How The Proposed Healthcare Legislation May Impact People With Diabetes

Our quality of life depends on several factors, one being the caliber our of healthcare.

With this in mind, the American Diabetes Association (ADA) recently sent a letter to Congressional leaders expressing concern about the proposed legislation to repeal and replace the Affordable Care Act (ACA).

While it’s understood that everyone has their own opinion regarding this matter, those whose lives are, or may be affected by diabetes might be interested in what aspects of the proposed bill has people at the ADA worried.

Four Areas of Concern

According to William T. Cefalu, M.D., the ADA’s Chief Scientific, Medical & Mission Officer, the ADA has “serious reservations” about four areas of the proposed healthcare legislation:

• 1. Tax Credits. The ADA finds the tax credits in the proposed American Health Care Act to be “significantly weaker” than the current ACA plan, especially for low and middle income people. Though the new bill might reduce premiums for individuals now in good health, the costs for people with diabetes will likely go up, and coverage will be less.
• Instead of the ACA’s premium subsidies, the proposed legislation offers age-based tax credits that range from about $2,000 to $4,000 annually.
• 2. Proposed Changes To Medicaid. The ADA strongly believes the proposed changes to Medicaid, such as the repeal of Medicaid expansion, will negatively impact low-income individuals and families managing diabetes, and will limit the early screening, diagnosis, and treatment of diabetes.
• The ADA also expresses “deep concerns” about the legislation’s per capita caps protocol for financing Medicaid. Per capita caps would allocate future Medicaid funds based on current state spending per enrollee.
• 3. Continuous Coverage Premium Penalty. The ADA states the proposed continuous coverage premium penalty is of “particular concern,” since many people experience a lapse in insurance coverage when they cannot afford premiums—not because they opt to be uninsured.
• The proposed continuous coverage premium penalty requires people purchasing health insurance to pay a 30 percent penalty if they were uninsured during the previous year.
• 4. Limiting Essential Benefits. The ADA is pleased that the new legislation retains the ACA’s Essential Health Benefits for small group and individual insurance plans. However, the bill disappointingly removes the Essential Health Benefits from Medicaid coverage.
• Essential Health Benefits are ten areas of service insurers must cover, such as physician services, in and outpatient hospital care, pregnancy and childbirth, mental health services, and prescription drug coverage.

The ADA is not alone with its concerns. Other medical provider groups are expressing doubts about the coverage and financial structure of the proposed legislation, including the American Nurses Association, the American Medical Association, the American Hospital Association, and the American Academy of Family Physicians.

Diabetes and its complications can be managed, and type 2 diabetes can often be prevented—if there is access to and availability of adequate and affordable health insurance. In the recent past, we have made great strides in improving the lives of those individuals with diabetes through innovative research, effective therapeutic interventions and improved access to care. If the ACA is repealed and not replaced by legislation that includes the aforementioned principles [adequate, affordable healthcare for everyone, including prevention], there will be serious health implications for our most vulnerable population.

~ William T. Cefalu, M.D., Chief Scientific, Medical & Mission Officer, ADA

Sources: American Diabetes Association; Urban; Forbes/Continuous Care; Healthcare.gov; Medicare Advocacy; Forbes/Nurses