For most of us living with diabetes, the words “pre-existing condition” are pretty commonplace. But for those who are relatively healthy, it is somewhat of a foreign concept. In fact, I overheard someone the other day saying, “I am so tired of hearing him (The President) talk about pre-existing conditions.” My immediate thought was, “Well, if you had any type of chronic illness, you wouldn’t feel that way.” Even though I had heard that the ACA would benefit people with chronic illnesses, I was still fuzzy about how…… until it came time to sign up for health insurance this year.
CASE IN POINT: As a nonprofit with three female employees who have type 1 diabetes, under the old health insurance rules (which allowed insurance companies to rank people higher based on pre-existing conditions, gender, and age, DiabetesSisters was ranked in the highest level for insurance. In other words, it cost the organization over $700 per month to provide individual (not family or dependent) health insurance to each person on staff. And let’s just say that it was not the best insurance. It had a relatively high deductible of $1500 (which is bad for those of us with diabetes because we spend so much on diabetes supplies, doctor’s appointments, etc. and almost always meet our deductible) and the office visit co-pays were relatively high as well ($25 PCP visit; $50 for specialist visit) . Once the deductible was met, insurance kicked in at 70%. Also, under the old health insurance rules, I was ineligible (due to my diabetes) for individual health insurance plans (the individual plans offered directly through the insurance company) and could only get health insurance through an employer or through my spouse’s employer.
Now, with the ACA in effect, DiabetesSisters was able to purchase individual plans for employees at a little over half the cost of the previous mediocre insurance plan, approximately $400 per person through the same health insurance company (BCBS). And…the insurance benefits are much better! The deductible is only $500, the office co-pays are minimal ($10 for PCP visit; $20 for specialist, and drug co-pays or minimal ($4 or $10 for generics or $30 or $50 for brand name). The maximum out-of-pocket expense is $1500 and once the deductible is met, insurance kicks in at 80%.
Naturally, those who are healthy don’t want their insurance costs to go up. I understand….no one wants to pay more. However, when you look at the bigger picture of making health insurance a level playing field for everyone and serving the greater good, I think it is a good trade-off. No one really thinks that its right to penalize/restrict/limit people who are diagnosed with a disease (cancer, muscular dystrophy, diabetes), right? I mean, they were already dealt a difficult hand of cards....Why add insult to injury by requiring these people to pay more for health insurance? As a society, we regularly attend and give monetarily to fund raisers for loved ones who are battling a disease to help them pay for treatments. Yet, at the same time, society expects these people to pay more for health insurance. It just doesn't make sense. And no one really thinks its right to make someone pay more for health insurance because they are female, right?? I mean, how was that ever legal anyway? I don't think there is anything else to say about that. No longer is providing good health insurance benefits such a financial struggle for employers. No longer will employers need to do all kinds of underground research to uncover any health conditions before offering someone a job (out of fear of high health insurance costs due to an unknown illness). No longer will people with diabetes be limited to certain jobs because they provide good health insurance. (Yes, the fateful words uttered by my mother upon graduation from college rang in my ears for decades after they were spoken: “Whatever you do, make sure you get a job that has good health insurance.”) No longer do I feel confined by my diabetes in the workplace or in the health insurance world.
It may not seem that big of a deal to some people, but just while writing this blog, I have felt myself sit up straight with the pride that I feel in being equal to everyone else in the world in this area.
If you want to find out more about the Affordable Care Act and how it might impact you, click here.