Private coverage can harm people with diabetes and other chronic disease
American Diabetes Association
February 8, 2005
Gaps found in all components of private health insurance coverage for people with diabetes
The American Diabetes Association in conjunction with the Georgetown University Health Policy Institute today announced the results of a 14-month study examining barriers to accessible, affordable and adequate health insurance for Americans with diabetes.
Common problems highlighted by the report document serious flaws in the private and publicly financed health insurance system in America. These flaws include health insurance policies that did not cover basic diabetes needs; high risk pools with pre-existing condition exclusions that deterred people from enrolling; health insurance premium surcharges for diabetes that drove premiums above what individuals and small businesses could afford; medical underwriting practices that designated diabetes as “uninsurable;” Medicaid eligibility limits that left many low income people unable to access this safety net; cumbersome insurance processes that fail to help people navigate complex rules and deadlines; and application procedures that drove many to give up on seeking coverage altogether.
“This study observed many instances in which having diabetes can make it harder to get and keep health insurance — a profound irony given the purpose of health insurance is to protect people when they are sick,” said Karen Pollitz, MPP, Project Director, Georgetown University Health Policy Institute. “People in transition following a job loss or change in family status often could not obtain new health coverage. Safety net options created to help in these circumstances often didn’t work because the help they offer is incomplete. People with stable coverage also had problems when they were underinsured, lacking coverage for blood glucose test strips and prescriptions or burdened by high deductibles. The people we talked to needed coverage that was available, affordable and adequate. Two out of three just didn’t work…”
R. Stewart Perry, Chair, Advocacy Committee of the American Diabetes Association added, “…most of the policy solutions currently being considered by our state and federal policymakers do little to fix the problems identified by the report.” “…it is time for policymakers to seriously rethink the flawed health insurance solutions up for debate that harm as opposed to benefit people…”
Press release:
http://www.diabetes.org/for-media/2005-press-releases/insurance-coverage.jsp
Executive Summary of the report:
http://www.healthinsuranceinfo.net/diabetes_and_health_ins_Exec_Summ.pdf
The full report:
http://web.diabetes.org/Advocacy/healthresearchreport.pdf
And some numbers from the study:
Problems studied were resolved when people could find health coverage that was simultaneously available, affordable and adequate. For most, however, health insurance and other safety net protections - such as COBRA and high-risk pools - often met only one or two of these three requirements, and so did not help. In particular:
- Individual health insurance - 395 people needed coverage in this market but only 15 could buy policies
- COBRA - 377 people lost or were losing job based coverage but only 31 took
COBRA - HIPAA - 87 people were HIPAA eligible but only 11 bought HIPAA coverage
- High-risk pools - 344 people needed coverage and lived in high-risk pool states but only 7 enrolled
http://www.healthinsuranceinfo.net/newsyoucanuse/08.html
Comment: More recent policy developments have placed a much greater emphasis on the importance of adequate coverage for ever expanding problems
of chronic disease. In the report above, if you merely replace the term “diabetes” with “chronic disease” you would have an inkling of the enormity of the problem that we are facing.
Current policy trends are to make health premiums more affordable and to reduce the responsibility of employers and the government for financing health care. The tragedy of these approaches is that they will only compound the problems of availability, affordability and adequacy of access and coverage presented in this report.
When our policymakers tell us that we can cover these problems with tax credits for individual plans, COBRA coverage, HIPAA coverage, high risk pools, Medicaid or any other “incremental” program, then stick this report in their face. With these programs, affordable access to comprehensive care is WORSE, not better! If we don’t take action now, the next incremental program will be “Friendly Universal Consumer Kare” (forgive the acronym).
Well we’ve been (same acronym)’d over enough! Let’s throw out our policymakers and bring in some people who care and will do the job right!
Don McCanne
(Disclaimer: The acronym was used without the knowledge or consent of the
PNHP leadership but is simply an expression of my profound, personal outrage
at our failure to introduce health care justice to the United States. Please feel free to share my vituperation with others.)