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T1D Patient Advocacy Group 'Deeply Upset' Over AHCA Provisions on Pre-Existing Conditions

Analysis  |  By Gregory A. Freeman  
   June 07, 2017

People with Type 1 diabetes are among the most vulnerable to coverage changes outlined in the American Health Care Act.

Americans with chronic health diseases such as type 1 diabetes (T1D) are at increased risk from any healthcare legislation that alters how health plans currently handle pre-existing conditions,  according to a warning issued by JDRF, a nonprofit organization that funds diabetes research.

JDRF is on record opposing the American Health Care Act (AHCA), the House Republicans' effort at reforming the Affordable Care Act. The nonprofit says the bill would jeopardize the insurance coverage of 1.25 million Americans with T1D.

JDRF was joined by 10 organizations in opposing the bill and any other healthcare reform effort that would endanger the insurance coverage of people with chronic diseases.

Republican Senators are working on their own version of a healthcare reform bill that would have to be reconciled with the House bill, which was dead on arrival in the Senate.  Senate Majority leader Mitch McConnell (R-KY) has reportedly told President Trump that the Senate could vote on healthcare legislation by July 4.


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Negotiations on the Hill should include careful consideration of what reform would do Americans with chronic diseases, says JDRF Chief Mission Officer Aaron Kowalski, MD.

 

TD is a life-threatening autoimmune disease that strikes both children and adults. Managing T1D over a lifetime, including paying for the daily insulin needed to live, is expensive and requires 24/7 vigilance and regular doctor appointments to avoid life-threatening medical emergencies and long-term complications such as blindness and kidney failure, Kowalski says.

As access to quality care becomes more expensive, the health of people with T1D suffers, he says, so AHCA-type changes in coverage for pre-existing conditions would be problematic.


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"We see this as a step backwards. People with Type 1 diabetes are very vulnerable to increases in the cost of treatments that sustain their lives," Kowalski says. "To be discriminated upon by pre-existing conditions like diabetes is unacceptable to us. We are letting Congress know that we need to preserve the protections that exist currently and not take them away."

JDRF established four principles that a healthcare reform bill would need to meet in order to protect the health of people with T1D and other chronic conditions:

  1. Preserve protections for those with pre-existing conditions: Individuals with pre-existing health conditions should have access to comprehensive health insurance at rates similar to their counterparts without pre-existing health conditions.
     
  2. Allow young adults to stay on their parent's insurance until the age of 26: Young adults should be allowed to stay on their parents' health insurance plan until the age of 26.
     
  3. Prohibit yearly and lifetime dollar limits for essential health benefits: Insurance companies should not be allowed to set annual or lifetime dollar limits on their spending for an individual's covered benefits.
     
  4. Close the donut hole in Medicare Part D: Provisions should remain in place to close the Medicare coverage gap for prescription medicines, known as the "donut hole," by 2020, which will help Medicare beneficiaries afford insulin and other needed drugs.

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"We're looking for legislation that ensures people with Type 1 diabetes are protected and have access to affordable healthcare," Kowalski says.

"Type 1 diabetes is 100% fatal without insulin; people with this disease cannot just stop taking insulin when they can't afford it.  If you don't have affordable access to a lifesaving drug, that is just not acceptable when our country is trying to develop a healthcare insurance model that is fair and sustainable."

Gregory A. Freeman is a contributing writer for HealthLeaders.


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