Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. Here, you can ask all the burning practical questions you may not know who to ask. Worried about what's to come in the New Year? Read on...

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Jessica, type 2 from Louisiana, writes:Oh my God. That healthcare court ruling in Texas...Should I be freaking out that I will lose my health insurance in the New Year? 

Wil@Ask D’Mine answers: No. Not at all. You should be freaking out that you will lose your health insurance at the end of 2019.

If then.

Here’s the thing. For now, the Affordable Care Act (ACA) remains the law of the land. That ruling by the Texas judge declaring “Obamacare” lock-stock-and-barrel unconstitutional did nothing more than set the juggernaut of the law into rumbling motion once more. This decision will work its way up to the Supreme Court—the final arbitrator of what is and what isn’t constitutional—in due time

Now, once it eventually gets there, if the justices uphold the Texas ruling, striking down the ACA in its entirety, then using one of the President’s favorite buzz words, it will be a COMPLETE DISASTER. 

At least for the average working person, elders, and the poor. Oh, yeah, and children, too.

Millions of Americans would lose their health insurance coverage. Many of them because of pre-existing conditions alone. The insurance companies will once again be able to deny coverage to people with pre-existing conditions, and without government subsidies to help them, they will have no choice but to do so in order to stay in business. So, what is a pre-existing condition? Diabetes, of course. COPD. Epilepsy. Hepatitis. Alzheimer’s. Lupus. Sleep apnea, obesity, pregnancy, alcoholism, and transsexualism—just to name a few. Plus, a closed and locked sneaky side door to denial would re-open: Lists of “declinable medications.” In other words, if you use one of the meds on these lists, your application for health coverage will be denied. In the diabetes world, the list included insulin, glucagon, and even humble metformin.

But the new throngs of uninsured wouldn’t be limited to folks who need insurance the most (those with a medical condition). They would also include many working people who simply don’t make enough to pay a thousand bucks or more each month for health insurance. Health insurance that will once again include annual and lifetime limits on coverage, no caps on out-of-pocket expenses, and premiums that could vary based on age, gender, or profession.

Of course, if the ACA were to go away, denials for pre-existing conditions wouldn’t be the only change. What else would go? Some very popular provisions. Provisions popular on both sides of the aisle. According to the highly regarded Kaiser Family Foundation, while protection for pre-existing conditions has become a political hot potato, it isn’t even near the top of the list of most popular provisions of the Affordable Care Act. The really popular items include being able to keep young adults on their parent’s health insurance, closing the infamous Medicare “donut hole,” free preventive health services, and subsidies for working people. 

Meanwhile, the foes of the ACA are yet to present an alternative plan. Hey, I’ll be the first to admit that Obamacare has its problems. Plenty of them. But that doesn’t mean I want to remove the patient’s diseased heart before a donor replacement has even been located. I think that we can all agree that would be a hell of a stupid way to practice medicine.

But enough doom and gloom. I don’t think this complete disaster is ever going to happen. First off, most experts think the high court won’t uphold the decision, if it even survives the appellate level to reach the high court in the first place. More importantly, there are new realities at play that didn’t exist in the bad old days that some people, for some reason, yearn to return to. And I believe that these new realities will ultimately triumph, and halt the dismantling of America’s first bid at universal healthcare for its people.

The first reality is that it’s much easier to deny a population of something they’ve never experienced, than it is to take away something they’ve been using. Back in the old days, we didn’t know any better. Denials for pre-existing conditions, lifetime caps, crazy out-of-pocket costs, and all the rest were just part and parcel of healthcare. But now we’ve seen another way. Now—for nearly a decade—we’ve been living in a different reality. It may not be perfect, but it’s better than it was before. The bottom line here is that it’s human nature to resist the revocation of benefits. Put another way, a happy toddler will scream, cry, and kick if you take his toys away. Take away our insurance and we’ll scream, cry, and kick at the polls.

Reality number two: Speaking of voting, given the trajectory of the appellate process, this whole thing is going to blow up going into the 2020 election, which will make for some very interesting politics, to say the least. I predict that it will become THE issue of the election.

Reality number three: Never mind the human suffering. Never mind the carnage. Never mind the fundamental unfairness. Show me the money. Everyone seems to forget one key thing about the pre-Obamacare health universe. It wasn’t a complete disaster, but it was on the verge of being one. We were a 200-ton locomotive screaming full speed toward a brick wall. The status quo at the time was a double-digit annual inflation rate in healthcare. Left alone, it would have completely bankrupted our country. I remember my boss at the clinic at the time, despairing over the fact that while our mission was to provide for the health of our community, due to the rising cost of premiums, the organization could no longer afford to provide healthcare for its own employees.

And speaking of money, reality number four: The Gig Economy. It used to be that people worked for big companies. Now, at least a third of American workers are independent freelancers of one sort or another, without company benefits. Eliminate the federal subsidies that adjust the cost of insurance based on income, and health insurance will be out of sight for many more people than it was a decade ago, when a full 20% of our population was uninsured. That was expensive for the country. People delayed care, got very sick, used expensive emergency room care, then couldn’t pay their bills. The legacy of lack of coverage is one reason Obamacare costs are running rampant: We let our people get too sick before we intervened. I wonder what our healthcare economy would look like if we’d had Carter Care or Johnson Care instead of Obamacare? We missed that boat, but we can’t afford to get on a boat where, between rising costs and coverage denials, we could be facing something like half of our population without insurance.

And finally, the last reality is that the ACA has friends in places it didn’t have before. It’s supported by the American Medical Association, the American Hospital Association, and America’s Health Insurance Plans

In plain English, that means doctors, hospitals, and even insurance companies want to keep it.

So even though I’m panic-prone—at least when it comes to things related to my health insurance—I’m not freaking out, and neither should you. Sure, we’re seeing the last desperate gasps of those who want to return to a mythical Camelot, a distant hazy dream world seen through rose-colored glasses. But the world has moved on. People have changed. The economy has changed. The only thing that’s lagging behind is politics and politicians.

And they’ll need to get on board, or get run over.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.