Insurance and access to care

ACA insurance in California is “too cheap to ignore”

The American Rescue Plan (ARP) has lowered premiums for people who get their coverage through the Affordable Care Act (ACA). As a result, California’s ACA exchange, Covered California, estimates the ARP will reduce its customers’ monthly premiums by an average of $180 per household. Additionally, in 2019, California provided state-funded tax credits, which provided further assistance to more people. The combined benefits could save people thousands of dollars.

Why it matters: 1.5 million Californians get their coverage through Covered California. In addition, 2.5 million Californian adults have diagnosed diabetes. Making Covered California more affordable will increase access to diabetes treatment for many more Californians.

What you can do: If you are a resident of California and want to find out if you qualify for federal assistance, go to www.coveredca.com.

Special enrollment period makes ACA enrollment more accessible and affordable

The Centers for Medicare and Medicaid Services (CMS) finalized its second update to the annual benefit and payment parameters rule. The rule makes it easier for people to sign up for a special enrollment period (SEP) to get coverage outside of open enrollment. In addition, the CMS is lowering consumers’ maximum out-of-pocket costs by $400 for 2022. Costs will be limited to $8,700 for individuals and $17,400 for plans with multiple people.

Why it matters: Medicaid enrollment has significantly increased throughout the pandemic. With these updates to CMS, more people will be able to get access to Medicare and Medicaid during a time when so many people have lost their health care coverage. This is especially beneficial for communities hardest hit by COVID-19 who are in need of affordable health care.

Medicaid enrollment increased by 5M during pandemic

A JAMA study found that Medicaid enrollment grew by about 5 million people from March through September 2020. Notably, enrollment growth was greater in states with smaller changes in unemployment in 2020. The study hypothesized that Medicaid growth could be the result of reduced work hours making more people eligible. Another reason for the enrollment increase could be a greater focus on healthcare during the pandemic.

Why it matters: The COVID-19 pandemic has brought to light the importance of accessible healthcare coverage. Most people have private coverage through their employer, yet millions lost health insurance over the past year. Medicaid expansion has also led to greater enrollment, suggesting a greater need for affordable health care.

Biden announces 1 million have enrolled in ACA special enrollment period

President Biden announced earlier this month that 1 million Americans have signed up for Affordable Care Act (ACA) health coverage from February 15 through April 30. The Biden Administration opened the special enrollment period as a result of the pandemic to allow people who needed health insurance to have extra time to sign up. The period will last until August 15 and the number of enrollees is expected to grow.

Why it matters: The ACA covered 1.9 million people with diabetes in 2019. Since its enactment, the ACA has proven to help people with diabetes get the treatment they need. The ACA has provided health coverage for many people who have lost their employer-based plans due to the pandemic.

What you can do: You can see if you qualify and sign up here.

Efforts to expand Medicaid in Missouri fail despite voter approval

In the fall of 2020, Missouri voters approved a constitutional amendment expanding Medicaid coverage in their state. Missouri Governor Mike Parson said that the state government will not pursue Medicaid expansion after the state’s General Assembly refused to fund it. State lawmakers stated that Missouri cannot afford to pursue expansion.

Why it matters: There are currently only 12 states that have not expanded their Medicaid programs. Medicaid expansion in Missouri would cover 275,000 additional Missourians out of the approximately 550,000 uninsured individuals. The Missouri State government’s decision also comes after the American Rescue Plan promised financial incentives for states to expand Medicaid. Medicaid expansion has proven to improve access to diabetes medications and overall enhance care.

What's next: Three people who would be eligible for Medicaid coverage have filed a lawsuit to require the state to expand its Medicaid program. The lawsuit focuses on the fact that Medicaid expansion was supported by 53% of Missouri voters last August. The trial will be on June 18th in Cole County.

Only 1 in 3 US adults with diabetes receive ADA-recommended care

New research has found that in 2017-2018, only one in three US adults with diabetes received five basic elements of care recommended by the American Diabetes Association (ADA). The basic elements include A1c testing, foot and eye exams, and cholesterol testing.

Why it matters: Providing affordable health care coverage can help ensure people with diabetes get the care they need. High costs and a lack of diabetes education serve as barriers to care for people with diabetes. Having access to reliable and easily understandable diabetes information can help people live healthier lives. Without recommended care, people with diabetes may experience more severe complications that can hurt their long term health

Diabetes is under-treated in low- and middle-income countries

Nearly half a billion people around the world have diabetes, but most are not getting adequate care that would allow them to live healthy lives. Only 1 in 10 people with diabetes in the 55 low- and middle-income countries studied receive the type of care that’s been proven to reduce diabetes complications. Additionally, many people don’t even know they have diabetes.

Why it matters: Too many people in low- and middle-income countries cannot afford quality diabetes care. Without adequate care, people with diabetes may experience severe complications that can have harmful effects on their long term health. These findings suggest a need to provide affordable and globally accessible diabetes treatment.

Insulin affordability

HR3 drug pricing bill sparks debate

A group of policymakers are pushing back Speaker Nancy Pelosi’s legislation, HR3, to lower prescription drug prices. These policymakers sent a letter to Pelosi, citing concerns that the bill could hurt drug companies’ ability to develop new drugs. In the letter, they advocated for a more modest drug pricing measure. HR3 would allow the government to negotiate lower drug prices and cap prices based on prices paid in other countries.

Why it matters: A majority of adults support action to lower the price of prescription drugs. In addition, 26% of people with diabetes in the US rationed their insulin at least once in 2019 because it is too expensive. Policy aimed to lower drug prices would allow people with diabetes to get the medications they need without having to worry about the high costs.

Texas insulin price cap law passes in the Senate, awaits Gov. Abbott’s signature

The Texas State Legislature just passed a bill that will cap the out-of-pocket cost for each insulin prescription to $25 per month. The bill is headed to Governor Greg Abbott’s desk where it awaits his signature. If passed, the price cap would reduce insulin costs for insured Texans on state-regulated health plans.

Why it matters: 2.8 million Texans have diabetes, which is approximately 12% of its adult population. An insulin price cap will ensure that those on state-regulated health plans will be able to afford this life-saving medication. Texas also joins the growing list of states that have passed insulin price caps--13 states currently have such laws in effect and many other states have proposed legislation.

Stigma and Society

AMA releases roadmap for improving racial justice, advancing health equity

The American Medical Association (AMA) released a three-year road map to improving racial justice and advancing health equity. The plan for its organizations includes five steps to begin addressing these challenges to dismantle structural racism.

Why it matters: It cannot be overstated that COVID-19 has disproportionately affected people of color. The pandemic has revealed racial and ethnic health disparities in diabetes that are a result of social inequalities like income, race, and education. The AMA roadmap and other health equity strategies are a step in the right direction towards dismantling previous racist, inaccessible, and overall socially unaware medical practices.

Telehealth program improves diabetes outcomes in Pequot Tribal Nation

The Mashantucket Pequot Tribal Nation has shown significant positive results in A1C reduction, weight loss, and reduced insulin loss after one year of using a telehealth program that treats people living with type 2 diabetes. After one year on this virtual care program developed by Virta Health, members of the Pequot community who have type 2 diabetes reduced their insulin use by 78 percent.

Why it matters: Native Americans are at a disproportionately higher risk for diabetes than any other racial group in the US. They are also at a much higher risk for severe complications, such as kidney failure and heart disease. Results like those in the Pequot nation  show that telehealth services can provide effective and accessible healthcare, especially for underserved communities.

Community health centers play critical role in equitable vaccine distribution

Community health centers have administered more than 10 million COVID-19 vaccines. 61% of those doses were given to racial and ethnic minorities in an effort to ensure vaccination equity.

Why it matters: Community health centers largely treat underserved individuals, who are more likely to have prediabetes or diabetes. Given the disproportionate impact of COVID-19 on people with diabetes, these health centers have played a critical role in equitably distributing the vaccine to low-income people with diabetes.

Legislation

Nevada’s ambitions for healthcare reform include a state-run public option

Nevada’s State Legislature is working on a bill that would create government-run health insurance. This would create a public option through the state-run insurance marketplace under the Affordable Care Act. The measure would require companies that provide Medicaid services to offer public option plans.

Why it matters: There are about 350,000 Nevada residents who do not have health insurance, and 12.4 percent of the adult population have diabetes. Supporters for the bill say that it would increase access to affordable care to a significant amount of these uninsured individuals.

What happens if we expand Medicare eligibility?

President Biden and other policymakers have proposed lowering the age of Medicare eligibility to 60. Studies show that lowering the age of Medicare eligibility to 60 would make care more affordable for people aged 60-64 and could reduce costs of employer health plans by as much as 15 percent.

Why it matters: Most adults age 60-64 have private coverage through their employer or the ACA marketplace. Analysis shows that adults who switch from employer plans to Medicare end up saving almost $4,000 each year. Older adults are also at higher risk of diabetes and therefore require more trips to the doctor and higher medical bills. Lowering the age of Medicare could improve access and affordability for these millions of people.

GAO calls for more telehealth research before permanent expansion

The Government Accountability Office (GAO) told Congress that government agencies should wait until there is more research before expanding telehealth coverage for Medicare and Medicaid programs. Some GAO officials worry that there have not been enough studies proving that virtual visits are as effective as in-person visits.

Why it matters: Telehealth coverage for many healthcare plans, including Medicare and Medicaid, is set to end when the public health emergency is over. Telehealth visits between doctors and patients increased throughout the pandemic. These services were critical in helping patients stay connected with their providers while maintaining social distancing. Because telehealth reduces barriers to care such as transportation, people with diabetes should have permanent access to these services to more easily access healthcare.

What's next: Several policymakers are in favor of maintaining telehealth coverage. They have proposed bills in the House and Senate, but whether or not these policies are successful remains to be seen.

What you can do: Look here for more information about what CMS can do to expand telehealth. Join diaTribe Change in advocating for permanent telehealth expansion.

Senate confirms Chiquita Brooks-LaSure to lead CMS

The Senate confirmed Chiquita Brooks-LaSure to oversee the Centers for Medicare and Medicaid Services (CMS). Brooks-LaSure will be the first Black woman confirmed to lead the agency.

Why it matters: Congress is not likely to support Biden’s progressive plan for healthcare reform, leaving CMS as the Administration's main resource for healthcare reform. Brooks-LaSure was a key drafter of the ACA and is well positioned to support Biden’s plan to protect and expand the ACA and increase access to healthcare in the US. Brooks-LaSure also signaled her support for permanently expanding telehealth which could help people with diabetes more easily access healthcare.

New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

The House and Senate have introduced bills aimed to make telehealth services used during the pandemic permanent for individuals on Medicaid and Medicare. The Permanency for Audio-Only Telehealth Act would enable audio-only telehealth services for Medicare enrollees. Senators have also proposed increasing telehealth access for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.

Why it matters: The temporary expansion of telehealth has made remote care more accessible but these benefits are set to end with the pandemic. If made permanent, millions of people with diabetes could access care remotely, reducing transportation and some cost barriers.

What you can do: Look here for more information about what CMS can do to expand telehealth. Join diaTribe Change in advocating for permanent telehealth expansion.