Report shows insurance cracks’ in diabetes care

Diabetics find it hard to get and keep insurance

During a program at the Washington, DC, office of the Kaiser Family Foundation, the Alexandria, VA-based American Diabetes Association (ADA), in conjunction with the Georgetown University Health Policy Institute, unveiled a study delineating how health insurance fails many Americans with diabetes.

The 14-month study of 851 people from across the United States identified a host of components in the health insurance system that can prevent diabetics from properly managing the disease. The report, Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes, was funded by the Commonwealth Fund, the Robert Wood Johnson Foundation, and the W.K. Kellogg Foundation.

Common problems highlighted by the report form a long list:

  • insurance policies that do not cover basic diabetes needs;
  • high-risk pools with pre-existing condition exclusions;
  • health insurance premium surcharges for diabetes that drive premiums above affordability;
  • underwriting practices designating diabetes as uninsurable;
  • Medicaid rules that make many low-income people ineligible;
  • complex processes and procedures that drive many to give up seeking coverage altogether.

Karen Pollitz, project director at the Georgetown University Health Policy Institute, says the study identifies a range of instances making it harder for those with diabetes to get and keep health insurance, calling this "a profound irony, given [that] the purpose of health insurance is to protect people when they are sick." Among these problem situations were job loss, family status change, and safety net plans that don’t work because what they offer is incomplete.

Undercoverage and uncontrolled diabetes

She notes that people with stable coverage also had problems with being underinsured, which caused them to lack coverage for blood glucose test strips and prescriptions or to have high deductibles. "The people we talked to needed coverage that was available, affordable, and adequate, and two out of three just didn’t work," Pollitz says. "Many people had trouble managing their diabetes, got sicker, or went into debt as a result. The implications of these coverage problems for public health, costs to Medicare and Medicaid, and the impact on the entire health system due to uncontrolled diabetes are enormous," she says.

According to R. Stewart Perry, chairman for the advocacy committee of the ADA, the report shows that a "patchwork health care system that just doesn’t fit together" puts people with diabetes "at serious risk."

"Most of the policy solutions currently being considered by our state and federal policy-makers do little to fix the problems identified by the report," he explains. "It is time for policy-makers to seriously rethink the flawed health insurance solutions up for debate that harm as opposed to benefit people with diabetes."

The ADA says as many as one in 10 Americans live with diabetes, and with a disease growth rate of 8% per year, one in three will have the disease by 2050. In 2002, 1 in 10 health care dollars and 1 in 4 Medicare dollars was spent for diabetes care. The cost of diabetes in 2002 in the United States was estimated to be $132 billion.