This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health.
The Affordable Care Act (ACA) will bring down the cost of health care by improving peoples’ health. A prime example is the ACA’s comprehensive approach to diabetes.
According to the National Diabetes Information Clearinghouse, diabetes affects around 25.8 million people today, which is 8.3 percent of our population. If left untreated, diabetes can spiral into a long list of serious complications. It is the leading cause of kidney failure, responsible for most new cases of blindness for people under 75 years old, and the number one reason for non-accident-related foot and leg amputations for adults. In 2007, diabetes claimed enough lives to rank as the seventh leading cause of death in America.
Diabetes is an expensive disease to treat. Diabetics spend, on average, 2.3 times more than their healthy counterparts do on medical care each year. The United States spends $116 billion every year in direct medical care to treat diabetes and loses $58 billion in lost productivity, disability, and premature mortality due to the chronic illness, a whopping total of $174 billion annually. If trends continue, the United States could see the incidence of diabetes go from 1 in 10 adults today to 1 in 3 adults by year 2050. And the cost for treating diabetes is predicted to increase by 100 percent as soon as 2025, reaching $514 billion. But it doesn’t have to come to that. Type 2 diabetes is the most common form of the disease and is known to be triggered by obesity and lifestyle, rendering it largely preventable through healthy diet and regular exercise.
The cost of care over a lifetime for a diabetic and the risk of developing expensive complications help to explain why insurance companies have found diabetics unfavorable to insure. Yet quality health insurance is what permits sustained relationships with primary care doctors, which facilitates prevention and health maintenance.
The ACA helps people with diabetes get the care they need at a price they can afford. For example:
- No more denial of coverage due to a preexisting condition. Prior to health reform, insurance companies could outright deny diabetics coverage simply because they were diabetic, or offer insurance but refuse to cover basic diabetes-related care. The ACA bans this discriminatory practice. The rule went into effect for children in the fall of 2010, and will go into effect for adults in 2014. To bridge the gap between now and 2014, uninsured adults with diabetes can enroll in a high-risk pool set up in each state. Illinois’s high risk pool, called IPXP, can be found online. For additional resources available to uninsured diabetics in Illinois, see the American Diabetes Association webpage.
- No more lifetime or annual limits on coverage, and no more rescissions. Insurance companies used to have free rein to place annual and lifetime limits on coverage, leaving people with chronic illnesses like diabetes afraid for the day their coverage would run out, and leaving many without access to affordable care. Insurance companies were also allowed to drop people from coverage when they came down with an illness, abandoning those who needed care the most. The ACA bans these practices.
- Medicaid expansion. In 2014, Medicaid will expand to include almost all persons at or below 133 percent of the federal poverty level. This historic expansion will bring health coverage and access to quality medical care to 16 million low-income individuals nationwide and around 700,000 here in Illinois. Given the higher risk that low-income families have for developing Type 2 diabetes, the Medicaid expansion is an important step forward to preventing and managing the chronic illness and will address both health disparities and the overall cost of the health care system.
- Tax credits and cost-sharing subsidies for low-middle income families.In 2014, individuals and families with income between 100 and 400 percent of the federal poverty level will be eligible to receive sliding scale tax credits and subsidies for cost-sharing to make coverage more affordable. This expansion of access to good insurance will improve prevention and maintenance.
Here are a few other ways the ACA is working to prevent diabetes and the serious and costly complications that go with it:
- No more co-payments for preventive health services for anybody with a “non-grandfathered” health insurance plan.The ACA establishes a set of preventive health services that must be offered free of co-payment for any person with a new plan or one that has changed significantly since the law was passed on March 23, 2010. The list includes blood pressure screening, Type 2 diabetes screening for adults with high blood pressure, obesity screening and counseling, and diet counseling for adults at higher risk of chronic disease, among others.
- The Centers for Disease Control created the National Diabetes Prevention Program. The ACA directed the Centers for Disease and Control and Prevention to implement a National Diabetes Prevention Program aimed at bringing evidence-based lifestyle-changing programs to communities across the country in an effort to prevent Type 2 diabetes. The prevention programs are centered around the goal of helping people to make modest lifestyle changes like improving their nutrition and getting at least 150 minutes of exercise in each week. The lifestyle-changing program actually reduced the risk of developing Type 2 diabetes by 58 percent over a three-year period in people who were at a heightened risk of the disease in the study. Once implemented across the country, this program could save $29.8 billion in medical costs and avert 885,000 cases of Type 2 diabetes over the course of 25 years.
The ACA’s strategies for handling diabetes are a strong example of the cost-saving, health-improving measures available under the act across the spectrum of health conditions.
For more diabetes-related information and resources, see the American Diabetes Association online. And go online to learn about how the Affordable Care Act is working to prevent the many other costly chronic health conditions prevalent in the United States.
Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!
This blog post was coauthored by Rachel Gielau.