OK, D-Peeps, don't pretend you're not a little bit confused about what's going on with healthcare reform at the moment. My favorite recent tweet that made me feel a little less stupid about the whole situation:
Clearly, the big win for us people with diabetes (PWDs) is that starting next year, insurers can no longer turn us away for having a pre-existing condition. Yay for that!
But obviously, this whole issue is highly politically charged. And to say the least: it's confusing! Apparently scores of people thought the current government standoff / shutdown would delay the new Health Insurance Marketplace from opening as planned on Oct. 1 -- allowing individuals, families, and small businesses to shop for (and compare) various private health insurance options, aka "health exchanges."
But nope, the Health Insurance Marketplace did indeed open for business on Oct. 1... sort of. The main site www.healthcare.gov has been ridden with glitches, as have the state-specific sites that are supposed to help you research and sign up for coverage in your area. My colleague Mike, who lives in Indiana, has been trying to sign up for new insurance online since Opening Day -- literally trying to log on several times a day for the last 15 days, and unable to do so. Yesterday he said he finally made a breakthrough by reaching a registration page, but when he input his info, the site wouldn't save it -- again giving him " too busy" or error messages. Aaaargh!
The federal government came up with a partial workaround just the other day. About nine days after going online, the site began offering a quick-glance database showing some of the options based on state and county, allowing people to get an idea of what premiums might look like starting in 2014.
But it's still confusing, with a lot of "premium" and "DirectAccess" terminology, so who knows how realistic the cost estimates are, for us PWDs in particular? For Mike in Indiana, he has what looks to be a few options but all of them appear to be at least twice (!) as expensive as the coverage he has now through his wife's insurance.
Where I live, in California, our exchange site CoveredCalifornia has been glitch-ridden too, and has been taking a beating for not listing doctors and hospitals covered in the plans available, and for potentially "misleading consumers about the kinds of plans they are buying." Across the board, experts are saying we should beware of the lowest-cost Exchange plans because the out-of-pocket deductible costs are so high.
None of this takes into account what employers might contribute, if they choose to have their employees use this system. And of course a big fear that many have is that private insurance offered through current employers may go away. Even though no one's forcing companies to stop offering insurance plans to employees, they may just choose to go that route if it's less expensive to their bottom line.
Maybe you already know this, but your coverage options through the Exchange Marketplace are broken down into four categories -- bronze, silver, gold and platinum (which sounds like corporate sponsorship lingo to me):
So if you choose a bronze health plan, you'll pay the smallest premium each month but will pay the highest out-of-pocket for each doctor's office visit and medicine; the reverse is true for a platinum plan. See above notes on lowest-cost plans.
If you need help choosing, you're supposed to be able to get in touch with a real-live assistant acting as a so-called "Health Insurance Marketplace Navigator" by visiting www.healthcare.gov or by calling 1-800-318-2596 (24 hours a day/7 days a week). But good luck with that, given how ridiculously paralyzed the main website has been!
The American Diabetes Association (ADA) has of course posted some stuff to help explain to PWDs how our coverage/options might be changing, although it's not the most straightforward guide you might have hoped for. One salient point is that you HAVE TO get on board. If you already have insurance through your employer, you're fine, but:
"Starting in 2014, most people will be required to have some kind of health insurance policy. Otherwise, they'll have to pay a fee with their federal income tax return, starting in 2015 (the return covering the 2014 tax year). The amount of the fee will be calculated based on income or a flat dollar amount, depending on which is the larger penalty. The flat dollar amount fee for the 2014 tax year is $95; it is scheduled to increase in 2015 to $325 and in 2016 to $695. After that, increases will be based on changes in the cost of living. Some people won't need to pay the fee, such as members of federally recognized Native American tribes or people who do not purchase health insurance for religious reasons*."
(*huh? Apparently you can be a "religious objector")
btw, open enrollment at Healthcare.gov ends on March 31, 2014. After that, in order to buy insurance in the Marketplace, you'll have to wait until the next annual open enrollment period -- Oct. 15 through Dec. 7 for coverage starting the following year -- unless you happen to qualify for a special enrollment period because of a "qualifying life event like a job loss, birth, or divorce."
If you Google "Diabetes and the Affordable Healthcare Act" specifically, you'll find a lot of the information out there focuses on seniors and Medicare recipients. But what about the rest of us?
The graphic with the coins above comes from a new flyer that the AADE (American Association of Diabetes Educators) is disseminating to its members. Thankfully that includes some good nuggets about what to expect as a PWD:
Diabetes treatments covered under the Affordable Care Act:
- Diabetes screenings for adults with high blood pressure
- Diabetes screenings for pregnant women
- Medical nutrition therapy for people with diabetes**
- An annual wellness visit to develop (or update) a personal prevention plan for Medicare participants
**This one will vary from state-to-state, so you'll have to investigate your state specific plan (assuming you can get on the website!)
The AADE writes that diabetes education, officially known as "Diabetes Self-Management Training" (or DSMT) "is not considered a 'free' preventive benefit, so patients will still have a copay. DSMT is not specifically mentioned (in the law), but is clearly part of the mainstream treatment regimen for diabetes, so we believe it will be covered in virtually all Marketplaces. However, states have the discretion to modify benefits within categories, or to put limits on certain benefits, such as the number of visits allowed."
This does not sound like good news, IMHPE (in my humble patient experience).
In any case, I believe this is all going to remain rather murky until our federal legislators work out their differences and decide what portions of "Obamacare" will be funded and go into effect.
One of the big points of contention is whether or not to repeal the medical device tax put into place early this year. Industry supporters want the tax scrapped on the grounds that it will reduce medical industry innovation, while the White House has stated: "The medical device industry, like others, will benefit from an additional 30 million potential consumers who will gain health coverage under the Affordable Care Act starting in 2014. This excise tax is one of several designed so that industries that gain from the coverage expansion will help offset the cost of that expansion."
Again, as patients (whose lives depend on medical gadgets) we're caught in the middle -- hoping at least some of these Powers That Be have our best interests in mind.
Besides feeling confused, as a person with an expensive chronic illness, it's hard not feel a little panicky while all of these changes remain up in the air. That's why I was comforted to stumble on a post from the Heath Affairs blog, titled, "Calm Down America: Obamacare Is Far From a Revolutionary Change in Our Health System." The authors argue that in reality, the new law "will have limited impact on how most Americans receive medical care and pay for it... under Obamacare most Americans will not experience any change in their health insurance; they will continue to receive coverage through their job and visit a physician or hospital as they have in the past."
Oy, I'm not sure status quo is a good thing here, considering how poor the state of diabetes care is across the board in this country.