Life, Liberty and the Pursuit of Healthcare
Editor’s Note: Tony Steuer has been an author, consultant, subject matter expert and consumer advocate in the insurance industry for 30 years. He’s written for and been interviewed for many major publications such as The Wall Street Journal, Forbes and The New York Times.
Having a child is one of the greatest things that can happen to you in life. We all hope for our children to be successful, happy and healthy. And raising a child is also a challenge under any circumstances. And one day, all of a sudden your world is turned upside down and your child’s doctor says the words that cannot be unspoken: your child has type 1 diabetes. And life is just not the same and one of the pillars for your child, that of being healthy is all of a sudden at risk.
As a chronic and intensive health condition, diabetes requires a lot of medical services and supplies ranging from insulin, glucagon, meters, test strips, lancets, continuous glucose monitors (CGMs), sensors, pumps, pump sets and so on and so on. Plus your candy bill is really high. And then you add on the doctors visits and related medical services and you are talking serious dollars.
If you are fortunate, you have good health insurance and everything is covered subject to co-pays and deductibles after you have paid quite a bit in health insurance premiums. However, what you pay in is a lot less than the cost of what you receive.
The Affordable Care Act was a game changer and allowed people with pre-existing conditions like diabetes to get health insurance. Prior to the Affordable Care Act, coverage was only available through an employer or through a limited capacity high risk pool for people with diabetes. So a lot of people with diabetes had no access to health insurance which meant either paying a LOT of money out of pocket to manage their diabetes or not managing it well as they could not afford to do so. It guarantees that regardless of your health history that you can get insurance coverage. And having a medical condition or not having a medical condition is just a random event, there is no logic to it and as in the case with type 1 diabetes (T1D), nothing that can be done to prevent or to foresee it.
The Affordable Care Act provides freedom to those with medical conditions to know that they are not tied to an employer who offers health insurance because they can get their own policy at any time. The ACA also provides a peace of mind to us as parents of a child with T1D that as long we have coverage, hopefully, our out-of-pocket costs will be reasonable and our son will have access to the necessary medical care and medical supplies.
And now that is under threat of being taken taken away. Our Congress has passed an incredibly dangerous bill called the American Health Care Act which would lead to the loss of insurance coverage for 24 million Americans at once and 52 million Americans by the year 2020. The nonpartisan Kaiser Family Foundation estimates that 27 percent of adults under age 65 have health conditions that would likely leave them uninsurable under practices that existed before the health care overhaul. It would also once again allow for insurance companies to deny coverage to those with pre-existing conditions such as T1D. And without health insurance, the costs to manage diabetes would be financially crippling just because of a random virus.
The GOP’s Obamacare replacement bill would protect just 5 percent of people with pre-existing conditions with the bottom line of the $23 billion in funding to cover those deemed uninsurable would be sufficient to cover just 110,000 Americans which is roughly 5 percent of the 2.2 million current enrollees with some type of pre-existing conditions. And even if the states were to add in the entire $100 billion of the AHCA’s Patient and State Stability Fund, this would still only be sufficient to cover a total of 600,000 people with pre-existing conditions (30 percent). And if you’re lucky enough to be part of that 5-30 percent, you’ll get to pay a higher premium since insurance companies will be able to charge more potentially if you let your coverage lapse.
When something is broken, the logical step is to try to fix it rather than to just throw it away as the AHCA does to the ACA. Instead we should look at how we can improve on the ACA to continue Medicaid expansion, lower premiums (and total out-of-pocket costs) and improve services. And yes, this is all really possible and I’ve outlined this in “A Health Insurance Roadmap.” The Roadmap provides clear fixes to the ACA to decrease costs through moving to a legitimate pricing model for health care services and supplies which could cut total annual spending on health care by 33 percent ($1 trillion) and other smaller measures.
Type 1 diabetes is hard enough without the financial burden. T1D is not something that anyone asks for, it just happens. What truly makes America great is that we have the freedom of speech and I am exercising that freedom and urging others to do the same. We need to make our voices heard in the U.S. Senate and urge them to do the right thing. I have started a petition for “A Practical and Fair Health Insurance Solution” based on “A Health Insurance Roadmap.” We can all make a difference and I hope you’ll join us. (Email Tony Steuer if you want to discuss!)