Diabetes and Obama Care

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1

Has anyone looked into the affects Obama Care will have on those of us living with Diabetes? Will we be covered for disability insurance now seeing that this new health care is supposed to help out people with pre-existing conditions? Will it affect those of us that are already insured through work when we need to see our Endo? Will we be told who we can see and how often? Will we be told what prescriptions we can have and how much? I have tried looking up information but can't find much specific to our (diabetics) situation. I'm just trying to get some info to either confirm or clear up my fears.

Thank you,

2

It is my understanding that the Affordable Care Act prevents insurers from denying coverage based on previous conditions, and prevents pricing coverage based on any consideration other than coverage features and age group.  That is, a, say,  $500 annual deductible policy would cost the same for a 50 year-old with diabetes and a 50 year-old without diabetes.   Private insurance companies will compete with one another based on coverage attributes and cost, which is expected to drive down cost.  Thus, coverage limits will not be federally mandated, but determined by the type of policy coverage you chose to purchase.  That is, you can by a "low cost" plan or a "high cost" premium plan, with only price as a differentiating factor.  Your health history cannot be used to determine your cost.   ACA also has already assured that there can be no waiting period for coverage of pre-existing conditions.  The no waiting period is feasible since all adults must buy insurance coverage, by either employer plan, private plan, or state-managed pooling plan, or pay a tax for nonparticipation.  I also understand that there will be a federal plan available for cases where states (like Georgia) refuse to implement a state-managed plan.  

3

The good news for people with diabetes is that we'll be able to get private health insurance because we won't be denied for preexisting conditions.  That begins in 2014.

The bad new about Obama Care is that it requires ALL people to either buy health insurance or pay a hefty tax.  There aren't any discounts if you already have insurance.  It's still just normal insurance with your same coverage and co-pays.  Insurance rates have increased 8 - 10% a year for the last several years and economists don't expect that to change.  The insurance companies will now just have more customers.  

Business Insider cited these numbers on the penalty for people who don't have insurance and I've also seen them verified on Fact Checker.  I have a friend who works in health insurance and he verified that was his understanding of the bill too:

The penalty/tax will be phased in from 2014 to 2016.

The minimum penalty/tax in 2016 will be $695 per person and up to 3-times that per family. After 2016, these amounts will increase at the rate of inflation.

The minimum penalty/tax per person will start at $95 in 2014 (and then increase through 2016)

No family will ever pay more than 3X the per-person penalty, regardless of how many people are in the family.

The $695 per-person penalty is only for those who make between $9,500 and ~$37,000 per year. If you make less than ~$9.500, you're exempt. If you make more than ~$37,000, your penalty is calculated by the following formula...

The penalty is 2.5% of any household income above the level at which you are required to file a tax return. That level is currently $9,500 per person and $19,000 per couple. The penalty on any income above that is 2.5%. So the penalty can get expensive quickly if you make a lot of money.

However, the penalty can never be more than the cost of a "Bronze" heath insurance plan purchased through one of the state "exchanges" that will be created as part of Obamacare. The CBO estimates that these policies will cost $4,500-$5,000 per person and $12,000-$12,500 per family in 2016, with the costs rising thereafter.

So, basically, you're looking at penalties of approximately the following at the following income levels:

Less than $9,500 income = $0

$9,500 - $37,000 income = $695

$50,000 income = $1,000

$75,000 income = $1,600

$100,000 income = $2,250

$125,000 income = $2,900

$150,000 income = $3,500

$175,000 income = $4,100

$200,000 income = $4,700

Over $200,000 = The cost of a "bronze" health-insurance plan

The IRS will not have the power to charge you criminally or seize your assets if you refuse to pay. The IRS will only have the ability to sue you. And the most the IRS can collect from you if it wins the suit is 2X the amount you owe. So if you want to thumb your nose at the penalty-tax, the IRS won't be able to do as much to you as they could if you refused to pay, say, income tax.

4

Jenna, what an extensive amount of details on the tax penalities for opting out of insurance coverage!  I think you must be a tax accountant!  

To my thinking, one would have to be foolish to seek to opt out.  The healthiest younger people I know are still subject to unanticipated needs for medical care, from accidents, lifestyle choices, and genetic frailties that have yet to appear.  

In our society, what goes around, comes around.  I believe it was economist Milton Friedman who first said there is no free lunch.  So, it seems a fair deal that everyone should have to participate in paying for healthcare coverage, in order that all would be covered.  It is a prerequisite to minimizing overall cost and maximizing overall benefit.  It is my understanding that Benjamin Franklin started insurance in the US with that financial risk-averaging idea in mind.  Insurance only works if it accomplishes risk averaging.  

On a personal level, I just want to have the freedom to buy health insurance at a fair price, rather than being denied coverage or required to pay an exhorbitant price anticipates that I will suffer all the diabetes health risks that I daily work my _ss off to avoid.

5

I think healthcare reform is needed, but I also don't think requiring everyone to buy health insurance is the best way.

Most people spend less paying for healthcare out of pocket than they would for insurance... that's how insurance companies make millions of dollars a year.  Low income people are already covered through medicare, medicaid and state healthcare plans.  

So you're basically penalizing healthy people who work.  That causes some to decide to quit their jobs or work part-time so they can be eligilble for low income health care.  Those who stay employed then have less disposale income, which hurts the economy too.  And only a very small percentage of people are positively impacted by the change.  Wouldn't it be better to try to help those people?  

It's a complicated issue but the problem is that universal healthcare hasn't worked well in the countries where it's implemented like the UK, Canada and Greece.  People from those countries still come to the US for the best medical treatment.  And people in those countries are limited by the types of pumps available and their access to good doctors.  

6

I'm not sure your assertions are factual.  I have work colleagues in the UK who are quite happy with their diabetes care.  I recall a Frontline episode comparing administrative costs for healthcare in the world's leading eight democracies.  All but the US supplied universal coverage.  All had better overall health statistics than the US.  The US had the highest administrative cost at 19% of total healthcare expenditures.  The country with the next-highest administrative cost was the UK at 8%.  To me, 19%-8%=11% extra administrative cost for "free choice" in a system that leaves >20% of the population uncovered is not a good deal.  I would wager that for every person who chooses to quit work for free healthcare, there are 10 who are financially wiped out by a single major accident or illness.

7

I think you both are missing my questions. I don't care if this is good for the majority or not. I do not agree with paying any extra taxes to pay for someone that does not work to have insurance, but that is beside the point of my questions. I want to know how it will affect us as diabetics. I work full time for our local high school district, our insurance is awesome and is paid for by the district. I am set, but the more I read I get confused... do I have to leave my insurance that I have currently to go to this new stuff with all these perimeters or face a tax increase on my personal taxes? My husband and I both work for the district so we are dual covered and it would obviously suck if we get charged for having our district take good care of us. My other concern being if this new health care reform will limit the care I receive from my specialist? Will it also limit the perscriptions I receive for all my Diabetic needs? Has anyone looked into this? That is where I worry and start to think I should start stashing any and all extra insulin and supplies I can possibly stash. Makes me feel like someone has my life (health) in their hands and I do not like that. Then the other part I am curious about is if this reform will allow those of us with a pre-exisiting condition to not be discriminated against, does that also mean that we can now get dissability insurance because they can't tell us no because we have a pre-exisiting condition?

8

sorry about that last post. This site just wigged out and did not show me all of your posts. My apologies.

9

It won't affect disability insurance, just health insurance.

You probably won't see an impact in cost, since you and your husband have insurance through your job.

It's unknown, but expected, that it will be more difficult to see a doctor or specialist since there will likely be more patients, but the same number of doctors.  

10

Hey Nikki, my understanding is that your insurance coverage will not be affected by the Affordable Care Act, since you already have employment-based coverage.  However, if you lost your job, or started a business, ACA would mean you could buy equivalent insurance coverage at a fair market price for your age group, without your diabetes history being a part of the pricing.  

Also, it is my understanding that under ACA, a portion of your employer contribution to your health insurance coverage may be taxed as ordinary income.  For example, if your employer pays $100 per month for your coverage while you pay $50 per month, the $100 may be subject to some income tax under ACA.   However, I believe there are to be income limits above which this tax kicks in, and possibly other conditions that limit the portion taxed to more premium coverage.  I think some of these details have yet to be worked out with the implementation.   Perhaps Jenna has more information on how the employer contribution could be taxed.  My guess would be that a married couple filing jointly on a gross income of $100,000 would see a net change of no more than $250 in total annual federal tax paid between 2012 and when full ACA implementation occurs in 2014.

Another consideration is that the current tax and spending negotiations between Congress and President Obama may come into play in affecting your total tax liability.  I'm not sure anyone can tell you just how this total tax liability will play out between now and late January.  

11

Nikki,

I have not read the ACA but I do have many folks in healthcare that have shared info on this subject. I believe the answer to your question is,,Yes, there will be changes that can and will change the kind of care, prescriptions and amounts, and the type of doctors and how often we can see them.

One friend, a diabetes educator, said that according to what she has read, she will not have a job by 2016. Another friend, a doctor, says she will give up her practice because there is no possible way she can see more patients. She spends 80 hrs a week seeing patients now.

medical supply chains will be pushed to their limits providing meds at "affodable" prices and most likely will go out of buisness andf patients will go without their much needed medicines.

I have read some parts of this bill and some of it sounds wonderful. No pre-existing condition will be denied coverage, your children can be insured under your policy till the age of 26, it all sounds wonderful but as I was going down Jenna's list of "penalties" I found my income level and was shocked. This I did not know. And it is scarey for me because not only do I have T1D, so does my 9 year old daughter.

The statement that "If you lose your job, the ACA provides for you to purchase coverage at an affordable fair market cost" is, well, rediculous. We already had that in my state, it was called "COBRA" and it was exactley what my employer paid for my family to be covered at a cost of $900 a month. I ask, I'm unemployed, how do I afford that? The answer was, I could not and my family lived without insurance till I landed the job I have now. We survived by calling manufacturers and begging them to "donate" supplys to us. I was one of the toughest times I have ever lived through in my life and I hope I never have to do that again.

Yes you should probably "stockpile" supplys. I am because when full implementation comes to pass it is my belief that times will get very, very hard for all diabetics and supplys will be very hard to get.

The UK has socialised medicine and will eventually run thenselves out of money and will go the way of Greece. It may take years but it will happen and that is exactley the road that our president has put us on.

To all on Typeonenation, sorry for my rant, but this is how I see it and I always called a turd a turd. The ACA is exactley that, A turd.

12

Nikki,

I have not read the ACA but I do have many folks in healthcare that have shared info on this subject. I believe the answer to your question is,,Yes, there will be changes that can and will change the kind of care, prescriptions and amounts, and the type of doctors and how often we can see them.

One friend, a diabetes educator, said that according to what she has read, she will not have a job by 2016. Another friend, a doctor, says she will give up her practice because there is no possible way she can see more patients. She spends 80 hrs a week seeing patients now.

medical supply chains will be pushed to their limits providing meds at "affodable" prices and most likely will go out of buisness andf patients will go without their much needed medicines.

I have read some parts of this bill and some of it sounds wonderful. No pre-existing condition will be denied coverage, your children can be insured under your policy till the age of 26, it all sounds wonderful but as I was going down Jenna's list of "penalties" I found my income level and was shocked. This I did not know. And it is scarey for me because not only do I have T1D, so does my 9 year old daughter.

The statement that "If you lose your job, the ACA provides for you to purchase coverage at an affordable fair market cost" is, well, rediculous. We already had that in my state, it was called "COBRA" and it was exactley what my employer paid for my family to be covered at a cost of $900 a month. I ask, I'm unemployed, how do I afford that? The answer was, I could not and my family lived without insurance till I landed the job I have now. We survived by calling manufacturers and begging them to "donate" supplys to us. I was one of the toughest times I have ever lived through in my life and I hope I never have to do that again.

Yes you should probably "stockpile" supplys. I am because when full implementation comes to pass it is my belief that times will get very, very hard for all diabetics and supplys will be very hard to get.

The UK has socialised medicine and will eventually run thenselves out of money and will go the way of Greece. It may take years but it will happen and that is exactley the road that our president has put us on.

To all on Typeonenation, sorry for my rant, but this is how I see it and I always called a turd a turd. The ACA is exactley that, A turd.

13

Nikki,

Good morning!  In addition to the last 2 postings  - which is all correct based on my extensive research - there's also a negative for those who have health issues beyond the normal.  Folks are not penalized due to weight, drug use or alcoholism which are choices, yet I have several auto-immune issues - T1D is just 1 of them which as we know, auto-immune is genetic not a lifestyle choice disease.  There are not "death panels" but there ARE boards who review latest meds and treatments based on the patient on paper.  Currently, insurances do the same HOWEVER, you can appeal and then threaten the Bureau of Insurance if it's a valid claim.  That's how I initially got my pump 16+ years ago (T1D x 39-yrs).  With my long list of diagnosis codes, I WOULD NOT receive approval for the meds or the treatments as on an actuarial table, I should be dead.  Yet, I exercise 60-min/day, eat healthy, work FT and keep going.  Once this ACA Board is in effect, there is no one and no way to appeal that decision.  No checks and balances for people like me.  

Brad - I don't consider your post a rant - it is what it is.  There is a LOT we don't know and hasn't been brought out on the Bill as the infamous statement from Pelosi said "Let's pass the Bill so we can find out what's in it".  Hmmm - makes you feel confident in the process considering Congress and Senate DO NOT get the same coverage.  The issue as well with employer coverage is how many employers will keep the expensive coverage for their employees?  Not many - I work for a HUGE medical sales company and there's already talk for 2014 that it'll save the company money.  Additionally, anyone who works in certain blue collar jobs might see their hours cut to 29/week to get around their designation as FT - it's already happening in the restaurant industry.  

I'd say read as much as you can, ask questions, contact your Congressman and Senators - let your voice be heard.  After all, it aint over til the fat lady sings and in my book - she's not done with this song!!!

Susie

14

Susie,

Glad to see there are more people out there that feel as I do. I work in the natural gas industry for the local ultility company and there are many things about the ACA that will drastically change our Republic. My hope is that we survive as a nation but my fear is that we will not. Thanks for the reply, have a great day!

15

Susie and Brad,

Please quote your sources for information about Obamacare.  Your comments sound more politically motivated than based on facts about the law.  The New England Journal of Medicine has had a series of expert contributor articles published on Obamacare since its passage in 2010.  These articles are available for view for free from their website, NEJM.org.

One more thing.  Notes that the American Medical Association, the JDRF, and AARP all endorsed the Affordable Care Act.

16

Randy,

If you google factual information on the ACA - you can find this information.  I contacted my representatives office and asked for the part of the plan that deals with these specific issues.  I then had a legal friend help interpret it.  Contacting whitehouse.gov isn't factual as it wouldn't be to use the RNC.  

I'd ask you to quote how these entities are independent.  1st - it is well documented that several companies are already discussing dropping coverage that they currently provide as ACA is cheaper; 2nd, it was also greatly reported and documented that AARP stands to make MILLIONS on the ACA so you'd have to question their "independence" in an endorsement; 3rd - there were plenty of physician members who are part of the AMA that came out AGAINST the ACA and the endorsement as they realize what this will do to the patient/physician relationship;  JDRF endorsed it PRIOR to knowing all of the facts - just like they all did.  These endorsements ALL occurred before they could even state what was 100% in the ACA.  It seems to me that you in fact aren't quoting anything factual but pointing to entities who have a bias.  Again, the NEJM (I work in medical research as a side note) are OPINION articles - similar to any newspaper's editorial - it is an opinion.  The kool-aid might taste good but the facts are the facts and they don't change.  

To think the ACA plan will solve all the problems is crazy - how would it be possible to provide MORE care to anyone and everyone that's BETTER care at less money?  Not logical and not possible.  That's basic dollars and cents.  If the math doesn't add up, you're right because it doesn't and it can't.  

I'm sorry if you've been misled.  

17

Susie and Brad,

It is such a scary thing to think about. In fact, it stresses me out beyond belief! My life is literally out of my hands when it comes to my supplies. I can't cut my food back, exercise more, quit smoking or drinking, have surgery to fix, or any of those other things people "assume' we can do to fix my disease. I didn't choose it, I didn't ask for it, and I certainly dont deserve to die from it! But they won't look at that. They look at their pocket book growing bigger. I pray mine has enough to last for the month and they want to afford all of their luxuries. If my school district continues talks of taking our insurance down or making us FT employees pay, I will really be screwed.

Randy-

This is not a political podium, its a simple fact of life or death for us as diabetics. It's a fear of not having the supplies you or as in Brad's case -yourself and your child need! Randy, as you plan your visits with your doctor every 3 months, or you have a time of erratic blood sugars and you NEED to get into your doctor quicly to get things under control --does it ever cross your mind, "what if I am not 'ALLOWED' to see him?" What about when you call your supply provider for your refills and one day you are told that it is not time for you to receive your portions? How about when you are down to the last 1/2 of your last bottle of insulin and you can't get any more??? What are you going to do? Maybe I'm just too "young" to think your way, maybe I just want to live to be a parent or grandparent? Either way, we live with a disease that medically and financially depend fully on our health insurance and/or income and the freedoms that come with that like seeing the doctors that you need or having the best of supplies to live as healthy and normal of a life.

I guess I should start getting perscriptions of needles and set an alarm to get my insulin and strips so that I have a chance of having left overs. I really don't want to be caught unprepared if the economy and our leaders continue down this reckless and ignorant road. I wish, more than anything, they (all people who make decisions for the people of the US) could walk the day in the shoes of someone living with a disease like ours.

I pray God will protect us and the very supplies we need.

18

Nikki - I feel your pain, I can't see the doctor - I still owe him from what Medicare didn't pay and on this fixed income, I am not sure how I am going to renew my insulin, syringe prescriptions - health dept maybe. But to top that, my prescriptions current the pharmacies will fill the syringes but they keep passing my insulin scripts around, I have had to transfer those 3 times in the last 3 months, I can only get one bottle at a time and I have to wait till the bottle is almost empty. Paying $100 per bottle makes a dent in food and utilities I have to have. I was told once that they had to send all their insulin back (which was lies) then the other two times they said they were out....  I never know what week I get to continue to live or when I need to make out a will. Stressful is mild description, like playing roulette with an automatic gun.

19

Suite and Nicki,

Just a few points in response to your messages.  Googling ACA is not exactly an objective means of research.  I would expect that the political right have done much more on the web to fight ACA than supporters have done to factually represent it.

The New England Journal of Medicine articles, more than 30 in total, are some factual, some opinion, and represent both supportive views and critical views.  Even the critical views make great use of factual support.    

20

Nikki,

How about the many people live with diabetes today, and do not have access to adequate supplies, education, physician care, and medication?  I believe that, over time, ACA will yield better medical care for more people at a more affordable price than the current system.  There will be some challenges with full implementation.  But, the facts that I've seen imply greater chance for improvement than the current system, with it's near-perpetual double-digit annual inflation, under-coverage, and exorbitant administrative cost.