This week marks the first anniversary of the Patient Protection and Affordable Care Act (also known as the Affordable Care Act, or simply the ACA). What is that? A piece of federal health care reform legislation that includes many new tools in the fight to Stop Diabetes®.
You see, under the old health care system, it was perfectly legal to deny health insurance to people with diabetes (or make them pay more for insurance coverage) simply because they had diabetes. Even some people with insurance coverage found that their plan had pre-existing coverage exclusion preventing coverage of the most basic diabetes needs, including insulin and test strips; so they’d have to pay for some of their supplies in addition to paying for their health insurance. Having no affordable access to care led many people to have no choice but to forgo the care they needed to prevent, delay or slow the progression of diabetes and its serious complications.
The ACA’s goal is to put an end to this. In the past year, some of its provisions have gone into effect and others will go into place between now and 2014.
So what does the ACA mean for people with diabetes?
1) No more denied coverage. When the law is fully in effect, it will no longer be legal for insurance companies to deny coverage because a person has a pre-existing condition, such as diabetes. Until then, however, the law sets up special plans, called the Pre-Existing Condition Insurance Plan (another acronym: PCIP), specially for people who otherwise could not get insurance under the old rules. PCIP is available until the provisions banning discrimination based on preexisting conditions are fully implemented in 2014. You can learn more of these at www.pcip.gov.
2) Children and young adults covered. The ACA already prohibits insurers from excluding children under age 19 with diabetes from being covered under their parents’ insurance plan simple because of their diabetes. Additionally, young adults (with or without diabetes) will be able to stay on their parents’ insurance plans until age 26.
3) Medicare benefits improved. The ACA brings new benefits for Medicare participants, too! These include a free wellness visit to identify health risks (such as diabetes or diabetes-related complications) and to develop a prevention plan. This year they are also taking steps to close the Medicare “donut hole” – the gap in drug coverage under Medicare. These provisions apply to anyone who is eligible for Medicare – both seniors and people who have a disability that prevents them from working.
The list for how ACA helps people with diabetes continues:
- accepting more low income people into Medicaid program
- providing tax credits and subsidies to people with moderate incomes (up to 400 percent of the poverty level)
- preventing insurers from dropping someone when he or she develops diabetes
- ending annual and lifetime limits on benefits
- disallowing insurers to charge higher rates simply because someone had diabetes.
The American Diabetes Association supported this legislation because the ACA provides so many benefits for people with diabetes. Advocating for changes that have positive results for people with diabetes is what the Association does – and so can you! Join us and celebrate the first birthday of the Affordable Care Act by signing up to be an advocate today!