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Diabetes And The Affordable Care Act

Trump's Plan To Replace Obamacare But Still Keep Those With Pre-existing Conditions Including Diabetes Covered - The Diabetic Journey

Trump's Plan To Replace Obamacare But Still Keep Those With Pre-existing Conditions Including Diabetes Covered - The Diabetic Journey

Trumps Plan To Replace Obamacare But Still Keep Those With Pre-existing Conditions Including Diabetes Covered Following the election on November 8, many in the diabetes community are concerned and questioning their future healthcare coverage as President Elect Trump will enter the White House. The Affordable Care ActObamacare is presumed to be repealed and replaced as part of his 100 day plan. The Affordable Care Act was implemented for many with pre-existing conditions as it provides insurance to over 20 million people; includthose with Type 1 Diabetes. It was intentioned to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare. But as of late there has been an outcry over insurance premium costs rising. Costs have been steadily increasing over the past few years and will be expected to be even higher in 2017. Many health insurance plans such as UnitedHealth opted out of Obamacare due to hundered of millions of dollars in losses. Leaving those insured by Obamacare left with not as many options. With the higher premiums and deductibles, many patients arent able to afford or recieve many benefits. Copayments are high and drug formularies are restrictive. Patients are often restricted to lower quality blood glucose meters and still have to come out of pocket up to (50% or more) after the deducticle for durable medical equipment (DME) to manage Type 1 Diabetes; including insulin pumps, CGMs, and other diabetes medical equipement. What what to expect next? Thats the question we are all wondering. Will the diabetes community still be given access to healthcare despite pre-existing conditions? The process to repeal this federal statute will need a supermajority by the Senate composed o Continue reading >>

The Affordable Care Act And Diabetes: Is There An Impact?

The Affordable Care Act And Diabetes: Is There An Impact?

Home / Resources / Articles / The Affordable Care Act and Diabetes: Is There an Impact? The Affordable Care Act and Diabetes: Is There an Impact? Increased access to healthcare can be beneficial to Medicaid recipients in expansion states How helpful was this article? (Please vote.) Medicaid coverage was expanded in January 2014 in twenty-six states and the District of Columbia via the adjustment of the programs income requirement. Adults under the age of sixty-five whose income does not exceed 138% of the federal poverty level became eligible for Medicaid benefits. Because of Medicaid expansion, millions of uninsured adults gained access to healthcare. It was the perfect opportunity for researchers to investigate whether or not Medicaid expansion would have an impact on early detection and diagnosis of disease. Diabetes diagnosis is the focus of this study, largely because it is such a common disease. More than twenty-eight million Americans are diabetic. Individuals newly diagnosed with diabetes were identified based on the assignment of a diabetes diagnosis code (250.x) or hemoglobin A1C levels greater than 6.4%. Data were collected from the Quest Diagnostics Database during the first six months of 2014, around the same time that the expansion started. These data were then compared to diagnosis rates from the previous year (2013). Individuals were further differentiated based on their healthcare coverage: Medicaid versus non-Medicaid enrollees. During the first six months of both 2013 and 2014, 434,288 individuals were newly diagnosed with diabetes: 215,398 in 2013 and 218,890 in 2014. Overall, there was a 1.6% increase in the number of individuals who were newly diagnosed, regardless of state of residence or healthcare coverage. Medicaid enrolled individuals who wer Continue reading >>

Would Diabetes Be Covered If Obamacare Is Repealed?

Would Diabetes Be Covered If Obamacare Is Repealed?

Would Diabetes be Covered if Obamacare is Repealed? One of the top legislative priorities under a Trump administration will be changing or repealing the Affordable Care Act (ACA), also known as Obamacare. This law is consequential to the diabetes community because it includes, among other things, a provision outlawing insurance companies from denying coverage based on preexisting conditions like diabetes. Heres an overview of what people are saying about the fate of the ACA: President-Elect Donald Trump has called the ACA a disaster, and has vowed to repeal and replace it with a different plan. What that plan would entail is an open question. While Mr. Trump has said before that he would want the plan to cover preexisting conditions so there arent, in his words, people dying in the streets, his official position paper on health care does not mention preexisting conditions at all. Donald Trump will be working with a Congress controlled by Republicans, as the GOP has won the majority of both the House of Representatives and the Senate in the 2016 elections. Republicans have repeatedly tried to repeal the ACA since its passage in 2009, so they will try to do so again under a Trump administration. In a Politico report , Senate Majority leader Mitch McConnell (Kentucky) said this week that repealing Obamacare was pretty high on the agenda. However, scrapping Obamacare will probably not be a short process. Thats because Republicans did not gain a supermajority in the Senate which could prevent Democrats there from blocking efforts to alter Obamacare. Democrats could, in theory, filibuster to prevent action on most bills, and Republicans would need 60 votes to end a filibuster; if everyone voted along party lines, the filibuster would not be defeated. This means that, for the Continue reading >>

Life With Diabetes Is Sweeter Thanks To Obamacare

Life With Diabetes Is Sweeter Thanks To Obamacare

Home | Blog | 2016 | 01 | 20 | Life with diabetes is sweeter thanks to Obamacare Life with diabetes is sweeter thanks to Obamacare ACA delivers consistent access to quality care and that makes a world of difference in managing and preventing the chronic condition Writer, communications strategist specializing in healthcare, issue advocacy When Alexander Star was 15 years old, he thought he was the picture of health, especially after he made the varsity basketball team. But when he told one of his teachers he needed to go to the bathroom every 10 minutes, she rightly told him he should be checked for diabetes. Frequent urination is a classic warning sign. When the doctors tested Stars blood glucose level, it was 1,300 mg/dL dangerously high considering that even in people with diabetes the goal is to keep blood glucose levels between about 100 and 150 mg/dL. The doctors wondered why I wasnt in a coma, says Star, who is now a 29-year-old recording artist/songwriter living in Florida. That was the beginning of my journey as a type 1 diabetic. He started taking better care of his health, which includes eating right, as well as taking insulin and checking his blood glucose levels multiple times a day, a regimen that can get expensive. He was covered under his fathers insurance plan until he turned 26 when he suddenly found himself without health insurance he could afford. The COBRA plan I was on shot up from $120 a month to $512 a month for the exact same plan, a cost that was not do-able for me, Star says. Fortunately, the Obamacare marketplace opened up soon after and he enrolled in a new plan. If it wasnt for Obamacare, I dont know how Id be capable of taking care of myself, Star says. Even if I had a lot of money, before Obamacare they could still decline me because I h Continue reading >>

Diabetes And The Affordable Care Act

Diabetes And The Affordable Care Act

University of New Mexico School of Medicine, Albuquerque, New Mexico. Address correspondence to:, Mark R. Burge, MD, University of New Mexico School of Medicine, UNM SOM INT MED MSC10_5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, E-mail:Email: [email protected] This article has been cited by other articles in PMC. The Affordable Care ActObamacareis the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different metallic insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. The Affordable Care Act (ACA), otherwise known as Obamacare, was passed by Cong Continue reading >>

Obamacare And Diabetes — Year Two

Obamacare And Diabetes — Year Two

What does the Affordable Care Act (the ACA, also known as “Obamacare”) mean for people with diabetes? ACA makes some changes that should help people with diabetes, and some that maybe aren’t so good. I’m not talking about ACA’s long-term effects on the health-care system or the economy. We’re just talking about immediate impacts on people with diabetes. The most important positive is that plans will no longer be allowed to deny coverage because of diabetes. According to the American Association of Diabetes Educators (AADE), “Starting in 2014 job-based plans and new individual plans aren’t allowed to deny coverage, charge more, or refuse to cover treatments due to a pre-existing condition such as diabetes.” Many readers have probably been denied coverage in the past. Have you noticed a difference with ACA? Another good thing: ACA requires “free preventive care” from most plans. This includes diabetes screenings for adults with high blood pressure and for pregnant women. It also requires “medical nutrition therapy” for people with diabetes. But the rules vary by state. What has been your experience? AADE believes that diabetes self-management training (DSMT) will be more readily covered under ACA, but we don’t know the exact status of DSMT yet. How much training will be covered, and how much will insurers pay? In theory, all plans have to provide basic levels of coverage and quality to be sold in the government’s “insurance marketplaces.” Most experts think this is a good thing, but some people are miffed. The coverage they have had for a long time does not meet government standards and is no longer available or is at least are harder to get. A major negative for young healthy people (though not for people with diabetes) is that they are Continue reading >>

Study: Affordable Care Act Helped Cover People With Chronic Illness

Study: Affordable Care Act Helped Cover People With Chronic Illness

Study: Affordable Care Act Helped Cover People with Chronic Illness A recent study found that more people with chronic illnesses, such as diabetes, have had insurance coverage under the Affordable Care Act (aka Obamacare). As the study authors have written, half of all Americans have 1 or more chronic illnesses and many in this group happen to beracial and ethnic minorities who havent had insurance coverage and access to care before the Patient Protection and Affordable Care Act. Does the Affordable Care Act Help Those with Chronic Diseases? Researcherslookedat nationally representative and non institutionalized sample of US patients. This involvedself-reported insurance coverage of 606,277 adults between age 18 and 64 who were living with a chronic disease. Patients also self-reported having a checkup, a personal physician, and not having to forgo a needed physician visit because of cost. Once the ACA was enacted, insurance coverage had increased by 4.9 percentage points according to researchers. Not having to skip a doctor visit went up by 2.4 percentage points, having a checkup went up by 2.7 percentage points, and having personal physician didnt change. The study authors wrote that though racial and ethnic minorities had greater improvements regarding various outcomes, approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation. Also, while all outcomes varied a good bit depending on the state, more coverage was seen in states that expanded Medicaid. While this study took into accountonly the first year of the ACAs major coverage expansion provisions, it shows that the Affordable Care Act/Obamacare did increase coverage and healthcare access to those with a chronic disease. How Continue reading >>

What Obamacare Feels Like To A Diabetic

What Obamacare Feels Like To A Diabetic

Others have written much about what the Affordable Care Act (ACA), also known as Obamacare, means for diabetics. I will leave the analysis to the people who have done the research. I just want to tell you what Obamacare feels like to a diabetic. First, some background on my current healthcare status: I have been with the same HMO, Kaiser, since before I was diagnosed with diabetes at the age of nine. I have therefore felt married to Kaiser; in Kaisers eyes, I do not have a pre-existing condition, whereas switching health insurance companies might expose me to being labeled with the big scarlet D for diabetic. Kaiser is pretty good as a health provider so long as you can find good doctors, and I am lucky enough to have lived in big cities with big hospitals where I have lots of choice. I am also lucky enough to have wanted to stay in California all this time, and to have a husband who is very good at talking his way through pharmacies and bureaucracies when I am busy weeping with frustration that they wont give me the medication I have been prescribed. (Thats a story for another time, though.) All that said, Kaiser raises its rates by 10 15% every year, and I dont like the feeling that if I wanted to change, or needed to move to the East Coast, I would be in a very precarious position. So on October 1st, I went to my states ACA exchange, CoveredCA . I was mostly curious, and wanted to see what the plans and rates would be; even if I want to change my healthcare, I intend to give this whole Obamacarething a few months to make sure Congress doesnt knife it in the back right after I make a switch. But, noncommittal as I was, I was floored by what I saw. I filled out the simple questionnaire on the website to see my options. They asked me about my age, my income, my family Continue reading >>

4 Things To Know About Aca Repeal And Diabetes

4 Things To Know About Aca Repeal And Diabetes

4 Things to Know About ACA Repeal and Diabetes Posted on April 24, 2017 by American Diabetes Association Update (5/31/17): On May 4th, the House of Representatives narrowly passed the American Health Care Act (AHCA). The AHCA has now moved to the Senate where Senators are currently considering potential changes to the legislation. If you havent already, please sign up to become an advocate and contact your Senators to urge them to protect health care for people with or at risk for diabetesand all Americans. Over the past several months, all eyes have been on Congress and the White House, as debate has swirled around the repeal and replacement of the Patient Protection and Affordable Care Act (ACA). As advocates for the nearly 116 million Americans living with or at risk for diabetes, we at the American Diabetes Association are committed to protecting access to adequate and affordable health care for everyone no matter his or her health status, income, age or employment. As you may have seen in the news, members of Congress returned home for their annual spring recess without passing legislation in the House of Representatives to repeal and replace the ACA. However, Congress returns to Washington on April 25 and a new vote on ACA repeal could happen within their first week in session. If you or a loved one is affected by diabetes, heres what you should know: Since December 2016, we have continuously urged Congress to not repeal the ACA without replacing it simultaneously with an alternative plan that does not result in a loss of coverage or benefits for people with, or at risk for, diabetes. In March, lawmakers introduced the American Health Care Act (AHCA). We were deeply concerned by this legislation, which would repeal key provisions of the ACA and lead to massive lo Continue reading >>

The Aca Repeal & Medicaid: What Would It Look Like For Patients With Diabetes?

The Aca Repeal & Medicaid: What Would It Look Like For Patients With Diabetes?

President Obama’s signature legislation, the Affordable Care Act (ACA), has touched the lives of nearly every American. Over 20 million people are currently covered by a healthcare plan governed and facilitated by the Health Insurance Marketplaces (healthcare.gov), established by the ACA. While many discussions focus on the Marketplace and ACA in general, an important discussion needs to happen about Medicaid. Medicaid expansion has opened up the opportunity for many people who didn’t qualify for Medicaid traditionally thanks to its income-only requirement. For people in the 32 states who have adopted the expansion, if their income is at or below 138 percent of the Federal Poverty Level (FPL), they can qualify for Medicaid. For all of its controversy, the facts remain clear: the ACA has helped millions of people afford healthcare coverage, access contraceptives, receive mammograms and other important health screenings, and provide healthcare to their children up to the age of 26. For people with diabetes, we cannot be charged more for coverage than those without diabetes and we cannot be denied. However, if the current Republican leadership gets its way, that’s all about to change. President Trump, Vice President Pence, and a sizeable number of Republican lawmakers in Congress have already begun to pave the way for a swift repeal of the ACA. What’s even more concerning to a large number of Americans is that they have no solid plan prepared to replace the ACA in the event of its repeal. (While they have proposed plans and two are in the markup phase, many experts have come forward to state that these are not solid or sustainable.) The initial plan is to repeal large portions of the ACA, including the Medicaid expansion, but the long game is to repeal virtually ev Continue reading >>

How The Senate Obamacare Repeal Bill Would Impact People With Diabetes

How The Senate Obamacare Repeal Bill Would Impact People With Diabetes

Read more: What the MacArthur Amendment Means for People with Type 1 The MacArthur amendment was included in the House bill to win votes from the more conservative members of the Republican caucus in that chamber. According to media reports, Senate Majority Leader Mitch McConnell (R-KY) is trying to walk a delicate line in an attempt to appease both the conservative and moderate wings of the Senate Republican caucus. The ban on higher premiums for those with preexisting conditions appears to be a concession towards moderate Republican senators, while an end to essential health benefits protection appears to be a concession toward the conservative wing. Facing uniform opposition from Democrats in the Senate, Republicans must vote as a unified block in favor of the bill for it to pass, and Senator McConnell has only three votes to spare among his caucus. Read more: Your Preexisting Condition is Probably Your Fault: Congressman In a move that also will impact thousands with diabetes, both bills would dramatically reshape Medicaid. The Senate bill provides a longer timeline than the House bill for the wind-down of the Medicaid expansion that occurred under the Affordable Care Act, but they both change the funding for Medicaid provided to the states from open-ended to a fixed budget. The Affordable Care Act, which this legislation would repeal and replace, was the first national legislation which barred insurers from charging more for preexisting conditions; it also was the first national legislation to set the standard for essential health benefits. It is believed that Senator McConnell wishes to bring the repeal-and-replace legislation to a vote sometime early next week. Insulin Nation will continue to report on this story as developments arise. You can read the text of t Continue reading >>

Are You Freaking Out About The Affordable Care Act Being Repealed?

Are You Freaking Out About The Affordable Care Act Being Repealed?

Are You Freaking Out about the Affordable Care Act Being Repealed? Diabetes Daily Co-Founder David Edelman weighs in on what this may mean for the millions of people with diabetes who depend on ACA coverage David Edelman is co-founder and CEO of Diabetes Daily , a leading diabetes online community. His goal: I strive to help everyone touched by diabetes achieve a healthier, happier and more hope-filled life. DiabeticLifestyle's Editor Maureen Connolly chatted with Edelman about the impact repealing the Affordable Care Act could have on the millions of people with diabetes who are currently insured by the ACA. First, how would you define the Affordable Care Act?The ACA is built on a three-legged stool: 1. Provide coverage to everyone regardless of pre-existing conditions. 2. Because of #1, you need a mandate requiring insurance coverage, or healthy people would be incentivized to wait until they are sick in order to sign up. 3. Because you require coverage, you need subsidies. This is basically the only way to make it work in a market-based system. (Which is why the conservative think-tank the Heritage Foundation developed the idea as a conservative alternative to a single-payer system like the NHS in the United Kingdom.) Do you see any problems with how the ACA currently functions?Absolutely. There are many problems with the ACA. For example, subsidies are phased out too early, making out-of-pocket costs expensive for the middle class. Also, many states have still chosen not to expand Medicaid, which means that the working poor are unable to afford insurance because they dont qualify for subsidies. There are many ways the law could be fixed through tweaks. However, those tweaks have been politically toxic and intentionally prevented in order to hamstring the law. Do yo Continue reading >>

American Diabetes Association Opposes Affordable Care Act Repeal Without Immediate Replacement

American Diabetes Association Opposes Affordable Care Act Repeal Without Immediate Replacement

American Diabetes Association Opposes Affordable Care Act Repeal Without Immediate Replacement Association calls for simultaneous, alternative plan that maintains or improves coverage for millions of people withand at risk fordiabetes As the leading voice for the nearly 30 million Americans living with diabetes and 86 million more with prediabetes, the American Diabetes Association (Association) expressed strong opposition to repealing the Affordable Care Act (ACA) without a simultaneous alternative in a letter sent to Congressional leadership yesterday. The ACA provides numerous health insurance protections for people with, and at risk for, diabetes and has greatly improved access to adequate and affordable health insurance, the letter reads. The Association strongly opposes going back to a time when people with diabetes were routinely denied health insurance or forced to pay exorbitant premiums simply because they have diabetes; when treatment for preexisting conditions like diabetes could be excluded from coverage; when people could find their insurance coverage was no longer available just when they needed it most; when individuals with diabetes were locked into a job because they could not otherwise obtain adequate health insurance for themselves or their families; and when seniors in the Medicare Part D donut hole had to pay for 100 percent of their drug costs. Congress should not risk critical advancements made under the ACA without simultaneously enacting a replacement plan that maintains or improves existing access to comprehensive, affordable health care coverage. The Association highlighted that the ACA ended fundamental inequities for people with diabetes, and urged Congress to ensure that a replacement meets the minimum standards of: Providing health insur Continue reading >>

This Is What Happens When People With Diabetes Lose Medicaid

This Is What Happens When People With Diabetes Lose Medicaid

In 2003, Jose Sanchez was a recent graduate just starting out in the world, hustling to get his graphic design business off the ground. Then, one day, his life changed. “I went to take a nap and then I didn’t wake up for two days,” he said. “When I woke up, I looked like the Matrix. I had all these tubes coming out of me.” Sanchez discovered he had Type 1 diabetes only after he had fallen into diabetic ketoacidosis, a life-threatening condition. His story is a reminder of what many diabetics went through in the years before the Affordable Care Act, and what many could face again if it’s rolled back. Because he had very little income at the time, Sanchez was able to qualify for New York State’s Medicaid program. Between changing his diet and lifestyle and getting insulin and other health care through Medicaid, he managed to stay relatively healthy after the incident. Eventually, he found stable employment and had a son. But then another disaster hit. In 2007, he learned that his job—working nights at Abercrombie & Fitch, prepping the store for the morning crowds—paid just a little too much for him to continue to qualify for Medicaid. “That’s when I found out the true cost of being a diabetic,” he said. Without insurance, insulinrefillsalone cost him $225 every three weeks. Diapers, food and milk for his son came first, so he rationed the medication and ended up in the emergency room over and over again, racking up tens of thousands of dollars in medical bills he had no way to pay on his salary. “I would end up being in the hospital for a weeklong visit as they brought my levels back down,” he said. “This just became routine. Once or twice I had to have the ambulance come and get me at my house.” For a lot of people like Sanchez, the expans Continue reading >>

Affordable Care Act Implementation

Affordable Care Act Implementation

Challenges and Opportunities to Impact Patients With Diabetes Alvin C. Powers, Jason A. Wexler, Robert W. Lash, Meredith C. Dyer,Mila N. Becker, and Robert A. Vigersky In the United States, slightly more than half of all adultswith diabetes receive guideline-consistent care. 1 Asmaller proportion has adequate cardiovascular risk factorcontrol. 2 Current care of individuals with diabetesand its complications and comorbidities exemplifiesmany of the challenges facing the U.S. healthcare system. 3 Based on the care costs relative to the outcomes achieved, Americans deserve greater value for ourhealthcare expenditures. Acknowledging the convergence of the diabetes epidemicand the passage of the Affordable Care Act (ACA),the Endocrine Society (ES) seized the opportunity to convenea Washington, DC, Summit on September 12, 2014,to explore the laws impact on patients with diabetes. Summitattendees and speakers included leading diabetesstakeholders, patient advocacy and community-basedgroups, health plans, research institutions, federal agencies,and policy makers. The agenda featured potentialpolicy solutions as well as challenges and opportunitiesresulting from ACA implementation. In the followingparagraphs, the ES briefly summarizes the proceedings. Examples of ACAs Implementation onDiabetes Care Although the full effect of the ACAs impact on diabetescare is still being determined, several benefits and challengesare already clear. Improved access has lowered the barrier for individuals with diabetes to receive care. Onestudy found a 23% increase in Medicaid patients diagnosedwith diabetes in states that adopted ACA Medicaidexpansion, vs a 0.4% increase in states that did not. 4 Given that approximately 25% of Americans with diabetesare undiagnosed and earlier diagnosis and tr Continue reading >>

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