Moving Mountains: How AHCA will affect local diabetes patients
July 13, 2017
Diabetes is a chronic disease for which there is no cure, and is considered a pre-existing condition. In Grand County, approximately 624 individuals have diabetes, according to the Colorado Health Department, or approximately one of 10 people in our county. Insulin is commonly used to treat diabetes and the consequences of untreated or inadequately treated diabetes are severe. Diabetes is a leading cause of blindness, kidney failure, amputation, and heart attacks. Medical costs exceed twice those of people without diabetes. The latest data show the total cost of care per diabetes patient was over $12,000 a year. It is the eighth leading cause of death in Colorado.
The out-of-pocket expenses for people with diabetes have soared in recent years to the point that people are not able to afford the needed insulin dose, or the blood sugar strips they use to decide the proper dose. The three pharmaceutical companies that produce insulin have jointly tripled the cost of insulin over the past 11 years. Doctors spend more time trying to help their patients determine how to afford their treatment than on educating them about the disease. The American Health Care Act will hurt people with diabetes in Grand County by ignoring the pharmaceutical companies' hold on our drug pricing, which is currently eight times that of other countries. In Canada, the price of a vial of insulin is $35 to $40 while in Grand County it is $280 to $330 a vial (costs per Safeway, City Market and Kremmling Mercentile). A person with Type 1 diabetes uses two to three vials a month, while a person with Type 2 diabetes who is resistant to insulin requires six or more vials a month. Blood sugar monitoring strips run another $100 a month. An out-of-pocket expense for managing diabetes with private insurance (80/20) coverage can run as high as $8,400 per year, even without doctor visit co-pays, and premiums.
Going back to letting insurance companies exclude those with pre-existing conditions or charging them more will be devastating for people with diabetes. High-risk pools for those with pre-existing conditions have been tried in Colorado and resulted in premiums 150 percent higher than the market rate and deductibles as high as $10,000. Even then, coverage was limited. The Senate version of the ACHA gives money in block grants to states, that may individually decide whether to insure those with pre-existing conditions, and also to decrease essential benefits, likely eliminating prescription drug coverage, making insulin an out-of-pocket expense.
Under the American Health Care Act, the Congressional Budget Office predicted that people with diabetes may decide that insurance coverage is not worth the expense of premiums, co-pays, and deductibles. This failure of affordability returns us to "care by emergency room", a very expensive way to treat diabetes and a cost we all shoulder. Also, older, lower income people will receive less financial assistance under the AHCA than they received under the Affordable Care Act.
Unfortunately, the $800 billion cut in Medicaid coverage and severely decreased spending proposed in the ACHA law will be stunningly severe. According to the CBO, by 2018 there will be 15 million more uninsured than currently under the Affordable Care Act. Children in Grand County with diabetes may depend on Medicaid for their healthcare. It is more humane and better economics to give people with diabetes the care and affordable insulin that they need to treat their diabetes. We all pay for people with diabetes who are not given access to good healthcare.
Deb Thomas-Dobersen is with Moving Mountains, a non-partisan, Grand County group of citizens dealing with issues that affect all of us.