Update (3/24/17): Since the original post was written (less than 24 hours ago!), the proposed American Health Care Act was amended. In the version that neared a vote yesterday, essential health benefits including maternity care and preventive services were going to be covered in the same way that they previously have been under the Affordable Care Act. Last night, the bill was amended to allow individual states to define their own set of essential health benefits. We had previously hoped that diabetes prevention programs would remain covered for people with prediabetes, and this recent development clearly threatens this possibility. We urge the reconsideration of this or any other developments that undermine preventive services for type 2 diabetes. The American Diabetes Association (ADA) also released a statement this morning opposing the current form of the bill and outlining several of the ways that it negatively impacts people with diabetes and prediabetes.

 

Healthcare coverage in the U.S. neared a tipping point today, as the American Health Care Act (AHCA) - the proposed replacement to the Affordable Care Act (ACA) introduced by the Obama administration seven years ago – neared a Congressional vote. The vote was postponed at the 11^th hour, after it became clear that it wouldn’t have enough support to pass the House of Representatives. Healthcare is an unbelievably complex issue, and we are glad to see that the delayed vote will prompt further discussions on the future of healthcare in the United States.

In its current form, the proposed AHCA is particularly troubling for people with prediabetes and diabetes, and for the diabetes field as a whole. This is especially true because the proposed plan shows the greatest increase in premiums for those in their 50s and early 60s (before qualifying for Medicare). Prediabetes rates increase with age, and with this comes an increase in the number of people living with and being diagnosed with type 2 diabetes. The proposed bill would raise costs for the very group that is at the highest risk for diabetes and the complications that can come with it. The Congressional Budget Office estimated that 24 million more people will be uninsured under the proposed AHCA than there are today – we suspect that these reductions in coverage will disproportionately occur among groups with the highest diabetes risk, including low-income Americans and people over the age of 50. Among Americans age 65 and over, 83% have either diabetes or prediabetes. As Americans move toward that age, we certainly don't want them to be unduly burdened in their efforts to be healthy as possible. And we don't want them to bear excessive costs either.

We have often said that diabetes is the public health challenge of our generation – almost 30 million people in the United States have diabetes, and 8 million of those people don’t know it. Almost 90 million more are living with prediabetes. Diabetes and prediabetes come at a cost of over $300 billion per year in the United States. We strongly believe that one of the keys to reining in this cost is investment in prevention – prevention of type 2 diabetes in people who are at risk (e.g. with prediabetes), and prevention of complications for those living with diabetes.

The ACA as it stands (often called Obamacare) is far from a perfect system, and we hope the current discussion will lead to a serious look at some of its flaws for example, it has been associated with the shifting of health coverage extra costs from employers to employees. But the ACA had certain positives for chronic conditions like diabetes that we feel it is essential to keep, most notably 1) the requirement that insurers cover people with pre-existing conditions and, 2) the coverage of preventive services, including the plan to start covering diabetes prevention programs (DPPs) for people with prediabetes beginning in 2018.

We are glad to see that the proposed AHCA has kept coverage for pre-existing conditions, and we urge policymakers to maintain coverage for essential health benefits inlcuding preventive services. Given the delay of the House vote, there is obvious uncertainty about what will happen. In fact, as we were writing this, the headline broke: “Pass Health Bill or Obamacare Stays, Trump Tells the G.O.P.” Regardless if the ACA stays or goes, we urge that the ongoing debate sparks an increased look at the importance of health coverage and chronic conditions. As we said, diabetes is critical public health challenge of our generation. It is crucial that whatever changes come to the healthcare landscape, people with or at risk for prediabetes, diabetes, and other chronic conditions are still able to access and afford healthcare.

-- By Ben Pallant and Kelly Close