existing conditions. (Just an FYI)

The changes to prevent barriers for those with a preexisting condition represent elimination of a real form of discrimination that has existed far too long. What is mind boggling is that those who argued against the bill in the name of freedom could not understand that the discrimination against those with a condition was a denial of their freedoms.

While much of the rest of bill may have more balanced pros and cons, this change is a real achievement for the roughly 20% of Americans with chronic conditions.

Thank you Kerri for giving me one positive thing that I can expect from this health care bill. For me, the speed at which I can get tests is an issue. If I had to wait 3 months for a mammogram or a CT scan like survivors in other countries have to do, I would have died of breast cancer 6 years ago. But now at least I don't have to feel tied to my job because of breast cancer or diabetes. One good thing is better than none.

Hi, I came over here from Shakesville. I love the succinct way you've put exactly what this new bill means to you. I personally am very glad about the new pre-existing conditions rules because my son has a chronic condition. Also, we'll now be able to keep him on our insurance until he's 26, even if he isn't able to go to school full time. (I hope he can, but we'll see.)

Also, I wanted to wish you much luck and happiness with your little one you're expecting. It means a lot to me to hear happy stories of women having successful pregnancies even with diabetes. My mom is diabetic, and it's heartening to me to see how far we've come since the late 1960's and 70's.

Wishing you all the best.

Having watched this historic legislation unfold with great interest from the other side of the world, I am delighted for you. Really. As a New Zealander I take being insured and having a comprehensive free healthcare system for granted.

The stories that I've read in the lead up to yesterday's vote at times made me cry. For everyone out there who's going to benefit from this because they were the 'unfortunates' who probably inherited the less than perfect gene and then caught the virus that triggered it... bless the changes due in 2014. I can only begin to imagine what a relief it must feel like.

I love your comment about "fields that inspire." Brilliant. I share your hope, fears, and frustrations, having been denied coverage myself, having had to make difficult life choices on the basis of my insurability (like marry before my wedding!).

This president is scary

As a Diabetic AND Cancer survivor I was left with $80K in bills after my insurance cap about 4 years ago. I will be paying that off for the rest of my life - it keeps me from buying a house among other things. Not to mention that I am not eligible for long term disability because of my diabetes and the fact that I had cancer. So yes, I am all for "reform".

Even though I wasn't sick, it was no ifs, ands, or buts, I had to take on COBRA the minute I graduated from college. As I mentioned somewhere else, my dad was the COBRA point person at his workplace at the time, so if I hadn't subscribed or hadn't paid on time without a job with insurance, he would have known. He had recently gone through losing nearly everything and the last thing he wanted was something apparently minor (say, an appendectomy) to put me in further debt than my student loans.

More people need to encourage their children this way - I think increasing the age to 26 will help. And I can't help but think about some kid with T1 who might be more likely to go to medical school with this sort of insurance and do research and find a cure.

Well, Steve, being a type 1 without health insurance is pretty scary. Do you know how that feels? To worry that you will quite literally die without your job? That if you don't get married, you won't have health coverage. That if you get laid off, and you can't afford COBRA, you're either back to the insulin from the stone ages -- and they don't even make long-actings like Ultralente or Lente anymore -- or you're dead?

Which is scarier to you? Frankly, death is always scarier to me.

Wow, wow wow. This is great, I too fear for my daughter and myself (I too have a chronic illness). I was introduced to your blog recently and LOVE IT!!!

Awesome coverage of great topics. I am dealing with a teenager with diabetes and it is no picnic. Sites like these give me comfort.

Whats bad as well that this forces you to be insured and if you ar not, then you are fined and who comes after you for the fines, the IRS.

Plus there are plans in the bills that are also take away your control to do what you need to do, if you dont play by there rules, say your a Type 2 and they figure diet is the only coverage you need, they wont pay for any drugs because that is how government entitiys work. If you have Medicare now, it wont be the same medicare when they get done withit.

It also means this. It is a good thing you had your baby now, because as the government see's it, if a woman is Diabetic, or has a disease that will be effected as a cost for them while the woman is pregnaut, then they wont let you and they can then enforce the abortion law they have and that will end the reproductive rights of people with illness.
It may sound hard to belive, but you watch. Plus it is in the bill.

The way they went about this bill was very horible, we needed health care insurance reform, just not THIS one.

I wish you well

Robert

Robert, that doesn't make any sense. This bill has a strong anti-abortion clause. Are you seriously saying that the government will invoke its "ability" to force you to have an abortion when the public money is not funding it?

Please tell me what pages and lines those statements are on in the bill so that I can read it for myself.

I understand that the bill is great for people who have pre-existing condition.. Here is my question?? I have never seen anywhere the prices for insurance. Anyone that has a critical health issues are RATED UP.. It is going to allow you to have insurance IF YOU CAN AFFORD IT!

I understand that the bill is great for people who have pre-existing condition.. Here is my question?? I have never seen anywhere the prices for insurance. Anyone that has a critical health issues are RATED UP.. It is going to allow you to have insurance IF YOU CAN AFFORD IT!

As the mother of a type 1 diabetic, I have spent many sleepless nights worrying about insurance. In today's economy, there is no security in employment. We've bounced back from 2 layoffs in 3 years. It's been difficult, but the most stressful part is worrying about that Cobra clock that keeps ticking away.
I know the current Health Care Reform is far from perfect, but we need change. It is a flawed and broken system. Before the recession, people paid cobra for a couple months and then got another corporate job with health benefits...after the recession...not so simple.
I too look forward to a world where my daughter is not chained to a particular job/insurance plan so she can afford the insulin and supplies her body requires to stay alive.
Thanks for writing a great blog.

Lots of great points in this post -- Only problem for us is the way the reform is affecting our current insurance! They decided to drop my insulin from their formulary drug list, and then we just got a letter that told us they were going out of the small group business in our state. So, once 2014 comes around, I will have a much better chance of singing the praises of this reform. As of right now, though, the required 6 months uninsured to get into the high-risk pool is seeming a little too close for comfort.

Thank you so much for this excellent post! I wanted to let you know MomsRising.org linked back to it in our healthcare blog carnival, http://www.momsrising.org/blog/welcome-bloggers-join-our-healthcare-blog-carnival-in-full-swing/

All the best,
Anita

i've seen nowhere what the cost of medical coverage is and who pays for it. Your company? Yeah, it pays maybe $1500 a month to your $500 a month. So who loses there? That company money is paid for in higher prices right? We don't intend to pay $2000 a month for health coverage right? So who pays? I think everyone would be happy to have 'no cost health care coverage'. But somebody has to pay for it, so who is it gonna be? The healthy paying for the sick? I just paid $1000 for a 45 minute root canal...is that fair?? Dental isn't covered under this plan either.
Hey, what is it we really want? Let's hear from you guys. Personally? I'm happy the Health Care Act passed and I hope to see positive things from it. Just so you know where I stand.

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